Item analysis of parent behavior ratings of executive function in children with spina bifida/hydrocephalus

Recent investigations have identified executive function deficits among children with Spina Bifida and hydrocephalus (SBH; Dennis et al., 1999, Kinsman et al., 1998). Executive functions involve "developing and approach" to performing a task that is not habitually performed (Mahone et al., 2002a). Measurement of executive functions yields separable components including working memory, inhibitory control, and response preparation (Denckla, 1996; Pennington, 1997). Caregiver ratings of children with SBH highlight deficits in metacognition, but not behavioral regulation (Mahone et al., 2002b). Within the metacognition area, parent reports of working memory and initiation problems correlate most significantly with their reports of self-care skills (Ries et al., 2003), suggesting that executive functions may mediate the independent implementation of adaptive skills in those with Spina Bifida. In the present study, parents of 30 children (15 boys, 15 girls, ages 10–18) with SBH completed the Behavior Rating Inventory of Executive Function (BRIEF; Gioia et al., 2000) as part of their child's routine outpatient visit. The BRIEF Parent Form contains 86 items, on which parents rate their child's behavior as occurring "never," "sometimes," or "often." The BRIEF is organized into eight scales and two primary indices (Metacognition and Behavioral Regulation). Frequency of item endorsement for the five Metacognition Index scales (Initiate, Working Memory, Plan/Organize, Organization of Materials, and Monitor) was examined in order to identify statements most frequently reported by parents as areas of concern. Items were reported as significant problems areas if rated "often" by at least 40% of the parents in the sample. On the Initiate scale, items of greatest concern included "has trouble getting started on homework or chores," and "lies around the house a lot ('couch potato')." On the Working Memory scale, items rated most frequently were: "has trouble with chores or tasks that have more than one step," "needs help from and adult to stay on task," and "has trouble finishing tasks." On the Plan/Organize scale, problem behaviors included "becomes overwhelmed by large assignments," and "does not plan ahead for school assignments." On Organization of Materials scale, items endorsed most frequently included "keeps room messy," "leaves a trail of belongings wherever he/she goes," and "leaves messes that others have to clean up." No items were endorsed as "often" at this rate on the Monitor scale. Our findings highlight the vulnerability of children with SBH to self-help tasks that depend on motor skills, speed, and the ability to manage multiple steps in chores. In contrast, BRIEF items involving rapid forgetting, boredom, and social intrusiveness were least frequently endorsed as problems by parents of children with SBH.