Hostname: page-component-7b9c58cd5d-f9bf7 Total loading time: 0 Render date: 2025-03-14T02:08:59.225Z Has data issue: false hasContentIssue false

Is the behavior rating inventory of executive function more strongly associated with measures of impairment or executive function?

Published online by Cambridge University Press:  01 March 2010

TARA MCAULEY*
Affiliation:
Department of Psychiatry Research, The Hospital for Sick Children, Toronto, Ontario, Canada
SHIRLEY CHEN
Affiliation:
Department of Psychiatry Research, The Hospital for Sick Children, Toronto, Ontario, Canada
LISA GOOS
Affiliation:
Department of Psychiatry Research, The Hospital for Sick Children, Toronto, Ontario, Canada
RUSSELL SCHACHAR
Affiliation:
Department of Psychiatry Research, The Hospital for Sick Children, Toronto, Ontario, Canada
JENNIFER CROSBIE
Affiliation:
Department of Psychiatry Research, The Hospital for Sick Children, Toronto, Ontario, Canada
*
*Correspondence and reprint requests to: Tara McAuley, PhD, Department of Psychiatry Research, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8. E-mail: tara.mcauley@sickkids.ca
Rights & Permissions [Opens in a new window]

Abstract

The Behavior Rating Inventory of Executive Function (BRIEF) is commonly used in the assessment of children and adolescents presenting with a wide range of concerns. It is unclear, however, whether the questionnaire is more closely related to general measures of behavioral disruption and impairment or to specific measures of executive function. In the present study, associations between the Behavioral Regulation Index and Metacognition Index of the BRIEF and cognitive, behavioral, and academic measures were examined in a sample of clinic-referred youth (n = 60) and healthy youth (n = 37) 6–15 years of age. Measures included ratings of inattentive and hyperactive-impulsive symptoms in youth, ratings of how well youth functioned in their everyday environments, youth’s scores on measures of reading and math, and youth’s scores on measures of inhibition, performance monitoring, and working memory. Although both BRIEF indices were strongly related to parent and teacher ratings of behavioral disruption and impairment, neither was associated with youth’s scores on the performance-based tasks of executive function. These findings support the use of the BRIEF as a clinical tool for assessing a broad range of concerns, but raise questions about the relation of the BRIEF to performance-based tasks that are commonly used to assess executive function. (JINS, 2010, 16, 495–505.)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2010

INTRODUCTION

Executive functions are a set of inter-related abilities that facilitate purposeful, goal-oriented behavior (Lezak, Reference Lezak1995). These abilities emerge early in life and continue to develop until mid to late adolescence or early adulthood (Romine & Reynolds, Reference Romine and Reynolds2005). Executive functions play an important role in the development of other abilities during this period, including learning and memory skills (Bjorklund & Douglas, Reference Bjorklund, Douglas and Cowan1997; Schlagmüller & Schneider, Reference Schlagmüller and Schneider2002), reading and math proficiency (McClelland, Cameron, Connor, Farris, Jewkes, & Morrison, Reference McClelland, Cameron, Connor, Farris, Jewkes and Morrison2007; St. Clair-Thompson & Gathercole, Reference St. Clair-Thompson and Gathercole2006), social-emotional competence (Riggs, Jahromi, Razza, Dillworth-Bart, & Mueller, Reference Riggs, Jahromi, Razza, Dillworth-Bart and Mueller2006), and level of adaptive functioning (Blair & Peters, Reference Blair and Peters2003). Impairments in executive functions are also considered to be a core feature of several developmental disorders, including autism (Russo, Flanagan, Iarocci, Berringer, Zelazo, & Burack, Reference Russo, Flanagan, Iarocci, Berringer, Zelazo and Burack2007) and Attention-Deficit/Hyperactivity Disorder (ADHD: Barkley, Reference Barkley1997; Willcutt, Doyle, Nigg, Faraone, & Pennington, Reference Willcutt, Doyle, Nigg, Faraone and Pennington2005). Given the involvement of executive functions in both typical and atypical development, they have become the focus of considerable clinical interest and empirical study.

The Behavior Rating Inventory of Executive Function (BRIEF) is a questionnaire that was developed to provide clinicians with a means of assessing the executive functions of youth in an ecologically valid manner (Gioia, Isquith, Guy, & Kenworthy, Reference Gioia, Isquith, Guy and Kenworthy2000a, Reference Gioia, Isquith, Guy and Kenworthy2000b). The BRIEF is based on the premise that parents and teachers can provide useful information about the executive functions of youth by reporting on their behavior outside of the testing environment. An overall index of executive dysfunction is provided by the Global Executive Composite, which is comprised of two subordinate indices called the Behavioral Regulation Index and the Metacognition Index. The Behavioral Regulation Index is comprised of 3 scales, including Inhibit (e.g., delay or stop impulsive behaviors), Shift (e.g., change tasks and adapt to new situations) and Emotional Control (e.g., modulate mood appropriately). The Metacognition Index is comprised of 5 scales, including Initiate (e.g., generate ideas, start new tasks), Working Memory (e.g., sustain one’s focus, keep information in mind), Plan/Organize (e.g., think prospectively, follow a plan), Organization of Materials (e.g., clean-up after oneself), and Monitor (e.g., check one’s work for errors, monitor the effect of one’s behavior on other people).

In clinical settings, the BRIEF has been used to evaluate the executive functions of children and adolescents presenting with a wide range of concerns. Studies have shown that children diagnosed with ADHD have higher scores on many of the BRIEF scales compared with children who do not have this disorder (Mahone, Cirino, et al., Reference Mahone, Cirino, Cutting, Cerrone, Hagelthorn and Hiemenz2002; Pratt, Campbell-LaVoie, Isquith, Gioia, & Suy, 2000, as cited in Gioia et al., Reference Gioia, Isquith, Guy and Kenworthy2000b; Toplack, Bucciarelli, Jain, & Tannock, Reference Toplack, Bucciarelli, Jain and Tannock2009). Similar findings have been obtained from children born with extremely low birth weight (Taylor, 2000, as cited in Gioia et al., Reference Gioia, Isquith, Guy and Kenworthy2000b), children with myelomeningocele and hydrocephalus (Mahone, Zabel, Levey, Verda, & Kinsman, Reference Mahone, Zabel, Levey, Verda and Kinsman2002), children diagnosed with autism spectrum disorders (Gilotty, Kenworthy, Sirian, Black, & Wagner, Reference Gilotty, Kenworthy, Sirian, Black and Wagner2002), and children who have experienced a focal brain lesion or severe traumatic brain injury (Anderson, Anderson, Northam, Jacobs, & Mikiewicz, Reference Anderson, Anderson, Northam, Jacobs and Mikiewicz2002; Conklin, Salorio, & Slomine, Reference Conklin, Salorio and Slomine2008; Mangeot, Armstrong, Colvin, Yeates, & Taylor, Reference Mangeot, Armstrong, Colvin, Yeates and Taylor2002).

