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BRIEF®2: Interpretive Report Copyright © 1996, 1998, 2000, 2015 by PAR. All rights reserved. May not be reproduced in whole or in
part in any form or by any means without written permission of PAR.
Version: 2.4.0.0
Teacher Form Interpretive Report
by Peter K. Isquith, PhD, Gerard A. Gioia, PhD, Steven C. Guy, PhD, Lauren
Kenworthy, PhD, and PAR Staff
Client name :
Sample Client
Client ID :
111
Gender :
Male
Age :
7
Grade :
2nd
Test date :
04/14/2015
Test form :
Teacher Form
Rater name :
Not Specified
Relationship to student :
Teacher
Knows student :
Very Well
Has known student for :
9 months
Student receiving special educational
services? :
No
This report is intended for use by qualified professionals only and is not to be shared
with the examinee or any other unqualified persons.
Sample Client (111) 2
04/14/2015
Validity
Before examining the Behavior Rating Inventory of Executive Function
®
, Second Edition
(BRIEF
®
2) Teacher Form profile, it is essential to carefully consider the validity of the
data provided. The inherent nature of rating scales (i.e., relying upon a third party for
ratings of a child’s behavior) carries potential rating and score biases. The first step is to
examine the protocol for missing data. With a valid number of responses, the BRIEF2
Inconsistency, Negativity, and Infrequency scales provide additional information about
the validity of the protocol.
Missing items
The respondent completed 63 of a possible 63 BRIEF2 items. For
reference purposes, the summary table for each scale indicates
the respondent’s actual rating for each item. There are no missing
responses in the protocol, providing a complete data set for
interpretation.
Inconsistency
Scores on the Inconsistency scale indicate the extent to which the
respondent answered similar BRIEF2 items in an inconsistent
manner relative to the clinical samples. For example, a high
Inconsistency score might be associated with the combination of
responding Never to the item “Small events trigger big reactions”
and Often to the item “Becomes upset too easily.” Item pairs
comprising the Inconsistency scale are shown in the following
summary table. T scores are not generated for the Inconsistency
scale. Instead, the absolute value of the raw difference scores for
the eight paired items are summed, and the total difference score
(i.e., the Inconsistency score) is compared with the cumulative
percentile of similar scores in the combined clinical sample and
used to classify the protocol as either Acceptable, Questionable,
or Inconsistent. The Inconsistency score of 1 is within the
Acceptable range, suggesting that the rater was reasonably
consistent in responding to BRIEF2 items.
Item
Inconsistency items
Response
Diff
3
When given three things to do, remembers only the first
or last
Often
0
19
Remaining content redacted for sample report purposes
Often
Sample Client (111) 3
04/14/2015
Item
Inconsistency items
Response
Diff
4
Often
0
20
Often
5
Sometimes
1
33
Often
6
Sometimes
0
14
Sometimes
12
Often
0
32
Often
16
Often
0
39
Often
22
Sometimes
0
56
Sometimes
60
Never
0
63
Never
Negativity
The Negativity scale measures the extent to which the
respondent answered selected BRIEF2 items in an unusually
negative manner relative to the clinical sample. Items comprising
the Negativity scale are shown in the following summary table. A
higher raw score on this scale indicates a greater degree of
negativity, with less than 3% of respondents scoring 5 or above in
the clinical sample.
As with the Inconsistency scale, T scores are not generated for
this scale. The Negativity score of 0 is within the acceptable
range, suggesting that the respondent’s view of Sample is not
overly negative and that the BRIEF2 protocol is likely to be valid.
Item #
Negativity items
Response
2
Resists or has trouble accepting a different way to solve a
problem with schoolwork, friends, tasks, etc.
Sometimes
11
Remaining content redacted for sample report purposes
Sometimes
31
Sometimes
34
Sometimes
37
Sometimes
43
Sometimes
45
Sometimes
49
Sometimes
Sample Client (111) 4
04/14/2015
Infrequency
The Infrequency scale measures the extent to which the
respondent endorsed items in an atypical fashion. The scale
includes three items that are likely to be endorsed in one
direction by most respondents. Marking Sometimes or Often to
any of the items is highly unusual, even in cases of severe
impairment.
Items comprising the Infrequency scale are shown in the
following summary table. A higher raw score on this scale
indicates a greater degree of infrequency, with less than 1% of
respondents scoring 1 or greater in the standardization sample.
