Behavior Rating Inventory of Behavior Rating Inventory of Executive FunctionExecutive Function

BRIEFBRIEFTM

Gerard A. GioiaGerard A. Gioia

Peter K. IsquithPeter K. Isquith

Steven C. GuySteven C. Guy

Lauren KenworthyLauren Kenworthy

Kimberly EspyKimberly Espy

Impetus:Impetus:

Clinical need for external validation, Clinical need for external validation, ecological validity, real-world anchorecological validity, real-world anchor

Common parent descriptionsCommon parent descriptions ALL research - observationsALL research - observations Performance tests vs rating scalesPerformance tests vs rating scales

What’s in a nameWhat’s in a name

Children’s Behavior QuestionnaireChildren’s Behavior Questionnaire Executive Function QuestionnaireExecutive Function Questionnaire Developmental Executive Function TestDevelopmental Executive Function Test Behavioral Evaluation of Executive Function (Youth?)Behavioral Evaluation of Executive Function (Youth?) Behavioral Assessment of Regulatory FunctionBehavioral Assessment of Regulatory Function Planning and Organization Rating QuestionnairePlanning and Organization Rating Questionnaire Parent Observation Rating QuestionnaireParent Observation Rating Questionnaire Behavior Rating Inventory of Executive FunctionBehavior Rating Inventory of Executive Function

The Purpose is to provide a measure of The Purpose is to provide a measure of executive function that is:executive function that is:

psychometrically sound psychometrically sound

sensitive to developmental changessensitive to developmental changes

high in ecological validity high in ecological validity

sufficiently broad to serve as a screen sufficiently broad to serve as a screen

comprehensive in sampling contentcomprehensive in sampling content

theoretically coherenttheoretically coherent

useful in targeting treatmentuseful in targeting treatment

Behavioral Definitions for Executive Behavioral Definitions for Executive Function DomainsFunction Domains

Inhibit - Control impulses; stop behaviorInhibit - Control impulses; stop behavior

Shift - Move freely from one activity/situation to Shift - Move freely from one activity/situation to another; transition; problem-solve flexiblyanother; transition; problem-solve flexibly

Emotional Control - Modulation emotional Emotional Control - Modulation emotional responses appropriatelyresponses appropriately

Behavioral Definitions for Executive Behavioral Definitions for Executive Function DomainsFunction Domains

Initiate - Begin activity; generate ideasInitiate - Begin activity; generate ideas

Working Memory - Hold information in mind for Working Memory - Hold information in mind for purpose of completing a taskpurpose of completing a task

Plan/organize - Anticipate future events; set goals; Plan/organize - Anticipate future events; set goals; develop steps; grasp main ideasdevelop steps; grasp main ideas

Monitor - Check work, assess own performanceMonitor - Check work, assess own performance

Development of the BRIEFDevelopment of the BRIEF

ContentContent

ReliabilityReliability

ValidityValidity

Age/ Gender FindingsAge/ Gender Findings

Modeling of Executive FunctionModeling of Executive Function

Item DevelopmentItem Development

Collected items from clinical workCollected items from clinical work

Idea generation sessions within groupIdea generation sessions within group

Requests from colleaguesRequests from colleagues

Review of behavior scales (CBCL/TRF, BASC, Review of behavior scales (CBCL/TRF, BASC, Conner’s, Vineland, Profile of Executive Control Conner’s, Vineland, Profile of Executive Control System, Cognitive Symptom Checklist)System, Cognitive Symptom Checklist)

Results of Item DevelopmentResults of Item Development

Items reviewed by group, colleagues, reading Items reviewed by group, colleagues, reading specialists:specialists:

180 initial items: redundant & non-specific180 initial items: redundant & non-specific

Item Tryout: 129 Parent/127 TeacherItem Tryout: 129 Parent/127 Teacher

Excess items based on item-total correlationsExcess items based on item-total correlations