The extent to which the BRIEF assesses executive dysfunction has been empirically examined using participants drawn from diverse clinical groups and spanning a relatively broad age range (Table 1). A general trend to have emerged from this literature is that the BRIEF is not typically associated with complex measures of executive function (e.g., Anderson et al., Reference Anderson, Anderson, Northam, Jacobs and Mikiewicz2002; Mahone, Cirino et al., Reference Mahone, Cirino, Cutting, Cerrone, Hagelthorn and Hiemenz2002; Vriezen & Pigott, Reference Vriezen and Pigott2002), although there has been the occasional exception (e.g., Mangeot et al., Reference Mangeot, Armstrong, Colvin, Yeates and Taylor2002). In contrast, measures of executive function that are thought to tap more circumscribed abilities have yielded inconsistent findings, with some studies reporting a lack of association (e.g., Conklin et al., Reference Conklin, Salorio and Slomine2008; Niendam, Horwitz, Bearden, & Cannon, Reference Niendam, Horwitz, Bearden and Cannon2007) and other studies reporting associations that are small to moderate in magnitude (e.g., Toplack et al., Reference Toplack, Bucciarelli, Jain and Tannock2009). Although the BRIEF is sensitive to behavioral disruption and impairment, it is unclear whether the questionnaire is a measure of executive dysfunction per se.

Table 1. Summary of studies examining associations between parent ratings on the BRIEF and performance-based tasks of executive function

Note

INH = Inhibition, SFT = Shift, EC = Emotional Control, INT - Initiate, WM = Working Memory, P/O = Plan/Organize, OM = Organization of Materials, MON = Monitor, BRI = Behavioral Regulation Index, MI = Metacognition Index, GEC = Global Executive Composite

a Examined associations with WM.

b Examined associations with INH, SFT, WM, P/O.

c Examined associations with INH, SFT, EC, INT, WM, P/O, OM, MON.

d Examined associations with BRI and MI.

e Examined associations with BRI, MI, GEC.

f Examined associations with INH, WM, BRI, MI, GEC.

In an effort to further elucidate the nature of the BRIEF, we examined associations between the Behavioral Regulation Index and Metacognition Index and a variety of cognitive, behavioral, and academic measures that were collected from a diverse sample of youth between 6 and 15 years of age. These measures included parent and teacher ratings of inattentive and hyperactive-impulsive symptoms in youth, parent and teacher ratings of behavioral and social-emotional problems experienced by youth, youth’s scores on measures of reading and math proficiency, and youth’s scores on measures of inhibition, performance monitoring, and working memory. Although these latter tasks provide a rather narrow conceptualization of the executive function construct, they were included in our study because they are widely recognized as core executive functions (Huizinga, Dolan, & van der Molen, Reference Huizinga, Dolan and van der Molen2006; Miyake, Friedman, Emerson, Witzki, & Howerter, Reference Miyake, Friedman, Emerson, Witzki and Howerter2000; Ridderinkhof, van den Wildenberg, Segalowitz, & Carter, Reference Ridderinkhof, van den Wildenberg, Segalowitz and Carter2004) and have been studied extensively in typically and atypically developing youth (for reviews see Pennington & Ozonoff, Reference Pennington and Ozonoff1996; Welsh, Reference Welsh, Molfese and Molfese2002).

Our predictions were informed by differing views of what the BRIEF measures. If the questionnaire is a general measure of behavioral disruption and impairment, then we would expect the Behavioral Regulation Index and Metacognition Index to be strongly associated with ratings of inattentive and hyperactive-impulsive symptoms in youth and with ratings of how well youth functioned in their everyday environments. We did not expect to see similar associations with the other measures that were administered. In contrast, if the questionnaire is a more specific measure of executive dysfunction, then we would expect the Behavioral Regulation Index and Metacognition Index to be strongly associated with youth’s scores on measures of inhibition, performance monitoring, and working memory. Because cognitive aspects of executive function are known to play an important role in the acquisition of academic skills (McClelland et al., Reference McClelland, Cameron, Connor, Farris, Jewkes and Morrison2007; St. Clair-Thompson & Gathercole, Reference St. Clair-Thompson and Gathercole2006), we would further expect the Metacognition Index to be strongly associated with youth’s proficiency in reading and math.

METHOD

Participants

Data from 97 participants 6 to 15 years of age were included in this study. Participants were drawn from an outpatient clinic in an urban pediatric hospital and included youth who were referred for attention, learning and/or behavioral problems (i.e., clinical group) and youth who were recruited to serve as healthy controls (i.e., control group). Information regarding mental health concerns was obtained from parents and teachers in semi-structured clinical interviews including the Parent Interview for Child Symptoms (Ickowicz, Schachar, Sugarman, Chen, Millette, & Cook, Reference Ickowicz, Schachar, Sugarman, Chen, Millette and Cook2006) and the Teacher Telephone Interview (Tannock, Hum, Masellis, Humphries, & Schachar, Reference Tannock, Hum, Masellis, Humphries and Schachar2002). Interviews were conducted by an individual with a Master’s degree who was trained in developmental psychopathology and who worked under the supervision of a registered clinician. Diagnoses were made by the clinician based on criteria in the Diagnostic and Statistics Manual of Mental Disorders, 4th Edition (American Psychiatric Association, 1994). Intellectual and academic testing was conducted by a trained psychometrist who also worked under the supervision of a registered clinician. Participants were excluded if they had a full scale IQ (Wechsler, Reference Wechsler1991, Reference Wechsler2003) of less than 70 or greater than 130 or invalid data on any of the measures that were used in the study. Demographic information is presented in Table 2.

