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Behavior Rating Inventory of Executive Function - Parent Questionnaire

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Purpose

The BRIEF is a measure used to assess executive function in children and adolescents ages 5-18 through parent report.

Link to Instrument

Behavior Rating Inventory of Executive Function - Parent Questionnaire

Acronym BRIEF

Area of Assessment

Attention & Working Memory
Cognition
Executive Functioning

Assessment Type

Proxy

Administration Mode

Paper & Pencil

Cost

Not Free

Actual Cost

$108.00

Cost Description

BRIEF Parent Questionnaire (Pack of 25), $108; BRIEF Parent Questionnaire Scoring Summary/Profile (Pack of 50), $93; BRIEF Parent/Teacher I-Adming (Online Administration), $4.50 per use (minimum order of 5); BRIEF Parent/Teacher Interpretive Report (Online Scoring), $6.70 per use (minimum order of 5); BRIEF Manual, $75.00

CDE Status

Not a CDE as of 5/12/2023

Diagnosis/Conditions

  • Brain Injury Recovery
  • Multiple Sclerosis

Populations

Neurological Disorders
Pediatric Disorders

Key Descriptions

  • Child’s parent or guardian completes form.
  • Parent must have had recent and extensive contact with the child over the past 6 months to complete form.
  • 8 clinical scales:
    1) Inhibit
    2) Shift
    3) Emotional Control
    4) Initiate
    5) Working Memory
    6) Plan/Organize
    7) Organization of Materials
    8) Monitor
  • Item level scores rated on a 3-point Likert scale from 1-3:
    1) Never
    2) Sometimes
    3) Often
  • Combined subscales also provide 3 index scores:
    1) Global Executive Composite (GEC) is the total score of all 8 clinical subscales
    2) Behavioral Regulation Index (BRI) is a score that includes Inhibit, Shift, Emotional Control)
    3) Metacognition Index (MCI) includes Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor
  • Item scores are summed for each clinical scale and index.
  • Using the appropriate gender and age range table, the raw scores are converted to T-scores, percentile and 90% confidence intervals.
  • Versions of the BRIEF include the following:
    1) BRIEF (Parent and Teacher questionnaires for children aged 5-18)
    2) BRIEF Preschool (BRIEF-P completed by either teacher, parent, or day care provider for children aged 2.0 to 5.11 years)
    3) BRIEF-Self-Report (BRIEF-SR, for children aged 11-18 years)

Number of Items

86

Equipment Required

  • Pen or pencil or Computer
  • Parent form

Time to Administer

10-15 minutes

Required Training

Reading an Article/Manual

Required Training Description

Practitioner should familiarize themselves with the BRIEF manual for proper administration and scoring procedures.

Age Ranges

Child

5 - 12

years

Adolescent

13 - 18

years

Instrument Reviewers

Initial review completed by Louisa Frederick, MOT, OTR/L. Updated 8/31/2022 by Stephanie Alvarado, MS, OTR/L, Columbia University (Master of Occupational Therapy student) and Anna Norweg, PhD, MA, OTR, Columbia University (Faculty mentor).

 

 

ICF Domain

Body Function

Measurement Domain

Cognition

Professional Association Recommendation

None found--last searched 8/22/2023.

Considerations

  • Further studies on the ecological validity of BRIEF in relation to behaviors within the home, classroom and community.
  • Further refinement to increase parent teacher interrater reliability.
  • Change scores available to evaluate cognitive function of children with unilateral, mild to moderate cerebral palsy should not be applied to children with more severe diagnosis of cerebral palsy or bilateral cerebral palsy.
  • Further studies with children with ADHD in the presence of other comorbidities may influence generalization.
  • High scores indicate higher levels of dysfunction in executive function.
  • Self-report (BRIEF-SR) for children age 11-18 and pre-school (BRIEF-P) versions for children age 2-5 available.
  • BRIEF2 now available that includes Parent, Teacher, and Self-Report forms with updated norms from all 50 U.S. States.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Pediatric Disorders

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Standard Error of Measurement (SEM)

Children with Unilateral Cerebral Palsy (Piovesana et al, 2015; n = 42; mean age = 11.96 years; 20 weeks ±2  between testing Time 1 and Time 2)

 

BRIEF Measures

Scale

SEM

Inhibit

7.68

Shift

6.89

Emotional Control

6.77

Initiate

6.63

Working Memory

5.08

Plan/Organize

4.4

Organization of Materials

3.68

Monitor

4.31

Behavioral Regulation Index(BRI)

6.14

Metacognition Index(MCI)

5.13

Global Executive Composite (GEC)

4.15

Minimal Detectable Change (MDC)

Children with Unilateral Cerebral Palsy (calculated from statistics in Piovesana et al, 2015)

BRIEF Measures

Scale

MDC

Inhibit

17.92

Shift

16.08

Emotional Control

15.08

Initiate

15.47

Working Memory

11.85

Plan/Organize

10.27

Organization of Materials

8.59

Monitor

10.06

Behavioral Regulation Index(BRI)

14.33

Metacognition Index(MCI)

11.97

Global Executive Composite (GEC)

9.68

Cut-Off Scores

Children aged 5-18 Years (Gioia et al, 2000; n = 1,419; mean age = 10.70(3.35) years; boys and girls)

  • A T-score of 65 or higher is interpreted as an abnormally elevated score for each of the scales and the three index measures.

