Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul;69(7):546-557.
doi: 10.1111/jir.13234. Epub 2025 Apr 6.

Feasibility and Preliminary Efficacy of an Executive Function Intervention for Young Children With Down Syndrome

Miranda E Pinks  1 , Madison M Walsh  1 , Sara Colaianni  2 , Sara Onnivello  2 , Chiara Marcolin  2 , Sarah Looney  1 , Elisa Rossi  2 , Francesca Pulina  2 , Mark A Prince  3 , Nathaniel R Riggs  1 , Susan Hepburn  1 , Lisa A Daunhauer  1 , Van Deusen Kaylyn  1 , Silvia Lanfranchi  2 , Deborah J Fidler  1
Affiliations

Feasibility and Preliminary Efficacy of an Executive Function Intervention for Young Children With Down Syndrome

Miranda E Pinks et al. J Intellect Disabil Res. 2025 Jul.

Abstract

Background: Individuals with Down syndrome (DS) have an elevated likelihood of challenges with executive function (EF) throughout the lifespan, and syndrome-informed intervention approaches that strengthen these foundations during early childhood may be beneficial. This single group baseline versus postintervention pilot study presents findings from the implementation of a syndrome-informed, parent-mediated intervention designed to support the development of EF in preschool-aged children with DS (EXPO: Executive Function Play Opportunities).

Method: Participants were 34 children aged 3-7 years old with DS and their caregivers. The full sample participated in a novel 12-week parent-mediated intervention focused on building working memory, inhibitory control, cognitive flexibility and planning skills. Participants were evaluated at baseline and poststudy for feasibility outcomes and preliminary evidence of intervention efficacy.

Results: Activities were feasible for families to implement and appropriate for the developmental range of participants in the study. Preliminary evidence of efficacy was observed via laboratory-based EF outcome measures. Within-sample heterogeneity in response to intervention was also observed.

Conclusions: EXPO is feasible for a larger trial in its current form. Additional intervention modifications may further increase the potential impact of EXPO by addressing heterogeneity in presentations among young children with DS.

Keywords: Down syndrome; executive function; parent‐mediated intervention; pilot study.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Participant flow through the EXPO 2.0 pilot study.
FIGURE 2
FIGURE 2
Number of EF tasks demonstrating gains by participant CA. (A) Total number of EF task gains without accounting for ceiling effects at baseline. (B) Total number of EF task gains accounting for ceiling effects on the Garage Game task at baseline. (C) Total number of EF task gains accounting for ceiling effects on the Adapted Reverse Categorisation (ARC) task at baseline. (D) Total number of EF task gains accounting for ceiling effects on the prohibition task at baseline.
FIGURE 3
FIGURE 3
Changes in participant working memory outcome from baseline to postintervention. Note: Lower scores indicate stronger working memory performances.
FIGURE 4
FIGURE 4
Changes in participant inhibition outcome from baseline to postintervention. Note: Higher scores indicate stronger inhibition performances.
FIGURE 5
FIGURE 5
Changes in participant shifting outcome from baseline to postintervention. Note: Higher scores indicate stronger cognitive flexibility performances.
See this image and copyright information in PMC

References

    1. Blair, C. , Zelazo P. D., and Greenberg M. T.. 2005. “The Measurement of Executive Function in Early Childhood.” Developmental Neuropsychology 28, no. 2: 561–571. - PubMed
    1. Carlson, S. M. , Zelazo P. D., and Faja S.. 2013. “Executive Function.” In The Oxford Handbook of Developmental Psychology, edited by Zelazo P. D., vol. 1. Oxford University Press.
    1. Colaianni, S. , Walsh M. M., Onnivello S., et al. 2025. “Acceptability of a Novel Parent‐Mediated Executive Function Intervention for Young Children With Down Syndrome in Italy.” Journal of Applied Research in Intellectual Disabilities 38, no. 2: e70038. 10.1111/jar.70038. - DOI - PMC - PubMed
    1. Cumming, G. 2013. Understanding the new Statistics: Effect Sizes, Confidence Intervals, and Meta‐Analysis. Routledge.
    1. Daunhauer, L. A. , and Fidler D. J.. 2011. “The Down Syndrome Behavioral Phenotype: Implications for Practice and Research in Occupational Therapy.” Occupational Therapy in Health Care 25, no. 1: 7–25. - PubMed