Table 2. Demographic variables

**p < .001, *p < .05

Procedure

A detailed account of our clinical research protocol has appeared elsewhere and will be reviewed only briefly (Schachar et al., Reference Schachar, Chen, Logan, Ornstein, Crosbie and Ickowicz2004). Informed consent was obtained from the participant and his or her parent/guardian by a trained health professional. Before the session, behavioral questionnaires were sent to the child’s home to be completed by the child’s parent/guardian and teacher. Completed questionnaires were returned to our clinic at the time of the appointment. During the session, each child worked individually with a trained psychology assistant. Academic and cognitive tasks were administered in randomized order. As the child worked, the parent/guardian completed a clinical interview in a separate room of the clinic. A clinical interview also was completed with the child’s teacher at a separate time over the phone. All youth participating in the study were free of medication 48 hr before the appointment. This protocol was approved by the Research Ethics Board at The Hospital for Sick Children and is consistent with the Helsinki Declaration.

Measures

Behavior Rating Inventory of Executive Function

The parent form of the BRIEF is an 86-item questionnaire that was developed to assess the executive functions of youth 5 to 18 years of age (Gioia et al., Reference Gioia, Isquith, Guy and Kenworthy2000a). Each item loads onto one of eight scales. Three scales yield a summary measure called the Behavioral Regulation Index and five scales yield a summary measure called the Metacognition Index. These indices reflect the extent to which youth engage in behaviors that may be indicative of impairment in one or more aspects of executive function. Chronbach’s α for the Behavioral Regulation Index is .96 for clinic-referred youth and .94 for youth drawn from a normative sample. Chronbach’s α for the Metacognition Index is .96 for clinic-referred youth and .96 for youth drawn from a normative sample (Gioia et al., Reference Gioia, Isquith, Guy and Kenworthy2000b).

Conners’ Rating Scales – Revised:Long

The CRS-R:L assesses symptoms of ADHD in youth 3 to 17 years of age (Conners, Reference Conners2001a, Reference Conners2001b). The parent form consists of 80 items and the teacher form consists of 59 items. Both forms of the questionnaire include an “L” scale reflecting symptoms of inattention (e.g., difficulty sustaining attention, being highly distractible) and an “M” scale reflecting symptoms of hyperactivity-impulsivity (e.g., restless, always on the go). Chronbach’s α for the L and M scales is .93 and .90 for males and .91 and .88 for females, respectively (Conners, Reference Conners2001c). There is significant overlap between items comprising the L and M scales of the CRS-R:L and items comprising the Inhibit and Working Memory scales of the BRIEF.

Ontario Child Health Study

The OCHS is a comprehensive questionnaire that assesses multiple aspects of child and adolescent health (Boyle et al., Reference Boyle, Offord, Hofman, Catlin, Byles and Cadman1987). Items from the parent and teacher forms of the questionnaire were used to evaluate impairment associated with behavioral and social-emotional problems experienced by youth (e.g., quality of relationships, engagement in activities, school truancy). The items we selected to examine impairment have been used in other studies for the same purpose (Lindsay, Offord, Boyle, & Racine, Reference Lindsay, Offord, Boyle and Racine1995; Sanford, Offord, Boyle, Peace, & Racine, Reference Sanford, Offord, Boyle, Peace and Racine1992). These items were summed to create two composite scores reflecting overall level of impairment as reported by parents and teachers, respectively. There was no overlap between the items we selected from the OCHS and items comprising the eight scales of the BRIEF or items comprising the L and M scales of the CRS-R:L.

Wide Range Achievement Test 3

The WRAT3 is a screen of academic proficiency that may be used across the life span (Wilkinson, Reference Wilkinson1993a). The Reading and Arithmetic subtests were administered in this study. Reading required participants to identify letters (if younger than 8 years) and/or read words aloud (if 8 years or older). Arithmetic required participants to answer orally presented words problems (if younger than 8 years) and/or solve written math problems (if 8 years or older). In people 6 to 15 years of age, Chronbach’s α is between .94 and .96 for Reading and between .88 and .94 for Arithmetic (Wilkinson, Reference Wilkinson1993b).

Stop-signal task

The stop-signal task is a well-established measure of inhibitory ability and performance monitoring (Lijffijt, Kenemans, Verbaten, & van Engeland, Reference Lijffijt, Kenemans, Verbaten and van Engeland2005; Oosterlaan, Logan, & Sergeant, Reference Oosterlaan, Logan and Sergeant1998; Schachar et al., Reference Schachar, Chen, Logan, Ornstein, Crosbie and Ickowicz2004). Our version of the stop signal task was presented in 4 blocks of 24 trials. At the beginning of each trial, a central fixation appeared for 500 ms. After the fixation disappeared, an X or an O appeared at the center of the computer screen for 1000 ms. Participants identified the letter by making a speeded key press response. After a blank intertrial interval of 2000 ms the next trial was presented. On 25% of trials, the appearance of the letter was followed by an auditory tone that signaled participants to inhibit their response. Timing of the signal was determined using a dynamic tracking algorithm (Logan & Cowan, Reference Logan and Cowan1994) such that participants were able to inhibit their response on approximately 50% of trials. Stop signal reaction time (SSRT) served as a measure of inhibition and was obtained by subtracting the mean delay of the stop signal from the mean time taken to respond to the letters. Post-error slowing (PES) served as a measure of performance monitoring and was obtained by subtracting the mean RT of correct trials following failed inhibit trials from the overall correct mean RT.

N-back task

The n-back task is a well-established measure of working memory (Owen, McMillan, Laird, & Bullmore, Reference Owen, McMillan, Laird and Bullmore2005). In our study, a spatial version of the 1-back task was presented in 4 blocks of 40 trials. At the beginning of each trial, a central fixation appeared for 500 ms. After the fixation disappeared, a white box appeared at a location on the computer screen for 1000 ms. Participants determined whether the location of the box on the present trial was the same as the location of the box 1 trial previous by making a speeded key press response. After a blank intertrial interval of 2000 ms the next trial was presented. Target accuracy (NBACC) served as a measure of working memory. Accuracy was inflected so that positive scores denoted worse performance, consistent with the other cognitive measures used in this study.

