4 - (SYM 20) Flexible Thinking Helps Us Feel Better: Supporting Emotion Regulation in Preschoolers Through Executive Function Intervention

Background: Executive functioning (EF) is a set of cognitive abilities that drives daily functioning through flexible regulation of thinking, behavior, and emotions. EF is a transdiagnostic predictor of academic, social, and mental health outcomes in many developmental and psychiatric conditions, making EF a promising intervention target. The goal of this project was to pilot Unstuck and On Target for Early Childhood (UOT-EC), adapted from the evidence-based Unstuck and On Target intervention for elementary school, as a transdiagnostic intervention to build EF and self-regulation in young children with flexibility challenges.

Methods: UOT-EC was developed by an interdisciplinary team and iteratively revised over three years, using feedback from community interventionists. It is delivered in small groups over 16 lessons, with family education materials to support generalization. UOT-EC was piloted in an ethnoracially diverse sample (n=26; 44.8% from historically marginalized ethnicities) across 3 settings: 1. Public charter preschools (n=25); 2. Private school for children with social-emotional needs (n=21) and 3. Outpatient academic medical center (n=12).  Inclusion criteria were flexibility deficits and intact language. More than half (n=29) had no prior diagnosis. Most common diagnoses were autism (n=16) and ADHD (n=7). Child EF was measured at pre- and post-intervention via parent report (BRIEF-P: Shift) and performance-based measures (Head-Toes-Knees-Shoulders; DAS-II: Pattern Construction). Social-emotional competence was measured via teacher (Child Behavior Rating Scale), and parent (BRIEF-P: Emotional Control) report, and classroom observations.

Results: Children in both school settings showed significant improvements on BRIEF-P Shift (t=3.41, p=.002; t=2.62, p=009) and Emotional Control (t=2.47, p=.012; t=2.70, p=.008). Children in private school improved on CBRS (t= -4.06, p< .001); children in public school improved on the DAS-II (t= -2.94, p< .004). Children at both public (t=1.62, p=.060) and private school (t=2.00, p=.030) school improved on classroom behaviors. Stepwise regression indicated EF (HTKS) significantly predicted CBRS emotional competence (F=8.11, p< .008), accounting for substantial variance (R²= .225). Post-intervention results for academic medical center are in progress.

Conclusions: UOT-EC shows promise as a transdiagnostic intervention to improve emotional well-being via EF skills. Further research is needed to assess effectiveness relative to control.