Long-Term Executive Function Deficits in Children With Traumatic Brain Injuries: Assessment Using the Behavior Rating Inventory of Executive Function (BRIEF)

Long-term deficits in executive functions following childhood traumatic brain injuries (TBI) were examined using the Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF approximately 5 years postinjury as part of a prospective study of children injured between the ages of 6 and 12. The children were between 10 and 19 years of age at the time of the assessment, and included 33 with severe TBI, 31 with moderate TBI, and 34 with orthopedic injuries. Parents also rated children's adaptive functioning and completed several other measures of parent and family functioning. Children were administered a neuropsychological test battery that included several measures of executive functions. The groups displayed a significant linear trend in BRIEF scores, with the largest deficits in executive functions reported in children with severe TBI. BRIEF scores were related consistently across groups to a test of working memory, but not to other neuropsychological measures. BRIEF scores also predicted children's adaptive functioning and behavioral adjustment, as well as parent psychological distress, perceived family burden, and general family functioning. The findings indicate that TBI results in long-term deficits in executive functions that are related to children's psychosocial outcomes, as well as to parent and family functioning.     

Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a Clinical Sample

Evidence for the validity of the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000) based on internal structure was examined in a sample of children with mixed clinical diagnoses via maximum likelihood confirmatory factor analysis. Four alternative factor models of children's executive function, based on current theories that posit a unidimensional versus fractionated model (Rabbitt, 1997; Shallice & Burgess, 1991), using the revised 9-scale BRIEF configuration that separates two components of the Monitor scale, were examined for model fit. A 3-factor structure best modeled the data when compared directly with 1-, 2-, and 4-factor models. The 3-factor model was defined by a Behavior Regulation factor consisting of the BRIEF Inhibit and Self-Monitor scales, an Emotional Regulation factor consisting of the Emotional Control and Shift scales, and a Metacognition factor composed of the Working Memory, Initiate, Plan/Organize, Organization of Materials, and Task-Monitor scales. The findings support a fractionated, multi-component view of executive function as measured by the BRIEF.     

Factorial validity of the Behavior Rating Inventory of Executive Function (BRIEF)-Teacher form

Deficits in executive function (self-regulatory mechanisms) have been linked with many childhood disorders including attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder, and conduct disorder. Executive functioning is typically assessed by individually administering performance-based measures in a clinical setting. However, performance-based methods are inefficient for school psychologists. A more feasibly implemented measure for applied settings is the Behavior Rating Inventory of Executive Function (BRIEF), but researchers have raised questions about the internal validity and the proposed factors. In this study, we examined the factor structure of the teacher form of the BRIEF in a sample of 2,044 general education elementary students and 131 teachers in a multilevel design. Results revealed support for a model with three factors at Level 1 and one general factor at Level 2. The results of our study do not support the current two-factor model of the published BRIEF protocol.     

Age-Related Changes in Executive Function: A Normative Study with the Dutch Version of the Behavior Rating Inventory of Executive Function (BRIEF)

This study examined age-related change in executive function by using a Dutch translation of the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000 Gioia, G. A., Isquith, P. K., Guy, S. C. and Kenworthy, L. 2000. Behavior Rating Inventory of Executive Function BRIEF): Professional manual, Lutz, FL: Psychological Assessment Resources.  [Google Scholar]) that was applied to a normative sample (age range 5–18 years). In addition, we examined the reliability and factorial structures of the Dutch BRIEF. Results with respect to age revealed a decrease in reported executive function problems with increasing age. On the Behavior Regulation Index (BRI), 5- to 8-year-olds showed significantly more executive function problems than 9- to 11-year-olds, as did the 12- to 14-year-olds compared to 15- to 18-year-olds (except on the Shift subscale). On the Metacognition Index, we found that 9- to 11-year-olds differed significantly from 5- to 8-year-olds on the Working Memory subscale. In addition, the current study showed that the internal consistency of the Dutch BRIEF is very high, and that this version of the BRIEF has a high test-retest stability. Item factor analysis confirmed the expected eight common factor model, and factor analysis of the eight test scores confirmed the two-factor model, as proposed by Gioia et al., in the Dutch data.     