RESULTS

Bivariate Correlations

Raw scores were converted into T scores using appropriate age and gender norms (BRIEF, CRS:R-L, WRAT3) or were transformed into residual scores that were corrected for age (PES, NBACC), gender (OCHS teacher form), or age and gender (SSRT). Bivariate correlations were initially inspected to assess the overall pattern of results (Table 3). The Behavioral Regulation Index and Metacognition Index were significantly inter-correlated (r = .75), as were parent and teacher ratings of youth’s inattentiveness and hyperactivity-impulsivity (rs = .35 to .66), parent and teacher ratings of youth’s ability to function (r = .49), youth’s scores on measures of reading and math (r = .51), and youth’s scores on measures of inhibition, performance monitoring, and working memory (rs = .25 to .59). The two indices of the BRIEF were significantly correlated with parent and teacher ratings of ADHD symptoms (rs = .34 to .81), with parent and teacher ratings of impairment (rs = .32 to .63), and with youth’s level of academic proficiency (rs = −.23 to −.45). Although correlations between the two indices of the BRIEF and youth’s performance on measures of executive function were smaller in magnitude, a somewhat stronger relationship was observed with working memory (rs = .19 to .26) than with inhibition or performance monitoring (rs = <.01 to .12).

Table 3. Correlations between the BRIEF and Behavioral, Cognitive, and Academic measures

**p < .01, *p < .05

Principal Components Analysis

To reduce the amount of data and facilitate interpretation of results, all measures (except the BRIEF) were entered into a principal components analysis with varimax rotation and Kaiser normalization. Principal components analysis produced a 3-factor solution that accounted for 64% of the variance in the data. Factor loadings and the proportion of variance explained by each factor are presented in Table 4. The first factor included parent and teacher ratings of inattention and hyperactivity-impulsivity in youth as well as parent and teacher perceptions of behavioral and social-emotional problems that were experienced by youth. This factor was interpreted as an index of behavioral disruption and impairment. The second factor included SSRT and PES from the stop-signal task and NBACC from the 1-back task. Because these variables reflect inhibition, performance monitoring, and working memory, this factor was interpreted as an index of executive function. The third factor included performance on tests of reading and arithmetic and was interpreted as an index of academic ability.

Table 4. Factor loadings and explained variance from the principal components analysis

Regression Analyses

Hierarchical regression analyses were conducted to determine the proportion of variance in each BRIEF index that was explained by the three factors identified in the principal components analysis after possible confounds were statistically controlled. In each regression, either the Behavioral Regulation Index or Metacognition Index served as the dependent measure. Sex, group membership, and IQ were entered as independent measures in the first step and factors representing problematic behavior, executive function, and academic ability were entered as independent measures in the second step. The final step included all possible 2-way interactions between variables that were entered in the first and second steps. None of these interactions were significant in either analysis (ps > .10), indicating that the relationship between the 2 indices of the BRIEF and the 3 factors identified in the principal components analysis did not vary according to sex, group membership, or IQ.

As shown in Table 5, 27% of the variance in the Behavioral Regulation Index and 26% of the variance in the Metacognition Index was uniquely explained by the three factors identified in the principal components analysis after sex, group membership, and IQ were statistically controlled. Inspection of individual B weights revealed that the Behavioral Regulation Index and Metacognition Index were positively associated with parent and teacher ratings of behavioral disruption and impairment, indicating that youth who had higher ratings on the BRIEF were more likely to have higher ratings of inattentive and/or hyperactive-impulsive symptoms and greater difficulty functioning in their everyday environments. Because these findings may reflect a common reporting source (i.e., the parent), we re-ran the analyses using only teacher ratings of behavioural disruption and impairment. In so doing, the same pattern of associations was observed. Inspection of individual B weights further revealed that the Metacognition Index was negatively associated with youth’s scores on measures of academic proficiency, indicating that that youth who had higher ratings on this particular index were more likely to have difficulties in reading and math. Neither index of the BRIEF was significantly associated with youth’s scores on performance-based tasks of executive function (ps > .10). Of note, when each of the eight BRIEF scales were separately treated as a dependent measure in the analyses, Inhibit, Shift, and Emotional Control showed the same pattern of results as the Behavioral Regulation Index and Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor showed the same pattern of results as the Metacognition Index.

Table 5. Regression analyses examining the relationship between the BRIEF and factors representing problem behavior, executive function, and academic ability

**p < .001, *p < .05

DISCUSSION

This study was undertaken to further elucidate the nature of the BRIEF. To address this aim, we examined associations between the BRIEF and a variety of cognitive, behavioral, and academic measures in a sample of youth who were drawn from an outpatient mental health clinic or who were recruited to serve as healthy controls. Measures were selected to represent a broad range of domains and included parent and teacher ratings of inattentive and hyperactive-impulsive symptoms in youth, parent and teacher ratings of behavioral and social-emotional problems experienced by youth, youth’s scores on measures of reading and math proficiency, and youth’s performance on the Stop Signal and 1-back tasks. These latter tasks tap circumscribed aspects of the executive function construct and, to our knowledge, have not previously been used in conjunction with the BRIEF.

A robust finding was that the Behavioral Regulation Index and Metacognition Index were strongly associated with parent and teacher ratings of attention problems in youth and with behavioral and social-emotional problems experienced by youth in their everyday lives. Although this finding is consistent with research suggesting that the BRIEF is sensitive to behavioral disruption and impairment, limitations of our design precluded us from determining whether the strength of these associations reflected variance attributable to a common underlying trait (i.e., trait variance) or variance that was attributable to the use of a common method (i.e., method variance). One approach that has been used to resolve this issue is the multitrait-multimethod design, in which two or more traits are assessed using two or more unique methods (for a more detailed discussion see Marsh & Grayson, Reference Marsh, Grayson and Hoyle1995). Although this approach requires intensive resources, it may provide a fruitful avenue for future explorations of the BRIEF.

