Executive Function Development in Preschool Children

描述（由申请人提供）：“个性化医疗”的一个核心原则是能够预测谁有可能出现以后的医疗状况，包括精神疾病（NIH, 2007）。为了改变我们对导致后来功能障碍的起源、机制和过程的认识，国家心理健康咨询委员会（2007年）呼吁增加纵向的、“基于轨迹的”研究，包括“敏感的、可延展的神经发育时期”，以满足新的NIMH战略计划的目标1和2。随着最近方法的进步，揭示了儿童精神病理学的发展途径，PA07-158反映了迫切需要确定特定的前体，以提高早期识别和干预。执行控制（EC）是儿童外化障碍（包括多动症）的一个强有力的候选前兆，尽管两个挑战阻碍了进展：1)缺乏EC的精确定义；2)对EC如何影响后来的功能结果的理解不足。在过去的资助期间，我们在定义学龄前儿童的EC方面取得了实质性进展，通过使用复杂的统计方法来经验地确定最佳拟合，理论推导模型。因此，这项更新申请的目的是阐明前体EC与后期功能结果的关系，这是临床应用的下一个转化步骤。参与者将是大型的，仔细的，纵向的（每9个月，3-0到5-3岁）抽样的学龄前队列（其中一半有社会人口风险），他们将在2009-2011年秋季进入一年级或二年级。将对春季1-4年级的功能结果进行多方法评估，重点关注外化问题（冲动/多动、注意力不集中、反抗和攻击）、社交技能（敏感性、责任感和同伴关系）、学术技能（数学和阅读成绩）和掌握问题（动机差、坚持、策略使用）。这一群体正处于5- 7年的关键转变阶段，这一发展转变的特点是成年人对目标导向思维、持续独立工作、适应性关系和社会功能的期望大幅增加。在这种从5岁到7岁的转变中，小学是这些增加的期望挑战或“迫使”孩子部署执行控制以成功管理这种转变的中心环境，这是后来功能成功的关键因素。采用结构方程模型检验学龄前儿童执行控制、5- 7岁转移行为和功能结果之间的先验直接关系和冥想关系。为了确定谁有更大的不良结果风险，将进行以人为中心的尖端生长混合模型，以确定具有不良EC发展的学龄前儿童的潜在亚群，然后比较后来的功能结果，并检查响应式养育的贡献。描述学龄前时期执行控制的性质及其与后期功能结果轨迹的关系，将阐明儿童精神病理学出错的基本机制，并确定未来工作中使用的前兆，为那些受益最多的人量身定制预防性干预措施。公共卫生相关性：从长远来看，识别导致后期功能障碍的早期前兆对于加强预防性干预至关重要。执行控制在外部化问题和相关的不良社会和学术结果中起着基本的，也许是因果的作用，因此在早期识别中是翻译使用的强有力的候选者。了解学龄前儿童执行控制与1-4年级功能结局的纵向关系，并在社会人口风险范围内的大型、特征明确的队列中描述可能的机制，将阐明通往精神病理学的重要发展途径。

DESCRIPTION (provided by applicant): One central tenet of "personalized medicine" is to be able to predict who is at risk for later medical conditions, including mental illness (NIH, 2007). To transform our knowledge of the origins, mechanisms, and processes that contribute to later dysfunction, the National Advisory Mental Health Council (2007) has called for increased longitudinal, "trajectory-based" studies that include "sensitive, malleable periods of neurodevelopment" to meet Objectives 1 and 2 of the new NIMH Strategic Plan. With recent methodological advances that have shed light on developmental pathways toward childhood psychopathology, there is a pressing need reflected in PA07-158 to identify specific precursors to improve early identification and intervention. Executive control (EC) is a strong candidate precursor for childhood externalizing disorders (including ADHD), although two challenges have hampered progress: 1) lack of a precise definition of EC and 2) inadequate understanding of how EC contributes to later functional outcomes. In this past funding period, we have made substantial progress in defining EC in preschool children by using sophisticated statistical methods to empirically determine the best fitting, theoretically derived model. The objective of this renewal application, then, is to elucidate how precursor EC relates to later functional outcome, the next translational step towards clinical application. Participants will be the large, carefully, longitudinally (every 9 months, 3-0 to 5-3 years) sampled preschool cohort (half are at sociodemographic risk) who will enter grades 1 or 2 in fall 2009-2011. Multi-method assessments of functional outcome in spring grades 1-4 will be conducted, focusing on externalizing problems (impulsivity/hyperactivity, inattention, defiance, and aggression), social skills (sensitivity, responsibility, and peer relationships), academic skills (mathematics and reading achievement), and mastery problems (poor motivation, persistence, strategy use). The cohort is on the cusp of a key 5->7 shift, the developmental transition characterized by a substantial increase in adult expectations for goal-directed thought, sustained independent work, adaptive relationships and social functioning. In this 5->7 shift, elementary school is the central context where these increased expectations challenge or "press" the child to deploy executive control to successfully manage this transition, a key factor in later functional success. Structural equation modeling will be used to test the a priori direct and meditation relations among preschool executive control, behavior in the 5->7 shift, and functional outcome. To pinpoint who is at greater risk for poor outcome, cutting-edge, person-centered growth mixture modeling will be conducted to identify latent subgroups of preschool children with poor EC development and then to compare later functional outcome and examine the contribution of responsive parenting. Characterizing the nature of executive control in the preschool period and how it relates to trajectories of later functional outcome will elucidate the fundamental mechanisms that go awry in childhood psychopathology and identify precursors for use in future work to tailor preventive interventions to those who stand to benefit most. PUBLIC HEALTH RELEVANCE: Identifying early precursors in pathways to later dysfunction is critical to enhance preventive interventions in the longer term. Executive control plays a fundamental, and perhaps causal, role in externalizing problems and related adverse social and academic outcomes, and therefore is a strong candidate for translational use in early identification. Understanding the longitudinal relations of preschool executive control and functional outcome in grades 1-4, and characterizing putative mechanisms in a large, well-characterized cohort who range in sociodemographic risk, will elucidate important developmental pathways towards psychopathology.