Confirmatory Factor Analysis of the BRIEF-2 Parent and Teacher Form: Relationship to Performance-Based Measures of Executive Functions and Academic Achievement

Carer-reported sleep disturbance and carer- and teacher-rated executive functioning in children with prenatal alcohol exposure and Fetal Alcohol Spectrum Disorder

Children with prenatal alcohol exposure (PAE) and Fetal Alcohol Spectrum Disorder (FASD) have high rates of sleep disturbance and marked difficulties with executive functioning (EF). Sleep disturbance has been associated with poorer EF across development in typically developing children. The contribution of insomnia symptoms and nightmares to EF difficulties in children with PAE and FASD is unclear. The current study examined whether caregiver-reported insomnia symptoms and nightmares predicted difficulties with EF in children with PAE who were assessed at FASD diagnostic clinics. Archival data on 116 children with PAE assessed at FASD diagnostic clinics were extracted from databases. Children were assigned to a preschool-age group (3.1 to 5.9 years, n = 40) and a school-age group (5.9 to 10.9 years, n = 76). Insomnia symptoms and nightmares were measured using items extracted from the Child Behavior Checklist (CBCL) while EF was measured using the caregiver and teacher Behavior Rating Inventory of Executive Function (BRIEF) rating forms. Bootstrapped regression models were used examine the effects of insomnia symptoms and nightmares on domains of EF in each group while adjusting for potential confounds. For preschool children, insomnia symptoms were associated with greater daytime tiredness while nightmares were associated with greater difficulties with Emergent Metacognition according to their teachers. For school-age children, insomnia symptoms predicted greater EF difficulties across most domains according to their caregivers but not teachers. Sleep disturbance may compound EF impairments in children with PAE and should be screened for as part of FASD diagnostic assessment.

Evaluation instruments for executive functions in children and adolescents: an update of a systematic review

INTRODUCTION

The aim of this study is to update a systematic review of instruments for evaluating the executive functions (EFs) in a pediatric population to assess their measurement properties.

AREA COVERED

Studies describing evaluation tools of EFs were systematically searched on four electronic databases: PubMed, EBSCO, Scopus, and Web of Science. To be included studies had to be on a population aged 0 to 18 were included. The individuals were either healthy or presented a neurodevelopment disorder. Risk of Bias was evaluated through the Consensus-based Standards to select the health Measurement Instruments (COSMIN).

EXPERT OPINION

The search was conducted on April 2023. Eighty-four papers met the inclusion criteria and were included in the study; the studies refer to 72 different evaluation tools of EFs. Most of the studies analyzed through a methodological quality analysis received an 'adequate' score. The instrument most mentioned was the Behavior Rating Inventory of Executive Function-2 (BRIEF2) in seven articles.

Psychometric properties of the Behavior Rating Inventory of Executive Function, second edition (BRIEF2) self-report form in Iranian adolescents

BACKGROUND

This study investigated the psychometric properties of a Persian translation of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) Self-Report form.

METHOD

Participants were 589 typically developing adolescents (336 girls and 253 boys), ages 11-18 years old (M = 15.16; SD = 2.04), in Iran. They completed the Persian version of the BRIEF2 Self-Report form and Teenage Executive Functioning Inventory (TEXI). The Persian translated BRIEF2 psychometric properties were examined via internal consistency, test-retest reliability, convergent validity via associations with TEXI scores, and internal structure using structural equation modeling (SEM) to evaluate fit of the three-factor structure from the original English version BRIEF2.

RESULTS

Findings indicated the Persian version of BRIEF2 Self-Report form yielded scores with robust reliability, with internal consistency ranging from .87 to .93 and test-retest correlations ranging from .89 to .96, and adequate convergent validity, with correlations with the TEXI ranging from .48 to .79. SEM revealed that a three-factor solution was the best fitting model for the seven subscales of the Persian BRIEF2.

CONCLUSION

These findings support the clinical use of the Persian BRIEF2 in Iranian adolescents, including the interpretation of the BRIEF2 three-factor structure, as well as the multidimensional nature of executive functions.

Use of the Weekly Calendar Planning Activity to Assess Executive Function in Adolescents With Autism Spectrum Disorder

IMPORTANCE

Youths with autism spectrum disorder (ASD) have challenges with executive function (EF). However, there are few measures to objectively assess EF, such as time management and prioritization. The Weekly Calendar Planning Activity (WCPA) is a promising performance-based EF measure that has rarely been used with youths with ASD.

OBJECTIVE

To characterize the performance of youths with ASD on the WCPA and the association of WCPA performance with caregiver-rated EF.

DESIGN

Observational and summary data obtained during a baseline evaluation for a research study.

SETTING

Middle school.

PARTICIPANTS

Thirty-nine adolescents with ASD and without an intellectual disability.