The aforementioned finding may cause one to speculate that the BRIEF is a measure of ADHD—a common disorder of childhood that is characterized by six or more symptoms of inattention and/or hyperactivity-impulsivity and associated impairment across multiple settings. Correlations between the BRIEF and ADHD questionnaires are typically moderate to large in magnitude, as are correlations between the BRIEF and ADHD scales on more general questionnaires of pathology and adaptive function (Burmeister, Hannay, Copeland, Fletcher, Boudousquie, & Dennis, Reference Burmeister, Hannay, Copeland, Fletcher, Boudousquie and Dennis2005; Gioia et al., Reference Gioia, Isquith, Guy and Kenworthy2000b; Mahone, Cirino, et al., Reference Mahone, Cirino, Cutting, Cerrone, Hagelthorn and Hiemenz2002; Sullivan & Riccio, Reference Sullivan and Riccio2006; Toplack et al., Reference Toplack, Bucciarelli, Jain and Tannock2009). Previous work has shown that children with ADHD have higher scores on the BRIEF compared with their unaffected peers (Mahone, Cirino, et al., Reference Mahone, Cirino, Cutting, Cerrone, Hagelthorn and Hiemenz2002; Pratt et al. 2000, cited in Gioia et al., Reference Gioia, Isquith, Guy and Kenworthy2000b; Toplack et al., Reference Toplack, Bucciarelli, Jain and Tannock2009), that the Working Memory scale is particularly sensitive to the diagnosis of ADHD (Isquith & Gioia, Reference Isquith and Gioia2000; McCandless & O’Laughlin, Reference McCandless and O’Laughlin2007), and that the Inhibit scale reliably differentiates between Inattentive and Combined subtypes of the disorder (Isquith & Gioia, Reference Isquith and Gioia2000; McCandless & O’Laughlin, Reference McCandless and O’Laughlin2007; Riccio, Homack, Pizzitola Jarratt, & Wolfe, Reference Riccio, Homack, Pizzitola Jarratt and Wolfe2006). More recent work also has shown that ratings on the Working Memory, Inhibit, Shift, and Plan/Organize scales are good predictors of ADHD status (Toplack et al., Reference Toplack, Bucciarelli, Jain and Tannock2009). This research may suggest that the BRIEF is primarily useful as a diagnostic tool for ADHD. However, other work has demonstrated that the BRIEF is elevated in youth presenting with a variety of issues (Anderson et al., Reference Anderson, Anderson, Northam, Jacobs and Mikiewicz2002; Gilotty et al., Reference Gilotty, Kenworthy, Sirian, Black and Wagner2002; Mahone, Zabel et al., Reference Mahone, Zabel, Levey, Verda and Kinsman2002; Mangeot et al., Reference Mangeot, Armstrong, Colvin, Yeates and Taylor2002; Taylor, 2000, as cited in Gioia et al., Reference Gioia, Isquith, Guy and Kenworthy2000b) and that it may show robust associations with behavioral disruption and impairment in unaffected youth who do not have ADHD or any other disorder (as demonstrated in our study). Although the BRIEF is sensitive to the symptoms and impairment that characterize ADHD, the scope of the BRIEF encompasses a broader range of concerns.

Another finding to emerge from our study was a strong association between the Metacognition Index and youth’s proficiency on measures of reading and math (see Waber, Gerber, Turcios, Forbes, & Wagner, Reference Waber, Gerber, Turcios, Forbes and Wagner2006, for similar results involving the teacher version of the BRIEF). These results are partly consistent with those of Mahone, Cirino, et al. (Reference Mahone, Cirino, Cutting, Cerrone, Hagelthorn and Hiemenz2002), who found that the Behavioral Regulation Index and Metacognition Index were associated with youth’s scores on a composite of math, although not to youth’s scores on a composite of reading. In comparison to the relatively basic measures of academic performance that were used in our study, Mahone, Cirino, et al. (Reference Mahone, Cirino, Cutting, Cerrone, Hagelthorn and Hiemenz2002) administered measures of single-word reading, reading comprehension, numerical calculations, and math reasoning to youth who were diagnosed with ADHD and/or Tourette Syndrome or who served as healthy controls. Although it is unclear why we failed to find an association between the Behavioral Regulation Index and math proficiency or why Mahone, Cirino, et al. (Reference Mahone, Cirino, Cutting, Cerrone, Hagelthorn and Hiemenz2002) failed to find an association between the Metacognition Index and reading proficiency, these discrepancies may reflect differences in the academic measures that were used in our studies and/or differences in the characteristics of our respective samples. It is likely that all scales of the BRIEF include items that are necessary for success at school; however, items reflecting self-regulatory skills (e.g., the Behavioral Regulation Index) and items reflecting metacognitive skills (e.g., the Metacognition Index) may be differentially sensitive to the kinds of school-related demands that are encountered by students of different ages (i.e., preschool vs. elementary vs. high school students). This is an issue that will be interesting to explore in future research.

Although the BRIEF scales have names that correspond to specific aspects of the executive function construct, we found no significant associations between the Behavioral Regulation Index or the Metacognition Index and youth’s scores on measures of inhibition, performance monitoring, and working memory. Similar null findings have been reported in other studies using different performance-based tasks of executive function (see Table 1). An illustrative example is provided by Vriezen and Pigott (Reference Vriezen and Pigott2002), who compared parent ratings on the BRIEF to children’s performance on the Wisconsin Card Sorting Test, Trail Making Test, and Verbal Fluency Test. All children had sustained moderate to severe traumatic brain injuries approximately 3 years before their enrollment in the study. Of these children, nearly a third had scores on the Behavioral Regulation Index, Metacognition Index, and Global Executive Composite that were in the clinically significant range (defined as a T score above 65). However, scores on these indices were not significantly correlated with children’s performance on any of the executive function measures (rs ranged from .03 to .26).

At present, reasons for the apparent dissociation between parent and teacher ratings on the BRIEF and youth’s scores on performance-based tasks of executive function are not well-understood. One set of interpretations is based on the premise that these measures assess different aspects of the same underlying construct. For example, it has been suggested that the executive function construct can be fractionated into a behavioral component that is assessed by the BRIEF and a cognitive component that is assessed by performance-based tasks (e.g., Anderson et al., Reference Anderson, Anderson, Northam, Jacobs and Mikiewicz2002). Although this has been offered as one possible explanation for null findings in the literature, it is inconsistent with recent neuroimaging findings suggesting that the two sets of measures share a common neuroanatomical substrate (Mahone, Martin, Kates, Hay, & Horska, Reference Mahone, Martin, Kates, Hay and Horska2009). An alternative, and perhaps more plausible explanation, is that performance-based tasks assess underlying skills whereas the BRIEF assesses the application of those skills at home and at school. It may be the case that environmental variables mediate this relationship, which would explain why youths’ scores on performance-based tasks do not necessarily correspond to parent and teacher ratings on the BRIEF. To our knowledge, potential mediators of this relationship have not yet been empirically examined.

Another interpretation is that performance-based tasks of executive function lack ecological validity due to the manner in which they are typically administered. Testing usually occurs in environments that are designed to minimize distractions, maximize support, and provide individuals with a high degree of structure (e.g., clear instructions, well-specified goals). Because these conditions bear little resemblance to the ones in which we typically function, it has been suggested that performance-based tasks do not engage the same set of skills that are required in naturalistic settings (Burgess, Reference Burgess and Rabbitt1997).