As with the Inconsistency and Negativity scales, T scores are not
generated for this scale. The Infrequency score of 0 is within the
acceptable range, reducing the likelihood of an atypical response
pattern.
Item #
Infrequency items
Response
18
Forgets his/her name
Never
36
Remaining content redacted for sample report purposes
Never
54
Never
End of Validity Section
Sample Client (111) 5
04/14/2015
Introduction
The BRIEF
®
2 is a questionnaire completed by parents and teachers of school-aged
children as well as adolescents ages 11 to 18. Parent and teacher ratings of executive
functions are good predictors of a child’s or adolescent’s functioning in many domains,
including the academic, social, behavioral, and emotional domains. As is the case for all
measures, the BRIEF2 should not be used in isolation as a diagnostic tool. Instead, it
should be used in conjunction with other sources of information, including detailed
history, other BRIEF2 and behavior ratings, clinical interviews, performance test results,
and, when possible, direct observation in the natural setting. By examining converging
evidence, the clinician can confidently arrive at a valid diagnosis and, most importantly,
an effective treatment plan. A thorough understanding of the BRIEF2, including its
development and its psychometric properties, is a prerequisite to interpretation. As
with any clinical method or procedure, appropriate training and clinical supervision are
necessary to ensure competent use of the BRIEF2.
This report is confidential and intended for use by qualified professionals only. This
report should not be released to the parents or teachers of the child being evaluated. If a
summary of the results specifically written for parents and teachers is desired, the
BRIEF2 Feedback Report can be generated and given to the interested parents and
teachers.
T scores are used to interpret the level of executive functioning as reported by parents
and teachers on the BRIEF2 rating forms. These scores are linear transformations of the
raw scale scores (M = 50, SD = 10). T scores provide information about an individual’s
scores relative to the scores of respondents in the standardization sample. Percentiles
represent the percentage of children in the standardization sample with scores at or
below the same value. For all BRIEF2 clinical scales and indexes, T scores from 60 to 64
are considered mildly elevated, and T scores from 65 to 69 are considered potentially
clinically elevated. T scores at or above 70 are considered clinically elevated.
In the process of interpreting the BRIEF2, review of individual items within each scale
can yield useful information for understanding the specific nature of the child’s
elevated score on any given clinical scale. In addition, certain items may be particularly
relevant to specific clinical groups. Placing too much interpretive significance on
individual items, however, is not recommended due to lower reliability of individual
items relative to the scales and indexes.
Sample Client (111) 6
04/14/2015
Overview
Sample’s teacher completed the Teacher Form of the Behavior
Rating Inventory of Executive Function
®
, Second Edition
(BRIEF
®
2) on 04/14/2015. There are no missing item responses in
the protocol. Responses are reasonably consistent. The
respondent’s ratings of Sample do not appear overly negative.
There were no atypical responses to infrequently endorsed items.
In the context of these validity considerations, ratings of Sample’s
executive function exhibited in everyday behavior reveal some
areas of concern.
The overall index, the GEC, was clinically elevated (GEC T = 72,
%ile = 98). The BRI, ERI, and CRI were all elevated (BRI T = 78,
%ile = 99; ERI T = 62, %ile = 88, CRI T = 70, %ile = 95),
suggesting self-regulatory problems in multiple domains.
Within these summary indicators, all of the individual scales are
valid. One or more of the individual BRIEF2 scales were elevated,
suggesting that Sample exhibits difficulty with some aspects of
executive function. Concerns are noted with his ability to resist
impulses, be aware of his functioning in social settings, react to
events appropriately, get going on tasks, activities, and
problem-solving approaches, sustain working memory, plan and
organize his approach to problem solving appropriately, be
appropriately cautious in his approach to tasks and check for
mistakes and keep materials and his belongings reasonably well
organized. Sample’s ability to adjust well to changes in
environment, people, plans, or demands is not described as
problematic by the respondent.
Current models of self-regulation suggest that behavior
regulation and/or emotion regulation, particularly inhibitory
control, emotional control, and flexibility, underlie most other
areas of executive function. Essentially, one needs to be
appropriately inhibited, flexible, and well-modulated
emotionally for efficient, systematic, and organized problem
solving to take place. Sample’s elevated scores on scales
reflecting problems with fundamental behavioral and/or
emotional regulation suggest that more global problems with
self-regulation are having a negative effect on active cognitive
problem solving. Behavior and emotion regulation concerns do
not negate the meaningfulness of the elevated CRI score. Instead,
one must simultaneously consider the influence of the
underlying self-regulation issues and the unique problems with
Sample Client (111) 7
04/14/2015
cognitive problem-solving skills.
