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A mild traumatic brain injury (TBI) constitutes the overwhelming majority of brain injury cases in children and adolescents. This article focuses on cerebral concussion, which can be viewed as a subset of mild TBI, which, until recently, has received limited attention in the pediatric assessment literature. Few extant measures appropriate to this condition in the developing child are available. A broadband approach to the assessment and management of concussion in children is presented, stressing the unique goals of the pediatric postinjury evaluation and treatment process in returning to home life, school, and sports/recreation. This approach calls for standardized assessment using diverse methods that tap multiple domains of the child's functioning, gathering input from key respondents across settings. Neuropsychological testing, together with structured symptom rating scales, provides a multilevel view of the effects of the concussion on the child. Structured data obtained with standardized methods from multiple sources provide more reliable and ecologically valid information to facilitate interventions in the child's key home and school environments. New pediatric assessment measures are presented, providing clinicians with tools to assess and manage this injury effectively. Two clinical cases highlight the use of the battery in guiding recovery. Continued research on the broadband concussion assessment model is needed. [ABSTRACT FROM AUTHOR]

OBJECTIVES: A dearth of standardized assessment tools exists to properly assess and triage mild traumatic brain injury (mTBI) in primary care and acute care settings. This article presents evidence of appropriate psychometric properties for the Acute Concussion Evaluation (ACE), a new structured clinical interview. PARTICIPANTS: Parent informants of 354 patients, aged 3 to 18 years, with suspected mTBI completed the ACE via telephone interview. MEASURE: Acute Concussion Evaluation. RESULTS: Evidence is presented for appropriate item-scale membership, internal consistency reliability as well as content, predictive, convergent/divergent, and construct validity of the ACE symptom checklist. CONCLUSIONS: Overall, the ACE symptom checklist exhibits reasonably strong psychometric properties as an initial assessment tool for mTBI. [ABSTRACT FROM AUTHOR]

A substantial number of children in foster care exhibit psychiatric difficulties. Recent epidemiological and historical trends in foster care, clinical findings about the adjustment of children in foster care and adult outcomes are reviewed, followed by a description of current approaches to treatment and extant empirical support. Available interventions for these children can be categorized as either symptom-focused or systemic, with empirical support for specific methods ranging from scant to substantial. Even with treatment, behavioral and emotional problems often persist into adulthood resulting in poor functional outcomes. We suggest that self-regulation may be an important mediating factor in the appearance of emotional and behavioral disturbance in these children. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To (a) identify post-concussion symptom scales appropriate for children and adolescents in sports; (b) review evidence for reliability and validity; and (c) recommend future directions for scale development. DESIGN: Quantitative and qualitative literature review of symptom rating scales appropriate for children and adolescents aged 5 to 22 years. INTERVENTION: Literature identified via search of Medline, Ovid-Medline and PsycInfo databases; review of reference lists in identified articles; querying sports concussion specialists. 29 articles met study inclusion criteria. RESULTS: 5 symptom scales examined in 11 studies for ages 5-12 years and in 25 studies for ages 13-22. 10 of 11 studies for 5-12-year-olds presented validity evidence for three scales; 7 studies provided reliability evidence for two scales; 7 studies used serial administrations but no reliable change metrics. Two scales included parent-reports and one included a teacher report. 24 of 25 studies for 13-22 year-olds presented validity evidence for five measures; seven studies provided reliability evidence for four measures with 18 studies including serial administrations and two examining Reliable Change. CONCLUSIONS: Psychometric evidence for symptom scales is stronger for adolescents than for younger children. Most scales provide evidence of concurrent validity, discriminating concussed and non-concussed groups. Few report reliability and evidence for validity is narrow. Two measures include parent/teacher reports. Few scales examine reliable change statistics, limiting interpretability of temporal changes. Future studies are needed to fully define symptom scale psychometric properties with the greatest need in younger student-athletes. [ABSTRACT FROM AUTHOR]