Normative Data

ADHD: (Parhoon et al., 2022; n = 253; mean age (SD) = 10.04 (1.42) years; 137 males, 116 females; BRIEF2 – Parents Report Form; Persian version)

  • Children aged 8-12 years

Means and Std. Deviations for the Nine Subscales of the BRIEF2 Parent Form

Brief2 scales

M (SD)

Inhibit

12.76 (2.45)

Self-Monitor

0.71 (1.65)

Shift

12.03 (2.58)

Emotional Control

11.48 (3.01)

Initiate

6.57 (1.2)

Working Memory

10.8 (2.34

Plan

12.4 (2.15)

Task Monitor

7.57 (1.87)

Organization of Materials

8.16 (1.54)

 

Means and Std. Deviations for the Three Indexes of the BRIEF2 Parent Form

Brief2 index

M (SD)

Behavior Regulation Index (BRI)

20.48 (3.52)

Emotion Regulation Index (ERI)

23.51 (5.2)

Cognitive Regulation Index (CRI)

45.52 (6.94)

 

Mean and Std. Deviation of the Total Executive Function (GEC) of the BRIEF2 Parent Form

Total Executive Function

M (SD)

Global Executive Composite (GEC)

89.52 (14.51)

 

Test/Retest Reliability

Children aged 5-18 years  (Huizinga and Smidts, 2011, n = 847; Dutch version)

 

Scale or Index

ICC

Inhibit

Excellent

.94

Shift

Excellent

.89

Emotional Control

Excellent

.90

Initiate

Excellent

.81

Working Memory

Adequate

.73

Plan/Organize

Excellent

.82

Organization of Materials

Excellent

.91

Monitor

Adequate

.75

Behavioral Regulation Index(BRI)

Excellent

.95

Metacognition Index(MCI)

Excellent

.84

Global Executive Composite (GEC)

Excellent

.86

 

ADHD: (Parhoon et al., 2022)

  • Excellent test-retest reliability of all three indexes (ICC = 0.81, 0.83, and 0.86) varying from 1-4 weeks
  • Excellent test-retest reliability of all nine subscales (ICC = 0.75-0.84, M = 0.80)
  • Excellent test-retest reliability of GEC (ICC = 0.90)

 

 

Internal Consistency

Children Aged 5-18:

  • Excellent (Cronbach’s alphas = .80-.98)(Gioia, et al., 2000)

  • Adequate to Excellent  (Cronbach’s alphas = .76-.96) (Huizinga and Smidts, 2011)

 

ADHD: (Parhoon et al., 2022)

  • Excellent internal consistency of all nine subscales (Cronbach’s alpha range from 0.87-0.89)
  • Excellent internal consistency of all three indexes (Cronbach’s alpha range from 0.86-0.87)
  • Excellent internal consistency of GEC (Cronbach’s alpha = 0.92)

 

 

Criterion Validity (Predictive/Concurrent)

Concurrent Validity:

ADHD and/or Tourette Syndrome (Mahone et al, 2002; n = 76 (ADHD = 18, mean age 11.20(2.5) years; Tourette Syndrome = 21, mean age = 10.00(1.80) years; Tourette Syndrome and ADHD = 17, mean age = 10.80(2.7) years, controls = 20, mean age = 10.60(3.60) years))

  • Excellent concurrent validity between BRIEF WM with Child Behavior Checklist, Diagnostic Interview for Children and Adolescents (DICA) & ADHD rating scale (r = .82, .75, & .87 respectively) and BRIEF MCI on same measures with correlations at .81, .74, and .85, respectively.

Predictive validity:

ADHD:  (McCandless & O’Laughlin, 2007; n = 70, mean age = 8.24(1.85) years referred for ADHD assessment)

  • Excellent: Behavior Regulation differentiates ADHD-Combined Type from non ADHD (r = .8)

ADHD: (Reddy et al, 2011; n = 58, mean age = 12.02(2.32months) years

  • Excellent correlation with BRI (r = .77) classified 79% of children with ADHD versus control group

Construct Validity

Convergent validity:

ADHD:  (Gioia et al, 2000, n = 100, mean age = 8.73(3.54) years)

  • Excellent correlations of the BRIEF BRI with the ADHD Rating Scale IV Inattention Index and Hyperactivity Index (r = .67 & .70, respectively).

