Inhibitory Control In Children Research Articles

Systolic Blood Pressure Mediates the Relationship Between Body Mass Index and Inhibitory Control in Children

Increased body mass index (BMI) and systolic blood pressure (SBP) have been shown to be associated with poorer inhibitory cognitive control throughout childhood and impact children´s health. Further statistical procedures may help to understand the nature of relationship between these variables in children. PURPOSE: Here, we verify the mediation role of the SBP in the relationship between BMI and inhibitory control. METHODS: Twenty non-normotensive (NNT) children (age: 10.86 (10.18-10.98) years; 8 hypertensive stage I; 1 hypertensive stage II and 11 pre-hypertensive) were paired with 20 normotensive (NT) children (age: 10.40 (9.86 – 10.69) years) by cardiorespiratory fitness, BMI, somatic maturation, scholar performance and age. They differed on SBP (NNT: 120.53±6.73 mmHg vs NT: 106.64±7.04 mmHg; p<0.01) and diastolic blood pressure (DBP) (NNT: 75.83±8.81 mmHg vs NT: 64.80±4.94 mmHg; p<0.01). BP was calculated by the average of three measures with a two-minute interval between them. Inhibitory control was measured by a food specific inhibitory Go/ No-go task. The Go stimuli were presented as office and bathroom pictures, whereas the No-go (inhibition) stimuli were food and toys images. Performance was evaluated based on number of errors during No-go stimuli. T-tests were applied to verify differences between independent variables and cognitive performance. Thereafter, a four step mediation was applied using SBP as a mediator of the relation between BMI and number of errors. RESULTS: NNT group had higher number of errors compared to NT one (4.14 ± 0.92 vs. 2.43 ± 0.54; p = 0.002). In addition, a relationship between BMI and number of errors (β = 0.38, SE = 0.16, p=0.02) was found. However, when considering SBP, this relationship was no longer statistically significant (β = 0.24, SE = 0.16, p = 0.13). The bootstrapped unstandardized indirect effect was 0.13 and the 95% confidence interval ranged from 0.02 to 0.35. This indicates SBP as a full mediation of the relation between BMI and inhibitory control. CONCLUSION: We confirm the relationship between body mass index and cognitive inhibitory control in children and for the first time present systolic blood pressure as a mediating mechanism.

Effects of Sleep Extension on Inhibitory Control in Children With ADHD: A Pilot Study

Objective: Children with ADHD often have sleep complaints and cognitive deficits. The aim of this pilot study was to determine whether sleep extension improves inhibitory control, a primary cognitive deficit in ADHD. Method: Children with (n = 11) and without (n = 15) ADHD participated in a within-subject sleep extension intervention that targeted nocturnal sleep duration. Sleep was assessed with actigraphy and polysomnography. Inhibitory control was assessed with a Go/No-Go task. Results: For children without ADHD, there was a significant main effect of time, such that morning inhibitory control was 10% greater than evening inhibitory control. However, inhibitory control did not differ between the baseline and extension conditions in this group. For children with ADHD, although morning inhibitory control did not differ from evening inhibitory control, sleep extension improved inhibitory control by 13% overall. Conclusion: These results suggest that a sleep extension intervention improves inhibitory control in children with ADHD.

Gains in teacher-child interaction quality and children's school readiness skills: Does it matter where teachers start?

Teachers' initial level of interactional quality at the beginning of a school year (baseline) was examined as a potential moderating factor in the relation between change in interactional quality and change in children's school readiness skills throughout an academic year. Participants were 269 preschool teachers and 1179 children from low-income backgrounds. Teacher-child interactions and children's school readiness skills were measured in the fall and spring of the preschool year. Overall, improvements in the quality of teacher-child interactions across the year were not significantly related to children's skill development. Three important findings emerged; two main effects and one interaction effect. Gains in teachers' instructional support across the year were related to children's literacy and inhibitory control development. Additionally, the relation between gains in teachers' emotional support and gains in children's inhibitory control was moderated by teachers' initial level of emotional support at the beginning of the year. These findings provide limited evidence for the need to consider teachers' initial level of quality and how much they change across the year in understanding the relation between quality of teacher-child interactions and children's skill development.

Fat mass predicts food-specific inhibitory control in children

Background/objectivesImpaired inhibitory control has been associated with obesity, high blood pressure and lack of physical fitness. These impairments are thought to be related to decreased cognitive control over excessive food consumption and may start in childhood. However, previous studies in children have examined inhibitory control deficits using general (non-food-specific) tasks and relied on body mass index, which does not distinguish the amount of fat mass. As fat mass, hypertension and physical fitness have been shown to play a role in cognition, the aim of this study was to investigate the relationship between these variables and food specific inhibitory control in children. Subjects/methodsChildren's (n = 48; Age 10.7 ± 0.6 years) general characteristics, fat mass, cardiorespiratory fitness, blood pressure and performance on a food-specific inhibitory control task (Go/No-go) were measured across two sessions. ResultsFat mass and sex were associated with inhibitory control performance, while no associations were found for cardiorespiratory fitness, blood pressure and other potential confounding variables (i.e. age, pubertal timing, body mass index, waist-to-hip ratio, scholar test performance and heart rate). Linear regression analyses showed that only fat mass predicted poorer food-specific inhibitory control (β = 0.36; ΔR2 = 0.04; p < .05) and sex predicted inhibitory control for toys (control condition) (β = 0.42; ΔR2 = 0.11; p < .01). Neither blood pressure nor cardiorespiratory fitness predicted food specific inhibitory control. ConclusionThese findings suggest that fat mass is an independent predictor of inhibitory control for food in children.