The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a standardized rating scale of subjective executive functioning. We provide univariate and multivariate base rates (BRs) for scale/index scores in the clinical range ( T scores ≥65), reliable change, and inter-rater information not included in the Professional Manual . Participants were adults (ages = 18-90 years) from the BRIEF-A self-report ( N = 1,050) and informant report ( N = 1,200) standardization samples, as well as test-retest ( n = 50 for self, n = 44 for informant) and inter-rater ( n = 180) samples. Univariate BRs of elevated T scores were low (self-report = 3.3%-15.4%, informant report = 4.5%-16.3%). Multivariate BRs revealed the common occurrence of obtaining at least one elevated T -score across scales (self-report = 26.5%-37.3%, informant report = 22.7%-30.3%), whereas virtually none had elevated scores on all scales. Test-retest scores were highly correlated (self = .82-.94; informant = .91-.96). Inter-rater correlations ranged from .44 to .68. Significant ( p < .05) test-retest T -score differences ranged from 7 to 12 for self-report, from 6 to 8 for informant report, and from 16 to 21 points for inter-rater T -score differences. Applications of these findings are discussed.

Objective: To evaluate whether fenfluramine (FFA) is associated with improvement in everyday executive function (EF)-self-regulation-in preschool-aged children with Dravet syndrome (DS)., Methods: Children with DS received placebo or FFA in one of two phase III studies (first study: placebo, FFA 0.2 mg/kg/day, or FFA 0.7 mg/kg/day added to stiripentol-free standard-of-care regimens; second study: placebo or FFA 0.4 mg/kg/day added to stiripentol-inclusive regimens). Everyday EF was evaluated at baseline and Week 14-15 for children aged 2-4 years with parent ratings on the Behavior Rating Inventory of Executive Function®-Preschool (BRIEF®-P); raw scores were transformed to T-scores and summarized in Inhibitory Self-Control Index (ISCI), Flexibility Index (FI), Emergent Metacognition Index (EMI), and Global Executive Composite (GEC). Clinically meaningful improvement and worsening were defined using RCI ≥ 90% and RCI ≥ 80% certainty, respectively. The associations between placebo vs FFA combined (0.2, 0.4, and 0.7 mg/kg/day) or individual treatment groups and the likelihood of clinically meaningful change in BRIEF®-P indexes/composite T-scores were evaluated using Somers'd; pairwise comparisons were calculated by 2-sided Fisher's Exact tests (p ≤ 0.05) and Cramér's V., Results: Data were analyzed for 61 evaluable children of median age 3 years (placebo, n = 22; FFA 0.2 mg/kg/day, n = 15; 0.4 mg/kg/day [with stiripentol], n = 10; 0.7 mg/kg/day, n = 14 [total FFA, n = 39]). Elevated or problematic T-scores (T ≥ 65) were reported in 55% to 86% of patients at baseline for ISCI, EMI, and GEC, and in ∼33% for FI. Seventeen of the 61 children (28%) showed reliable, clinically meaningful improvement (RCI ≥ 90% certainty) in at least one BRIEF®-P index/composite, including a majority of the children in the FFA 0.7 mg/kg/day group (9/14, 64%). Only 53% of these children (9/17) also experienced clinically meaningful reduction (≥50%) in monthly convulsive seizure frequency, including 6/14 patients in the FFA 0.7 mg/kg/day group. Overall, there were positive associations between the four individual treatment groups and the likelihood of reliable, clinically meaningful improvement in all BRIEF®-P indexes/composite (ISCI, p = 0.001; FI, p = 0.005; EMI, p = 0.040; GEC, p = 0.002). The FFA 0.7 mg/kg/day group showed a greater likelihood of reliable, clinically meaningful improvement than placebo in ISCI (50% vs 5%; p = 0.003), FI (36% vs 0%; p = 0.005), and GEC (36% vs 0%; p = 0.005). For EMI, the FFA 0.7 mg/kg/day group showed a greater likelihood of reliable, clinically meaningful improvement than the FFA 0.2 mg/kg/day group (29% vs 0%; p = 0.040), but did not meet the significance threshold compared with placebo (29% vs 5%; p = 0.064). There were no significant associations between treatment and the likelihood of reliable, clinically meaningful worsening (p > 0.05)., Significance: In this preschool-aged DS population with high baseline everyday EF impairment, FFA treatment for 14-15 weeks was associated with dose-dependent, clinically meaningful improvements in regulating behavior, emotion, cognition, and overall everyday EF. These clinically meaningful improvements in everyday EF were not entirely due to seizure frequency reduction, suggesting that FFA may have direct effects on everyday EF during the early formative years of neurodevelopment., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Bishop is Principal Consultant for Global Pharma Consultancy, LLC, which has received consultancy fees from Zogenix for research support; Dr. Isquith and Dr. Gioia are Associate Consultants for Global Pharma Consultancy, LLC, which has received consultancy fees from Zogenix for research support, and have received royalties from Psychological Assessment Resources (PAR, Inc.) for sale of the BRIEF® instruments; Dr. Knupp received research grants during the conduct of the study from Zogenix and the Pediatric Epilepsy Research Foundation, and outside the submitted work received research grants from the Colorado Department of Public Health and West Therapeutics and was a DSMB member for Greenwich Pharmaceuticals; Dr. Scheffer received compensation from Zogenix during the conduct of the study; personal fees from GlaxoSmithKline, Eisai, BioMarin, Nutricia, and Xenon Pharmaceuticals outside the submitted work; research funding from the National Health and Medical Research Council, Health Research Council of New Zealand, and National Institutes of Health; personal fees and other compensation from UCB; and other compensation with Zynerba Pharmaceuticals, GW Pharmaceuticals, Ovid Therapeutics, Marinus, and Ultragenyx; Dr. Nabbout received research support from Eisai, GW Pharma, UCB, and Zogenix; served as a consultant/advisor for Eisai, Biogen, GW Pharma, Novartis, Shire, and Zogenix; and served in a speaker role for Advicenne, Eisai, BioMarin, GW Pharma, Novartis, and Zogenix; Dr. Specchio has received consulting fees from Zogenix and support from LivaNova, BioMarin; she has served as a paid consultant for LivaNova; Dr. Sullivan received research grants from Zogenix (with travel support), Stoke, Marinus, and Biopharm; has served as a consultant/advisor for the Dravet Syndrome Foundation, Epygenix, Encoded, GW Pharma, Asceneuron, Longboard Pharmaceuticals, Knopp Biosciences, and Neurocrine; as a reviewer for the Epilepsy Study Consortium; and has stock options in Epygenix; Dr. Auvin has received personal fees from Arvelle, Biocodex, GW Pharma, and Xenon; personal fees and nonfinancial support from Biomarin, GW Pharma, and Nutricia; personal fees/grants from Eisai and UCB Pharma for work as an investigator; and research support from Zogenix; Dr. Cross received grants from Zogenix, Marinus, GW Pharma, Vitaflo, the National Institute of Health Research (NIHR), EPSRC, GOSH Charity, ERUK, the Waterloo Foundation, and the Great Ormond Street Hospital Biomedical Research Centre; she has been a consultant/advisor for Zogenix and GW Pharma, for which remuneration was made to the department outside of the submitted work; chair of the Medical Board for DravetUK, Hope for Hypothalamic Hamartoma, and Matthew’s Friends; supported by the NIHR Biomedical Research Centre at Great Ormond Street Hospital; endowed chair at UCL Great Ormond Street Institute of Child Health; Dr. Guerrini received research grants from Zogenix during the conduct of the study and received personal fees as a speaker or consultant from Zogenix outside the submitted work; he has served as an investigator for studies with Biocodex, UCB, Angelini, and Eisai Inc, and as a speaker/advisory board member for Biocodex, Novartis, Biomarin, and GW Pharma outside the submitted work; Dr. Gammaitoni, Dr. Galer, and Dr. Farfel were employees of and had ownership interest in Zogenix at the time of the study., (Copyright © 2022 UCB. Published by Elsevier Inc. All rights reserved.)

