What do people respond to when rating executive function? – a cognitive interviewing investigation of BRIEF-A informant ratings in severe aphasia

Abstract

Purpose Executive dysfunction is common in persons with severe aphasia. Assessing these functions in this population is challenging. Informant ratings, such as the BRIEF-A, might be a useful alternative to neuropsychological tests. However, research has shown weak relationships between tests and ratings. The aim of this study was to understand how significant others of people with severe aphasia interpret and respond to questions about executive function in the informant report version of BRIEF-A. Methods Eleven significant others were interviewed about a subset of the BRIEF-A items, using cognitive interviewing. Interviews were subjected to thematic analysis. Results There was variation in the interpretation of the items of BRIEF-A which frequently corrupted the items’ relation to what it was intended to measure. Further, informants wavered between considering the person with aphasias’ ability or actual performance and many had lowered their expectations. The language problems caused by the aphasia affected the validity of some items. Conclusions The quantitative results of BRIEF-A informant ratings should be interpreted with caution, since it is unclear to what extent the responses represent executive function. The use of informant ratings does not solve the problem with aphasia being a confounding factor in assessment of executive function. IMPLICATIONS FOR REHABILITATION Assessing executive function in people with severe aphasia is important but challenging. Quantitative results of informant ratings of executive function, such as BRIEF-A, in this population should be interpreted with caution, since it is unclear to what extent the ratings represent executive function. Using informant ratings does not solve the problem of the aphasia being a confounding factor, since the aphasia impacts on the validity of some of the items.