BRIEF

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• BRIEF
• Behavior Rating Inventory
• Of
• Executive Function
• By Chris Mayer

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BRIEF

• Questionnaire for parents teachers that allows
  professionals to assess executive function
  behaviors at home in school.
• Assesses children ages 5-18.
• Consists of 8 clinical scales Inhibit, Shift,
  Emotional Control, Initiate, Working Memory,
  Plan/Organize, Organization of Materials,
  Monitor. Also contains 2 validity scales
  Negativity Inconsistency
• Clinical scales combine into two factors which
  create composite indexes Metacognition (MI)
  Behavioral Regulation (BRI). Global Executive
  Composite (GEC) is the combination of BRI MI.

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What is Executive Function?

• EF is an umbrella term that covers interrelated
  functions that are responsible for purposeful,
  goal-directed, problem-solving behaviors, and
  emotional control.
• Stuss Benson (1986) Hierarchical Model of EF
  says EF relates to the highest levels of
  cognition anticipation judgment
  self-awareness decision-making. These are
  called the directive or cognitive control
  functions. A secondary level of basic cognitive
  functions is made up of language, visual-spatial
  abilities, memory, etc.

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Executive Function System

• EF is not only in the frontal lobes of the brain.
  
• The frontal region is VERY reciprocally connected
  with other major brain systems such as limbic
  system (motivation), reticular activating system
  (arousal), posterior association cortex
  (perceptual/cognitive), motor regions.
• A disorder within ANY of these areas can cause EF
  problems.
• Working memory is thought to be a key aspect of
  the EF system.

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BRIEF Materials

• Professional Manual
• Parent Form
• Teacher Form
• 2-sided Summary/Profile Form

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Standardization

• Normative sample was based on the 1999 US census
  data according to age, gender, SES, ethnicity,
  geographical population density.
• Sample was collected from urban, suburban rural
  public private schools in Maryland.
• Criteria for inclusion children ages 5-18, no
  history of special ed or psychotropic medication,
  and no more than 10 of blank questionnaire
  items.
• 1,419 parents 720 teachers (only 1 _at_ child)
• Average education level of P raters was 14.2 yrs.
  83 were mothers.

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Reliability

• Tested with measures of internal consistency,
  interrater agreement and test-retest reliability.
• Internal consistency (ind. test items on a scale
  measure the same construct) Both P T Forms had
  high IC ranging from r.80-.98
• Interrater reliability (2 independent raters rate
  a child in a similar way) Correlations between P
  T were moderate, r.32. P rated kids as having
  greater problems than the T. (n296 childrens P
  T forms)
• Test-Retest (stability over time)
• P n54 from normative grp, range r.76-.85, 2
  wks
• P n40 from clinical grp, range r.72-.84, 3
  wks
• T n41 from normative grp, range r.83-.92,
  3.5 wks
• Overall, little change in T-scores (1-3 pts)

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Validity

• Construct validity was examined with convergent
  discriminant measures, and factor analyses.
• Used multitrait-multimethod matrix to check
  convergent discriminant validity with other
  related vs nonrelated rating scales (ADHD- Rating
  Scale IV 100, CBC 200, Teachers Report Form
  192, BASC 80, Conners Rating Scale 25)
  from data with clinically referred kids. Showed
  general pattern of convergent validity with
  inattention impulsivity scales and discriminant
  validity with behavioral/emotional functioning
  scales.
• Factor analyses were done on 3 P T data sets
  for further interpretation on construct validity
  (the normative subsample, the combined
  subsamples, BRIEF in combination with the other
  behavior rating scales). These statistics showed
  support for the 2-factor structure, and similar
  convergence/discrimination with other scales as
  did the multitrait-multimethod matrix.

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Administration

• Parents Form should be completed by a parent or
  guardian. Best practice for both to complete a
  form. If only one is available, it should be the
  parent with the most recent extensive contact.
• Teachers Form should be completed by an adult
  whos had at least 1 month of daily contact with
  the child in the academic setting. More than 1
  rater from different classrooms or subjects may
  be useful.
• Verbal Instructions Parents observe a lot about
  their childs problem solving and behavioral
  functioning that cannot be measured in an office
  visit. Your help is essential to me as I try to
  understand your child. This questionnaire lets
  you document your observations of your child at
  home. Please read the instructions and respond
  to all of the items, even if some are difficult
  or do not seem to apply..

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Scoring

• The scoring sheet is below the answer sheet. It
  is accessed by tearing off the perforated tab.
  Rater responses are already recorded on the
  sheet.
• Transfer circled scores to the box on that
  line. (The boxes correspond to the clinical
  scales)
• Sum subtotals for p. 1, transfer to p. 2, and add
  to get Total Scale Raw Scores.

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• Transfer these scores to the Scoring Summary
  Table.
• Note- the last 14 (P) 13 (T) items are not
  included in the Total Raw Scores.
• Missing items If more than 14 items have been
  left blank, the protocol cannot be scored. Also,
  if more than 2 items on any scale are blank, that
  scale cannot be scored. Blank items are scored
  with 1 point (items 73-86 P 74-86 T are
  excluded).