There is a paucity of research examining multivariate base rates (MBRs) of elevated scores in pediatric rating scales of cognition. We present novel MBR information on the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) for several clinical groups: Attention-Deficit/Hyperactivity Disorder Combined Presentation (ADHD-C); ADHD Inattentive Presentation (ADHD-I); Autism Spectrum Disorder (ASD); and Specific Learning Disorder with impairment in Reading (SLD-R). Participants included children diagnosed as having ADHD-C ( n  = 350), ADHD-I ( n  = 343), ASD ( n  = 390), or SLD-R ( n  = 240). Cumulative MBRs (e.g., the % of a sample having one or more elevated scores) were examined for each BRIEF2 form (Parent, Teacher, and Self-Report) and at three T -score cutoffs ( T  ≥ 60, T  ≥ 65, and T  ≥ 70). The MBR of obtaining at least one elevated score was common across clinical groups and forms at T  ≥ 60 (ADHD-C = 90.5-98.1%; ADHD-I = 83.9-98.7%; ASD = 90.3-96.9%, SLD-R = 60.0-78.4%), T  ≥ 65 (ADHD-C = 66.7-97.2%; ADHD-I = 77.5-94.9%; ASD = 77.3-92.7%; SLD-R = 38.5-64.0%), and T  ≥ 70 (ADHD-C = 52.4-89.4%; ADHD-I = 64.8-84.2%; ASD = 54.5-83.2%; SLD-R = 26.9-44.1%). MBRs appeared to differ as a function of group (ADHD-C > ADHD-I > ASD > SLD-R) and form (Parent > Teacher > Self-Report) though future research with well-defined samples is needed to investigate this. We provide novel MBR information to enhance clinical interpretation of BRIEF2 data.

