The aim of this proposal is a comprehensive 5-year plan for a Mentored Patient-Oriented Research Career Development Award for the CANDIDATE, Irene M. Loe, MD, and Instructor in Developmental Medicine at Stanford University. As a developmental-behavioral pediatrician, her long-term research objectives are to (1) elucidate neurobiological and developmental mechanisms underlying executive function (EF), attention, and behavior problems in children at risk for neurodevelopmental disorders, (2) design, implement, and evaluate innovative clinical treatments that can be applied in early childhood to prevent, treat, and improve outcomes in children at risk for EF and attention impairments, and (3) document long-term impact of interventions on functional outcomes and neural organization. The CAREER DEVELOPMENT plan includes didactic work and tutorials in biostatistics and randomized clinical trials (RCT); mentored training; and experimental research. The research supports Dr. Loe's development of expertise in EF in preschool children; implementation of advanced statistical methods; and experience in designing and implementing an RCT. The ENVIRONMENT at Stanford University provides outstanding resources for education and training of researchers in academic medicine. Dr. Heidi Feldman, developmental-behavioral pediatrician, and Dr. Susan Landry, developmental psychologist, both child development experts with expertise in EF and RCTs serve as co-mentors. Consultants are Drs. Philip Lavori, Linda Pfiffner, and David Stevenson, all experienced in RCT, and who bring expertise in biostatistics, EF and attention-deficit/hyperactivity disorder (ADHD), and preterm children, respectively. The RESEARCH evaluates two highly prevalent populations at risk for EF impairment: (1) preterm children (preterm-risk) and (2) children with first-degree family member with ADHD (family-risk). This innovative research plan is divided into 2 parts: Part 1. EF Characteristics/EF Profiles study is designed to compare EF skills in groups with (1) preterm- risk, (2) family-risk, and (3) matched full-term controls. We compare groups to each other directly, hypothesizing poor working memory in preterm-risk and poor response inhibition in family-risk. Part 2. Response to Treatment study is an RCT of placebo or home-based computerized training for preterm preschoolers with EF impairment. The training targets working memory, and the main outcome measure is performance on untrained working memory tasks.
EF skills are linked to academic achievement, and EF impairments are found in neurodevelopmental disorders. EF skills may serve as important markers or predictors of outcome, as well as targets for intervention to improve outcomes. Effective interventions for EF impairments in preschool children capitalize on potential neural plasticity and could lead to improved functional outcomes. The proposed training and research studies lay the foundation for a long-term programmatic research agenda for Dr. Loe's career. She will have the requisite skills and experience to become an independent researcher focused on the neurobiological basis, development, and improvement of EF skills.
