Assessing ADHD in Children: Why Include the BRIEF2 in Your ADHD Evaluations?

ADHD is one of the most commonly diagnosed neurodevelopmental disorders in children, affecting approximately 11.4% of U.S. children aged three to 17. Despite this prevalence, accurately identifying ADHD—and distinguishing it from other conditions with overlapping symptoms—remains a clinical challenge. Children with anxiety, autism spectrum disorder, or trauma histories may exhibit behaviors that mimic ADHD, such as impulsivity, distractibility, or difficulty with emotional regulation.

This diagnostic complexity underscores the importance of using tools that go beyond surface-level symptom checklists during ADHD evaluations. One such tool is the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF2), which offers a deeper look into the executive functioning deficits that often underlie ADHD. Executive functions like working memory, inhibition, and task initiation are central to ADHD, but they are also relevant to other conditions. By assessing these domains across home, school, and social environments, the BRIEF2 helps clinicians build a more nuanced understanding of a child’s behavior.

For psychologists and mental health professionals, incorporating the BRIEF2 into ADHD evaluations isn’t just best practice—it’s a strategic move toward more accurate diagnoses, earlier interventions, and better outcomes for children and families.

Understanding the Link Between ADHD and Executive Function

ADHD is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity. The symptoms that children exhibit typically include:

• Inattention
  • Fails to give close attention to details or makes careless mistakes
  • Has trouble holding attention on tasks or play activities
  • Does not seem to listen when spoken to directly
  • Fails to follow through on instructions and fails to finish tasks
  • Has trouble organizing tasks and activities
  • Avoids or dislikes tasks that require sustained mental effort
  • Loses necessary items (e.g., school materials, pencils, books)
  • Is easily distracted
  • Is forgetful in daily activities
• Hyperactivity
  • Fidgets with hands or feet or squirms in seat
  • Leaves seat in situations when remaining seated is expected
  • Runs or climbs in inappropriate situations
  • Is unable to play or engage in leisure activities quietly
  • Is often “on the go” or acts as if “driven by a motor”
  • Talks excessively
• Impulsivity
  • Blurts out answers before questions have been completed
  • Has difficulty waiting their turn
  • Interrupts or intrudes on others

These symptoms often interfere with functioning across home, school, and social environments. What many may not realize, however, is that these hallmark behaviors are deeply rooted in deficits in executive functioning (EF), or the mental processes that enable individuals to plan, focus attention, remember instructions, and juggle multiple tasks successfully.

While ADHD is one of the most common neurodevelopmental conditions affecting children, executive function challenges are not exclusive to ADHD. They also appear in children with autism spectrum disorder, anxiety, depression, and learning disabilities, which can make differential diagnosis particularly complex. 

The Value of Including the BRIEF2 in ADHD Evaluations

With ADHD diagnoses on the rise (an estimated seven million children in the U.S. have received an ADHD diagnosis, conveying a dramatic increase from previous decades), it is now more important than ever to gain a comprehensive understanding of a child or adolescent’s symptoms. Traditional assessment tools may only scratch the surface of determining that a child may have ADHD, but incorporating additional psychological assessment tools provides a more complete picture of their symptomatology.

For example, the Clinical Assessment of Attention Deficit-Child (CAT-C) thoroughly assesses symptoms of attention-deficit disorder and attention-deficit/hyperactivity disorder in children. The BRIEF2 complements the CAT-C (or other ADHD screening tools) by shining a light on specific symptoms of executive dysfunction. This is especially helpful given that many behaviors that are seen as signs of ADHD may simply be due to environmental factors (such as overuse of electronic devices, which may lead the child to be easily distracted or have trouble focusing) or other conditions.

Using the BRIEF2 in tandem with other assessment tools is also helpful in locations, as some states have additional requirements that must be met in order for an ADHD diagnosis to be given. Dr. Irene Piryatinsky, a clinical psychologist in Massachusetts—where neuropsychological testing is often necessary for medication approval—uses the BRIEF2 help her differentiate between ADHD and other conditions like trauma or anxiety. This assessment tool also allows her to explore behavioral dimensions that go beyond cognition, such as emotional regulation and task monitoring.

Unlocking Potential Through Early Identification of ADHD

In the complex landscape of childhood behavioral assessment, precision matters. ADHD shares symptoms with a range of other conditions, making accurate diagnosis both essential and challenging. The BRIEF2 stands out as a powerful tool for psychologists and mental health professionals—not only for its ability to assess executive function across multiple domains, but also for its Parent/Teacher form that includes an optional ADHD score profile, interpretive text, and DSM-5 ADHD Symptom Checklist.

By incorporating the BRIEF2 into their evaluation process, clinicians gain access to actionable insights that go beyond base-level behaviors. These insights support more confident diagnoses, tailored interventions, and better outcomes for children and families. Whether used in schools, clinics, or private practice, the BRIEF2 empowers professionals to make informed, evidence-based decisions that reflect the full complexity of a child’s cognitive and behavioral profile.

For those committed to delivering the highest standard of care, the BRIEF2 isn’t just a helpful tool—it’s an essential part of the diagnostic toolkit.