Confirmatory factor analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a clinical sample.

Evidence for the validity of the Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000) based on internal structure was examined in a sample of children with mixed clinical diagnoses via maximum likelihood confirmatory factor analysis. Four alternative factor models of children's executive function, based on current theories that posit a unidimensional versus fractionated model (Rabbitt, 1997; Shallice & Burgess, 1991), using the revised 9-scale BRIEF configuration that separates two components of the Monitor scale, were examined for model fit. A 3-factor structure best modeled the data when compared directly with 1-, 2-, and 4-factor models. The 3-factor model was defined by a Behavior Regulation factor consisting of the BRIEF Inhibit and Self-Monitor scales, an Emotional Regulation factor consisting of the Emotional Control and Shift scales, and a Metacognition factor composed of the Working Memory, Initiate, Plan/Organize, Organization of Materials, and Task-Monitor scales. The findings support a fractionated, multi-component view of executive function as measured by the BRIEF.     

Psychometric Support for an Abbreviated Version of the Behavior Rating Inventory of Executive Function (BRIEF) Parent Form

The objectives of this study were to systematically develop and evaluate the psychometric properties of an abbreviated version of the Behavior Rating Inventory of Executive Function (BRIEF) Parent Report; a questionnaire widely used by pediatric neuropsychologists. A total of 24 items from the original BRIEF Parent Form were selected for the short-form, which was then evaluated in three complementary samples, according to six a priori psychometric criteria. The short-form generally demonstrated appropriate psychometric qualities, with convincing evidence for the reliability and validity of the three composite indices: Behavioral Regulation, Metacognition, and the Global Executive Composite. Potential clinical applications include screening at-risk children in medical clinics to facilitate appropriate referrals for further psychological consultation. In research settings, the short-form can be easily integrated into studies involving mass collection of data (e.g., large-scale epidemiological research), facilitating advancements in the scientific understanding of neuropsychological morbidity in medically involved populations.     

Confirmatory Factor Analysis of the Behavior Rating Inventory of Executive Function (BRIEF): Support for a distinction between Emotional and Behavioral Regulation

Previous research has supported a three-factor division of the Behavior Rating Inventory of Executive Function (BRIEF) when dividing the parent form in 9 instead of 8 subscales. The present study investigated different factor models in the 8- and 9-scale division in both the parent and teacher form of the Norwegian BRIEF version. Confirmatory Factor Analyzes showed best fit for the three-factor model in a mixed healthy and clinical sample, indicating a distinction between Emotional and Behavioral Regulation. This division is in accordance with present knowledge of brain function and may increase the specificity of executive dysfunction in clinical groups.     

Frequency of scale elevations and factor structure of the Behavior Rating Inventory of Executive Function (BRIEF) in children and adolescents with intractable epilepsy.

The Behavior Rating Inventory of Executive Function (BRIEF) is a standardized rating scale that provides information about the nature and extent of executive function deficits displayed by children and adolescents in daily life. BRIEF protocols completed by parents of 80 children with intractable epilepsy were evaluated with respect to prevalence and severity of scale elevations in the sample, and also with respect to factor structure. Overall, the sample was rated as having significantly more executive function problems than healthy children in the BRIEF standardization sample; elevations on the Working Memory and Plan/Organize scales were most frequently seen. Fully 36% of the sample had four or more significantly elevated scales. However, 31% of the sample had no clinically elevated scales, indicating that executive difficulties, though frequent, are not necessarily characteristic of all children with severe epilepsy. As in the validation studies reported in the manual, a two-factor solution emerged from a principal factor analysis of BRIEF scales. However, the factor structure as given in the manual was not entirely replicated; specifically, the Monitor scale was found to load equivalently on both factors. The results of this study suggest that a substantial proportion of children with intractable epilepsy display significant executive function deficits in daily life. Research into the relationship of BRIEF scores to other measures of executive functioning in children with epilepsy is needed to further clarify its clinical utility.     