Sample Client (111) 8
04/14/2015
BRIEF
®
2 Teacher Score Summary Table
Index/scale
Raw score
T score
Percentile
90% C.I.
Inhibit
24
78
99
73-83
Self-Monitor
14
72
99
67-77
Behavior Regulation Index (BRI)
38
78
99
74-82
Shift
13
55
80
49-61
Emotional Control
15
66
91
62-70
Emotion Regulation Index (ERI)
28
62
88
58-66
Initiate
11
69
98
64-74
Working Memory
22
74
99
69-79
Plan/Organize
17
62
92
56-68
Task-Monitor
15
63
92
58-68
Organization of Materials
11
65
93
59-71
Cognitive Regulation Index (CRI)
76
70
95
67-73
Global Executive Composite (GEC)
142
72
98
70-74
Validity scale
Raw score
Percentile
Protocol classification
Negativity
0
98
Acceptable
Inconsistency
1
98
Acceptable
Infrequency
0
99
Acceptable
Note: Male, age-specific norms have been used to generate this profile.
For additional normative information, refer to Appendixes A–C in the BRIEF
®
2 Professional Manual.
Sample Client (111) 9
04/14/2015
Profile of BRIEF
®
2 T Scores
Note: Male, age-specific norms have been used to generate this profile.
For additional normative information, refer to Appendixes A–C in the BRIEF
®
2 Professional Manual.
Sample Client (111) 10
04/14/2015
Clinical Scales
The BRIEF2 clinical scales measure the extent to which the respondent reports problems
with different types of behavior related to the nine domains of executive functioning.
The following sections describe the scores obtained on the clinical scales and the
suggested interpretation for each individual clinical scale.
Inhibit
The Inhibit scale assesses inhibitory control and impulsivity. This
can be described as the ability to resist impulses and the ability to
stop one’s own behavior at the appropriate time. Sample’s score
on this scale is clinically elevated (T = 78, %ile = 99) as
compared to his peers. Children with similar scores on the Inhibit
scale typically have marked difficulty resisting impulses and
difficulty considering consequences before acting. They are often
perceived as (1) being less in control of themselves than their
peers, (2) having difficulty staying in place in line or in the
classroom, (3) interrupting others or calling out in class
frequently, and (4) requiring higher levels of adult supervision.
Often, caregivers and teachers are particularly concerned about
the verbal and social intrusiveness and the lack of personal safety
observed in children who do not inhibit impulses well. Such
children may display high levels of physical activity,
inappropriate physical responses to others, a tendency to
interrupt and disrupt group activities, and a general failure to
look before leaping.
In the contexts of the classroom and assessment settings, children
with inhibitory control difficulties often require a higher degree
of external structure to limit their impulsive responding. They
may start an activity or task before listening to instructions,
before developing a plan, or before grasping the organization or
gist of the situation.
Examination of the individual items that comprise the Inhibit
scale may be informative and may help guide interpretation and
intervention.
Item #
Inhibit items
Response
1
Is fidgety
Often
10
Remaining content redacted for sample report purposes
Often
Sample Client (111) 11
04/14/2015
Item #
Inhibit items
Response
16
Often
24
Often
30
Often
39
Often
48
Often
58
Often
Self-Monitor
The Self-Monitor scale assesses awareness of the impact of one’s
own behavior on other people and outcomes. It captures the
degree to which a child or adolescent is aware of the effect that
his or her behavior has on others and how it compares with
standards or expectations for behavior. Sample’s score on the
Self-Monitor scale is clinically elevated, suggesting substantial
difficulty with monitoring his behavior in social settings (T = 72,
%ile = 99). Children with similar scores tend to show limited
awareness of their behavior and the impact it has on their social
interactions with others.
Item #
Self-Monitor items
Response
4
Is unaware of how his/her behavior affects or bothers
others
Often
13
Remaining content redacted for sample report purposes
Often
20
Often
26
Sometimes
59
Often
Sample Client (111) 12
04/14/2015
Shift
The Shift scale assesses the ability to move freely from one
situation, activity, or aspect of a problem to another as the
circumstances demand. Key aspects of shifting include the ability
to make transitions, tolerate change, problem solve flexibly,
switch or alternate attention between tasks, and change focus
from one task or topic to another. Mild deficits may compromise
efficiency of problem solving and result in a tendency to get
stuck or focused on a topic or problem, whereas more severe
difficulties can be reflected in perseverative behaviors and
marked resistance to change. Sample’s score on the Shift scale is
within the average range compared with peers (T = 55, %ile = 80).
