Executive Function/Metacognitive Training: Early Intervention for At-Risk Preschoolers

 
Grant #: R34 MH095911
PI: Leanne Tamm, PhD
Collaborators: Jeffery Epstein, PhD, Richard Loren, PhD, Annie Garner, PhD

Disruptive behavior disorders, particularly ADHD, constitute one of the most common diagnoses in preschool children. Disruptive behaviors cause significant emotional distress for caregivers and children due to high expulsion rates from daycare or early education settings, demands on caregiver’s time, accident proneness and other safety concerns. However, there are few evidence-based early interventions preschoolers with attention and behavior problems. An intervention targeting executive functioning which includes the ability to regulate behavior, working memory, and attention control, could be helpful for preschoolers because these skills are identified by kindergarten teachers as important for school readiness. We have developed a promising intervention, Executive Training of Attention and Metacognition (ETAM), for preschoolers.  Parent report liking the intervention and improvements in attention, behavior, and cognitive skills. Although these data are promising, the intervention needs more development, and we need to show that the intervention itself is helpful versus improvements arising from the attention paid to children and parents by the caring team of researchers.  Thus, the purpose of this study is to develop an alternative comparison condition (most likely a group teaching topics relevant to parents of preschoolers like nutrition, sleep, and safety).  Then we will investigate how well the intervention works by inviting 60 families to participate and randomly assigning (like a coin flip) them to either the ETAM group or the comparison group.

Primary Aim: To establish the feasibility of a measurement model for a future randomized clinical trial. Specifically to develop a comparison group and to assess:

• the feasibility of identifying, enrolling and retaining preschoolers at-risk for ADHD
• acceptability of randomization choices to intervention and comparison conditions
• feasibility of implementing the measurement protocol for both interventions
• feasibility of operationalizing the delivery of ETAM and comparison conditions
• feasibility of assessing both trained and untrained areas of functioning, and assessing whether improvements in executive functioning are related to functional outcomes in other domains such as social functioning, academic functioning, and school readiness

Exploratory Aim 1: To assess whether ETAM compared to the comparison group improves executive functioning and functional outcomes (i.e., ADHD symptoms, academic readiness, social competence) and to assess whether gains are maintained

Exploratory Aim 2: To conduct exploratory analyses on variables (e.g., parental ADHD or depression, child executive functioning severity, parent-child relationship, etc.) that might moderate or mediate response to ETAM