@ BRIEF-P Wh Behavior Rating Inventory of Executive Function Preschool Version RATING FORM PhD, Kimberly Andrews Espy, PhD, and Peter K. Isquith, PhD Instructions to Parents and Teachers On the following pages is a list of statements that describe young children. We would like to know if the child has had problems with these behaviors during the past 6 months. Please answer all the items the best that you can. Please do not skip any items. Think about the child as you read these statements and circle: NN ifthe behavioris Never a problem S ifthe behavior is Sometimes a problem © ifthe behavior is Often a problem For example, if having tantrums when told “No” is never a problem, you would circle N for this item: Has tantrums when told “No” @ s o Ifyou make a mistake or want to change your answer, DO NOT ERASE. Instead draw an X through the answer you want to change and then circle the correct answer: Has tantrums when told “No” ® © o Before you begin answering the items, please fill in the child’s name, gender, age, and birth date, as well as your name, relationship to the child, and today’s date in the spaces provided at the top of the next page. If you are the child’s teacher or child care provider, please check the box next: to the response that best describes how well vou know the child and indicate. how long vou have known the child in the space provided. PAR 16204 N. Florida Ave. * Lutz, FL 33549 » 1.800.331.8378 + www.parinc.com CCepyight © 1865, 1288, 2000, 2007, 2008 by FAR. Al fs served May nx be rprocced incl rin arin any fom or by ary meas witout writen permission ot PAR Ths ois printed in parle in on catonlss pepo. Any oer version unauthorized. Moan Emerat Te EG eer sa AB BirthDate Wis ce ve ar Today’sDate_ / 7 Relationship io Cie: CI Mother Cather C)teacher* Cl other = sie Ye Foe well do you know the cite?” CNet Went C1 norerately Welt C1 Very Well ‘Have known the child for__T months Cl years, Child's Name ‘Your Name __ / ? During the past 6 months, how often has each of the following behaviors been a problem? 41, Overreacts to small problems NS) 0 2. When given two things to do, remembers only the fist or last Neos 10) Is unaware of how hisiher behavior afects or bothers others, REST Siokatsh 4, When instructed to clean up, puts things away in a disorganized, random way Ns 0 '5. Becomes upset with new situations aS: 6. Has explosive, angry outbursts Ns 0 7. Has trouble carrying out the actions needed to complete tasks (such as trying one puzzle pieoe at atime, cleaning up fo earn a reward) Necrosis ce 8, Does not stop laughing at funny things or events when others stop sat ‘9, Needs to be told to begin a task even when wing to doit Me Ree: 410._Has trouble adjusting to new people (such as babysitter, teacher, fiend, or day care worker) Ny gS7 tO: 11. Becomes upset io easily NZ 37 SS 42. Has trouble concentrating on games, puzzles, or play activities No Sur.) 48, Has to be more closely supervised than siniler playmates, NEAT Sade 14, When sent o get something, forgets what he/she is supposed to get TREE So, 45, {s upset by a change in plans of routine (for example, order of dally activites, adding last minute errands to schedule, change in driving route to store) NES SO 16. Has outburst fr litle reason N= 8-50: 17, Repeats the same mistakes over and over even after help is given NK so 18. Acts wilder or sili than others in groups (such as birthday parties, pay group) NS S320. 491 Cannot find clothes, shoes, toys, or books even when heYshe has been given spectic instructions Nios! SNS 20. Takes a longtime to fee comfortable in new places or stuations (such as visting distant relatives cor new fiends) Ne arcing) 21. Mood changes frequently Nee Sie 22. Makes sily mistakes on things he/she can do Ns 0 23, Is fidgety, restless, or Squirmy NSS 24, Has trouble folowing established routines for steeping, eating, or pay activities Naree sate 25. 1s bothered by loud noises, bright lights, or certain smells Ns 0 26. Small events ‘rigger big reactions NS Ga. 27. Has trouble wih activities or tasks that have more than one step nasal 28. \simpubsive N eestor: 28. Has trouble thinking ofa different way to solve a problem or complete an activity when stuck NESS 20. Is disturbed by changes in the environment (such as new furniture, things in room moved around, or new clothes) Ns 0During the past 6 months, how often has each of the following behaviors been a problem? j ‘Angry or tearful outbursts are intense but end suddenly Needs help from adult to stay on task oes not notice when hisiher behavior causes negative reactions Leaves messes that others have to clean up even after instruction, Has trouble changing activities Reacts more strongly to situations than other children . Forgets what hefshe is doing inthe midle ofan activity Does not realize that certain actions bother others Gets caught up in the small details ofa tasK or situation and misses the main idea 40. Has trouble ‘Joining in at unfair socal events (such as birtndey partes, picnics, holiday gatherings} 41._Is easly overwhelmed or overstmulated by typical dally activities SBEB8 ees =) zie = = zie ae a= BLGLLOHOD oo Bo domemodom| s 42. Has trouble finishing tasks (such as games, puzzles, pretend play activities) 43. Gets out of contol more than playmates ‘44, Cannot find things in room or play area even when given speofc instructions 45. Resists change of routine foods, places, eto 46. After having a problem, wil slay disappointed for afong time 447. Cannot stay on the same topic when talking 48. Talks or plays too loudly 49. Does not complete tasks even after given directions 50. Aca ona ovine Fac Ly ean (ches ond ay ‘or peop) 51, Has trouble getting started on activites or tasks even after instructed 52._Acts too wild or out of control ie) = ae) = es el = =pe= DRHDHRDHH 000 GO0000000 53, Does not try as hard as hisiher ability on activities 54, Has trouble putting the brakes on hisiher actions even after being asked 6. Unable to finish desorbing an event, person, or story, 56. Completes tasks or activites too quickly 57. Is unaware when he/she does well and not well 58. Gets easly sidetracked during activites, 59, Has trouble remembering something, even aflera brief period of ime 60. Becomes too sily 61, Has a short attention span 62, Plays carelessly or recklessly in situations where he/she could be hurt such as playground, swimiring poo!) 63._ Is unaware when helshe performs a task right or wrong Be =e 2 eee zz COGOHHHH® oo eco0000000 oo