Abstract：
BACKGROUND: Early executive functioning (EF) skills are foundational capabilities that predict school readiness, academic development and psychiatric risk. Early interventions enhancing these capabilities could have critical import in improving outcomes. However, to develop interventions, it is necessary to identify specific EF skills that will vary with child age. Thus, we aimed to examine the characteristics and efficacy of interventions targeting EF in infancy and early childhood up to age 3.
METHODS: A comprehensive search of PubMed, Embase, CINAHL and APA PsycINFO databases was performed for studies published before December 2022. Randomized and non-randomized studies of interventions designed to improve at least one EF skill in children ≤3 years were included. EF skills included attentional control, inhibition/self-regulation, activity initiation, working memory, cognitive flexibility, planning ability, problem-solving and performance monitoring. We independently extracted data, used the revised Cochrane Risk-of-Bias tool to assess the quality of the evidence and conducted Synthesis Without Meta-analysis (SWiM). The overall quality of the evidence and the strength of recommendations was determined using elements of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS: Thirty-five studies met inclusion criteria (original n = 7467). Studies were highly variable in the EF skill targeted, target subject (i.e., child, parent and teacher), nature and dosage of the intervention, and timing of outcome assessment. Most interventions focused on improving impulse control and self-regulation. The overall quality of evidence was low to moderate with a high risk of bias, though six studies had low risk of bias but yielded mixed findings of efficacy.
CONCLUSIONS: The relatively small number of early EF intervention studies uses such variable methods that there is currently no converging evidence of efficacy to recommend a specific intervention. Thus, findings support the need for a more systematic, targeted approach to the design and implementation of early EF interventions for target populations.
METHODS: A comprehensive search of PubMed, Embase, CINAHL and APA PsycINFO databases was performed for studies published before December 2022. Randomized and non-randomized studies of interventions designed to improve at least one EF skill in children ≤3 years were included. EF skills included attentional control, inhibition/self-regulation, activity initiation, working memory, cognitive flexibility, planning ability, problem-solving and performance monitoring. We independently extracted data, used the revised Cochrane Risk-of-Bias tool to assess the quality of the evidence and conducted Synthesis Without Meta-analysis (SWiM). The overall quality of the evidence and the strength of recommendations was determined using elements of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
RESULTS: Thirty-five studies met inclusion criteria (original n = 7467). Studies were highly variable in the EF skill targeted, target subject (i.e., child, parent and teacher), nature and dosage of the intervention, and timing of outcome assessment. Most interventions focused on improving impulse control and self-regulation. The overall quality of evidence was low to moderate with a high risk of bias, though six studies had low risk of bias but yielded mixed findings of efficacy.
CONCLUSIONS: The relatively small number of early EF intervention studies uses such variable methods that there is currently no converging evidence of efficacy to recommend a specific intervention. Thus, findings support the need for a more systematic, targeted approach to the design and implementation of early EF interventions for target populations.
摘要：
背景：早期执行功能（EF）技能是预测学校准备的基础能力，学术发展和精神病风险。加强这些能力的早期干预措施可能对改善结果具有重要意义。然而,为了制定干预措施，有必要确定特定的EF技能，这将随着儿童年龄而变化。因此，我们旨在研究针对婴儿和3岁以下儿童早期EF的干预措施的特点和疗效.
方法：对PubMed的全面搜索，Embase,CINAHL和APAPsycINFO数据库用于2022年12月之前发表的研究。纳入了旨在改善≤3岁儿童至少一项EF技能的干预措施的随机和非随机研究。EF技能包括注意力控制，抑制/自我调节，活动启动,工作记忆,认知灵活性，规划能力,解决问题和性能监控。我们独立提取数据，使用修订后的Cochrane偏差风险工具评估证据质量,并进行了无Meta分析的综合分析(SWiM).证据的总体质量和建议的强度是使用建议等级评估的要素确定的，开发和评估(等级)方法。
结果：35项研究符合纳入标准（原始n=7467）。研究在EF技能目标方面差异很大，目标对象(即，孩子,家长和老师)，干预的性质和剂量，和结果评估的时机。大多数干预措施侧重于改善冲动控制和自我调节。总体证据质量低到中等，偏倚风险很高，尽管有6项研究偏倚风险较低,但却得出了不同的疗效结果.
结论：使用可变方法的早期EF干预研究数量相对较少，因此目前尚无疗效一致的证据来推荐特定的干预措施。因此，研究结果支持需要更系统的，有针对性地设计和实施针对目标人群的早期EF干预措施。
方法：对PubMed的全面搜索，Embase,CINAHL和APAPsycINFO数据库用于2022年12月之前发表的研究。纳入了旨在改善≤3岁儿童至少一项EF技能的干预措施的随机和非随机研究。EF技能包括注意力控制，抑制/自我调节，活动启动,工作记忆,认知灵活性，规划能力,解决问题和性能监控。我们独立提取数据，使用修订后的Cochrane偏差风险工具评估证据质量,并进行了无Meta分析的综合分析(SWiM).证据的总体质量和建议的强度是使用建议等级评估的要素确定的，开发和评估(等级)方法。
结果：35项研究符合纳入标准（原始n=7467）。研究在EF技能目标方面差异很大，目标对象(即，孩子,家长和老师)，干预的性质和剂量，和结果评估的时机。大多数干预措施侧重于改善冲动控制和自我调节。总体证据质量低到中等，偏倚风险很高，尽管有6项研究偏倚风险较低,但却得出了不同的疗效结果.
结论：使用可变方法的早期EF干预研究数量相对较少，因此目前尚无疗效一致的证据来推荐特定的干预措施。因此，研究结果支持需要更系统的，有针对性地设计和实施针对目标人群的早期EF干预措施。
