NIH award advances early support for executive function
Researchers test classroom strategies designed to strengthen executive function in young children with disabilities.
Allison B. Ratto, PhD, clinical psychologist and assistant director for clinical operations in the Center for Autism Spectrum Disorders at Children’s National, has received an R01 award for $1.3 million from the National Institutes of Health (NIH) to test an early intervention designed to strengthen executive function in young children with disabilities.
The project will evaluate Unstuck and On Target for Early Childhood (Unstuck-EC), a classroom-based program for preschoolers showing early risks for developmental and mental health conditions, adapted from the evidence-based Unstuck and On Target curriculum for neurodivergent youth ages 8 to 11. Unstuck-EC helps young children build skills such as flexibility, planning and emotional and behavioral regulation.
Why it matters
Mental and behavioral health conditions among U.S. adolescents increased 35% from 2016 to 2023, underscoring the need for evidence-based support earlier in childhood. Executive function is an important contributor to mental health, learning and daily functioning.
For children with disabilities, early executive function challenges can predict later aggression, anxiety and mood concerns, as well as difficulties with academic, emotional and adaptive functioning. These children also face an elevated risk of preschool expulsion, which can contribute to poorer mental health and academic outcomes over time.
“Although universal classroom programs can support executive function, their results are mixed and they may not adequately serve children with disabilities who have identified challenges,” Ratto said. “Unstuck-EC could become the first Tier 2 executive function intervention designed for young children and delivered by the preschool teachers who support them every day.”
Testing Unstuck-EC in preschool classrooms
Working with an advisory board and guided by the Practical, Robust Implementation and Sustainability Model (PRISM), the team will adapt Unstuck-EC for use by preschool classroom teachers. Researchers will then partner with local public preschools on a two-school-year hybrid effectiveness-implementation trial involving 90 children: 45 receiving Unstuck-EC and 45 continuing with services as usual.
Researchers expect children participating in Unstuck-EC to improve their executive function skills. They also anticipate that teachers will gain knowledge and use more strategies that support executive function in the classroom.
The study will also explore whether the program can improve children’s mental health and reduce expulsion risk while easing teacher strain and strengthening teacher self-efficacy. In addition, the team will evaluate the program’s reach, adoption and implementation to prepare for a larger randomized comparative effectiveness trial.
Children’s National leads the way
Unstuck-EC was developed with input from early childhood providers and showed promise in a preliminary development trial when delivered by behavioral and developmental specialists. The new award will help move the intervention into public preschool classrooms, where teachers can incorporate practical strategies into children’s daily routines.
By combining intervention research with real-world implementation, the project aims to create a scalable approach that helps young children with disabilities build foundational skills for learning, behavior and long-term mental health.