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Negativity Inconsistency Scales

• Negativity Scale Items marked with an N in the
  margin of the Score Sheet are included in this
  scale. Any of these items that are rated as a
  3 should be circled in the Negativity column on
  the Scoring Summary. Enter the of circled
  items at the bottom of the column for the
  Negativity Score.
• Inconsistency Scale These items (19 pairs) have
  a circled I in the margin of the Scoring sheet.
  Transfer the scores to the columns for this
  scale on the Scoring Summary. For each pair,
  find the difference in the scores. Sum the
  differences to get the Inconsistency Score.

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Converting Raw Scores

• Find the normative table for the gender and age
  in the Appendices of the Manual. Write them in
  the Scoring Summary Table.
• Look up sum of raw scores for T-scores and
  percentiles.
• The information for the 90 CI is at the bottom
  of each column in the Appendices. Add/subtract
  the CI value to the T-score to get the confidence
  interval.
• Plot scores on the Profile Form.
• T-score of 50 Mean, 10 SD
• Score of 65 1.5 SD from Mean, and is the
  threshold for an abnormally elevated score (shown
  in grey on Profile Form)

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Clinical Interpretation Issues

• To interpret this inventory you need a solid
  working understanding of EF concepts and
  knowledge of the clinical manifestations
  assessment of EF.
• There is no disorder of EF, but there are a
  variety of disorders that involve aspects of the
  EF system. There are also syndromes diagnoses
  that have a pattern of EF dysfunction.
• One difficulty is separating out the control
  function (e.g. organizing what to say) from the
  domain function (e.g. syntax, vocabulary,
  semantics).
• The more novel and complex the situation, the
  more EF is used.
• T-scores represent the childs level of EF as
  reported by the rater. The ile shows how much
  of the norm sample the score exceeds. Higher
  scores higher dysfunction.

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Consider validity of the protocol

• There is inherent bias in a 3rd party rating
  scale.
• Look for unusual response patterns such as all
  the same score or alternating scores (1, 2, 3).
• Inconsistency Scale shows whether similar items
  are rated the same. Scored as acceptable (6),
  questionable (7-8) inconsistent (9). If the
  rater can explain the inconsistencies, the
  protocol may be valid. Example 7. Has angry
  explosive outbursts 25. Has outbursts for
  little reason.
• Negativity Scale less than 3 of the norm sample
  raters scored above 7. Scores above 4 should be
  considered high. Higher than 7, likely the child
  has a serious executive dysfunction, or the rater
  has a very negative view of the child. 13. Acts
  upset by a change of plans.

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Clinical Scale Interpretation

• Inhibit measures the ability to inhibit or
  resist an impulse to stop your behavior at the
  right time. In the literature, this scale is
  described as the core deficit in ADHD,
  Predominately Hyper-Impulsive Type. Children who
  score high are often intrusive lack personal
  safety.
• Shift measures the ability to move from one
  situation/activity to another. Mild problems
  might show up in inefficient problem solving.
  Severe problems may create perseverative
  behavior. High scores on this scale are often
  seen in kids with PDD.
• Emotional Control measures the ability to
  modulate your emotional responses. Might see
  easy crying, tantrums, hysterical laughing-
  emotional behavior doesnt match the situation or
  isnt age appropriate.

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• Initiate measures the ability to begin an
  activity or independently create ideas/solutions.
  Teachers might complain that the kids just cant
  get started or need lots of prompts. Problems on
  this scale often affect fluency scores in
  cognitive tests. Also, oppositional behavior
  needs to be ruled out.
• Working Memory measures the ability to hold
  information in mind to complete a task. This is
  very important for multi-step tasks. High scores
  might correlate with problems with sustained
  performance on a task, changing tasks often, or
  not finishing things. This scale may be useful
  in assessing ADHD, Predominantly Inattentive
  Type.
• Monitor assesses habits of checking work and
  self-monitoring. May rush through work make
  careless mistakes.

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• Plan/Organize measures ability to manage the
  demands of an activity. 2 parts anticipating
  setting goals sequencing Planning ordering
  information, getting the main idea Organizing.
• Organization of Materials measures orderliness,
  keeping track of things. Kids who have high
  scores on this scale are the ones who constantly
  loose things. Often they can be helped by
  teaching them how to organize.
• BRI (Behavioral Regulation Index) measures the
  childs ability to shift cognitive set modulate
  emotions behavior by appropriate inhibitory
  control. (Inhibit, Shift, Emotional Control)
• MI (Metacognition Index) measures the ability to
  start, plan, organize sustain future-oriented
  problem solving in working memory. (Initiate,
  WM, Planning/Organization, Organization of
  Materials Monitor)

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• GEC (Global Executive Composite) is a summary
  score. To use it there cant be a significant
  difference between BRI MI scores because it
  would be likely to hide important information.
• BRIEF profiles that show possible scale
  elevations are available for ADHD, TBI,
  Tourettes Disorder with without ADHD, Reading
  Disorder, low birth weight, high functioning
  Autism, PDD, MR. Also for frontal lesions
  extrafrontal lesions.

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