Transcript BRIEF ® : Behavior Rating Inventory Of Executive Function

®
BRIEF :
Behavior Rating Inventory
of Executive Function®
Authors: Gerard A. Gioia, PhD, Peter K. Isquith, PhD,
Steven C. Guy, PhD, and Lauren Kenworthy, PhD
Publisher: PAR, Inc.
BRIEF Authors
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Gerard A. Gioia, Children’s National Medical
Center
Peter K. Isquith, Dartmouth Medical School
Robert M. Roth, Dartmouth Medical School
Steven C. Guy, Independent Practice
Lauren Kenworthy, Children’s National
Medical Center
Kimberly Andrews Espy, Vice Provost,
University of Nebraska, Lincoln
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Overview of the BRIEF
Purpose: Assess impairment of executive
function
 For: Ages 5-18 years
 Administration: Individual, 86 items
 Time: 10-15 minutes to administer; 15-20
minutes to score by hand, software available
for scoring and interpretation
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Overview of the BRIEF
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Utilizes parent and teacher input in the
evaluation of the child’s behavioral
functioning
The BRIEF is useful in evaluating children
with a wide spectrum of developmental and
acquired neurological conditions, such as:
Learning disabilities
 Low birth weight
 Attention-deficit/hyperactivity disorder
 Tourette's disorder
 Traumatic brain injury
 Pervasive developmental disorders/autism
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Interest in Executive
Function in Children
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5 articles in 1985
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500
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14 articles in 1995
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501 articles in 2005
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Bernstein & Waber,
Executive Function in
Education, 2007
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100
0
1985
1995
2005
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Methods of Assessing EF
Macro
Micro
Performance
Tests
Observations
r
ito
s
rg
/O
M
on
4
er
ial
3
M
at
ib
it
Problem:
Pl
an
Goal:
W
M
70
65
60
55
50
45
40
Count the number of moves
Sh
ift
Em
ot
io
na
l
Structural &
Functional
Imaging
In
h
Genetics
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Measurement of Executive
Functions
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Executive functions are dynamic, fluid
No formal, single test adequate to capture
EF
Many tests are too structured to adequately
assess EF
Need intra-individual approach
“Executive” is often provided by the
examiner
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Limitations of
Performance Tests
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EF tests are molar, tapping several EF and non-EF
functions that can be disrupted in many ways
Differences in cognitive “style” or ability can affect
EF performance regardless of EF
Sensitivity/Specificity limited − Patients who should
have EF deficits do well on EF tests; EF performance
not sensitive to frontal vs. extra-frontal lesions
Discriminant Validity − If EF tasks are impaired in
several disorders, then EFs are not helpful in
distinguishing between disorders
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Pennington & Ozonoff, 1996
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Impetus
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Clinical need for efficient external validation
Collect standardized observational reports of
everyday functioning
Ecological validity, real-world anchor
Common parent descriptions of everyday
executive difficulties
Frustration with available performance tests
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Purpose: provide a measure of
executive function that is:
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psychometrically sound
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sensitive to developmental changes
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high in ecological validity
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sufficiently broad to serve as a screen
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comprehensive in sampling content
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theoretically coherent
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useful in targeting treatment
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Purpose of the BRIEF
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The BRIEF consists of two rating forms
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86 items on both questionnaires
 Parent
 Teacher
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Additional BRIEF Products
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BRIEF Preschool (Ages 3-5 years)
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BRIEF Self-Report (Ages 13-18 years)
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BRIEF Software (Scoring & Reporting)
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BRIEF Adult (Ages 18-90 years)
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A BRIEF Genealogy
2000
2003
2004
2005
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Monitor
MetaCognition
Organization
of Materials
Plan/Organize
Working Memory
Initiate
Emotional Control
Behavioral
Regulation
Shift
Inhibit
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Behavioral Definitions for
the Clinical Scales
