Behavior Rating Inventory of Executive Function® (BRIEF®)


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  • Behavior Rating Inventory of Executive Function® (BRIEF®)

    1. 1. 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.
    2. 2. BRIEF Authors 10/18/10 <ul><li>Gerard A. Gioia, Children’s National Medical Center </li></ul><ul><li>Peter K. Isquith, Dartmouth Medical School </li></ul><ul><li>Robert M. Roth, Dartmouth Medical School </li></ul><ul><li>Steven C. Guy, Independent Practice </li></ul><ul><li>Lauren Kenworthy, Children’s National Medical Center </li></ul><ul><li>Kimberly Andrews Espy, Vice Provost, University of Nebraska, Lincoln </li></ul>
    3. 3. <ul><ul><li>Purpose: Assess impairment of executive function </li></ul></ul><ul><ul><li>For: Ages 5-18 years </li></ul></ul><ul><ul><li>Administration: Individual, 86 items </li></ul></ul><ul><ul><li>Time: 10-15 minutes to administer; 15-20 minutes to score by hand, software available for scoring and interpretation </li></ul></ul>10/18/10 Overview of the BRIEF
    4. 4. Overview of the BRIEF <ul><li>Utilizes parent and teacher input in the evaluation of the child’s behavioral functioning </li></ul><ul><li>The BRIEF is useful in evaluating children with a wide spectrum of developmental and acquired neurological conditions, such as: </li></ul><ul><ul><ul><li>Learning disabilities </li></ul></ul></ul><ul><ul><ul><li>Low birth weight </li></ul></ul></ul><ul><ul><ul><li>Attention-deficit/hyperactivity disorder </li></ul></ul></ul><ul><ul><ul><li>Tourette's disorder </li></ul></ul></ul><ul><ul><ul><li>Traumatic brain injury </li></ul></ul></ul><ul><ul><ul><li>Pervasive developmental disorders/autism </li></ul></ul></ul>10/18/10
    5. 5. Interest in Executive Function in Children <ul><li>5 articles in 1985 </li></ul><ul><li>14 articles in 1995 </li></ul><ul><li>501 articles in 2005 </li></ul><ul><ul><ul><li>Bernstein & Waber, </li></ul></ul></ul><ul><ul><ul><li>Executive Function in </li></ul></ul></ul><ul><ul><ul><li>Education, 2007 </li></ul></ul></ul>10/18/10
    6. 6. Methods of Assessing EF 10/18/10 Micro Macro Performance Tests Observations Structural & Functional Imaging Genetics
    7. 7. Measurement of Executive Functions 10/18/10 <ul><li>Executive functions are dynamic, fluid </li></ul><ul><li>No formal, single test adequate to capture EF </li></ul><ul><li>Many tests are too structured to adequately assess EF </li></ul><ul><li>Need intra-individual approach </li></ul><ul><li>“ Executive” is often provided by the examiner </li></ul>
    8. 8. Limitations of Performance Tests <ul><li>EF tests are molar, tapping several EF and non-EF functions that can be disrupted in many ways </li></ul><ul><li>Differences in cognitive “style” or ability can affect EF performance regardless of EF </li></ul><ul><li>Sensitivity/Specificity limited − Patients who should have EF deficits do well on EF tests; EF performance not sensitive to frontal vs. extra-frontal lesions </li></ul><ul><li>Discriminant Validity − If EF tasks are impaired in several disorders, then EFs are not helpful in distinguishing between disorders </li></ul><ul><ul><ul><li>Pennington & Ozonoff, 1996 </li></ul></ul></ul>10/18/10
    9. 9. Impetus 10/18/10 <ul><li>Clinical need for efficient external validation </li></ul><ul><li>Collect standardized observational reports of everyday functioning </li></ul><ul><li>Ecological validity, real-world anchor </li></ul><ul><li>Common parent descriptions of everyday executive difficulties </li></ul><ul><li>Frustration with available performance tests </li></ul>
    10. 10. Purpose: provide a measure of executive function that is: 10/18/10 <ul><li>psychometrically sound </li></ul><ul><li>sensitive to developmental changes </li></ul><ul><li>high in ecological validity </li></ul><ul><li>sufficiently broad to serve as a screen </li></ul><ul><li>comprehensive in sampling content </li></ul><ul><li>theoretically coherent </li></ul><ul><li>useful in targeting treatment </li></ul>
    11. 11. <ul><li>The BRIEF consists of two rating forms </li></ul><ul><ul><li>Parent </li></ul></ul><ul><ul><li>Teacher </li></ul></ul><ul><li>86 items on both questionnaires </li></ul>10/18/10 Purpose of the BRIEF
    12. 12. Additional BRIEF Products <ul><li>BRIEF Preschool (Ages 3-5 years) </li></ul><ul><li>BRIEF Self-Report (Ages 13-18 years) </li></ul><ul><li>BRIEF Software (Scoring & Reporting) </li></ul><ul><li>BRIEF Adult (Ages 18-90 years) </li></ul>10/18/10