Final Scale: 90 items retainedFinal Scale: 90 items retained

BRIEF: InhibitBRIEF: Inhibit Gets in your faceGets in your face Has trouble stopping when sillyHas trouble stopping when silly Is squirmyIs squirmy Does not stop laughing at joke when friends stopDoes not stop laughing at joke when friends stop Has to be closely supervisedHas to be closely supervised Des not think before doingDes not think before doing Acts wilder or sillier than others in groupsActs wilder or sillier than others in groups Makes odd noises, hums, mutters or singsMakes odd noises, hums, mutters or sings Interrupts othersInterrupts others

BRIEF: ShiftBRIEF: Shift Does same thing over and over for no apparent reasonDoes same thing over and over for no apparent reason Is stubbornIs stubborn Cannot get a disappointment off their mindCannot get a disappointment off their mind Resists accepting a different way to solve a problemResists accepting a different way to solve a problem Becomes upset with new situationsBecomes upset with new situations Tries same approach to problems even when it doesn't Tries same approach to problems even when it doesn't

workwork Acts upset by change in plansActs upset by change in plans Not creative in problem solvingNot creative in problem solving

BRIEF: Emotional ControlBRIEF: Emotional Control

Overreacts to small problemsOverreacts to small problems Explosive, angry outburstsExplosive, angry outbursts Tearful easilyTearful easily Mood changes frequentlyMood changes frequently Reacts more strongly than other childrenReacts more strongly than other children Becomes too sillyBecomes too silly

BRIEF: InitiateBRIEF: Initiate

Is not a self-starterIs not a self-starter Needs to be told to begin a task even when willingNeeds to be told to begin a task even when willing Has trouble coming up with ideas for what to do in Has trouble coming up with ideas for what to do in

play or free timeplay or free time Has trouble getting started on homework or choresHas trouble getting started on homework or chores Does not take initiativeDoes not take initiative Complains there is nothing to doComplains there is nothing to do Lies around the house a lot (couch potato)Lies around the house a lot (couch potato)

BRIEF: Working MemoryBRIEF: Working Memory

Is absent-mindedIs absent-minded When given three things to do, remembers only the When given three things to do, remembers only the

first or lastfirst or last Trouble with multi-step choresTrouble with multi-step chores Forgets when he was doingForgets when he was doing Trouble remembering things even for a few minutesTrouble remembering things even for a few minutes Has a short attention spanHas a short attention span Has trouble completing tasksHas trouble completing tasks Is easily distractedIs easily distracted

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

BRIEF: Organization of MaterialsBRIEF: Organization of Materials

Leaves playroom a messLeaves playroom a mess Loses lunch box, lunch money, permission slips, Loses lunch box, lunch money, permission slips,

homeworkhomework Cannot find clothes, glasses, shoes, toys, etcCannot find clothes, glasses, shoes, toys, etc Backpack is disorganizedBackpack is disorganized Forgets to hand in homework even when Forgets to hand in homework even when

completedcompleted

BRIEF: MonitorBRIEF: Monitor

Doesn't ask for help when neededDoesn't ask for help when needed Doesn't check work for mistakesDoesn't check work for mistakes Makes careless errorsMakes careless errors Poor handwritingPoor handwriting Unaware of how behavior affects othersUnaware of how behavior affects others Leaves work incompleteLeaves work incomplete