METHOD

Youth were administered the WCPA; caregivers completed EF ratings. Descriptive statistics characterized WCPA performance. Correlations between WCPA scores and age, IQ, and EF ratings were computed.

RESULTS

The majority of youth performed poorly on the WCPA and lacked insight into their poor performance. Many struggled to enter appointments. Appointment accuracy was <30%. The most common errors were location errors. Appointment accuracy and planning time were moderately associated with IQ but not with caregiver-rated EF or age.

CONCLUSIONS AND RELEVANCE

Overall, the WCPA was cognitively demanding for youths with ASD without an intellectual disability. These results have implications for using evidence-based strategies to teach adolescents with ASD how to manage their time and plan and prioritize homework assignments, upcoming tests or quizzes, and extracurricular activities. Plain-Language Summary: Youths with autism spectrum disorder have significant problems with executive function, particularly organization, prioritization, time management, and planning. There are few objective, performance-based measures of executive function, especially those that can be used with autistic youths. To our knowledge, this study is the first to use the Weekly Calendar Planning Activity (WCPA) with autistic adolescents who do not have an intellectual disability. The WCPA captured their deficits related to executive function and could be a useful tool for assessment and treatment planning.

Prevalence, comorbidities, and profiles of neurodevelopmental disorders according to the DSM-5-TR in children aged 6 years old in a European region

Background

There are no studies that measure the prevalence and real comorbidities of neurodevelopmental disorders (NDDs) according to the DSM-5-TR in 6-year-old children in population and clinical samples or studies that measure them as a whole. The data on the prevalence of these disorders are usually disparate because of the estimation methods (direct/indirect), the type of sample (population/clinical/school), and the ages studied.

Methods

The initial sample (289 subjects) was representative of 6-year-old children in the entire population of Menorca, obtained from pediatric primary care services (100% of the sample). The patients were divided into two groups based on the criterion of verification of clinical warning signs. One of the groups represented the clinical or experimental sample (EG) (81 subjects) at risk of NDDs; the other group was considered the control sample (CG) (210 subjects), and they were subjects without risk of suffering NDDs. A direct clinical assessment of the clinical sample was carried out, and they were administered the Wechsler Intelligence Scale for Children (WISC-V), the Clinical Evaluation of Language Fundamentals (CELF-5), the Battery for the evaluation of the processes of revised reading (Batería para la evaluación de los procesos de lectura revisada - PROLEC-R), the Test for the Diagnosis of Basic Mathematical Competences, (TEDI-MATH), and the Developmental Coordination Disorder Questionnaire (DCDQ).

Results

A total of 21.5% of the initial sample suffered from an NDD. A total of 2.4% presented autism spectrum disorder (ASD); 14% presented attention-deficit hyperactivity disorder (ADHD); 0.34% presented mild intellectual disability; 9.54% presented communication disorder (CD) (5.8% language disorder, 3.4% phonological disorder, and 0.34% stuttering); 10% presented learning disorder with reading difficulties; 5.8% presented learning disorder with difficulties in writing; 3.11% presented learning disorder with difficulties in mathematics; 1% presented transitory tic disorder; 0.34% presented chronic tic disorder; 1% presented Tourette syndrome; 2% presented motor coordination disorder (MCD); and 0.34% presented stereotypic movement disorders. Male children were more affected than female children in general, with male/female ORs of 0.14/0.92 for the presence of comorbidities, 0.11/0.88 for combined ADHD, 0.06/0.87 for language disorder, 1.02/1.27 for MCD, and 1.39/1.02 for inattentive ADHD.

Conclusion

In disadvantaged contexts, there was a higher prevalence of NDDs and comorbidities, unless the disorder was extreme, in which case only the NDD manifestations were presented. A significant proportion of the sample had not been previously diagnosed (88.6%); therefore, early detection programs are recommended to identify warning signs and develop policies that help and support the most disadvantaged sectors of the population.

Factor structure and measurement invariance of the BRIEF2 Parent Form across gender in a Portuguese sample

This study aimed to investigate the factor structure and the measurement invariance across gender of the BRIEF2 Parent Form in Portuguese typically developing children. Participants were 700 typically developing children (n = 352 girls and n = 348 boys) aged 6-16 years. Confirmatory factor analysis was used to test five competing factor models. Consistent with the BRIEF2 original dimensional structure, the three-factor model demonstrated the most adequate fit to the data. The measurement invariance of the three-factor model across gender was supported (configural, metric, and partial scalar invariance). Overall, the BRIEF2 Parent Form showed adequate psychometric properties, suggesting that it is a useful instrument to assess everyday executive functioning based on reports of behaviors observed by parents in healthy Portuguese children.