In contrast to this view, recent work in the education literature has demonstrated that youth’s scores on performance-based tasks of executive function are related to their experiences in at least one naturalistic setting—that of the school. Youth’s scores on performance-based tasks have been shown to predict proficiency in specific academic skills (McClelland et al., Reference McClelland, Cameron, Connor, Farris, Jewkes and Morrison2007; St. Clair-Thompson & Gathercole, Reference St. Clair-Thompson and Gathercole2006), achievement on national curriculum assessments (Gathercole & Pickering, Reference Gathercole and Pickering2000; Jarvis & Gathercole, Reference Jarvis and Gathercole2003), risk of grade retention (Biederman et al., Reference Biederman, Monuteaux, Doyle, Seidman, Wilens and Ferrero2004), and teacher perceptions of student function (Diamantopoulou, Rydell, Thorell, & Bohlin, Reference Diamantopoulou, Rydell, Thorell and Bohlin2007). These findings provide preliminary support for the ecological validity of performance-based tasks of executive function. In future studies, it will be important to examine associations between these tasks and a greater variety of real-world outcomes.

A final interpretation is that the BRIEF does not measure executive functions to the extent that is commonly believed. As has already been mentioned, numerous studies have failed to find associations between parent and teacher ratings on the BRIEF and performance-based tasks of executive function (see, for example, Table 1). Many of these tasks were developed to assess specific facets of the executive function construct, were validated with brain lesioned patients (e.g., Drewe, Reference Drewe1974; Shallice, Reference Shallice1982), and have neuroanatomical substrates that have since been well-specified (e.g., Newman, Carpenter, Varma, & Just, Reference Newman, Carpenter, Varma and Just2003; Smith, Taylor, Brammer, & Rubia, Reference Smith, Taylor, Brammer and Rubia2004). In future studies, it will be important to verify the validity of the BRIEF by comparing the questionnaire to naturalistic tasks that require the application of executive functions in more complex contexts.

Although our study raises questions about the relation of the BRIEF to performance-based tasks that are commonly used to assess executive functions, it supports the use of the BRIEF as a clinical tool for assessing a broad range of concerns. In clinical settings, the BRIEF may be used to identify youth who are experiencing behavioral difficulties and who may be at increased risk for the development of social and school-related problems. When used in conjunction with other assessment tools, the BRIEF can help to further delineate the nature of difficulties that are experienced by youth and inform decisions regarding psychological intervention and educational planning.

ACKNOWLEDGMENTS

We thank Catherine Munns for assistance with the literature review, Troy Climans, Jonathan Lipszyc, Shalaine Payne, and Mehereen Wadiwalla for their input regarding this manuscript, and the families whose time and effort made this project possible. This project was supported by the Canadian Institute for Health Research (CIHR) grants 64277/44070. The authors have no conflict of interest to disclose.