Reliability: Internal ConsistencyReliability: Internal Consistency

InitiateInitiate

Working MemoryWorking Memory

Plan/OrganizePlan/Organize

Organization of MaterialsOrganization of Materials

MonitorMonitor

InhibitInhibit

ShiftShift

Emotional ControlEmotional Control

ParentParent TeacherTeacher

.82.82 .84 .84

.92.92 .90 .90

.91.91 .87 .87

.88.88 .90 .90

.85.85 .89 .89

.94.94 .95 .95

.88.88 .91 .91

.92.92 .94 .94

Reliability: Internal ConsistencyReliability: Internal Consistency

MetacognitionMetacognition

Behavioral RegulationBehavioral Regulation

Global Executive CompositeGlobal Executive Composite

ParentParent TeacherTeacher

.96.96 .98 .98

.96.96 .97 .97

.98.98 .98 .98

Reliability: Test-RetestReliability: Test-Retest

ScaleScale

InitiateInitiate

Working MemoryWorking Memory

Plan/OrganizePlan/Organize

Org of MaterialsOrg of Materials

MonitorMonitor

InhibitInhibit

ShiftShift

Emotional ControlEmotional Control

ParentParent ParentParent TeacherTeacher

ClinicalClinical NormNorm NormNorm

.77.77 .80 .80 .87 .87

.82.82 .85 .85 .86 .86

.80.80 .85 .85 .88 .88

.84.84 .79 .79 .83 .83

.80.80 .76 .76 .87 .87

.76.76 .84 .84 .91 .91

.72.72 .78 .78 .83 .83

.79.79 .79 .79 .82 .82

Reliability: Test-RetestReliability: Test-Retest

MetacognitionMetacognition

Behavioral Behavioral RegulationRegulation

Global Executive Global Executive CompositeComposite

ParentParent ParentParent TeacherTeacher

ClinicalClinical NormNorm Norm Norm

.83.83 .88 .88 .90 .90

.80.80 .84.84 .92 .92

.81.81 .86.86 .91 .91

ValidityValidity

Content Content Item developmentItem development

Expert AgreementExpert Agreement

Item-Total CorrelationsItem-Total Correlations

ConstructConstruct Multitrait-Multimethod MatrixMultitrait-Multimethod Matrix

Factor StructureFactor Structure

Clinical Group Clinical Group ComparisonsComparisons

Construct Validity - Factor AnalysisConstruct Validity - Factor Analysis

Allows examination of the structure of the Allows examination of the structure of the BRIEF to assist in clinical scale/ index BRIEF to assist in clinical scale/ index developmentdevelopment

Resulting factors can serve as clinical entities; Resulting factors can serve as clinical entities; meta-scale (latent) structural factorsmeta-scale (latent) structural factors

Various extraction methods: PFA, PCAVarious extraction methods: PFA, PCA

Various rotational methods: Varimax, obliqueVarious rotational methods: Varimax, oblique

Summary of Exploratory FASummary of Exploratory FA

Consistent 2-factor model found with normative, clinical Consistent 2-factor model found with normative, clinical samples; BRIEF factors differentiate from other behavior samples; BRIEF factors differentiate from other behavior rating scale factors.rating scale factors.

MetacognitionMetacognition Initiate, Working Memory, Plan/Organize, Organization Initiate, Working Memory, Plan/Organize, Organization

of Materials, Monitorof Materials, Monitor (Inhibit)(Inhibit)

Behavioral RegulationBehavioral Regulation Inhibit, Shift, Emotional ControlInhibit, Shift, Emotional Control (Monitor)(Monitor)

The Structure of Executive FunctionThe Structure of Executive Function

Interest in BRIEF goes beyond its use as a clinical Interest in BRIEF goes beyond its use as a clinical tooltool

Allows an opportunity to explore the theoretical Allows an opportunity to explore the theoretical structure of executive function (EF)structure of executive function (EF)

Others have asked whether EF is a unitary or Others have asked whether EF is a unitary or “fractionated” supervisory/ regulatory system“fractionated” supervisory/ regulatory system

Theory testing also can assist our approach to Theory testing also can assist our approach to clinical application of the BRIEF as a measure of clinical application of the BRIEF as a measure of EFEF

Diagnostic Group StudiesDiagnostic Group Studies ADHD-Inattentive vs ADHD-CombinedADHD-Inattentive vs ADHD-Combined

BRI and Monitor: Combined > Inattentive & ControlsBRI and Monitor: Combined > Inattentive & Controls MCI: Both ADHD groups > ControlsMCI: Both ADHD groups > Controls

• B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. GuyB. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. Guy

• P. Isquith, G. Gioia & S. GuyP. Isquith, G. Gioia & S. Guy

Severe vs Mild/Moderate TBISevere vs Mild/Moderate TBI BRI & Init, Plan/Org, WM, Monitor: Severe > ControlsBRI & Init, Plan/Org, WM, Monitor: Severe > Controls Working Memory: Severe > Mild/Moderate > ControlsWorking Memory: Severe > Mild/Moderate > Controls

• H. G. Taylor et al.H. G. Taylor et al.