The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2) is a standardized rating (self, parent, and teacher) scale of executive functioning in children and adolescents. Here, we provide multivariate base rate (MBR) information (for the Self, Parent, and Teacher forms), which is not included in the BRIEF2 Professional Manual . Participants were children and adolescents for the BRIEF2 Self-Report (ages = 11-18; N = 803), Parent-Report (ages = 5-18; N = 1,400), and Teacher-Report (ages = 5-18; N = 1,400) standardization samples. We focused on cumulative (e.g., % of sample with one or more elevated scores) MBRs across scales, which were examined at three elevation levels on each form: T ≥ 60, ≥65, and ≥70. Across forms, MBRs predictably decreased with increasing number of elevated scores and at higher cutoffs. The cumulative MBR of having at least one score at T ≥ 60 was common (37.5-42.2%), but less frequent at T ≥ 70 (15.4-17.4%). The probability of having elevated scores on all scales was very low, irrespective of form, age, or elevation threshold ( T ≥ 60 = 2.4-4.4%; T ≥ 65 = 1.0-1.4%; T ≥ 70 = 0.0-0.7%). There was no clinically meaningful relation between demographic factors (age, gender, race, and parental education) and MBRs. These data provide clinicians and researchers with an enhanced way of concurrently interpreting multiple BRIEF2 scales.

