Introduction Of The Behavior Rating Scale Of Executive Function (BRIEF) Parent Form For School Age Children Into China And Application In ADHD

[Objectives](1) To test the reliability and validity of the BRIEF parent form for school age children in China.(2) Using the BRIEF to explore the ecological charateristics of executive function in ADHD and subtypes.(3) Using the BRIEF to test the effect of extended-released methylphenidate (ConcertaTM) on executive function in ADHD, and to evaluate the correlation between the improvement of executive function and that of ADHD core symptoms.[Methods](1) Two hundred sixteen patients (ADHD, schizophrenia or autism) and three hundred eleven normal controls were recruited in this research. The subjects'parents completed the BRIEF,the ADHD rating scale-â…£,the Conners and the Rutter Questionnaires. And the performance-based tests of executive function including Rey-Osterrieth Complex Figure (ROCF) ,trail-making test, digit span test, Tower of Hano(iTOH)and Stroop test were carried out among some of the controls and ADHD subjects.(2) The ADHD sample consisted of 52 children with ADHD-I, 29 children with ADHD-C and 45 normal controls in this study. They were 6-13 years old, DSM-â…£diagnosed and psychotropic medication vacant. All the ADHD subjects finished the C-WSCI. And the parents completed the BRIEF. (3) Twenty six ADHD children, aged 8-14 years, participated in a 4-6 week open-trial study of extended-released methylphenidate ( 18-54mg/d ) . Executive function and ADHD symptoms were evaluated with the parent form of the BRIEF,the ADHD rating scale-â…£and the IOWA Conners Questionnaire before and after the treatment.[Results](1) Test-retest reliability was 0.68-0.89 and Cronbach coefficient was 0.74-0.96 except for the initial subscale(0.61). Subscale scores of BRIEF were moderately correlated(r=0.41-0.64) with those of other criteria scales such as the ADHD rating scale-â…£et al. The correlations (r=0.32-0.41)between subscale scores of BRIEF and some indexes of the performance-based tests of executive function in the control group existed [For example, the inhibition subscale score correlated with detailed score of ROCF delayed recall test and Stroop word-color interference time(r=-0.32, 0.38). The working memory subscale score correlated with time for trial B of the trail-making test, numbers of backwards digit test and Stroop word-color interference time(r=0.30, -0.39, 0.41)], though those in the case group was not detected. Lisrel Confirmatory factor analysis showed the 8-subscale model of BRIEF reasonable.(2) Compared with control group, ADHD groups ( ADHD-C, ADHD-I, ADHD-I+C ) got significant higher scores on all subscales of the BRIEF(P=0.000-0.026). And ADHD-C group got significant higher scores on inhibition, working memory, plan, organization and monitor subscales of the BRIEF than ADHD-I group(P=0.001-0.0470).(3) The mean item raw score of global executive composite (GEC), metacognition index (MI), working memory, monitor and inhibition subscales of the BRIEF significantly decreased after ConcertaTM treatment ( t =2.763-3.380, p < 0.050). The reduction rates of MI and the 5 subscales attached to MI were moderately correlated to the maximum reduction rates of the inattentive subscale of ADHD rating scale-â…£(r = 0.415-0.640, p < 0.050). The correlation between the reduction rate of inhibition subscale and the maximum reduction rates of ADHD symptom were not significant.[Conclusions](1) The BRIEF parent form for school age children was proved to have adequate reliability and validity in China.(2) a. Compared with controls, the 6-13 year-old ADHD boys (ADHD-C, ADHD-I, ADHD-I+C) exihibited significant executive function deficits on all subscales of the BRIEF. b. The executive dysfunction was shown to be more severe in ADHD-C boys than in ADHD-I boys, especially on the inhibition subscale. ADHD-C boys had more problems than ADHD-I boys on working memory, plan, organization and monitor subscales as well, which need further investigation.(3) The extended-released methylphenidate was proved to have the potential to improve executive function of ADHD as measured by the BRIEF. But the improvement of inhibition might not parallel that of the core symptoms of ADHD.