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

 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
 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 4
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Interest in Executive
Function in Children
 5 articles in 1985 600

500

 14 articles in 1995 400

300

 501 articles in 2005 200

100
 Bernstein & Waber,
Executive Function in 0
1985 1995 2005
Education, 2007 5
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 Methods of Assessing EF

Micro Macro
Genetics Structural & Performance Observations
Functional Tests
Imaging
Count the number of moves 70
Goal: 65
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Measurement of Executive
Functions
 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
 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 11/6/2018

Impetus
 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:

 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
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Purpose of the BRIEF
 The BRIEF consists of two rating forms
 Parent
 Teacher

 86 items on both questionnaires

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Additional BRIEF Products

 BRIEF Preschool (Ages 3-5 years)

 BRIEF Self-Report (Ages 13-18 years)

 BRIEF Software (Scoring & Reporting)

 BRIEF Adult (Ages 18-90 years)

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 A BRIEF Genealogy

2000 2003 2004 2005

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 Monitor
Meta- Organization
Cognition of Materials
Plan/Organize

Working Memory

Initiate

Emotional Control
Behavioral
Shift
Regulation

Inhibit

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Behavioral Definitions for
the Clinical Scales

 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
 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

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Administering the
BRIEF Parent Form

 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
 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
 Calculate the raw score by transferring the
circled responses to the box for that item

 Sum the scores in each column and record

the sum in the box for that column

 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

 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
 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
 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
 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

 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
 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. 29
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Interpreting the
BRIEF Parent/Teacher Forms
 All results should be viewed in the context
of a complete evaluation

 High scores do not indicate “A Disorder of

Executive Function”

 Problems may be developmental or acquired

and, thus, are suggestive of differing
treatment approaches

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Steps to BRIEF Interpretation
 Examine validity scales
 Inconsistency
 Negativity
 Examine clinical scales
 Examine indexes, Global Executive
Composite
 Individual item analysis
 Within scale items
 Nonscale items
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Interpretation
 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
 Professional Manual

 Computer Scoring and Interpretive Reporting

 Integrated Reporting

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 BRIEF Basics
BRIEF BRIEF-P BRIEF-SR BRIEF-A
Items / 86/8 63/5 80/8 75/9
Scales
α .80-.90s .80-.90s .80-.90s .93-.98s

Retest .80-.90s .80-.90s .80-.90s .94-.96s

Inter-rater Parent – Teacher Parent – Teacher Self – Parent = .50 Self–Informant = .64
r = .30 r = .17 - .28 Self –Teacher = .25

Covary BASC, CBCL, CBCL, CBCL, BASC, BDI, FrSBe, DEX,

ADHD-IV ADHD-IV ADHD-IV, CHQ CAD, STAI

Clinical ADHD, LD, TS, ASD, ADHD, ADHD, ASD, ADHD, MCI, TBI,
groups ASD, Frontal Language, LBW Anx/Dep, MS, Epilepsy
lesion, DM (T1)
PKU,Trauma

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Reliability
 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
 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
 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
 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
 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
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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
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Case Example
 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
 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.
 Media violence exposure - Kronenberger et al. 2005.
 Spina bifida and hydrocephalus - Burmeister et al., 2005; Brown, 2005;
Mahone et al., 2002.
 Obstructive sleep apnea - 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. 47
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 Frontal lesions, PKU & hydrocephalus - Anderson et al., 2002.