Objective: Individuals with Dravet syndrome (DS) experience frequent pharmacoresistant seizures beginning in infancy. Most exhibit poor neurodevelopmental outcomes including motor function difficulties, behavior problems, and cognitive impairment. Cognitive deficits in children with DS have been associated with seizure frequency and antiseizure medication (ASM) use. Recent research in children and young adults with DS has begun to examine the role of executive functions (EFs), as these include higher-order cognitive functions and may mediate the relationship between risk factors and cognitive impairment. Current conceptualizations, however, of EFs involve the broader self-regulation of cognitive, behavioral, and emotional domains. We explored relationships between reduction in convulsive seizure frequency and everyday EFs in a subset of children and young adults with DS treated with adjunctive fenfluramine for 1 year., Methods: This is a post-hoc analysis of data from children and young adults with Dravet syndrome aged 5-18 years who participated in a phase 3 randomized, placebo-controlled clinical trial (core study) followed by completion of at least 1 year of fenfluramine treatment in an open-label extension (OLE) study. Eligible children and young adults started the OLE study at 0.2 mg/kg/day fenfluramine and were titrated to optimal seizure control and tolerability (maximum daily dose: 26 mg/day). Parents/caregivers documented convulsive seizure frequency per 28 days (i.e., monthly convulsive seizure frequency [MCSF]) by electronic diary. A parent/caregiver for each child also completed the Behavior Rating Inventory of Executive Function (BRIEF®) parent form, a questionnaire capturing parents'/caregivers' perceptions of everyday EF that was included as a safety measure to assess treatment-related adverse effects on EF during the trial. Ratings on BRIEF® were mapped to the current edition, the BRIEF®2 parent form, and were used to calculate T-scores for the Behavior Regulation Index (BRI), Emotion Regulation Index (ERI), Cognitive Regulation Index (CRI), and Global Executive Composite (GEC). Change in BRIEF®2 T-scores from baseline in the core study to Year 1 of the OLE study was calculated. Spearman's rho correlation coefficients assessed associations between change in BRIEF®2 indexes/composite T-scores and percentage change in MCSF. Children and young adults were divided into 2 groups based on percentage of MCSF reduction achieved from pre-randomization baseline in the core study to Year 1 of the OLE study: <50% and ≥50% MCSF reduction. Changes in the distribution of BRIEF®2 indexes/composite T-scores were compared between MCSF reduction groups using Mann-Whitney U tests. The proportions of children and young adults in these groups who showed clinically meaningful improvement in everyday EF, defined as Reliable Change Index (RCI) values ≥95% certainty relative to a reference population of neurotypically developing healthy volunteers, were then assessed by cross-tabulations and Somers' D tests (p ≤ 0.05). When there was a significant meaningful improvement in an index score, post-hoc analyses using the same statistical methods were conducted to evaluate the individual BRIEF®2 scales composing that index. Supplemental analyses examined the proportions of patients in MCSF reduction groups <25% and ≥75% who achieved clinically meaningful improvement or worsening in everyday EF using RCI values ≥95% certainty and ≥80% certainty, respectively, relative to the reference population., Results: At the time of analysis, 58 children and young adults (mean age: 11 ± 4 years) had reached OLE Year 1 of fenfluramine treatment with a 75% median percentage reduction in seizure frequency from pre-randomization baseline. Overall, there was a significant correlation between change in MCSF and change in BRIEF®2 T-scores for ERI (p = 0.008), but not for BRI, CRI, or GEC (p > 0.05). At OLE Year 1, 78% (n = 45) of total children/young adults had ≥50% MCSF reduction (50% [n = 29] achieved ≥75% MCSF reduction) and 22% (n = 13) of total children/young adults had <50% MCSF reduction (12% [n = 7] showed <25% MCSF reduction). The ≥50% MCSF reduction group was significantly more likely to achieve clinically meaningful improvement (RCI ≥ 95% certainty) in ERI (p = 0.002) and in CRI (p = 0.001) than the <50% MCSF reduction group. There were no significant differences in the proportions of children and young adults in the 2 MCSF reduction groups showing clinically meaningful worsening (RCI ≥ 80% certainty) on the BRIEF®2 indexes/composite., Significance: In children and young adults with DS, the magnitude of reduction in MCSF after long-term treatment with adjunctive fenfluramine was associated with clinically meaningful levels of improvement in everyday EF. Seventy-eight percent (78%) of children and young adults treated with adjunctive fenfluramine for 1 year in the OLE study achieved ≥50% reduction in MCSF, for a magnitude of efficacy associated with a significantly greater likelihood of experiencing clinically meaningful improvement in emotion regulation and cognitive regulation., (Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.)

Executive function (EF) difficulties are a core neuropsychological feature of pediatric epilepsy, and parent-report measures of EF concerns are an important complement to task-based EF measures. The Behavior Rating Inventory of Executive Function (BRIEF) has shown sensitivity to parent-reported EF concerns in epilepsy and other pediatric populations. We compared profiles of parent-reported EF concerns using the BRIEF and its revision, the BRIEF2, in 117 pediatric patients with focal onset epilepsy to examine the clinical utility of the revised scale. We then compared BRIEF2 profiles between patients and age- and gender-matched healthy controls. Among patients, profiles on the BRIEF did not globally differ from the BRIEF2, and agreement was very good across scales. Patients and controls differed significantly on the BRIEF2, with patients showing higher EF difficulties reported by parents across most scales. High rates of clinical elevation among patients emerged on the Task Monitor, Plan/Organize, Working Memory, and Shift scales. Younger age of epilepsy onset, chronic epilepsy, and right hemisphere seizure focus were associated with higher parent-reported EF concerns. Findings suggest that the BRIEF2 demonstrates similar performance to the BRIEF among pediatric patients with focal onset epilepsy who are most at risk in the areas of task monitoring, working memory, planning and organization, and flexibility. These findings are informative when comparing literature across versions and provide additional insight into the nature of parent-reported EF difficulties among children with focal onset epilepsy.