References

REFERENCES

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders - 4th ed. Washington, DC: American Psychiatric Association.Google Scholar
Anderson, V.A., Anderson, P., Northam, E., Jacobs, R., & Mikiewicz, O. (2002). Relationships between cognitive and behavioral measures of executive function in children with brain disease. Child Neuropsychology, 8, 231240.CrossRefGoogle ScholarPubMed
Barkley, R.A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 6594.CrossRefGoogle ScholarPubMed
Biederman, J., Monuteaux, M.C., Doyle, A.E., Seidman, L.J., Wilens, T.E., Ferrero, F., et al. . (2004). Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. Journal of Consulting and Clinical Psychology, 72, 757766.CrossRefGoogle ScholarPubMed
Bjorklund, D.F., & Douglas, R.N. (1997). The development of memory strategies. In Cowan, N. (Ed.), The development of memory in childhood. Studies in developmental psychology (pp. 201246). Hove, England: Psychology Press.Google Scholar
Blair, C., & Peters, R. (2003). Physiological and neurocognitive correlates of adaptive behavior in preschool among children in Head Start. Developmental Neuropsychology, 24, 479497.CrossRefGoogle ScholarPubMed
Bodnar, L.E., Prahme, M.C., Cutting, L.E., Denckla, M.B., & Mahone, E.M. (2006). Construct validity of parent ratings of inhibitory control. Child Neuropsychology, 13, 345362.CrossRefGoogle Scholar
Boyle, M.H., Offord, D.R., Hofman, H.G., Catlin, G.P., Byles, J.A., Cadman, D.T., et al. . (1987). Ontario Child Health Study, I: Methodology. Archives of General Psychiatry, 44, 826831.CrossRefGoogle ScholarPubMed
Brown, T.M., Ris, M.D., Beebe, D., Ammerman, R.T., Oppenheimer, S.G., Yeates, K.O., & Enrile, B.D. (2008). Factors of biological risk and reserve associated with executive behaviors in children and adolescents with spina bifida myelomeningocele. Child Neuropsychology, 14, 118134.CrossRefGoogle ScholarPubMed
Burgess, P.W. (1997). Theory and methodology in executive function and research. In Rabbitt, P. (Ed.), Methodology of frontal and executive function (pp. 81116). Hove, England: Psychology Press.Google Scholar
Burmeister, R., Hannay, H.J., Copeland, K., Fletcher, J.M., Boudousquie, A., & Dennis, M. (2005). Attention problems and executive functions in children with spina bifida and hydrocephalus. Child Neuropsychology, 11, 265283.CrossRefGoogle ScholarPubMed
Conklin, H.M., Salorio, C.F., & Slomine, S.F. (2008). Working memory performance following pediatric traumatic brain injury. Brain Injury, 22, 847857.CrossRefGoogle Scholar
Conners, K. (2001a). Conners’ parent rating scale – Revised:long. Toronto, ON: Multi-Health Systems Inc.Google Scholar
Conners, K. (2001b). Conners’ teacher rating scale – Revised:long. Toronto, ON: Multi-Health Systems Inc.Google Scholar
Conners, K. (2001c). Conners’ rating scales-revised. Technical manual. Toronto, ON: Multi-Health Systems Inc.Google Scholar
Drewe, E.A. (1974). The effect of type and area of brain lesion on Wisconsin Card Sorting Test performance. Cortex, 10, 159170.CrossRefGoogle ScholarPubMed
Diamantopoulou, S., Rydell, A.M., Thorell, L.B., & Bohlin, G. (2007). Impact of executive functioning and symptoms of attention deficit hyperactivity disorder on children’s peer relations and school performance. Developmental Neuropsychology, 32, 521542.CrossRefGoogle ScholarPubMed
Gathercole, S.E., & Pickering, S.J. (2000). Working memory deficits in children with low achievements in the national curriculum at 7 years of age. British Journal of Educational Psychology, 70, 177194.CrossRefGoogle ScholarPubMed
Gilotty, L., Kenworthy, L., Sirian, L., Black, D.O., & Wagner, A.E. (2002). Adaptive skills and executive function in autism spectrum disorders. Child Neuropsychology, 8, 241248.CrossRefGoogle ScholarPubMed
Gioia, G.A., Isquith, P.K., Guy, S.C., & Kenworthy, L. (2000a). The behavior rating inventory of executive function. Lutz, FL: Psychological Assessment Resources.Google Scholar
Gioia, G.A., Isquith, P.K., Guy, S.C., & Kenworthy, L. (2000b). The behavior rating inventory of executive function. Professional manual. Lutz, FL: Psychological Assessment Resources.Google Scholar
Huizinga, M., Dolan, C.V., & van der Molen, M.W. (2006). Age-related change in executive function: Developmental trends and a latent variables analysis. Neuropsychologia, 44, 20172036.CrossRefGoogle Scholar
Ickowicz, A., Schachar, R., Sugarman, R., Chen, S., Millette, C., & Cook, L. (2006). The parent interview for child symptoms (PICS): A situation-specific clinical research interview for attention deficit hyperactivity and related disorders. Canadian Journal of Psychiatry, 50, 325328.CrossRefGoogle Scholar
Isquith, P.K., & Gioia, G.A. (2000). BRIEF predictions of ADHD: Clinical utility of the behavior rating inventory of executive function for detecting ADHD subtypes in children. Archives of Clinical Neuropsychology, 15, 780781.CrossRefGoogle Scholar
Jarvis, H.L., & Gathercole, S.E. (2003). Verbal and non-verbal working memory and achievements on National Curriculum tests at 11 and 14 years of age. Educational and Child Psychology, 20, 123140.CrossRefGoogle Scholar
Lezak, M.D. (1995). Neuropsychological assessment. New York, NY: Oxford University Press.Google Scholar
Lijffijt, M., Kenemans, J.L., Verbaten, M.N., & van Engeland, H. (2005). A meta-analytic review of stopping performance in attention-deficit/hyperactivity disorder: Deficient inhibitory motor control? Journal of Abnormal Psychology, 114, 216222.CrossRefGoogle ScholarPubMed
Lindsay, J.H., Offord, D.R., Boyle, M.H., & Racine, Y.A. (1995). Factors predicting use of mental health and social services by children 6–16 years old: Findings from the Ontario Child Health Study. American Journal of Orthopsychiatry, 65, 7686.Google Scholar
Logan, G.D., & Cowan, W.B. (1994). On the ability to inhibit thought and action: A theory of an act of control. Psychological Review, 91, 295327.CrossRefGoogle Scholar
Mahone, M.E., Cirino, P.T., Cutting, L.E., Cerrone, P.M., Hagelthorn, K.M., Hiemenz, J.R., et al. . (2002). Validity of the behavior rating inventory of executive function in children with ADHD and/or Tourette syndrome. Archives of Clinical Neuropsychology, 17, 643662.CrossRefGoogle ScholarPubMed
Mahone, M.E., Martin, R., Kates, W., Hay, T., & Horska, A. (2009). Neuroimaging correlates of parent ratings of working memory in children. Journal of the International Neuropsychological Society, 15, 3141.CrossRefGoogle Scholar
Mahone, M.E., Zabel, T.A., Levey, E., Verda, M., & Kinsman, S. (2002). Parent and self-report ratings of executive function in adolescents with myelomeningocele and hydrocephalus. Child Neuropsychology, 8, 258270.CrossRefGoogle ScholarPubMed
Mangeot, S., Armstrong, K., Colvin, A.N., Yeates, K.O., & Taylor, G.H. (2002). Long-term executive function deficits in children with traumatic brain injuries: Assessment using the Behavior Rating Inventory of Executive Function (BRIEF). Child Neuropsychology, 8, 271284.CrossRefGoogle ScholarPubMed
Marsh, H.W., & Grayson, D. (1995). Latent variable models of multitrait-multimethod data. In Hoyle, R.H. (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 177198). Thousand Oaks, CA: Sage Publications, Inc.Google Scholar
