Clinical Utility of the Behavior Rating Inventory of Executive Function-Self-Report (BRIEF-SR) in Adolescents With Traumatic Brain Injury

Objective: To evaluate the factor structure and correlates of the Behavior Rating Inventory of Executive Function-Self-Report (BRIEF-SR) in 118 adolescents with traumatic brain injury (TBI). Method: Cross-sectional study. Maximum-likelihood exploratory, as well as confirmatory, factor analysis. External correlates of factor scores were evaluated. Results: Two latent constructs were identified, with notable variation in scale loading pattern compared with standardization sample findings of the BRIEF-SR. These factors covaried inversely with severity of TBI; more severe injuries were associated with lower self-ratings of executive dysfunction, indicating a possible lack of deficit awareness in those with relatively severe injuries. Premorbid ADHD affected both factors, resulting in higher self-ratings of executive dysfunction, suggesting preserved awareness of preexisting difficulties in those with uncomplicated mild injuries. In addition, males reported less executive dysfunction than females. Conclusions/Implications: Findings suggest that the BRIEF-SR measures somewhat different latent constructs after TBI than in typically developing adolescents, and that BRIEF-SR scores need to be considered in concert with objective measures of injury severity and premorbid demographic and historical variables.