Behavior Rating Inventory of Executive Function BRIEFTM

1. Behavior Rating Inventory of Executive FunctionBRIEFTM Gerard A. Gioia Peter K. Isquith Steven C. Guy Lauren Kenworthy Kimberly Espy

2. Impetus: Clinical need for external validation, ecological validity, real-world anchor Common parent descriptions ALL research - observations Performance tests vs rating scales

3. What’s in a name Children’s Behavior Questionnaire Executive Function Questionnaire Developmental Executive Function Test Behavioral Evaluation of Executive Function (Youth?) Behavioral Assessment of Regulatory Function Planning and Organization Rating Questionnaire Parent Observation Rating Questionnaire Behavior Rating Inventory of Executive Function

4. The Purpose is to provide a measure of executive function that is: psychometrically sound sensitive to developmental changes high in ecological validity sufficiently broad to serve as a screen comprehensive in sampling content theoretically coherent useful in targeting treatment

5. Behavioral Definitions for Executive Function Domains Inhibit - Control impulses; stop behavior Shift - Move freely from one activity/situation to another; transition; problem-solve flexibly Emotional Control - Modulation emotional responses appropriately

6. Behavioral Definitions for Executive Function Domains Initiate - Begin activity; generate ideas Working Memory - Hold information in mind for purpose of completing a task Plan/organize - Anticipate future events; set goals; develop steps; grasp main ideas Monitor - Check work, assess own performance

7. Development of the BRIEF Content Reliability Validity Age/ Gender Findings Modeling of Executive Function

8. Item Development Collected items from clinical work Idea generation sessions within group Requests from colleagues Review of behavior scales (CBCL/TRF, BASC, Conner’s, Vineland, Profile of Executive Control System, Cognitive Symptom Checklist)

9. Results of Item Development Items reviewed by group, colleagues, reading specialists: 180 initial items: redundant & non-specific Item Tryout: 129 Parent/127 Teacher Excess items based on item-total correlations Final Scale: 90 items retained

10. BRIEF: Inhibit Gets in your face Has trouble stopping when silly Is squirmy Does not stop laughing at joke when friends stop Has to be closely supervised Des not think before doing Acts wilder or sillier than others in groups Makes odd noises, hums, mutters or sings Interrupts others

11. BRIEF: Shift Does same thing over and over for no apparent reason Is stubborn Cannot get a disappointment off their mind Resists accepting a different way to solve a problem Becomes upset with new situations Tries same approach to problems even when it doesn't work Acts upset by change in plans Not creative in problem solving

12. BRIEF: Emotional Control Overreacts to small problems Explosive, angry outbursts Tearful easily Mood changes frequently Reacts more strongly than other children Becomes too silly

13. BRIEF: Initiate Is not a self-starter Needs to be told to begin a task even when willing Has trouble coming up with ideas for what to do in play or free time Has trouble getting started on homework or chores Does not take initiative Complains there is nothing to do Lies around the house a lot (couch potato)

14. BRIEF: Working Memory Is absent-minded When given three things to do, remembers only the first or last Trouble with multi-step chores Forgets when he was doing Trouble remembering things even for a few minutes Has a short attention span Has trouble completing tasks Is easily distracted

15. BRIEF: Plan/Organize Tests poorly despite knowing answers Good ideas but can't get the job done Written work poorly organized Starts project without the right materials Trouble planning for future play activities Does not connect tonight's homework with grades Unrealistic Goals Underestimates time needed to complete tasks

16. BRIEF: Organization of Materials Leaves playroom a mess Loses lunch box, lunch money, permission slips, homework Cannot find clothes, glasses, shoes, toys, etc Backpack is disorganized Forgets to hand in homework even when completed

17. BRIEF: Monitor Doesn't ask for help when needed Doesn't check work for mistakes Makes careless errors Poor handwriting Unaware of how behavior affects others Leaves work incomplete

18. Reliability: Internal Consistency Initiate Working Memory Plan/Organize Organization of Materials Monitor Inhibit Shift Emotional Control Parent Teacher .82 .84 .92 .90 .91 .87 .88 .90 .85 .89 .94 .95 .88 .91 .92 .94

19. Reliability: Internal Consistency Metacognition Behavioral Regulation Global Executive Composite Parent Teacher .96 .98 .96 .97 .98 .98

20. Reliability: Test-Retest Scale Initiate Working Memory Plan/Organize Org of Materials Monitor Inhibit Shift Emotional Control Parent Parent Teacher Clinical Norm Norm .77 .80 .87 .82 .85 .86 .80 .85 .88 .84 .79 .83 .80 .76 .87 .76 .84 .91 .72 .78 .83 .79 .79 .82

21. Reliability: Test-Retest Metacognition Behavioral Regulation Global Executive Composite Parent Parent Teacher Clinical Norm Norm .83 .88 .90 .80 .84 .92 .81 .86 .91

22. Validity Content Item development Expert Agreement Item-Total Correlations Construct Multitrait-Multimethod Matrix Factor Structure Clinical Group Comparisons

23. Construct Validity - Factor Analysis Allows examination of the structure of the BRIEF to assist in clinical scale/ index development Resulting factors can serve as clinical entities; meta-scale (latent) structural factors Various extraction methods: PFA, PCA Various rotational methods: Varimax, oblique