Objective: The aim is to investigate the everyday executive function (EF) in children with Tourette syndrome (TS), Inattentive or Combined presentations of ADHD (ADHD-I/ADHD-C), autism spectrum disorders (ASD), and typically developing children (TDC)., Method: Nineteen TS, 33 ADHD-C, 43 ADHD-I, 34 ASD, and 50 TDC participated (8-17 years). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF)., Results: TS, ADHD-C, ADHD-I, or ASD were rated with significantly more regulation problems on all scales compared with TDC. Considerable overlap of symptoms between clinical groups made differentiation difficult on individual scales. Scale configurations showed children with TS to have more problems with emotional control (EC) than cognitive flexibility in relation to children with ASD, more problems with EC than inhibitory control in relation to ADHD-C, and more problems with EC than planning/organizing in relation to ADHD-I., Conclusion: Paired BRIEF scales dissociated EF problems in children with TS from children with ADHD-C, ADHD-I, or ASD. Clinical relevance is discussed.

Development of emotion regulation strategy use involves a transition from reliance on suppression during childhood to greater use of reappraisal in adolescence and adulthood-a transition that parallels developmental changes in executive functions. We evaluated the relationship between emotion regulation strategy use and executive functioning in the everyday life of 70 typically developing adolescents who completed the Emotion Regulation Questionnaire for Youth and the Behavior Rating Inventory of Executive Function-Self-Report. Results indicated that greater reliance on reappraisal was associated with better executive functions, while reliance on suppression was related to poorer executive functions. Findings suggest that adolescents who rely on reappraisal may have more cognitive resources to help them remain attentive and well regulated in their daily lives. On the other hand, if better executive functions facilitate the use of reappraisal, adolescents' ability to regulate their emotions could potentially be enhanced via supports for executive functions.

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

Executive dysfunction is present in children, adolescents, and adults with a wide range of clinical conditions. A growing body of literature has demonstrated the usefulness of rating scales designed to gauge executive functioning in everyday life. In this article, we discuss evidence supporting the use of such rating scales to assess intervention outcome, how they may inform development of interventions, and how comparing rater perspectives can assess awareness of cognitive dysfunction. We provide an example of how an executive function rating scale helped define intervention targets and measured outcomes in a recently published real-world intervention for children with autism spectrum disorder. Rating scales of executive function provide valuable information with respect to treatment planning and assessment of intervention outcome.

The Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) is a questionnaire measure designed to assess executive functioning in everyday life. Analysis of data from the BRIEF-A standardization sample yielded a two-factor solution (labeled Behavioral Regulation and Metacognition). The present investigation employed confirmatory factor analysis (CFA) to evaluate four alternative models of the factor structure of the BRIEF-A self-report form in a sample of 524 healthy young adults. Results indicated that a three-factor model best fits the data: a Metacognition factor, a Behavioral Regulation factor consisting of the Inhibit and Self-Monitor scales, and an Emotional Regulation factor composed of the Emotional Control and Shift scales. The three factors contributed 14%, 19%, and 24% of unique variance to the model, respectively, and a second-order general factor accounted for 41% of variance overall. This three-factor solution is consistent with recent CFAs of the Parent report form of the BRIEF. Furthermore, although the Behavioral Regulation factor score in the two-factor model did not differ between adults with attention-deficit/hyperactivity disorder and a matched healthy comparison group, greater impairment on the Behavioral Regulation factor but not the Emotional Regulation factor was found using the three-factor model. Together, these findings support the multidimensional nature of executive function and the clinical relevance of a three-factor model of the BRIEF-A.

Executive functions play a vital role in the everyday functioning of healthy individuals across the lifespan and have been implicated in a wide variety of clinical conditions. Historically, the assessment of executive functions in clinical and research settings relied on performance-based measures. A number of authors have argued, however, that such measures have limited ecological validity. In response to this limitation of performance-based measures, several rating scales have been developed that seek to gauge a person's or their knowledgeable informant's (e.g., parent or teacher) subjective view of executive functioning in everyday life. In this article we review evidence supporting the use of rating scales of executive function including profiles in clinical populations, biological correlates, relationships to relevant outcome measures such as academic performance, and correlations with performance-based measures. We conclude that performance-based and rating scale measures provide complementary information with respect to a child's executive functions, offering a more comprehension view than either approach alone.