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Inhibit: Control impulses; stop behavior
Shift: Move freely from one activity/situation
to another; transition; problem-solve flexibly
Emotional Control: Modulate emotional
responses appropriately
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Behavioral Definitions for
the Clinical Scales
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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
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Administering the
BRIEF Parent Form
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Materials: Parent Form and a pen/pencil
Parent Form is filled out by a parent;
preferably, by both parents
Parent must have recent and extensive
contact with the child over the past 6 months
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Administering the
BRIEF Teacher Form
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Can be filled out by any adult with extended
contact with the child in an academic
setting; typically a teacher, but an aide is
acceptable
Minimum familiarity is 1 month
Multiple ratings across classrooms may be
useful for comparison purposes
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Scoring the
BRIEF Parent/Teacher Forms
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Calculate the raw score by transferring the
circled responses to the box for that item
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Sum the scores in each column and record
the sum in the box for that column
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Transfer the summed scores from page 1 to
the appropriate box on page 2 and then sum
the scores for each scale
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Scoring the
Negativity Scale
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To score the Negativity scale, find all of the
“N” items that received a score of 3
Sum the number of “N” items that received
a score of 3 and record that number in the
Negativity scale box in the Scoring
Summary/Profile Form
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Scoring the
Inconsistency Scale
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Scoring the Inconsistency scale is more
complex and requires greater attention to
detail
Inconsistency items have an I in the margin
of the scoring sheet
Transfer the scores for the 10 item pairs to
the appropriate boxes on the Scoring
Summary/Profile Form
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Scoring the
Inconsistency Scale
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For each item pair, calculate the absolute
value of the difference for the items
Then, sum the difference values for the
10 pairs to obtain the Inconsistency scale
score
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Obtaining Standard Scores for the
BRIEF Parent/Teacher Forms
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Once raw scores for all scales are obtained,
find the appropriate table in the appendixes
Tables are broken down by form
(Parent/Teacher), age, and gender of
the child
Standard scores have a mean of 50 and a
SD of 10; percentile ranks also are available
in the tables
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Comparison Tables
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Separate normative tables for both the
Parent and Teacher Forms provide T scores,
percentiles, and 90% confidence intervals
for four developmental age groups (5-18
years) by gender of the child
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Joshua
ADHD - Combined Type
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Computerized Scoring
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BRIEF Software Portfolio (BRIEF-SP)
provides unlimited scoring and report
generation for the BRIEF Parent Form, the
BRIEF Teacher Form, the BRIEF-SR, the
BRIEF-P Parent Form, and the BRIEF-P
Teacher Form. Three reports are available −
an Interpretive Report, a Feedback Report,
and a Protocol Summary Report.
Separate software is available for the
BRIEF-P only and the BRIEF-A only.
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Interpreting the
BRIEF Parent/Teacher Forms
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All results should be viewed in the context
of a complete evaluation
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High scores do not indicate “A Disorder of
Executive Function”
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Problems may be developmental or acquired
and, thus, are suggestive of differing
treatment approaches
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Steps to BRIEF Interpretation
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Examine validity scales
 Inconsistency
 Negativity
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Examine clinical scales
Examine indexes, Global Executive
Composite
Individual item analysis
 Within scale items
 Nonscale items
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Interpretation
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T scores at the Domain level; higher scores
suggest a higher level of dysfunction
For the Inconsistency scale, look at scores ≥7
as indicative of a high degree of inconsistency
in rater response
A high Negativity scale score indicates the
degree to which the respondent answers
selected questions in an unusually negative
manner. “Is information consistent with other
sources?”