24. Summary of Exploratory FA Consistent 2-factor model found with normative, clinical samples; BRIEF factors differentiate from other behavior rating scale factors. Metacognition Initiate, Working Memory, Plan/Organize, Organization of Materials, Monitor (Inhibit) Behavioral Regulation Inhibit, Shift, Emotional Control (Monitor)

25. The Structure of Executive Function Interest in BRIEF goes beyond its use as a clinical tool Allows an opportunity to explore the theoretical structure of executive function (EF) Others have asked whether EF is a unitary or “fractionated” supervisory/ regulatory system Theory testing also can assist our approach to clinical application of the BRIEF as a measure of EF

26. Diagnostic Group Studies ADHD-Inattentive vs ADHD-Combined BRI and Monitor: Combined > Inattentive & Controls MCI: Both ADHD groups > Controls B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. Guy P. Isquith, G. Gioia & S. Guy Severe vs Mild/Moderate TBI BRI & Init, Plan/Org, WM, Monitor: Severe > Controls Working Memory: Severe > Mild/Moderate > Controls H. G. Taylor et al. TS vs ADHD vs TS+ADHD BRI & MCI: ADHD & TS+ADHD > TS & Controls E. M. Mahone

27. Diagnostic Group Studies Reading Disorders Working Memory: Reading > Controls Plan/Organize: Reading > Controls B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. Guy Extremely Low Birth Weight vs VLBW Monitor, WM, Shift, Inhibit, Init, Plan/Org: ELBW > Controls Initiate & Plan/Org: ELBW > VLBW . G. Taylor et al. Mental Retardation Working Memory: MR > Controls B. Pratt & T. Chapman

28. Diagnostic Group Studies High Functioning Autism All BRIEF Scales: HFA > Controls R. Landa & M. Goldberg Pervasive Developmental Disorders All BRIEF Scales: PDD > Controls L. Kenworthy & S. Guy Frontal vs Extrafrontal Lesions All Scales: Frontal & Extrafrontal > Controls Inhibit: Frontal > Extrafrontal > Controls R. Jacobs, V. Anderson, S. Harvey

29. Conclusion “The BRIEF is a reliable and valid behavior rating scale of executive functions in children and adolescents that can (a) become an integral part of the clinical and school assessment of children and adolescents and (b) assist with focussed treatment and educational planning for children with disorders of executive function.” (Gioia, Isquith, Guy & Kenworthy, 2000, p. 4)

30. Clinical Implications Two factors and component parts are to be considered in interpretation Behavioral Regulation, esp. Inhibit, must be considered first prior to Metacognition Treatment of Behavioral Regulation is likely a necessary precursor to Metacognition treatment Treatment of metacognition via active problem-solving strategies

31. BRIEF Administration and Scoring

32. BRIEF Administration and Scoring Intro to Forms - Parent, Teacher Scoring Sheet Scoring Summary Profile Sheet Case Example

33. Steps to BRIEF Interpretation Examine validity scales Inconsistency Negativity Examine clinical scales Examine Indexes, Global Executive Composite Individual item analysis Within scale items Non-scale items

34. Son of BRIEF: The BRIEF-Preschool Version Gerard A. Gioia Kimberly Andrews Espy Peter K. Isquith

35. Or:The Developmental Inventory Assessment of Preschool Executive Regulation (DIAPER)

36. Executive Function in Preschoolers: Common View Young children: lack inhibitory control exhibit significant distractibility have difficulty shifting among tasks do not organize, plan, or monitor their actions or performance

37. Views from Developmental Neuropsychology Executive functions DO originate in infancy BUT, not available in full final form HOWEVER, measurement is possible if developmentally appropriate tasks are used AND, we must take into account the preschooler’s behavioral repertoire

38. BRIEF-Preschool Version Sample: n=450 Parents, 300+ Teachers Age 2- 5 years Diverse sample: ethnically, regionally, SES 129 97 63 items

39. BRIEF-P Domains Inhibit Shift Emotional Control Working Memory Plan/ Organize Organization (of Materials) Monitor Initiation

40. Reliability: Internal Consistency Working Memory (17) Plan/Organize (10) Inhibit (16) Shift (10) Emotional Control (10) Parent Teacher .88 .95 .80 .86 .90 .95 .85 .90 .86 .94

41. Stability of Preschool Executive Behaviors:Test - Retest Reliability Scale r Inhibit .90 Shift .88 Emotional Control .87 Working Memory .85 Plan/Organize .78 Test-Retest Interval 1 - 9 weeks, M = 4.5 weeks

42. BRIEF-P Construct Validity Factor 1 = Emergent Metacognition; Factor 2 = Flexibility Factor 3 = Inhibitory Self-Control.

44. Clinical vs Control Samples

45. Bride of the BRIEF The BRIEF-Self-Report

46. Parent vs Self-Report BRIEF: Correlations ranged from .25 (Inhibit) to .64 (Working Memory) Parent ratings higher for Metacognition Children’s ratings higher for behavioral regulation Neither Parent nor Child BASC were elevated