It is well established that brain injuries adversely affect the executive functions and their development. Mark Ylvisaker had a substantial impact on how we assess and treat children and adolescents with disrupted executive functions secondary to traumatic brain injury. He articulated core principles for effective assessment and intervention that emphasized the importance of real-world meaning and application. He taught us that assessment that captures a child's everyday functioning in the context of real-world demands is often more informative than traditional neuropsychological measures alone and that interventions that improve functioning in the real-world environment are most useful. His pragmatic model influenced our own efforts to measure executive function and to develop intervention systems for children with executive function deficits. This article reviews the development of the Behavior Rating Inventory for Executive Function as an approach to ecological assessment of children and adolescents with traumatic brain injury. As we take what we learned from Mark Ylvisaker, it becomes increasingly apparent that our assessment and intervention methods, especially as related to the executive functions, demand an everyday, real-world context.

Background: Patients with schizophrenia commonly show deficits in working memory on objective neuropsychological measures, and brain imaging studies have documented neural abnormalities during performance of working memory tasks. It remains unclear to what extent such patients are able to accurately gauge the integrity of their working memory in their daily lives., Aims: We evaluated the relationship between subjective rating of working memory integrity in daily life and volumes of the frontal, temporal, and parietal lobes in patients with schizophrenia., Methods: Participants included 29 patients with schizophrenia and 26 healthy comparison subjects. Participants completed a structural magnetic resonance imaging (MRI) scan, the Self Report form of the Behavioral Rating Inventory of Executive Function - Adult version (BRIEF-A), and Digit Span Backwards as an objective measure of working memory. Lobar volumes were obtained using an automated processing package and adjusted for total intracranial volume., Results: The patient group reported worse working memory in daily life, and performed worse on Digit Span Backwards, than the comparison group. Within the patient group, poorer working memory in daily life was associated with smaller left and right frontal lobe volumes. Shorter backwards digit span was associated with smaller left frontal and left and right temporal lobe volumes., Conclusions: The significant relationship between frontal lobe volumes and subjective working memory in daily life provides some support for the validity of self report measures of cognitive functioning in patients with schizophrenia, and provides further evidence for a contribution of frontal lobe abnormality to executive dysfunction in the illness., ((c) 2010 Elsevier B.V. All rights reserved.)

Amnestic mild cognitive impairment (MCI) is characterized by impaired episodic memory, although subtle executive problems have been noted on neuropsychological tests. Recent research also has described a group of healthy, non-depressed older adults with significant cognitive complaints (CC) but normal performance on neuropsychological testing. These individuals show structural and functional brain changes intermediate between those seen in MCI and healthy older adults without such complaints (HC). We evaluated executive functions in MCI and CC using the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A), a newly developed self- and informant report questionnaire in 29 patients with amnestic MCI, 28 CCs, and 30 demographically matched HCs. MCI and CC participants reported significant difficulties with selective aspects of executive functioning relative to HCs despite clinically normal performance on neuropsychological tests of this cognitive domain. Scores were generally in the pattern of MCI>CC>HC, and findings were most pronounced for working memory. Additionally, MCI and CC participants were more likely than their informants to report clinically meaningful executive problems, though informants identified a similar pattern of difficulty overall. Results failed to reveal strong relations between the BRIEF-A and standardized neuropsychological tests of executive function. Overall findings indicate that the BRIEF-A is sensitive to subtle executive changes in MCI and CC and suggest the need for research to determine if executive complaints are predictive of clinical course.

Assessment of the overarching self-regulatory mechanisms, or executive functions, in any age group is challenging, in part due to the complexity of this domain, in part due to their dynamic essence, and in part due to the inextricable links between these central processes and the associated domain-specific processes, such as language, motor function, and attention, over which they preside. While much progress has been made in clinical assessment approaches for measuring executive functions in adults and to some extent in adolescents and school-aged children, the toolkit for the preschool evaluator remains sparse. The past decade, however, has seen a substantial increase in attention to executive functions in very young children from a developmental neuropsychological perspective. With this has come a necessity for better, more specific, and more internally valid performance measures, many of which are now described in the experimental literature. Few such tasks, however, have adequately demonstrated psychometric properties for clinical application. We present two performance tasks designed to tap selective aspects of executive function in preschoolers that are emerging from the experimental laboratory and hold promise of appropriate reliability and validity for the clinical laboratory. Performance tests alone, however, are insufficient to develop a comprehensive picture of a child's executive functioning. Thus, we present a rating scale of preschoolers' executive function in the everyday context, and advocate a model of executive function assessment that incorporates both controlled performance tasks that target specific aspects of executive function and parent/teacher ratings that target more global aspects of self-regulation in the everyday context., ((c) 2005 Wiley-Liss, Inc.)