Variability Across Caregiver and Performance-Based Measures of Executive Functioning in an Acute Pediatric Neurocritical Care Population

Youth admitted to the pediatric intensive care unit (PICU) for traumatic brain injury (TBI) commonly struggle with long-term residual effects in the domains of physical, cognitive, emotional, and psychosocial/family functioning. In the cognitive domain, executive functioning (EF) deficits are often observed. The Behavior Rating Inventory of Executive Functioning, Second Edition (BRIEF-2) is a parent/caregiver-completed measure that is regularly utilized to assess caregivers' perspectives of daily EF abilities. Using parent/caregiver-completed measures like the BRIEF-2 in isolation as outcome measures for capturing symptom presence and severity might be problematic given that caregiver ratings are vulnerable to influence from external factors. As such, this study aimed to investigate the association between the BRIEF-2 and performance-based measures of EF in youth during the acute recovery period post-PICU admission for TBI. A secondary aim was to explore associations among potential confounding factors, including family-level distress, injury severity, and the impact of pre-existing neurodevelopmental conditions. Participants included 65 youths, 8-19 years of age, admitted to the PICU for TBI, who survived hospital discharge and were referred for follow-up care. Non-significant correlations were found between BRIEF-2 outcomes and performance-based measures of EF. Measures of injury severity were strongly correlated with scores from performance-based EF measures, but not BRIEF-2. Parent/caregiver-reported measures of their own health-related quality of life were related to caregiver responses on the BRIEF-2. Results demonstrate the differences captured by performance-based versus caregiver-report measures of EF, and also highlight the importance of considering other morbidities related to PICU admission.

A Validation Study of the BRIEF-2 Among Kindergarteners and First Graders At-Risk for Behavior Problems

Early identification of executive dysfunction and timely school-based intervention efforts are critical for students at risk for problematic behaviors during early elementary school. The original Behavior Rating Inventory of Executive Functioning (BRIEF) was designed to measure real-world behavioral manifestations of executive functioning, neurocognitive processes critical for school success. With the updated BRIEF-2, independent validation is needed with kindergarten and first grade students at risk for emotional and behavioral disorders. Thus, using item level analyses, we examined the factor structure of the BRIEF-2 Teacher Rating form with 1,112 students. Results indicated little evidence for the original three-index model and supported a modified two-index model, with a Cognitive Regulation Index and an overall Behavior-Emotion Regulation Index. Criterion related validity indicated positive relationships with performance-based executive functioning (Head-Toes-Knees-Shoulders) and later internalizing and externalizing behaviors. We discuss implications of findings for early identification and school-based intervention efforts, as well as future research.

Changes in executive function in pediatric brain tumor survivors

OBJECTIVE

Pediatric oncology survivors are at risk for executive function (EF) and working memory (WM) deficits, which can be measured via performance-based measures or rating scales. Previous studies have shown these measurement methods to be weakly correlated. This study aimed to describe parent-rated EF and performance-based WM (PBWM) in pediatric brain tumor (BT) survivors, examine change in EF and PBWM across time, and investigate the relationship between parent-rated WM and PBWM.

METHOD

The sample included 56 patients diagnosed with a BT in childhood (M_age  = 6.94 years; SD = 4.05) seen twice for clinical neuropsychological evaluation. PBWM was examined via the auditory WM scale from a Wechsler intelligence measure or Differential Ability Scales-II. Parents completed the Behavior Rating Inventory of Executive Function (BRIEF)/BRIEF-P/BRIEF-2 as a measure of global EF (Global Executive Composite [GEC]), metacognitive skills (Metacognitive Index/Cognitive Regulation Index [MI/CRI]), behavioral regulation (Behavior Regulation Index [BRI]), and emotional regulation (Emotion Regulation Index [ERI]).

RESULTS

GEC, MI/CRI, and ERI at Time 1 were significantly above the mean (p < .01); BRI and PBWM did not differ from the normative mean. All measures were significantly higher than the normative mean at Time 2 (p < .05). PBWM was both clinically and statistically elevated (p < .001). There was a significant change across time in PBWM (p < .05), but not GEC, MI/CRI, ERI, or BRI. PBWM was weakly correlated with the BRIEF WM subscale at Time 1 and Time 2 (all p > .05).

CONCLUSIONS

Multiple measures of EF should be considered when providing diagnoses and recommendations for pediatric BT survivors. Furthermore, given declines across time, findings document need for continued monitoring and reassessment of survivors as they get further out from treatment.