This suggests that Sample is generally able to change from task to
task or from place to place without difficulty, is able to think of or
accept different ways of solving problems, and is able to
demonstrate flexibility in day-to-day activities.
Item #
Shift items
Response
2
Resists or has trouble accepting a different way to solve a
problem with schoolwork, friends, tasks, etc.
Sometimes
11
Remaining content redacted for sample report purposes
Sometimes
17
Sometimes
31
Sometimes
40
Never
49
Sometimes
60
Never
63
Never
Sample Client (111) 13
04/14/2015
Emotional Control
The Emotional Control scale measures the impact of executive
function problems on emotional expression and assesses a child’s
ability to modulate or regulate his or her emotional responses.
Sample’s score on the Emotional Control scale is potentially
clinically elevated compared with peers (T = 66, %ile = 91). This
score suggests marked concerns with regulation or modulation of
emotions. Sample likely overreacts to events and likely
demonstrates sudden outbursts, sudden and/or frequent mood
changes, and excessive periods of emotional upset. Poor
emotional control is often expressed as emotional lability, sudden
outbursts, or emotional explosiveness. Children with difficulties
in this domain often have overblown emotional reactions to
seemingly minor events. Caregivers and teachers of such children
frequently describe a child who cries easily or laughs hysterically
with small provocation or a child who has temper tantrums of a
frequency or severity that is not age appropriate.
Item #
Emotional Control items
Response
6
Has explosive, angry outbursts
Sometimes
14
Remaining content redacted for sample report purposes
Sometimes
22
Sometimes
27
Sometimes
34
Sometimes
43
Sometimes
51
Never
56
Sometimes
Sample Client (111) 14
04/14/2015
Initiate
The Initiate scale reflects a child’s ability to begin a task or
activity and to independently generate ideas, responses, or
problem-solving strategies. Sample’s score on the Initiate scale is
potentially clinically elevated compared with peers (T = 69, %ile =
98). This suggests that Sample has marked difficulties getting
going on tasks, activities, and problem-solving approaches. Poor
initiation typically does not reflect noncompliance or disinterest
in a specific task. Children with initiation problems typically
want to succeed at and complete a task, but they have trouble
getting started. Caregivers of such children frequently report
observing difficulties getting started on homework or chores,
along with a need for extensive prompts or cues to begin a task
or activity. Children with initiation difficulties are at risk for
being viewed as unmotivated. In the context of psychological
assessment, initiation difficulties are often demonstrated in the
form of slow speed of output despite prompts to work quickly
and difficulty generating ideas such as for word and design
fluency tasks. There is often a need for additional prompts from
the examiner to begin tasks in general. Alternatively, initiation
deficits may reflect depression, and this should particularly be
examined if this finding is consistent with the overall affective
presentation of the child.
Item #
Initiate items
Response
9
Is not a self-starter
Sometimes
38
Remaining content redacted for sample report purposes
Often
50
Often
55
Often
Sample Client (111) 15
04/14/2015
Working Memory
The Working Memory scale measures online representational
memory—that is, the capacity to hold information in mind for the
purpose of completing a task; encoding information; or
generating goals, plans, and sequential steps to achieve goals.
Working memory is essential to carrying out multistep activities,
completing mental manipulations such as mental arithmetic, and
following complex instructions. Sample’s score on the Working
Memory scale is clinically elevated compared with peers (T = 74,
%ile = 99). This suggests that Sample has substantial difficulty
holding an appropriate amount of information in mind or in
active memory for further processing, encoding, and/or mental
manipulation. Further, Sample’s score suggests difficulties
sustaining working memory, which has a negative impact on his
ability to remain attentive and focused for appropriate lengths of
time. Caregivers describe children with fragile or limited
working memory as having trouble remembering things (e.g.,
phone numbers or instructions) even for a few seconds, losing
track of what they are doing as they work, or forgetting what
they are supposed to retrieve when sent on an errand. They often
miss information that exceeds their working memory capacity
such as instructions for an assignment. Clinical evaluators may
observe that Sample cannot remember the rules governing a
specific task (even as he works on that task), rehearses
information repeatedly, loses track of what responses he has
already given on a task that requires multiple answers, and
struggles with mental manipulation tasks (e.g., repeating digits
in reverse order) or solving arithmetic problems that are orally
presented without writing down figures.