  • Excellent correlations of the BRIEF GEC with the ADHD Rating Scale’s Inattention and Hyperactivity Indexes at 0.63 & 0.60, respectively

  • Adequate correlations of the BRIEF Initiate scale to Child Behavior Checklist Scales (CBCL) with Withdrawn, Anxious/Depressed and Attention Problems(r = .50, r = .52, r = 0.5 respectively)

ADHD:  (McCandless & O’Laughlin, 2007; n = 70, mean age = 8.24(1.85) years referred for ADHD assessment)

  • Excellent correlations of the BRIEF BRI with the ADHD Rating Scale IV Inattention Index and Hyperactivity Index (r = .67, & .70, respectively).

ADHD: (Parhoon et al., 2022; n = 253; mean age (SD) = 10.04 (1.42) years)

  • Excellent correlation between the composite score of the indexes and subscales of the Persian BRIEF-2 and the mean CHEXI (Childhood Executive Function Inventory) total executive function score (r = 0.70)
  • Excellent correlation between the Persian BRIEF-2 GEC and Total Executive Function Score of the CHEXI (r = 0.83)

ADHD: (Zarrabi et al., 2015; n = 30; mean age (SD) = 8.96 (1.5) years; 6 females, 24 males)

  • Excellent correlation between BRIEF MCI (Metacognition Index) and the ADHD-RS (Attention-deficit/hyperactivity disorder Rating Scale) Inattentive Index (r = 0.723)
  • Adequate correlation between BRIEF MCI and the ADHD-RS Hyperactivity Index (r = 0.560)
  • Adequate correlation between BRIEF BRI (Behavioral Regulation Index) and the ADHD-RS Hyperactivity Index (r = 0.591)
  • Adequate correlation between BRIEF BRI and the ADHD-RS Inattentive Index (r = 0.437)

Disruptive Behavior Disorders: (Ezpeleta et al., 2015; n = 620; mean age (SD) = 3.0 (0.16) years; 311 males, 309 females; Spanish version of BRIEF)

  • Poor correlation between the BRIEF-P GEC and total score of SDQ-Parent (Strengths and Difficulties Questionnaire, Parent Edition) (r = 0.28).
  • Excellent correlation between the BRIEF-P GEC and total score of SDQ-Teacher (Strengths and Difficulties Questionnaire, Teacher Edition) (r = 0.82)

Content Validity

  • Items were selected from clinical interviews of parents, teachers, and agreement from an expert panel of 12 pediatric neuropsychologists was also used.

  • Items refined via item-total correlations and interrater agreement (Gioia et al, 2000)

  • Items were evaluated by 20 occupational therapists with extensive experience in evaluation and treatment of patients with executive functioning deficits (Ghafari et al., 2018, p. 60, Persian version).

  • Content Validity Index (CVI) was rated for simplicity (S-CVI) and clarity (C-CVI), and relevance (R-CVI) (Ghafari et al., 2018, p. 61, Persian version).

    • S-CVI > 0.79 (for all 80 items)

    • C-CVI > 0.79 (for all 80 items)

    • R-CVI > 0.79 (for 76 items) 

Face Validity

  • Items were selected from clinical interviews of parents, teachers, and agreement from an expert panel of 12 pediatric neuropsychologists was also used.

  • Items refined via item-total correlations and interrater agreement (Gioia et al., 2000)

Neurological Disorders

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Internal Consistency

Neurodevelopmental Disorders: (Halvorsen et al., 2019; n = 281; mean age (SD) = 10.96 (3.36) years)

  • Excellent internal consistency between all nine subscales (Cronbach’s alpha range from 0.82-0.92*)
  • Excellent Internal consistency between all three indexes (Cronbach’s alpha range from 0.94-0.96*)

Neurodevelopmental Disorders: (Garcia Fernandez et al., 2014; n = 125; mean age (SD) = 12.68 (5.22) years; 54 females, 71 males; Spanish translation)

  • Excellent internal consistency between subscales (Cronbach’s alpha range from 0.82-0.94*)
  • Excellent internal consistency between indexes (Cronbach’s alpha = 0.96*)

*Scores higher than 0.9 may indicate redundancy in the scale questions

Construct Validity

Convergent validity:

Neurodevelopmental Disorders: (Garcia Fernandez et al., 2014)

