Executive function is the higher-level cognitive process that controls the lower-level process for goal-directed behavior. These skills are associated with the frontal lobe and fully develop in early adulthood. Even though these functions are 99% heritable, the brain is plastic; therefore, executive functioning skills can be strengthened. Executive functioning skills predict more successful outcomes in the school setting than Intelligence Quotient (IQ).
Evaluations are the first step to starting the OT process and will determine if an individual qualifies or does not qualify for services. An OT practitioner may use standardized assessments to provide quantitative value to the evaluation report. Having solid numbers speeds up progress reporting and guides intervention selection. In the school setting, the most significant focus is the student’s ability to access their education. Executive function skills are utilized daily in school; therefore, it should be more of a focus for Occupational Therapy practitioners.
The Behavior Rating Inventory of Executive Function, Second Edition, aka the BRIEF-2, questionnaire assesses executive function behaviors in children ages 5 to 18 in the home and school setting. The BRIEF-2 is a standardized assessment and takes about 10-15 minutes to complete. The BRIEF-2 has three report forms to choose from:
The rater reflects on problem behavior over the past six months and then rating on a scale of “Never,” “Sometimes,” and “Often.”
Once the rater has answered all the assessment questions, the T scores are calculated using the tables in the back of the scoring book. These scores will significantly impact creation goals, selection interventions, and IEP accommodations.
The Inconsistency, Negativity, and Infrequency scales provide a score and a range of acceptable values for each scale. The score should be interpreted cautiously if it is above a certain level.
The “Behavioral Regulation Index (BRI)” is the ability to regulate and monitor behavior effectively and is comprised of a total of the “Inhibit” and “Self-Monitor” sections.
The “Emotional Regulation Index (ERI)” is the ability to regulate emotional responses, including responses to changing situations, and is comprised of the “Shift” and “Emotional Control” sections.
The “Cognitive Regulation Index (CRI” is the ability to control and manage cognitive processes and problem-solve effectively and is comprised of the “Initiate,” “Working Memory,” “Plan/Organize,” “Task-Monitor,” and “Organization of Materials” sections.
The Global Executive Composite (GEC) is the overarching summary score incorporating all scales. GEC captures the elevation or severity of the overall profile. BRI + ERI + CRI = GEC.
“The ultimate goal of executive function intervention is to establish regular behavioral and cognitive routines to maximize independent, goal-oriented, problem-solving.”BRIEF-2 Interpretation Report (pg. 52)
The Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) is one of my favorite OT evaluations because it provides excellent information on how to help students succeed in their school setting and eventually hold down a job.
Here is the link to the BRIEF-2 evaluation: https://www.parinc.com/products/pkey/24
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