Appropriate working memory is necessary to sustaining
performance and attention. Parents of children with difficulties in
this domain report that they cannot stick to an activity for an
age-appropriate amount of time and that they frequently switch
or fail to complete tasks. Although working memory and the
ability to sustain it have been conceptualized as distinct entities,
behavioral outcomes of these two domains are often difficult to
distinguish.
Item #
Working Memory items
Response
3
When given three things to do, remembers only the first
or last
Often
Sample Client (111) 16
04/14/2015
Item #
Working Memory items
Response
12
Remaining content redacted for sample report purposes
Often
19
Often
25
Often
28
Often
32
Often
41
Sometimes
46
Sometimes
Sample Client (111) 17
04/14/2015
Plan/Organize
The Plan/Organize scale measures a child’s ability to manage
current and future-oriented task demands. The scale has two
components: Plan and Organize. The Plan component captures
the ability to anticipate future events, to set goals, and to develop
appropriate sequential steps ahead of time to carry out a task or
activity. The Organize component refers to the ability to bring
order to information and to appreciate main ideas or key
concepts when learning or communicating information. Sample’s
score on the Plan/Organize scale is mildly elevated compared
with peers (T = 62, %ile = 92). This suggests that Sample has some
difficulty with planning and organizing information, which has a
negative impact on his approach to problem solving. Planning
involves developing a goal or end state and then strategically
determining the most effective method or steps to attain that
goal. Evaluators can observe planning when a child is given a
problem requiring multiple steps (e.g., assembling a puzzle or
completing a maze). Sample may underestimate the time
required to complete tasks or the level of difficulty inherent in a
task. He may often wait until the last minute to begin a long-term
project or assignment for school, and he may have trouble
carrying out the actions needed to reach his goals.
Organization involves the ability to bring order to oral and
written expression and to understand the main points expressed
in presentations or written material. Organization also has a
clerical component that is demonstrated, for example, in the
ability to efficiently scan a visual array or to keep track of a
homework assignment. Sample may approach tasks in a
haphazard fashion, getting caught up in the details and missing
the big picture. He may have good ideas that he fails to express
on tests and written assignments. He may often feel
overwhelmed by large amounts of information and may have
difficulty retrieving material spontaneously or in response to
open-ended questions. He may, however, exhibit better
performance with recognition (multiple-choice) questions.
Item #
Plan/Organize items
Response
7
Does not plan ahead for school assignments
Often
15
Remaining content redacted for sample report purposes
Sometimes
23
Sometimes
Sample Client (111) 18
04/14/2015
Item #
Plan/Organize items
Response
35
Often
44
Sometimes
52
Sometimes
57
Never
61
Sometimes
Task-Monitor
The Task-Monitor scale assesses task-oriented monitoring or
work-checking habits. The scale captures whether a child
assesses his or her own performance during or shortly after
finishing a task to ensure accuracy or appropriate attainment of a
goal. Sample’s score on the Task-Monitor scale is mildly elevated,
suggesting some difficulty with task monitoring (T = 63, %ile =
92). Children with similar scores tend to be less cautious in their
approach to tasks or assignments and often do not notice and/or
check for mistakes. Caregivers often describe children with
task-oriented monitoring difficulties as rushing through their
work, as making careless mistakes, and as failing to check their
work. Clinical evaluators may observe the same types of
behavior during formal assessment.
Item #
Task Monitor items
Response
5
Work is sloppy
Sometimes
21
Remaining content redacted for sample report purposes
Sometimes
29
Sometimes
33
Often
42
Often
62
Often
Sample Client (111) 19
04/14/2015
Organization of
Materials
The Organization of Materials scale measures orderliness of
work, play, and storage spaces (e.g., desks, lockers, backpacks,
and bedrooms). Caregivers and teachers typically can provide an
abundance of examples describing a child’s ability to organize,
keep track of, or clean up his or her belongings. Sample’s score
on the Organization of Materials scale is potentially clinically
elevated compared with children (T = 65, %ile = 93). Sample is
described as having marked difficulty (1) keeping his materials
and belongings reasonably well organized, (2) having his
materials readily available for projects or assignments, and (3)
finding his belongings when needed. Children who have
significant difficulties in this area often do not function efficiently
in school or at home because they do not have ready access to
what they need and must spend time getting organized rather
than producing work. Pragmatically, teaching a child to organize
his or her belongings can be a useful, concrete tool for teaching
greater task organization.