  • Adequate correlation between BRIEF BRI and the ADHD RS-IV Attention Deficit Index (r = 0.44)
  • Excellent correlation between BRIEF Metacognition Index (MI) and the ADHD RS-IV Attention Deficit Index (r = 0.67)
  • Adequate correlation between BRIEF Metacognition Index (MI)  and the ADHD RS-IV Hyperactivity Index (r = 0.38)
  • Excellent correlation between BRIEF BRI and the ADHD RS-IV Hyperactivity Index (r = 0.70)

 

Content Validity

  • Items were evaluated by 20 occupational therapists with extensive experience in evaluation and treatment of patients with executive functioning deficits.
  • Content Validity Index (CVI) was rated for simplicity (S-CVI) and clarity (C-CVI) (Ghafari et al., 2018).
    • Excellent S-CVI > 0.79
    • Excellent C-CVI > 0.79

Bibliography

Ezpeleta, L., Granero, R., Penelo, E., de la Osa, N., & Domènech, J. M. (2015). Behavior Rating Inventory of Executive Functioning–Preschool (BRIEF-P) applied to teachers: Psychometric properties and usefulness for disruptive disorders in 3-year-old preschoolers. Journal of Attention Disorders, 19(6), 476-488.

García Fernández, T., González García, J. A., Rodríguez Pérez, C., Álvarez García, D., & Álvarez Pérez, L. (2014). Psychometric characteristics of the BRIEF scale for the assessment of executive functions in Spanish clinical population. Psicothema, 26(1), 47-56.

Ghafari, R., Alizadeh, M., & Khalafbeigi, M. (2018). Preparation and Validation of Persian Version of Behavior Rating Inventory of Executive Function (BRIEF-SR) in 11–18-Year-Old Normal Adolescence. Function and Disability Journal, 1(3), 58-67.

Gioia, G., Isquith, P., Guy, S., & Kenworthy, L. Behaviour Rating Inventory of Executive Function. Odessa, FL: Psychological Assessment Resources; 2000.

Gioia G, Isquith P, Retzlaff P, Espy K. Confirmatory factor analysis of the Behavior Rating Inventory of Executive Function (BRIEF) in a clinical sample. Child Neuropsychology [serial online]. December 2002;8(4):249-257.

Halvorsen, M., Mathiassen, B., Amundsen, T., Ellingsen, J., Brøndbo, P. H., Sundby, J., Steinsvik, O. O., & Martinussen, M. (2019). Confirmatory factor analysis of the behavior rating inventory of executive function in a neuro-pediatric sample and its application to mental disorders. Child Neuropsychology, 25(5), 599-616. 

Huizinga M, Smidts D. Age-Related Changes in Executive Function: A Normative Study with the Dutch Version of the Behavior Rating Inventory of Executive Function (BRIEF). Child Neuropsychology [serial online]. January 2011;17(1):51-66.

Mahone EM, Cirino PT, Cutting LE, Cerrone PM, Hagelthorn KM, Hiemenz, J.R., et al. Validity of the behavior rating inventory of executive function in children with ADHD and/or Tourette syndrome. Arch Clin Neuropsychol. 2002; 17 (7):643–62.

McCandless S, O’ Laughlin L. The Clinical Utility of the Behavior Rating Inventory of Executive Function (BRIEF) in the Diagnosis of ADHD. Journal of Attention Disorders. 2007; 10(4):381-389. doi: 10.1177/1087054706292115.

Parhoon, K., Moradi, A., Alizadeh, H., Parhoon, H., Sadaphal, D. P., & Coolidge, F. L. (2022). Psychometric properties of the behavior rating inventory of executive function, (BRIEF2) in a sample of children with ADHD in Iran. Child Neuropsychology, 28(4), 427-436. 

Piovesana, A. M., Ross, S., Whittingham, K., Ware, R. S., & Boyd, R. N. (2015). Stability of Executive Functioning Measures in 8–17-Year-Old Children With Unilateral Cerebral Palsy. The Clinical Neuropsychologist, 29(1), 133-149.

Rasmussen, Carmen, Rosalyn McAuley, and Gail Andrew. "Parental ratings of children with fetal alcohol spectrum disorder on the behavior rating inventory of executive function (BRIEF)." J FAS Int 5.e2 (2007): 1-8.

Reddy LA, Hale JB, Brodzinsky LK. Discriminant validity of the Behavior Rating Inventory of Executive Function Parent Form for children with attention-deficit/hyperactivity disorder. School Psychology Quarterly. 2011; 26(1):45-55. doi: 10.1037/a0022585.

Zarrabi, M., Shahrivar, Z., Doost, M. T., Khademi, M., & Nejad, G. Z. (2015). Concurrent validity of the behavior rating inventory of executive function in children with attention deficit hyperactivity disorder. Iranian journal of psychiatry and behavioral sciences, 9(1).

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