Confirmatory factor analysis of the Behavior Rating Inventory of Executive Functioning (BRIEF) in children and adolescents with ADHD

The Behavior Rating Inventory of Executive Functioning (BRIEF) is a parent report measure designed to assess executive skills in everyday life. The present study employed a confirmatory factor analysis (CFA) to evaluate three alternative models of the factor structure of the BRIEF. Given the executive functioning difficulties that commonly co-occur with attention-deficit/hyperactivity disorder (ADHD), the participants included 181 children and adolescents with a diagnosis of ADHD. The results indicated that an oblique two-factor model, in which the Monitor subscale loaded on both factors (i.e., Behavioral Regulation, Metacognition) and measurement errors for the Monitor and Inhibit subscales were allowed to correlate, provided an acceptable goodness-of-fit to the data. This two-factor model is consistent with previous research indicating that the Monitor subscale reflects two dimensions (i.e., monitoring of task-related activities and monitoring of personal behavioral activities) and thus loads on multiple factors. These findings support the clinical relevance of the BRIEF in children with ADHD, as well as the multidimensional nature of executive functioning.     

Factor structure of the Behavior Rating Inventory of Executive Functions (BRIEF-P) at age three years

The preschool period is an important developmental period for the emergence of cognitive self-regulatory skills or executive functions (EF). To date, evidence regarding the structure of EF in preschool children has supported both unitary and multicomponent models. The aim of the present study was to test the factor structure of early EF as measured by the Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P). BRIEF-P consists of five subscales and three broader indexes, hypothesized to tap into different subcomponents of EF. Parent ratings of EF from a nonreferred sample of children recruited from the Norwegian Mother and Child Cohort Study (N = 1134; age range 37–47 months) were subjected to confirmatory factor analyses (CFA). Three theoretically derived models were assessed; the second-order three-factor model originally proposed by the BRIEF-P authors, a “true” first-order one-factor model and a second-order one-factor model. CFA fit statistics supported the original three-factor solution. However, the difference in fit was marginal between this model and the second-order one-factor model. A follow-up exploratory factor analysis (EFA) supported the existence of several factors underlying EF in early preschool years, with a considerable overlap with the five BRIEF-P subscales. Our results suggest that some differentiation in EF has taken place at age 3 years, which is reflected in behavior ratings. The internal consistency of the BRIEF-P five clinical subscales is supported. Subscale interrelations may, however, differ at this age from those observed in the preschool group as a whole.     

Long-term executive function deficits in children with traumatic brain injuries: assessment using the Behavior Rating Inventory of Executive Function (BRIEF).

Long-term deficits in executive functions following childhood traumatic brain injuries (TBI) were examined using the Behavior Rating Inventory of Executive Function (BRIEF). Parents completed the BRIEF approximately 5 years postinjury as part of a prospective study of children injured between the ages of 6 and 12. The children were between 10 and 19 years of age at the time of the assessment, and included 33 with severe TBI, 31 with moderate TBI, and 34 with orthopedic injuries. Parents also rated children's adaptive functioning and completed several other measures of parent and family functioning. Children were administered a neuropsychological test battery that included several measures of executive functions. The groups displayed a significant linear trend in BRIEF scores, with the largest deficits in executive functions reported in children with severe TBI. BRIEF scores were related consistently across groups to a test of working memory, but not to other neuropsychological measures. BRIEF scores also predicted children's adaptive functioning and behavioral adjustment, as well as parent psychological distress, perceived family burden, and general family functioning. The findings indicate that TBI results in long-term deficits in executive functions that are related to children's psychosocial outcomes, as well as to parent and family functioning.     