Item #
Organization of Materials items
Response
8
Cannot find things in desk
Often
37
Remaining content redacted for sample report purposes
Sometimes
45
Sometimes
47
Sometimes
53
Sometimes
Sample Client (111) 20
04/14/2015
Summary Indexes and Global Executive Composite
Behavior Regulation,
Emotion Regulation,
and Cognitive
Regulation Indexes
The Behavior Regulation Index (BRI) captures the child’s ability
to regulate and monitor behavior effectively. It is composed of
the Inhibit and Self-Monitor scales. Appropriate behavior
regulation is likely to be a precursor to appropriate cognitive
regulation. It enables the cognitive regulatory processes to
successfully guide active, systematic problem solving and more
generally supports appropriate self-regulation.
The Emotion Regulation Index (ERI) represents the child’s ability
to regulate emotional responses and to shift set or adjust to
changes in environment, people, plans, or demands. It is
composed of the Shift and Emotional Control scales. Appropriate
emotion regulation and flexibility are precursors to effective
cognitive regulation.
The Cognitive Regulation Index (CRI) reflects the child’s ability
to control and manage cognitive processes and to problem solve
effectively. It is composed of the Initiate, Working Memory,
Plan/Organize, Task-Monitor, and Organization of Materials
scales and relates directly to the ability to actively problem solve
in a variety of contexts and to complete tasks such as schoolwork.
Examination of the indexes reveals that the BRI is clinically
elevated (T = 78, %ile = 99), the ERI is mildly elevated (T = 62,
%ile = 88), and the CRI is clinically elevated (T = 70, %ile = 95).
This suggests difficulties with all aspects of executive function
including inhibitory control, self-monitoring, emotion regulation,
flexibility, and cognitive regulatory functions including ability to
sustain working memory and to initiate, plan, organize, and
monitor problem solving.
Sample Client (111) 21
04/14/2015
Global Executive
Composite
The Global Executive Composite (GEC) is an overarching
summary score that incorporates all of the BRIEF2 clinical scales.
Although review of the BRI, ERI, CRI, and individual scale scores
is strongly recommended for all BRIEF2 profiles, the GEC can
sometimes be useful as a summary measure. In this case, at least
two summary indexes are substantially different, with T scores
separated by an unusually large number of points relative to the
standardization sample, where differences of this magnitude
occurred less than 10% of the time. Thus, the GEC may not
adequately reflect the overall profile or severity of executive
function problems. With this in mind, Sample’s T score of 72
(%ile = 98) on the GEC is clinically elevated compared with the
scores of his peers, suggesting significant difficulty in one or
more areas of executive function.
Sample Client (111) 22
04/14/2015
Comparison of BRIEF2 Working Memory and Inhibit Scales
to ADHD Groups
The BRIEF2 Inhibit and Working Memory scales , in the context of a comprehensive
assessment, may be helpful in identifying children with suspected
attention-deficit/hyperactivity disorder (ADHD). Theoretically, inhibitory control
enables self-regulation, and working memory enables sustained attention. It is
important at the outset, however, to appreciate the distinction between executive
functions and the diagnosis of ADHD: Executive functions are neuropsychological
constructs, whereas ADHD is a neuropsychiatric diagnosis based on a cluster of
observed symptoms. Although it is well-established that different aspects of executive
dysfunction contribute to the symptoms that characterize ADHD, executive dysfunction
is not synonymous with a diagnosis of ADHD. Further, problems with inhibitory
control and, in particular, working memory are not unique to the diagnosis of ADHD
but may be seen in many developmental and acquired conditions. Therefore, the
following analysis may be useful when there is a question about the presence or absence
of an attention disorder but should not be used in isolation or as the sole basis of
diagnosis. Information from the BRIEF2 may be helpful when combined with other
information such as parent and teacher ratings on broad-band scales, ADHD specific
scales, clinical interviews, observations and performance assessment.