    13. 13. A BRIEF Genealogy <ul><li>2000 2003 2004 2005 </li></ul>10/18/10
    14. 14. 10/18/10 Meta- Cognition Behavioral Regulation Working Memory Initiate Plan/Organize Inhibit Shift Emotional Control Monitor Organization of Materials
    15. 15. Behavioral Definitions for the Clinical Scales <ul><li>Inhibit: Control impulses; stop behavior </li></ul><ul><li>Shift: Move freely from one activity/situation to another; transition; problem-solve flexibly </li></ul><ul><li>Emotional Control: Modulate emotional responses appropriately </li></ul>10/18/10
    16. 16. Behavioral Definitions for the Clinical Scales <ul><li>Initiate: Begin activity; generate ideas </li></ul><ul><li>Working Memory: Hold information in mind for purpose of completing a task </li></ul><ul><li>Plan/Organize: Anticipate future events; set goals; develop steps; grasp main ideas </li></ul><ul><li>Monitor: Check work; assess own performance </li></ul>10/18/10
    17. 17. Administering the BRIEF Parent Form <ul><li>Materials: Parent Form and a pen/pencil </li></ul><ul><li>Parent Form is filled out by a parent; preferably, by both parents </li></ul><ul><li>Parent must have recent and extensive contact with the child over the past 6 months </li></ul>10/18/10
    18. 18. Administering the BRIEF Teacher Form <ul><li>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 </li></ul><ul><li>Minimum familiarity is 1 month </li></ul><ul><li>Multiple ratings across classrooms may be useful for comparison purposes </li></ul>10/18/10
    19. 19. Scoring the BRIEF Parent/Teacher Forms <ul><li>Calculate the raw score by transferring the circled responses to the box for that item </li></ul><ul><li>Sum the scores in each column and record the sum in the box for that column </li></ul><ul><li>Transfer the summed scores from page 1 to the appropriate box on page 2 and then sum the scores for each scale </li></ul>10/18/10
    20. 20. 10/18/10
    21. 21. Scoring the Negativity Scale <ul><li>To score the Negativity scale, find all of the “N” items that received a score of 3 </li></ul><ul><li>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 </li></ul>10/18/10
    22. 22. Scoring the Inconsistency Scale <ul><li>Scoring the Inconsistency scale is more complex and requires greater attention to detail </li></ul><ul><li>Inconsistency items have an I in the margin of the scoring sheet </li></ul><ul><li>Transfer the scores for the 10 item pairs to the appropriate boxes on the Scoring Summary/Profile Form </li></ul>10/18/10
    23. 23. Scoring the Inconsistency Scale <ul><li>For each item pair, calculate the absolute value of the difference for the items </li></ul><ul><li>Then, sum the difference values for the 10 pairs to obtain the Inconsistency scale score </li></ul>10/18/10
    24. 24. 10/18/10
    25. 25. Obtaining Standard Scores for the BRIEF Parent/Teacher Forms <ul><li>Once raw scores for all scales are obtained, find the appropriate table in the appendixes </li></ul><ul><li>Tables are broken down by form (Parent/Teacher), age, and gender of the child </li></ul><ul><li>Standard scores have a mean of 50 and a SD of 10; percentile ranks also are available in the tables </li></ul>10/18/10
    26. 26. Comparison Tables <ul><li>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 </li></ul>10/18/10
    27. 27. 10/18/10 Joshua ADHD - Combined Type
    28. 28. 10/18/10
    29. 29. 10/18/10 Computerized Scoring <ul><li>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. </li></ul><ul><li>Separate software is available for the BRIEF-P only and the BRIEF-A only. </li></ul>
    30. 30. Interpreting the BRIEF Parent/Teacher Forms <ul><li>All results should be viewed in the context of a complete evaluation </li></ul><ul><li>High scores do not indicate “A Disorder of Executive Function” </li></ul><ul><li>Problems may be developmental or acquired and, thus, are suggestive of differing treatment approaches </li></ul>10/18/10
    31. 31. Steps to BRIEF Interpretation <ul><li>Examine validity scales </li></ul><ul><ul><li>Inconsistency </li></ul></ul><ul><ul><li>Negativity </li></ul></ul><ul><li>Examine clinical scales </li></ul><ul><li>Examine indexes, Global Executive Composite </li></ul><ul><li>Individual item analysis </li></ul><ul><ul><li>Within scale items </li></ul></ul><ul><ul><li>Nonscale items </li></ul></ul>10/18/10