TS vs ADHD vs TS+ADHDTS vs ADHD vs TS+ADHD BRI & MCI: ADHD & TS+ADHD > TS & ControlsBRI & MCI: ADHD & TS+ADHD > TS & Controls

• E. M. MahoneE. M. Mahone

Diagnostic Group StudiesDiagnostic Group Studies Reading DisordersReading Disorders

Working Memory: Reading > ControlsWorking Memory: Reading > Controls Plan/Organize: Reading > ControlsPlan/Organize: Reading > Controls

• B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. GuyB. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia & S. Guy

Extremely Low Birth Weight vs VLBWExtremely Low Birth Weight vs VLBW Monitor, WM, Shift, Inhibit, Init, Plan/Org: ELBW > ControlsMonitor, WM, Shift, Inhibit, Init, Plan/Org: ELBW > Controls Initiate & Plan/Org: ELBW > VLBWInitiate & Plan/Org: ELBW > VLBW

• . G. Taylor et al.. G. Taylor et al.

Mental RetardationMental Retardation Working Memory: MR > ControlsWorking Memory: MR > Controls

• B. Pratt & T. ChapmanB. Pratt & T. Chapman

Diagnostic Group StudiesDiagnostic Group Studies High Functioning AutismHigh Functioning Autism

All BRIEF Scales: HFA > ControlsAll BRIEF Scales: HFA > Controls• R. Landa & M. GoldbergR. Landa & M. Goldberg

Pervasive Developmental DisordersPervasive Developmental Disorders All BRIEF Scales: PDD > ControlsAll BRIEF Scales: PDD > Controls

• L. Kenworthy & S. GuyL. Kenworthy & S. Guy

Frontal vs Extrafrontal LesionsFrontal vs Extrafrontal Lesions All Scales: Frontal & Extrafrontal > ControlsAll Scales: Frontal & Extrafrontal > Controls Inhibit:Inhibit: Frontal > Extrafrontal > ControlsFrontal > Extrafrontal > Controls

• R. Jacobs, V. Anderson, S. HarveyR. Jacobs, V. Anderson, S. Harvey

ConclusionConclusion

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

Clinical ImplicationsClinical Implications

Two factors and component parts are to be Two factors and component parts are to be considered in interpretationconsidered in interpretation

Behavioral Regulation, esp. Inhibit, must be Behavioral Regulation, esp. Inhibit, must be considered first prior to Metacognitionconsidered first prior to Metacognition

Treatment of Behavioral Regulation is likely Treatment of Behavioral Regulation is likely a necessary precursor to Metacognition a necessary precursor to Metacognition treatmenttreatment

Treatment of metacognition via active Treatment of metacognition via active problem-solving strategiesproblem-solving strategies

BRIEF Administration BRIEF Administration and Scoringand Scoring

BRIEF Administration BRIEF Administration and Scoringand Scoring

Intro to Forms - Parent, TeacherIntro to Forms - Parent, Teacher Scoring SheetScoring Sheet Scoring SummaryScoring Summary Profile SheetProfile Sheet Case ExampleCase Example

Steps to BRIEF InterpretationSteps to BRIEF Interpretation

Examine validity scalesExamine validity scalesInconsistencyInconsistencyNegativityNegativity

Examine clinical scalesExamine clinical scales Examine Indexes, Global Executive Examine Indexes, Global Executive

CompositeComposite Individual item analysisIndividual item analysis

Within scale itemsWithin scale itemsNon-scale itemsNon-scale items

Son of BRIEF: Son of BRIEF: The BRIEF-Preschool VersionThe BRIEF-Preschool Version

