Executive Function/Metacognitive Training for At-Risk Preschoolers

针对高危学龄前儿童的执行功能/元认知培训

• 批准号: 8486496
• 负责人: LEANNE TAMM
• 金额: $ 22.03万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8486496
• 关键词: Academy; Accident Proneness; Affect; Age; American; Area; Attention; Attention deficit hyperactivity disorder; Behavior; Behavioral Symptoms; Brain; Buffers; Caregivers; Child; Child Development; Clinical Trials; Data; Development; Diagnosis; Disruptive Behavior Disorder; Early Intervention; Education; Educational Intervention; Enrollment; Exposure to; Feasibility Studies; Frequencies; Funding; Future; Grant; Growth; Guidelines; Home environment; Impairment; Informal Social Control; Intervention; Label; Link; Measurement; Measures; Mediating; Mediator of activation protein; Memory; Modeling; Modification; Monitor; Neurocognitive; Nursery Schools; Outcome; Outcome Assessment; Outpatients; Parent-Child Relations; Parents; Pediatrics; Pharmaceutical Preparations; Physicians; Pilot Projects; Placebo Effect; Population; Preschool Child; Problem behavior; Protocols documentation; Psychopathology; Public Health; Randomized; Readiness; Research; Resort; Risk; Safety; Schools; Self-control as a personality trait; Services; Severities; Short-Term Memory; Social Functioning; Symptoms; Testing; Time; Training; age group; base; child depression; cognitive control; comparison group; cost; cost effective; design; early childhood; emotional distress; evidence base; executive function; functional outcomes; improved; inattention; innovation; kindergarten; operation; programs; psychopharmacologic; psychosocial; response; skills; social skills; success; teacher; therapy design

DESCRIPTION (provided by applicant): Disruptive behavior disorders, particularly Attention-Deficit/Hyperactivity Disorder (ADHD), constitute one of the most common diagnoses in preschool children (1). Disruptive behaviors are a major public health problem including causing significant emotional distress for caregivers and children, expulsion from daycare or early education settings, demands on caregiver's time, accident proneness and other safety concerns (2, 3). However, few evidence-based early interventions exist for preschoolers with attention and behavior problems, which is critical because they are strongly suggested as the first line of treatment for preschoolers with ADHD (4). Because executive functioning (EF) has been consistently been proposed as a putative factor in the development of disruptive behavior disorders an intervention targeting EF (e.g., inhibition, working memory), attention, and metacognition during early childhood could likely affect the development of disruptive behavior disorders in preschoolers. Indeed, EF skills are identified by kindergarten teachers as primary prerequisites for school success (5). EF deficits independently contribute to poorer outcomes in ADHD (6-8), and have been linked directly to academic (9-11) and social functioning deficits (12-14). Given that EF and brain development are rapidly developing during the preschool years (15), preschoolers may benefit most from an early intervention targeting EF skills. We have developed a promising intervention, Executive Training of Attention and Metacognition (ETAM), for preschoolers, and have conducted a small preliminary open trial demonstrating the initial acceptability of the intervention. We also found significant moderate effect sizes on objective measures of EF (16) and moderate to large effect size reductions in ratings of inattention and behavioral symptoms by parents, clinicians, and teachers. An RCT is needed to investigate if these positive effects on executive functioning, attention, and behavior are due to ETAM or to the effect of parental attention and/or a placebo effect. Consistent with the parameters of the R34 mechanism we propose to assess the feasibility of a design for a future RCT. We will develop an attention control (AC) comparison group and assess the feasibility of: identifying, enrolling and retaining preschoolers at-risk for ADHD, randomization choices, the measurement of EF and functional outcomes, and delivery protocol for both AC and ETAM by conducting a pilot RCT with 60 children at-risk for ADHD. Exploratory aims include assessing whether children in the ETAM group show gains compared to those in AC on targeted (trained) outcomes (i.e., measures of EF) and untrained outcomes (i.e., ADHD symptoms, academic readiness, social competence). We will also assess whether gains are maintained as well as investigate potential moderators/mediators. Given the relation of EF to a number of aspects of child development-including academic skills, social competence, and risk for psychopathology-research promoting EF in young children is a scientific priority.

描述（由申请人提供）：破坏性行为障碍，特别是注意力缺陷/多动障碍（ADHD），是学龄前儿童最常见的诊断之一（1）。破坏性行为是一个主要的公共卫生问题，包括造成严重的情绪困扰的照顾者和儿童，从日托或早期教育环境中驱逐，对照顾者的时间，事故倾向和其他安全问题的要求（2，3）。然而，对于有注意力和行为问题的学龄前儿童，几乎没有基于证据的早期干预措施，这是至关重要的，因为它们被强烈建议作为ADHD学龄前儿童的一线治疗（4）。由于执行功能（EF）一直被认为是破坏性行为障碍发展的一个假定因素，因此针对EF的干预（例如，抑制，工作记忆），注意力和元认知在幼儿期可能会影响破坏性行为障碍的发展。事实上，幼儿园教师认为EF技能是学校成功的主要先决条件（5）。EF缺陷独立地导致ADHD的不良结果（6-8），并与学术（9-11）和社会功能缺陷（12-14）直接相关。鉴于EF和大脑发育在学龄前阶段迅速发展（15），学龄前儿童可能从针对EF技能的早期干预中受益最多。我们已经开发了一种有前途的干预措施，注意力和元认知（ETAM）的执行培训，学龄前儿童，并进行了一个小型的初步开放试验，证明了初步的可接受的干预。我们还发现，EF的客观测量结果具有显著的中等效应量（16），父母、临床医生和教师对注意力不集中和行为症状的评分具有中等至较大的效应量降低。需要一项随机对照试验来研究这些对执行功能、注意力和行为的积极影响是否是由于ETAM或父母注意力的影响和/或安慰剂效应。与R34机制的参数一致，我们建议评估未来随机对照试验设计的可行性。我们将开发一个注意力控制（AC）对照组，并评估以下方面的可行性：识别、招募和保留有ADHD风险的学龄前儿童，随机化选择，EF和功能结局的测量，以及AC和ETAM的交付协议，通过对60名有ADHD风险的儿童进行试点RCT。探索性目标包括评估ETAM组的儿童与AC组的儿童相比，在目标（训练）结果方面是否表现出进步（即，EF的测量）和未经训练的结果（即，ADHD症状，学术准备，社会能力）。我们还将评估收益是否得到维持，并调查潜在的主持人/调解人。考虑到EF与儿童发展的许多方面的关系，包括学术技能，社会能力和精神病理学风险，促进幼儿EF的研究是科学的优先事项。