    32. 32. Interpretation <ul><li>T scores at the Domain level; higher scores suggest a higher level of dysfunction </li></ul><ul><li>For the Inconsistency scale, look at scores ≥ 7 as indicative of a high degree of inconsistency in rater response </li></ul><ul><li>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?” </li></ul>10/18/10
    33. 33. Interpretive Options <ul><li>Professional Manual </li></ul><ul><li>Computer Scoring and Interpretive Reporting </li></ul><ul><li>Integrated Reporting </li></ul>10/18/10
    34. 34. BRIEF Basics 10/18/10 BRIEF BRIEF-P BRIEF-SR BRIEF-A Items / Scales 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 Inter-rater 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
    35. 35. Reliability <ul><li>High internal consistency ( α = .80-.98) </li></ul><ul><li>Test-retest reliability r s = .82 for parents and .88 for teachers; moderate correlations between teacher and parent ratings ( r s = .32-.34) </li></ul>10/18/10
    36. 36. Validity <ul><li>Convergent validity established with other measures: inattention, impulsivity, and learning skills </li></ul><ul><li>Divergent validity demonstrated against measures of emotional and behavioral functioning </li></ul><ul><li>Working Memory and Inhibit scales differentiate among ADHD subtypes </li></ul>10/18/10
    37. 37. Standardization Population <ul><li>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 </li></ul>10/18/10
    38. 38. Clinical Standardization Population <ul><li>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) </li></ul>10/18/10
    39. 39. 10/18/10
    40. 40. Diagnostic Group Studies <ul><li>Reading Disorders </li></ul><ul><ul><li>Working Memory: Reading > Controls </li></ul></ul><ul><ul><li>Plan/Organize: Reading > Controls </li></ul></ul><ul><ul><ul><ul><li>B. Pratt, F. Campbell-LaVoie, P. Isquith, G. Gioia, & S. Guy </li></ul></ul></ul></ul><ul><li>Extremely Low Birth Weight vs VLBW </li></ul><ul><ul><li>Monitor, WM, Shift, Inhibit, Init, Plan/Org: ELBW > Controls </li></ul></ul><ul><ul><li>Initiate & Plan/Org: ELBW > VLBW </li></ul></ul><ul><ul><ul><ul><li>G. Taylor, et al. </li></ul></ul></ul></ul><ul><li>Mental Retardation </li></ul><ul><ul><li>Working Memory: MR > Controls </li></ul></ul><ul><ul><ul><ul><li>B. Pratt & T. Chapman </li></ul></ul></ul></ul>10/18/10
    41. 41. Diagnostic Group Studies <ul><li>High Functioning Autism </li></ul><ul><ul><li>All BRIEF scales: HFA > Controls </li></ul></ul><ul><ul><ul><ul><li>R. Landa & M. Goldberg </li></ul></ul></ul></ul><ul><li>Pervasive Developmental Disorders </li></ul><ul><ul><li>All BRIEF scales: PDD > Controls </li></ul></ul><ul><ul><ul><ul><li>L. Kenworthy & S. Guy </li></ul></ul></ul></ul><ul><li>Frontal vs. Extrafrontal Lesions </li></ul><ul><ul><li>All scales: Frontal & Extrafrontal > Controls </li></ul></ul><ul><ul><li>Inhibit: Frontal > Extrafrontal > Controls </li></ul></ul><ul><ul><ul><ul><li>R. Jacobs, V. Anderson, & S. Harvey </li></ul></ul></ul></ul>10/18/10
    42. 42. Case Example <ul><li>Joshua: </li></ul><ul><ul><li>8-year-old left-handed male </li></ul></ul><ul><ul><li>Attention-Deficit/Hyperactivity Disorder, </li></ul></ul><ul><li>Combined Type </li></ul>10/18/10
    43. 43. 10/18/10 Joshua ADHD - Combined Type
    44. 44. 10/18/10 Joshua ADHD - Combined Type
    45. 45. 10/18/10
    46. 46. 10/18/10
    47. 47. 10/18/10 BRIEF Clinical Studies <ul><li>ADHD - Jarratt et al., 2005; Loftis, 2005; Viechnicki, 2005; Lawrence et al., 2004; Blake- Greenberg, 2003; Palencia, 2003; Kenealy, 2002; Mahone et al., 2002. </li></ul><ul><li>Reading disorders - Gioia et al., 2002; Pratt, 2000. </li></ul><ul><li>Autism spectrum disorders - Gilotty et al., 2002; Gioia et al., 2002. </li></ul><ul><li>Bipolar disorder vs. ADHD - Shear et al., 2002. </li></ul><ul><li>Tourette’s syndrome - Mahone et al., 2002; Cummings et al., 2002. </li></ul><ul><li>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. </li></ul><ul><li>Media violence exposure - Kronenberger et al. 2005. </li></ul><ul><li>Spina bifida and hydrocephalus - Burmeister et al., 2005; Brown, 2005; Mahone et al., 2002. </li></ul><ul><li>Obstructive sleep apnea - Beebe, 2004, 2002. </li></ul><ul><li>Galactosemia - Antshel et al., 2004. </li></ul><ul><li>Childhood onset MS - McCann et al., 2004. </li></ul><ul><li>Sickle cell - Kral et al., 2004. </li></ul><ul><li>22q11 deletion - Kiley-Brabeck, 2004. </li></ul><ul><li>PKU - Antshel et al., 2003. </li></ul><ul><li>Frontal lesions, PKU & hydrocephalus - Anderson et al., 2002. </li></ul>