Profile analyses have shown that children diagnosed with different disorders often have
recognizable and logical scale profiles on the BRIEF2. Children with ADHD, inattentive
presentation (ADHD-I) tend to have greater elevations on Working Memory,
Plan/Organize, and Task-Monitor scales than their typically developing peers but lower
scores on the BRI and ERI than children diagnosed with ADHD, combined presentation
(ADHD-C).
The BRIEF2 Teacher Form Working Memory scale exhibits limited sensitivity but good
specificity for detecting a likely diagnosis of ADHD regardless of whether inattentive or
combined type. In combined research and clinical samples, T scores of 65 or greater on
the Working Memory scale discriminated between healthy controls and children with
either the inattentive or combined type of ADHD with 74% classification accuracy. The
likelihood that a child with a T score of 65 or higher is a true case of ADHD was .86
(positive predictive value), whereas the likelihood that a child with a score below 65
would not have ADHD was .69 (negative predictive value). The likelihood of a child
being correctly identified as meeting criteria for a diagnosis of ADHD was more than 6
times greater with a Working Memory T score of 65 or greater.
The Inhibit scale can help further distinguish between children with ADHD-I versus
those with ADHD-C. Using a T score of 65 or greater, approximately 72% of children
were correctly classified as being diagnosed with ADHD-C versus ADHD-I in a
Sample Client (111) 23
04/14/2015
combined research and clinical sample. Children with T scores at or above 65 on the
Inhibit scale are 3.5 times more likely to be diagnosed with the combined type than the
inattentive type of ADHD. If the cutoff is increased to a T score of 70 or greater on the
Inhibit scale, sensitivity is reduced but specificity is increased. Children with T scores of
70 or more are more than 4 times more likely to have a diagnosis of ADHD-C than
ADHD-I.
While the BRIEF2 may be a helpful and efficient tool in evidence-based assessment for
ADHD, it is important that all relevant data be considered in the context of clinical
judgment before reaching a diagnostic decision.
In this particular profile, Teacher ratings of Sample’s working memory (T = 74, %ile =
99) are clinically elevated. T scores of 70 or greater on the BRIEF2 Teacher Form were
seen in over 40% of children clinically diagnosed with either type of ADHD but were
seen in only less than 3% of typically developing children and 4% of children with
learning disabilities. Scores at this level are more than 6 times more likely to be seen in
students diagnosed with ADHD and half as likely to be seen in typically developing
students, raising the possibility of the presence of ADHD. In considering ADHD
presentations, the Inhibit scale may be useful in the context of a significantly elevated
Working Memory scale. Sample’s ratings of his inhibitory control were also clinically
elevated (T = 78, %ile = 99). Students with significantly elevated Working Memory and
Inhibit T scores in a clinical sample were correctly classified as being diagnosed with
ADHD-C approximately 80% of the time.
Sample Client (111) 24
04/14/2015
Comparison of BRIEF2 Shift Scale to Children with Autism
Spectrum Disorders (ASD)
Children with Autism Spectrum Disorder (ASD) have difficulties with executive
functions related to flexibility, planning, organization, and other aspects of
metacognition. Numerous studies have shown a signature BRIEF profile in children
with ASD with elevations across most BRIEF scales and a peak in problems captured on
the Shift scale. Parent and teacher ratings on the BRIEF2 in large numbers of clinically
referred children with well-defined ASD diagnoses showed similar patterns of
elevations on most scales with a prominent peak on the Shift scale. While the BRIEF2 is
not intended as a stand-alone diagnostic instrument, it can be useful as part of a more
comprehensive assessment for a wide range of clinical conditions. For children with
ASD, the BRIEF2 adds value to other measures of everyday functioning, social
responsiveness, and ASD characteristics in the context of medical history in reaching a
comprehensive diagnostic picture.
The BRIEF2 Teacher Form Shift scale exhibits good specificity for ruling out children
who do not have ASD. This is reflected in the positive predictive values of .92 for
teacher ratings at or above 65 and .98 when using a cutoff of 70. In clinical samples, T
scores of 65 or greater on the Shift scale discriminated between healthy controls and
children with ASD with 78% classification accuracy, and with 69% accuracy when T
scores were greater than or equal to 70. The lower classification accuracy is due to
reduced sensitivity at higher T scores for teacher ratings. The likelihood of a child being
correctly identified as meeting criteria for a diagnosis of ADHD was 10 times greater
(positive likelihood ratio = 10.83) with a Shift T score of 65 or greater, while the
likelihood of a child with an ASD being incorrectly ruled out was reduced by half
(negative likelihood ration = .41).