We hypothesized that the Digit Span (DS) subtest and component tasks (Wechsler, 1991) would show strong relationships with a dichotic listening test (Musiek, 1983). In two sets of archival clinical data (N = 74 and N = 51) we demonstrated that: (a) individuals with central auditory deficits had lower DS scores, F(1, 72) = 7.34, p = .008; eta2 = .09; and (b) left-ear dichotic deficits impacted forward span, F(2, 48) = 8.45, p = .001. Right-ear dichotic listening performance also accounted for significant variance in digit forward span (R2 = 0.17, p = .003). While limited in scope, the studies conclude that forward but not reverse span performance is strongly related to dichotic listening, and can serve as a marker for possible central auditory deficits.

Executive dysfunction is a common outcome in children who have sustained traumatic brain injury (TBI). Appropriate assessment of these complex interrelated regulatory functions is critical to plan for the necessary interventions yet present a challenge to our traditional methodologies. Ecological validity has become an increasingly important focus in neuropsychological assessment with particular relevance for the executive functions, which coordinate one's cognitive and behavioral capacities with real-world demand situations. The Behavior Rating Inventory of Executive Function (BRIEF) was developed to capture the real-world behavioral manifestations of executive dysfunction. Its development and various forms of validity, including ecological validity, are described. Application of the BRIEF's methodology to the assessment of executive dysfunction in TBI is provided. We advocate a multilevel approach to understanding executive function outcome in TBI, including traditional test-based measures of executive function, real-world behavioral manifestation of executive dysfunction, and the environmental system factors that impact the child. In this model, ecologically valid assessment of executive dysfunction provides an important bridge toward understanding the impact of component-level (i.e., test-based) deficits on the child's everyday adaptive functioning, which can assist the definition of targets for intervention.

Clinical assessment of executive function in preschool-age children is challenging given limited availability of standardized tasks and preschoolers' variable ability to participate in lengthy formal evaluation procedures. Given the benefits of ecological validity of measuring behavior by rating scales, the Behavior Rating Inventory of Executive Function (Gioia, Isquith, Guy, & Kenworthy, 2000) was modified for use with children ages 2 through 5 years to assess executive functions in an everyday context. The scale development process, based on samples of 460 parents and 302 teachers, yielded a single 63-item measure with 5 related, but nonoverlapping, scales, with good internal consistency and temporal stability. Exploratory factor analyses identified 3 consistent factors: Emergent Metacognition, Flexibility, and Inhibitory Self-Control across parent and teacher samples. In a second study with a mixed sample of preschool children with various developmental disorders, parents and teachers rated these preschool children as having greater executive difficulties in most domains than matched controls. Such rating-scale methodology may be a useful complementary tool by which to reliably assess executive functions in preschool children via everyday behaviors in the natural environment.

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

Executive function profiles were examined within and between several clinical disorders via the multi-domain Behavior Rating Inventory of Executive Function (BRIEF; Gioia, Isquith, Guy, & Kenworthy, 2000). Parent ratings of children with Inattentive and Combined types of Attention-Deficit/Hyperactivity Disorder (ADHD-I, ADHD-C), Autistic Spectrum Disorders (ASD), moderate and severe Traumatic Brain Injury (TBI), and Reading Disabilities (RD) were compared with controls. Profile analysis revealed significant (p<.01) and substantial (eta2>.10) differences in global elevations and in profile of scale elevations between diagnostic groups. ASD, ADHD-I and ADHD-C groups exhibited greater elevations across the BRIEF scales than did RD and Severe TBI groups, who were in turn more elevated than Moderate TBI and Control groups. The ADHD-C group was unique in its frequency and severity of inhibitory deficits, while the ASD group was distinguishable by its deficits in flexibility. Within diagnostic groups, relative risk for executive dysfunction was calculated with variability present in the frequency of clinically elevated scales. While the BRIEF captures executive profiles characteristic of specific disorders in the clinical setting, it is not diagnostic in its own right and is best used within the context of a broad based evaluation.