Impact on Executive Dysfunctions of Gamification and Nongamification in Playing Board Games in Children at Risk of Social Exclusion

Objective: Modern board and card game-based cognitive interventions and gamification practices showed effectiveness in boosting executive functions and decreasing behavioral problems in children. However, the combination of both game-based methods has not been tested. Therefore, the main aim of this study was to test the effectiveness of gamification in modern board and card game-based cognitive interventions in Spanish schoolchildren at risk of social exclusion. Materials and Methods: In this multicenter single-blind study with a quasi-experimental design, 176 schoolers (6-13 years old) were assigned to a gamified group (with a narrative context and a rewarding system) and 107 to a nongamified group (with no narrative context or rewarding system). The interventions were implemented in regular classes. Behavioral executive dysfunction was assessed using the Behavior Rating Inventory of Executive Function, Second Revision (BRIEF-2) (Teacher form), pre- and postintervention. Results: We found significant time effects in all BRIEF-2 domains with small and medium effect sizes (d = -0.35 to d = -0.62). The nongamified group showed significantly higher decreases in all measures than those who used gamification. Conclusions: It is possible that playing for the joy of playing in the nongamified group was enough motivation to focus on the task, while adding gamification elements did not favor greater effectiveness of the program.

The dimensionality of the Behavior Rating Inventory of Executive Function, Second Edition in a clinical sample

The parent-report Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) is a widely used pediatric neuropsychological measure. Unfortunately, despite meaningful changes from its predecessor, few studies have examined its internal factor structure (now with Behavioral Regulation [BRI], Emotion Regulation [ERI], and Cognitive Regulation [CRI]), and no available literature has investigated higher order models for the BRIEF-2. This study sought to address this shortcoming in the literature by investigating and reporting on the dimensionality of the parent-report BRIEF-2 in a clinical sample. Two hundred and two (202) pediatric neuropsychology examinees (M age = 9.90; 68% males) with complete data for the parent-report BRIEF-2 were included. Descriptive results revealed generally elevated scores across BRIEF-2 scales (Global Executive Composite M T = 70.16). Exploratory factor analyses suggested two factors (CRI and BRI/ERI) should be extracted, and that higher order models should be considered. Confirmatory factor analyses suggested that a direct hierarchical/bifactor two-factor structure (which was more parsimonious than the theoretical three-factor model) provided the best fit, with a bulk of the variance explained by the general GEC factor. The BRIEF-2 may be best interpreted at the overall level, with relatively less weight given to the index variables, particularly within clinical samples with high levels of reported executive functioning difficulties. Implications of these findings, limitations of the present study, and appropriate directions for future inquiry were discussed.

The Childhood Executive Functioning Inventory (CHEXI) Parent and Teacher Form: Factor Structure and Cognitive Correlates in Spanish-speaking Children from Argentina

The aims of the present study were: (1) to explore the CHEXI factor structure parent (n = 183) and teacher (n = 206) forms in Spanish-speaking children aged 6 to 11  years, (2) to analyze the relationship between parent- and teacher-rated data and performance-based measures of EF (including working memory, inhibition, and cognitive flexibility tasks) and academic achievement and (3) to examine the association between parents and teachers reports. Confirmatory Factor analysis (CFA) showed that the two-factor model including (1) Working memory and (2) Inhibition best fit the data. McDonald's Omega coefficient was adequate for both the total parents (ω = .98). and teachers' (ω = .98) scales. In addition, low and selective associations were found between performance and rater-based assessments. However, stronger associations were observed between CHEXI and academic performance with differences according to the informant (parents vs. teachers). Finally, low correlations were found between parents and teachers reports. Taken together, our results suggest that the CHEXI is a reliable measure to assess EF in Argentinean Spanish-speaking children, supporting existing evidence that proposes that ratings and performance-based measures would assess different underlying mental constructs. Clinical and educational implications for considering both perspectives during neuropsychological assessment, further including parent- and teacher-rated reports are discussed.

Dimensional structure of the BRIEF2 and its relations with ADHD symptoms and task performance on executive functions in Chinese children

This study examined the dimensional structure of the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) in a Chinese sample of children with attention-deficit/hyperactivity disorder (ADHD)-related concerns and the correlations of the BRIEF2 with the children's ADHD symptoms and their performance on executive function (EF) tasks. Participants were 339 Chinese children aged 6-15 (M = 9.18 years, SD = 2.33; boys: 78.2%) recruited from 35 schools in Hong Kong. The results from confirmatory factor analyses revealed the best fit for a three-factor nine-scale model compared to a two-factor or single-factor model. Significant correlations were found between the BRIEF2 parent and teacher forms for the Behavioral Regulation Index and Cognitive Regulation Index, but not for the Emotion Regulation Index. Associations between performance on an EF task and the rating of the corresponding subscale on the BRIEF2 purportedly measuring the same EF construct were not consistently observed. Lastly, the BRIEF2 showed good convergent validity with the ratings of ADHD symptoms on the Swanson, Nolan, and Pelham Rating Scale Version IV (SNAP-IV). This study provided plausibly the first evidence on the dimensional structure of the BRIEF2 Parent and Teacher Forms in an Asian sample and confirmed the factorial validity of the Chinese version of the BRIEF2.