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Interpretive Options
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Professional Manual
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Computer Scoring and Interpretive Reporting
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Integrated Reporting
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BRIEF Basics
BRIEF
BRIEF-P
BRIEF-SR
BRIEF-A
86/8
63/5
80/8
75/9
α
.80-.90s
.80-.90s
.80-.90s
.93-.98s
Retest
.80-.90s
.80-.90s
.80-.90s
.94-.96s
Parent – Teacher
r = .30
Parent – Teacher
r = .17 - .28
Self – Parent = .50
Self –Teacher = .25
Self–Informant = .64
Covary
BASC, CBCL,
ADHD-IV
CBCL,
ADHD-IV
CBCL, BASC,
ADHD-IV, CHQ
BDI, FrSBe, DEX,
CAD, STAI
Clinical
groups
ADHD, LD, TS,
ASD, Frontal
lesion,
PKU,Trauma
ASD, ADHD,
Language, LBW
ADHD, ASD,
Anx/Dep,
DM (T1)
ADHD, MCI, TBI,
MS, Epilepsy
Items /
Scales
Inter-rater
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Reliability
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High internal consistency (α = .80-.98)
Test-retest reliability
rs = .82 for parents and .88 for teachers;
moderate correlations between teacher and
parent ratings (rs = .32-.34)
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Validity
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Convergent validity established with
other measures: inattention, impulsivity,
and learning skills
Divergent validity demonstrated against
measures of emotional and behavioral
functioning
Working Memory and Inhibit scales
differentiate among ADHD subtypes
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Standardization Population
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Normative data based on child ratings from
1,419 parents and 720 teachers from rural,
suburban, and urban areas, reflecting 1999
U.S. Census estimates for SES, ethnicity,
and gender distribution
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Clinical Standardization Population
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Clinical sample included children with
developmental disorders or acquired
neurological disorders (e.g., reading
disorder, ADHD subtypes, TBI, Tourette's
disorder, mental retardation, localized brain
lesions, high functioning autism)
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Diagnostic Group Studies
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Reading Disorders
 Working Memory: Reading > Controls
 Plan/Organize: Reading > Controls
– B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia, & S. Guy
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Extremely Low Birth Weight vs VLBW
 Monitor, WM, Shift, Inhibit, Init, Plan/Org:
ELBW > Controls
 Initiate & Plan/Org: ELBW > VLBW
– G. Taylor, et al.
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Mental Retardation
 Working Memory: MR > Controls
– B. Pratt & T. Chapman
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Diagnostic Group Studies
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High Functioning Autism
 All BRIEF scales: HFA > Controls
– R. Landa & M. Goldberg
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Pervasive Developmental Disorders
 All BRIEF scales: PDD > Controls
– L. Kenworthy & S. Guy
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Frontal vs. Extrafrontal Lesions
 All scales: Frontal & Extrafrontal > Controls
 Inhibit: Frontal > Extrafrontal > Controls
– R. Jacobs, V. Anderson, & S. Harvey
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Case Example
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Joshua:
 8-year-old left-handed male
 Attention-Deficit/Hyperactivity Disorder,
Combined Type
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Joshua
ADHD - Combined Type
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Joshua
ADHD - Combined Type
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BRIEF Clinical Studies
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ADHD -
Jarratt et al., 2005; Loftis, 2005; Viechnicki, 2005; Lawrence et al., 2004;
Blake-Greenberg, 2003; Palencia, 2003; Kenealy, 2002; Mahone et al., 2002.
Reading disorders - Gioia et al., 2002; Pratt, 2000.
Autism spectrum disorders - Gilotty et al., 2002; Gioia et al., 2002.
Bipolar disorder vs. ADHD - Shear et al., 2002.
Tourette’s syndrome - Mahone et al., 2002; Cummings et al., 2002.
Traumatic brain injury - Landry et al., 2004; Brookshire et al., 2004; Gioia et al.,
2004; Mangeot et al., 2002; Vriezen et al., 2002; Jacobs, 2002.
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Media violence exposure - Kronenberger et al. 2005.
Spina bifida and hydrocephalus - Burmeister et al., 2005; Brown, 2005;
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Obstructive sleep apnea -
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Mahone et al., 2002.
Beebe, 2004, 2002.
Galactosemia - Antshel et al., 2004.
Childhood onset MS - McCann et al., 2004.
Sickle cell - Kral et al., 2004.
22q11 deletion - Kiley-Brabeck, 2004.
PKU - Antshel et al., 2003.
Frontal lesions, PKU & hydrocephalus -
Anderson et al., 2002.
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