In this particular profile, Teacher ratings of Sample’s cognitive and behavioral flexibility
(T = 55, %ile = 80) are within normal limits. This suggests that Sample does not exhibit
the cognitive rigidity and adherence to routine and sameness that is often seen in
children diagnosed with ASD.
Sample Client (111) 25
04/14/2015
Executive Function Interventions
Ratings of Sample’s everyday functioning revealed some areas of concern.
Recommendations for interventions and accommodations are offered according to the
identified concerns. While the efficacy of each intervention has not been empirically
demonstrated, the majority are common interventions that are likely familiar to the
intervention team. These recommendations are general and are intended here as
suggestions or ideas that may be tailored to suit Sample’s needs. As with any
intervention, clinical judgment is paramount.
Remaining content redacted for sample report purposes
Sample Client (111) 26
04/14/2015
References
Braga, L. W., Rossi, L., Moretto, A. L. L., da Silva, J. M., & Cole, M. (2012). Empowering
preadolescents with ABI through metacognition: Preliminary results of a randomized
clinical trial. NeuroRehabilitation, 30, 205-212.
Chan, D. Y. K., & Fong, K. N. K. (2011). The effects of problem-solving skills training
based on metacognitive principles for children with acquired brain injury attending
mainstream schools: A controlled clinical trial. Disability & Rehabilitation, 33, 2023-2032.
Kenworthy, L., Anthony, L. G., Alexander, K. C., Werner, M. A., Cannon, L., &
Greenman, L. (2014). Solving executive functioning challenges: Simple ways to get kids with
autism unstuck and on target. Baltimore, MD: Brookes Publishing.
Levine, B., Robertson, I. H., Clare, L., Carter, G., Hong, J., Wilson, B. A., … & Struss, D.
T. (2000). Rehabilitation of executive functioning: An experimental-clinical validation of
goal management training. Journal of the International Neuropsychological Society, 6,
299-312.
Marlowe, W. B. (2001). An intervention for children with disorders of executive
functions. Developmental Neuropsychology, 18, 445-454.
Wade, S. L., Wolfe, C. R., Brown, T. M., & Pestian, J. P. (2005). Can a web-based family
problem-solving intervention work for children with traumatic brain injury?.
Rehabilitation Psychology, 50, 337-345.
Wade, S. L., Wolfe, C. R., & Pestian, J. P. (2004). A web-based family problem-solving
intervention for families of children with traumatic brain injury. Behavior Research
Methods, Instruments, & Computers, 36, 261-269.
Ylvisaker, M. (Ed.). (1998). Traumatic brain injury rehabilitation: Children and adolescents
(2nd ed.). Boston, MA: Butterworth-Heinemann.
Ylvisaker, M., & Feeney, T. (1998). Collaborative brain injury intervention: Positive everyday
routines. San Diego, CA: Singular Publishing Group.
Ylvisaker, M., Szekeres, S., & Feeney, T. (1998). Cognitive rehabilitation: Executive
functions. In M. Ylvisaker (Ed.), Traumatic brain injury rehabilitation: Children and
adolescents (2nd ed., pp. 221-269). Boston, MA: Butterworth-Heinemann.
Sample Client (111) 27
04/14/2015
BRIEF
®
2 Teacher Form Item Response Table
Item
Response
Item
Response
Item
Response
1
Often
22
Sometimes
43
Sometimes
2
Sometimes
23
Sometimes
44
Sometimes
3
Often
24
Often
45
Sometimes
4
Often
25
Often
46
Sometimes
5
Sometimes
26
Sometimes
47
Sometimes
6
Sometimes
27
Sometimes
48
Often
7
Often
28
Often
49
Sometimes
8
Often
29
Sometimes
50
Often
9
Sometimes
30
Often
51
Never
10
Often
31
Sometimes
52
Sometimes
11
Sometimes
32
Often
53
Sometimes
12
Often
33
Often
54
Never
13
Often
34
Sometimes
55
Often
14
Sometimes
35
Often
56
Sometimes
15
Sometimes
36
Never
57
Never
16
Often
37
Sometimes
58
Often
17
Sometimes
38
Often
59
Often
18
Never
39
Often
60
Never
19
Often
40
Never
61
Sometimes
20
Often
41
Sometimes
62
Often
21
Sometimes
42
Often
63
Never
*** End of Report ***