McCandless, S., & O’Laughlin, L. (2007). The clinical utility of the Behavior Rating Inventory of Executive Function (BRIEF) in the Diagnosis of ADHD. Journal of Attention Disorders, 10, 381389.CrossRefGoogle ScholarPubMed
McClelland, M.M., Cameron, C.E., Connor, C.M., Farris, C.L., Jewkes, A.M., & Morrison, F.J. (2007). Links between behavioral regulation and preschoolers’ literacy, vocabulary, and math skills. Developmental Psychology, 43, 947959.CrossRefGoogle ScholarPubMed
Miyake, A., Friedman, N.P., Emerson, M.J., Witzki, A.H., & Howerter, A. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41, 49100.CrossRefGoogle ScholarPubMed
Newman, S.D., Carpenter, P.A., Varma, S., & Just, M.A. (2003). Frontal and parietal participation in problem solving in the Tower of London: fMRI and computational modeling of planning and high-level perception. Neuropsychologia, 41, 16681682.CrossRefGoogle Scholar
Niendam, T., Horwitz, J., Bearden, C., & Cannon, T. (2007). Ecological assessment of executive dysfunction in the psychosis prodrome: A pilot study. Schizophrenia Research, 93, 350354.CrossRefGoogle ScholarPubMed
Oosterlaan, J., Logan, G.D., & Sergeant, J. (1998). Response Inhibition in AD/HD, CD, Comorbid AD/HD+CD, Anxious, and control children: A meta-analysis of studies with the stop task. Journal of Child Psychology and Psychiatry, 39, 411425.Google ScholarPubMed
Owen, A.M., McMillan, K.M., Laird, A.R., & Bullmore, E. (2005). N-back working memory paradigm: A meta-analysis of normative functional neuroimaging studies. Human Brain Mapping, 25, 4659.CrossRefGoogle ScholarPubMed
Parrish, J., Geary, E., Jones, J., Seth, R., Hermann, B., & Seidenberg, M. (2007). Executive functioning in childhood epilepsy: Parent report and cognitive assessment. Developmental Medicine & Child Neurology, 49, 412416.CrossRefGoogle ScholarPubMed
Pennington, B.F., & Ozonoff, S. (1996). Executive functions and developmental psychobehavioral disruption. Journal of Child Psychology and Psychiatry, 37, 5187.CrossRefGoogle Scholar
Riccio, C.A., Homack, S., Pizzitola Jarratt, K., & Wolfe, M.E. (2006). Differences in academic and executive function domains among children with ADHD Predominantly Inattentive and Combined Types. Archives of Clinical Neuropsychology, 21, 657667.CrossRefGoogle ScholarPubMed
Ridderinkhof, K.R., van den Wildenberg, W.P.M., Segalowitz, S.J., & Carter, C.S. (2004). Neurocognitive mechanisms of cognitive control: The role of prefrontal cortex in action selection, response inhibition, performance monitoring, and reward-based learning. Brain and Cognition, 56, 129140.CrossRefGoogle ScholarPubMed
Riggs, N.R., Jahromi, L.B., Razza, R.P., Dillworth-Bart, J.E., & Mueller, U. (2006). Executive function and the promotion of social-emotional competence. Journal of Applied Developmental Psychology, 27, 300309.CrossRefGoogle Scholar
Romine, C.B., & Reynolds, C.R. (2005). A model of the development of frontal lobe functioning: Findings from a meta-analysis. Applied Neuropsychology, 12, 190201.CrossRefGoogle Scholar
Russo, N., Flanagan, T., Iarocci, G., Berringer, D., Zelazo, P.D., & Burack, J.A. (2007). Deconstructing executive deficits among persons with autism: Implications for cognitive neuroscience. Brain and Cognition, 65, 7786.CrossRefGoogle ScholarPubMed
Sanford, M.N., Offord, D.R., Boyle, M.H., Peace, A., & Racine, Y.A. (1992). Ontario child health study: Social and school impairments in children aged 6 to 16 years. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 6067.CrossRefGoogle ScholarPubMed
Schachar, R.J., Chen, S., Logan, G.D., Ornstein, T.J., Crosbie, J., Ickowicz, A., et al. . (2004). Evidence for an error monitoring deficit in attention deficit hyperactivity disorder. Journal of Abnormal Child Psychology, 32, 285293.CrossRefGoogle ScholarPubMed
Schlagmüller, M., & Schneider, W. (2002). The development of organizational strategies in children: Evidence from a microgenetic longitudinal study. Journal of Experimental Child Psychology, 81, 298319.CrossRefGoogle ScholarPubMed
Shallice, T. (1982). Specific impairments in planning. Philosophical Transcripts of the Royal Society of London, 298, 199209.Google ScholarPubMed
Smith, A.B., Taylor, E., Brammer, M., & Rubia, K. (2004). Neural correlates of switching set as measured in fast, event-related functional magnetic resonance imaging. Human Brain Mapping, 21, 247256.CrossRefGoogle ScholarPubMed
St. Clair-Thompson, H.L., & Gathercole, S.E. (2006). Executive functions and achievements in school: Shifting, updating, inhibition, and working memory. Quarterly Journal of Experimental Psychology, 59, 745759.CrossRefGoogle ScholarPubMed
Sullivan, J.R., & Riccio, C.A. (2006). An empirical analysis of the BASC Frontal Lobe / Executive Control scale with a clinical sample. Archives of Clinical Neuropsychology, 21, 495501.CrossRefGoogle ScholarPubMed
Tannock, R., Hum, M., Masellis, M., Humphries, T., & Schachar, R. (2002). Teacher telephone interview for children’s academic performance, attention, behavior, and learning: DSM-IV version (TTI-IV). Toronto, ON: The Hospital for Sick Children. Unpublished document.Google Scholar
Toplack, M.E., Bucciarelli, S.M., Jain, U., & Tannock, R. (2009). Executive functions: Performance based measures and the Behavior Rating Inventory of Executive Function (BRIEF) in adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). Child Neuropsychology, 15, 5372.CrossRefGoogle Scholar
Vriezen, E.R., & Pigott, S.E. (2002). The relationship between parental report on the BRIEF and performance-based tasks of executive function in children with moderate to severe traumatic brain injury. Child Neuropsychology, 8, 296303.CrossRefGoogle Scholar
Waber, D.P., Gerber, E.B., Turcios, V.Y., Forbes, P.W., & Wagner, E.R. (2006). Executive functions and performance on high-stakes testing in children from urban schools. Developmental Neuropsychology, 29, 459477.CrossRefGoogle ScholarPubMed
Wechsler, D. (1991). Wechsler intelligence scale for children. 3rd ed.San Antonio, TX: Harcourt Assessment.Google Scholar
Wechsler, D. (2003). Wechsler intelligence scale for children. 4th ed.San Antonio, TX: Harcourt Assessment.Google Scholar
Welsh, M. (2002). Developmental and clinical variations in executive functions. In Molfese, D.L. & Molfese, V. (Eds.), Developmental variations in learning: Applications to social, executive function, language, and reading skills (pp. 139185). Mahwah, NJ: Lawrence Erlbaum Associates Publishers.Google Scholar
Wilkinson, G.S. (1993a). Wide range achievement test 3. Wilmington, DE: Wide Range Inc.Google Scholar
Wilkinson, G.S. (1993b). Wide range achievement test 3. Administration manual. Wilmington, DE: Wide Range Inc.Google Scholar
Willcutt, E.G., Doyle, A.E., Nigg, J.T., Faraone, S.V., & Pennington, B.F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57, 13361346.CrossRefGoogle ScholarPubMed
Figure 0

Table 1. Summary of studies examining associations between parent ratings on the BRIEF and performance-based tasks of executive function

Figure 1

Table 2. Demographic variables

Figure 2

Table 3. Correlations between the BRIEF and Behavioral, Cognitive, and Academic measures

Figure 3

Table 4. Factor loadings and explained variance from the principal components analysis

Figure 4

Table 5. Regression analyses examining the relationship between the BRIEF and factors representing problem behavior, executive function, and academic ability