Gerard A. GioiaGerard A. Gioia

Kimberly Andrews EspyKimberly Andrews Espy

Peter K. IsquithPeter K. Isquith

Or:Or:

The Developmental Inventory The Developmental Inventory Assessment of Preschool Executive Assessment of Preschool Executive RegulationRegulation

(DIAPER)(DIAPER)

Executive Function in Preschoolers: Executive Function in Preschoolers: Common ViewCommon View

Young children:Young children: lack inhibitory controllack inhibitory controlexhibit significant distractibilityexhibit significant distractibilityhave difficulty shifting among taskshave difficulty shifting among tasksdo not organize, plan, or monitor their actions do not organize, plan, or monitor their actions

or performanceor performance

Views from Developmental Views from Developmental NeuropsychologyNeuropsychology

Executive functions DO originate in infancyExecutive functions DO originate in infancy BUT, not available in full final formBUT, not available in full final form HOWEVER, measurement is possible if HOWEVER, measurement is possible if

developmentally appropriate tasks are useddevelopmentally appropriate tasks are used AND, we must take into account the AND, we must take into account the

preschooler’s behavioral repertoirepreschooler’s behavioral repertoire

BRIEF-Preschool VersionBRIEF-Preschool Version

Sample: n=450 Parents, 300+ TeachersSample: n=450 Parents, 300+ TeachersAge 2- 5 yearsAge 2- 5 yearsDiverse sample: ethnically, regionally, SESDiverse sample: ethnically, regionally, SES

129 97 63 items129 97 63 items

BRIEF-P DomainsBRIEF-P DomainsInhibitInhibitShiftShiftEmotional ControlEmotional ControlWorking MemoryWorking MemoryPlan/ OrganizePlan/ OrganizeOrganization (of Materials)Organization (of Materials)MonitorMonitorInitiationInitiation

Reliability: Internal ConsistencyReliability: Internal Consistency

Working Memory (17)Working Memory (17)

Plan/Organize (10)Plan/Organize (10)

Inhibit (16)Inhibit (16)

Shift (10)Shift (10)

Emotional Control (10)Emotional Control (10)

ParentParent TeacherTeacher

.88.88 .95 .95

.80.80 .86 .86

.90.90 .95 .95

.85.85 .90 .90

.86.86 .94 .94

Stability of Preschool Executive Behaviors:Stability of Preschool Executive Behaviors:Test - Retest Reliability Test - Retest Reliability

ScaleScale rr

InhibitInhibit .90.90

ShiftShift .88.88

Emotional ControlEmotional Control .87.87

Working MemoryWorking Memory .85.85

Plan/OrganizePlan/Organize .78.78

Test-Retest Interval 1 - 9 weeks, M = 4.5 weeksTest-Retest Interval 1 - 9 weeks, M = 4.5 weeks

BRIEF-P BRIEF-P Construct ValidityConstruct Validity

Factor 1 = Emergent Metacognition; Factor 1 = Emergent Metacognition; Factor 2 = FlexibilityFactor 2 = Flexibility Factor 3 = Inhibitory Self-Control.Factor 3 = Inhibitory Self-Control.

Diagnostic Group

Scale Controls Preemie Language ADHD PDD

Inhibit 7.2 11.8 32.1 76.5 87.5

Shift 7.2 20.6 28.6 29.4 68.8

Emotional Control 6.3 8.8 28.6 47.1 75

Working Memory 9.6 35.3 39.3 70.6 75

Plan/Organize 2.8 17.6 28.6 76.5 56.3

Inhibitory Self-Control Index

6.3 14.7 28.6 76.5 93.8

Flexibility Index 6.7 8.8 28.6 29.4 75

Emergent Metacognition Index

7.0 29.4 32.1 70.6 68.8

Global Executive Composite

6.5 17.6 35.7 70.6 81.3

Percentage of Dx Groups With T> 65 on BRIEF-P ScalesPercentage of Dx Groups With T> 65 on BRIEF-P Scales

Clinical vs Control SamplesClinical vs Control Samples

0

0.5

1

1.5

2

2.5

Inhibit Shift EC WM Plan/Org

BRIEF-P Scale

Par

ent

Rat

ing

Clinical (45) Control (45)

**** ** ** **

* p < .001* p < .001

Bride of the BRIEFBride of the BRIEFThe BRIEF-Self-ReportThe BRIEF-Self-Report

ScaleNumberof Items Behavioral description

Clinical scales

Inhibit 13 Controls impulses and behavior; appropriately stops and modulates own behavior at the proper time or in the proper context.

