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.

Public Health Relevance

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.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Mentored Patient-Oriented Research Career Development Award (K23)
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Special Emphasis Panel (ZHD1-DSR-W (90)S)
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Griffin, James
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Stanford University
Schools of Medicine
United States
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Whitgob, Emily E; Loe, Irene Marilyn (2018) Impact of Chronic Medical Conditions on Academics of Children in the Child Welfare System. Front Public Health 6:267
Won, Dana C; Guilleminault, Christian; Koltai, Peter J et al. (2017) It Is Just Attention-Deficit Hyperactivity Disorder…or Is It? J Dev Behav Pediatr 38:169-172
Loe, Irene M; Feldman, Heidi M (2016) The Effect of Bilingual Exposure on Executive Function Skills in Preterm and Full-Term Preschoolers. J Dev Behav Pediatr 37:548-56
Feldman, Heidi M; Buysse, Christina A; Hubner, Lauren M et al. (2015) Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs. J Dev Behav Pediatr 36:207-17
Adams, Jenna N; Feldman, Heidi M; Huffman, Lynne C et al. (2015) Sensory processing in preterm preschoolers and its association with executive function. Early Hum Dev 91:227-33
Loe, Irene M; Chatav, Maya; Alduncin, Nidia (2015) Complementary assessments of executive function in preterm and full-term preschoolers. Child Neuropsychol 21:331-53
Wusthoff, Courtney J; Loe, Irene M (2015) Impact of bilirubin-induced neurologic dysfunction on neurodevelopmental outcomes. Semin Fetal Neonatal Med 20:52-57
Loe, Irene M; Feldman, Heidi M; Huffman, Lynne C (2014) Executive function mediates effects of gestational age on functional outcomes and behavior in preschoolers. J Dev Behav Pediatr 35:323-33
Alduncin, Nidia; Huffman, Lynne C; Feldman, Heidi M et al. (2014) Executive function is associated with social competence in preschool-aged children born preterm or full term. Early Hum Dev 90:299-306