Changing developmental trajectories through early executive function intervention in early childhood education

The National Institute of Mental Health awarded Children's Research Institute $479,144 on August 5, 2026, under the Mental Health Research Grants program (CFDA 93.242) to develop and test Unstuck and On Target for Early Childhood (Unstuck-EC), a tier 2 executive function intervention for preschool children with disabilities.

The award funds a randomized controlled trial comparing Unstuck-EC, implemented by preschool classroom teachers, against services-as-usual care. Unstuck-EC adapts the evidence-based Unstuck and On Target: 8-11 intervention for younger children and targets executive function deficits that predict later aggression, anxiety, mood challenges, and poor academic and adaptive functioning in neurodevelopmental conditions including autism and ADHD. The intervention is designed to reduce preschool expulsion risk and improve developmental trajectories for young children with identified executive function challenges.

Children's Research Institute, a nonprofit pediatric research organization based in Washington, DC, serves as the recipient. Performance occurs in Washington, DC, with a period of performance extending from August 5, 2026, through April 30, 2029. This award is classified as a Project Grant, the standard assistance mechanism for investigator-initiated research under the NIMH program.

Abstract

There is a paucity of interventions targeted to changing developmental trajectories for young children with disabilities. As we face a continuing youth mental health crisis (currently estimated to affect 13% of youth, with a 35% increase between 2016-2023), there is an urgent need for evidence-based, early intervention that can address skill deficits and improve outcomes. Executive function has been identified as a transdiagnostic, underlying driver of mental health outcomes, and deficits are present across childhood disabilities. Executive function deficits in early childhood predict later aggression, anxiety, and mood challenges, as well as emotional, academic, and adaptive functioning in neurodevelopmental conditions such as autism and adhd. Children with disabilities and associated early executive function challenges are at elevated risk for preschool expulsion and a subsequent cascade of poor mental health and academic outcomes. Universal (tier 1) programs for early childhood executive functioning have mixed outcomes and do not adequately meet the needs of children with disabilities and identified challenges with executive function. This project proposes to test a novel executive function intervention, unstuck and on target for early childhood (unstuck-EC), compared to a services-as-usual control, implemented by preschool classroom teachers of children with disabilities, as the first tier 2 (selective) executive function intervention for young children. Unstuck-EC is adapted from the evidence-based unstuck and on target: 8-11, which is designed to be implemented in schools as a tier 2 intervention for executive function challenges in neurodivergent youth. Unstuck-EC has been developed with input from early childhood providers and shown promise of efficacy in a preliminary development trial, when implemented by behavioral and development specialists. Grounded in the prism framework, we will collaborate with an advisory board to adapt unstuck-EC for implementation by preschool teachers. We will partner with local public preschools to conduct a hybrid (type 1) effectiveness-implementation trial (n=100 unstuck-EC, n=60 services as usual control), over the course of two school years. We predict that children in unstuck-EC will show gains in executive function, and teachers will show improved knowledge and use of executive-function supporting strategies. We will also explore potential improvements in child mental health and expulsion risk, as well as in teacher strain and self-efficacy. Finally, we will assess factors related to reach, adoption, and implementation of unstuck-EC, preparing for a future, larger randomized comparative effectiveness trial.