Shift 10 Moves freely from one situation, activity, or aspect of a problem to another as the situation demands; makes transitions; solves problems flexibly.

*Behavioral Shift 5 Adjusts behaviorally to changes in environment or schedule.

*Cognitive Shift 5 Problem solves flexibly.

Emotional Control 10 Modulates emotional responses appropriately to situational demand or context.

Monitor 6 Aware of strengths and weaknesses; aware of own behavior and impact on others.

Working Memory 12 Holds information in mind for the purpose of completing a task or making the appropriate response; stays with, or sticks to, an activity.

Plan/Organize 13 Anticipates future events or consequences; uses goals or instructions to guide behavior in context; develops or implements appropriate steps ahead of time to carry out an associated task or action.

Organization of Materials

7 Keeps work and school materials organized; able to organize environment such as backpack and room.

Task Completion 10 Completes school work or chores in timely fashion; finishes tests within time limits; works at a satisfactory pace.

Scale/Index # Items αInhibit 13 .87Shift 10 .82 Behavioral Shift 5 .74 Cognitive Shift 5 .72Emotional Control 10 .86Monitor 6 .75Working Memory 12 .86Plan/Organize 13 .85Organization of Materials 7 .75Task Completion 10 .86Behavioral Regulation Index 39 .93Metacognition Index 42 .95Global Executive Composite 81 .96

Internal ConsistencyInternal Consistency

Scale/Index ra

Inhibit .77

Shift .71

Behavioral Shift .69

Cognitive Shift .65

Emotional Control .84

Monitor .59

Working Memory .85

Plan/Organize .77

Organization of Materials .79

Task Completion .82

Behavioral Regulation Index .84

Metacognition Index .87

Global Executive Composite (GEC) .89

Test-Retest ReliabilityTest-Retest Reliability

Parent vs Self-Report BRIEF:Parent vs Self-Report BRIEF:

Correlations ranged from .25 (Inhibit) Correlations ranged from .25 (Inhibit) to .64 (Working Memory)to .64 (Working Memory)

Parent ratings higher for MetacognitionParent ratings higher for Metacognition Children’s ratings higher for behavioral Children’s ratings higher for behavioral

regulationregulation Neither Parent nor Child BASC were Neither Parent nor Child BASC were

elevatedelevated

BRI MI GEC

Behavioral Regulation Index

.52

Metacognition Index .57

Global Executive Composite (GEC)

.56

Parent-Self Correlations for IndexesParent-Self Correlations for Indexes

30

40

50

60

70

80

Inhibit

Shift EC

Monitor

WM

Plan/Org

Materials

BRI

MI

GEC

Scale

T S

core

Parent Self-Report

Parent & Self Reports in Adolescents with ASDParent & Self Reports in Adolescents with ASD

Case ExamplesCase Examples

Joshua - 8 year old left handed male, Joshua - 8 year old left handed male,

Attention Deficit Hyperactivity Disorder, Attention Deficit Hyperactivity Disorder,

Combined TypeCombined Type

Juan - 12 year old male, Traumatic Brain Juan - 12 year old male, Traumatic Brain

Injury at age 5 yearsInjury at age 5 years

JoshuaJoshua

ADHD - Combined TypeADHD - Combined Type

JoshuaJoshua

ADHD - Combined TypeADHD - Combined Type

JuanJuan

Traumatic Brain InjuryTraumatic Brain Injury

JuanJuan

Traumatic Brain InjuryTraumatic Brain Injury