Factor Structure and Discriminative Validity of the Eyberg Child Behavior Inventory With Young Children

This study examined the factor structure and discriminative validity of the Eyberg Child Behavior Inventory (ECBI) with community-based and clinic-referred samples of young children (2–6 years). In the community sample, confirmatory factor analysis indicated a three-factor structure with components reflecting Inattentive, Oppositional Defiant, and Conduct Problem Behavior. In the clinic sample, component scores differentiated children with specific behavior problems from children without significant externalizing symptoms. However, component scores did not differentiate within the externalizing spectrum. The data suggest that ECBI components may be useful to screen community-based and clinic-referred young children for externalizing symptoms, but may be less useful to identify children with specific behavior problems.     

Much ado about norming: The Behavior Rating Inventory of Executive Function

The Behavior Rating Inventory of Executive Function (BRIEF) is a rating scale designed to assess executive functions in everyday life that is widely used in school and clinical settings and in research studies. It has been recently suggested, however, that the limited geographic stratification of the standardization sample renders the measure overly sensitive. We evaluated this hypothesis by examining BRIEF scores across studies of typically developing children and adolescents. Thirty-nine studies were identified that included at least one of three possible index scores. Mean scores across studies were (a) within one to two T-score units from the standardization sample mean of 50, (b) tended to be slightly lower than 50, and (c) were unrelated to geographic location (US Census regions or internationally). These findings refute recent claims that the BRIEF is overly sensitive and further add to the large body of literature supporting the validity of the measure.     

Construct and criterion validity of the Behaviour Rating Inventory of Executive Function (BRIEF) in children referred for neuropsychological assessment after paediatric traumatic brain injury

The construct and criterion validities of the parent version of the Behaviour Rating Inventory of Executive Function (BRIEF) were evaluated in a sample of 100 6- to 16-year-old children with traumatic brain injury (TBI). Maximum-likelihood factor analysis identified two latent constructs that largely replicated the factor structure reported for the standardization sample, with the notable exception that the Inhibit scale covaried primarily with the metacognition factor and not with behavioural regulation factor. Only the former factor demonstrated evidence for sensitivity to the severity of TBI. Results on both factors were affected by a premorbid history of attention-deficit/hyperactivity disorder or other out-patient psychiatric treatment. It is concluded that the BRIEF has construct and criterion validity in the evaluation of children with TBI but that findings on this instrument can only be interpreted within the context of review of the child's premorbid history.     

The Attention and Executive Function Rating Inventory (ATTEX): Psychometric properties and clinical utility in diagnosing ADHD subtypes

Klenberg, L., Jämsä, S., Häyrinen, T., Lahti‐Nuuttila, P. & Korkman, M. (2010). The Attention and Executive Function Rating Inventory (ATTEX): Psychometric properties and clinical utility in diagnosing ADHD subtypes. Scandinavian Journal of Psychology, 51, 439–448. This study presents a new inventory, the Attention and Executive Function Rating Inventory (ATTEX), and examines the psychometric properties and the clinical utility of ATTEX in indentifying the attention deficit hyperactivity disorder combined type (ADHD‐C) and the ADHD predominantly inattentive type (ADHD‐I) in school environments. A normative sample of Finnish 7‐ to 15‐year‐old children and adolescents (N = 701) and a clinical sample consisting of children with ADHD‐C (N = 190) and ADHD‐I (N = 25) were examined with the ATTEX and the ADHD Rating Scale‐IV. The ATTEX and its scales had good internal consistency reliability (0.67–0.98) and criterion validity (0.68–0.95). Normative data was provided for the total normative sample and for boys and girls separately. Gender differences were noted in the ATTEX scores, boys having consistently higher scores on all ATTEX scales. The effect of age was significant only for one of the ten scales, the Motor hyperactivity scale, 7‐year‐olds having more problems of hyperactivity than 14‐year‐olds. Lower parent education level and the child’s learning difficulties were related to higher ratings of EF problems in ATTEX. When different cutoff scores for boys and girls were applied, ATTEX was sensitive in identifying children with attention deficit disorders. In addition, ATTEX was accurate in differentiating children with ADHD‐I from children with ADHD‐C. In this Finnish sample, ATTEX showed solid psychometric properties and could be used as a reliable tool in the diagnostic evaluation of ADHD‐C and ADHD‐I.