A Randomized Controlled Trial on the Effects of Aerobic and Coordinative Training on Neural Correlates of Inhibitory Control in Children.

Whereas aerobic training has found to be beneficial for inhibitory control, less is known on the efficiency of other exercise types in children. The present study compared the effects of aerobic and coordinative training on behavioral and neurophysiological measures of inhibitory control. Forty-five children were randomly assigned (1:1:1 ratio) to groups performing aerobic training, coordinative training or assisted homework sessions over 10 weeks. Before and after intervention, all participants completed a Flanker task. The P300 component of event-related potentials elicited from the task was recorded via electroencephalography. Additionally, aerobic fitness and gross-motor skills were assessed using 20 m Shuttle Run and Heidelberg Gross-Motor Test, respectively. Statistical analyses revealed no time by group interactions for the P300 component (amplitude, latency), p = 0.976, η2 = 0.007, and behavioral performance (reaction time, accuracy), p = 0.570, η2 = 0.045. In contrast, there was a significant group-difference in pre- to post-test changes in aerobic fitness, p = 0.008, η2 = 0.246, with greater improvements following aerobic and coordinative training compared to assisted homework sessions. In conclusion, no differences regarding the efficiency of aerobic and coordinative training for the enhancement of inhibitory control were found as both exercise programs failed to elicit changes in speed and accuracy of stimulus evaluation and the allocation of attentional resources.

Parental warmth and harsh discipline as mediators of the relations between family SES and Chinese preschooler’s inhibitory control

This study aimed to investigate the association between family socioeconomic status (SES) and child inhibitory control, and whether this association would be mediated by parental warmth or harsh discipline. Two hundred seventy-three Chinese preschool-age children and their mothers and fathers participated. Parental warmth and harsh discipline were assessed by father-report and by mother-report, respectively. Child inhibitory control was assessed by laboratory tasks and mother-report. Results of structural equation modeling suggested that higher family SES was associated with child better inhibitory control, and maternal but not paternal warmth or harsh discipline played partial mediating roles in this association. The findings highlight the importance of determining particular family ecology that impedes the development of self-regulation in young children, and also provide encouraging support for interventions targeting parenting practices as a vehicle to improve children’s developmental outcomes.

A developmental cascade model for early adolescent-onset substance use: the role of early childhood stress.

Backgrounds and aimsDespite the link between stress and addictive behavior in adulthood, little is known about how early life stress in families predicts the early emergence of substance use in adolescence. This study tested a developmental cascade model, proposing that early stressful life events and negative parent–child interaction covary, and both disrupt the refinement of inhibitory control, which evolves into problem behavior in middle/late childhood and subsequent substance use exploration in early adolescence.MethodsData came from the Early Steps Multisite study, a community sample of at‐risk families in the metropolitan US areas of Pittsburgh (Pennsylvania), Eugene (Oregon) and Charlottesville (Virginia) with children aged 2 years at the start of the study and 14 years at the last measurement (n = 364). Structural equation modeling was used to test the proposed model.ResultsEarly stressful life events and negative parent–child interaction assessed at ages 2–5 were negatively related to inhibitory control at ages 7 and 8. Low levels of inhibitory control were prognostic of childhood problem behavior at ages 9 and 10. Finally, late childhood problem behavior was associated with substance use at age 14. Parental drug use was directly related to substance use at age 14.ConclusionsEarly life stress may disrupt child inhibitory control, which can cascade into behavioral and peer problem behavior in childhood and, in turn, heighten the risk for early adolescent substance use.

Aberrant functional connectivity of inhibitory control networks in children with autism spectrum disorder.

Development of inhibitory control is a core component of executive function processes and a key aspect of healthy development. Children with autism spectrum disorder (ASD) show impairments in performance on inhibitory control tasks. Nevertheless, the research on the neural correlates of these impairments is inconclusive. Here, we explore the integrity of inhibitory control networks in children with ASD and typically developing (TD) children using resting state functional Magnetic Resonance Imagaing (MRI). In a large multisite sample, we find evidence for significantly greater functional connectivity (FC) of the right inferior frontal junction (rIFJ) with the posterior cingulate gyrus, and left and right frontal poles in children with ASD compared with TD children. Additionally, TD children show greater FC of rIFJ with the superior parietal lobule (SPL) compared with children with ASD. Furthermore, although higher rIFJ-SPL and rIFJ-IPL FC was related to better inhibitory control behaviors in both ASD and TD children, rIFJ-dACC FC was only associated with inhibitory control behaviors in TD children. These results provide preliminary evidence of differences in intrinsic functional networks supporting inhibitory control in children with ASD, and provide a basis for further exploration of the development of inhibitory control in children with the disorder. Autism Research 2018, 11: 1468-1478. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Inhibitory control is an important process in healthy cognitive development. Behavioral studies suggest that inhibitory control is impaired in autism spectrum disorder (ASD). However, research examining the neural correlates underlying inhibitory control differences in children with ASD is inconclusive. This study reveals differences in functional connectivity of brain networks important for inhibitory control in children with ASD compared with typically developing children. Furthermore, it relates brain network differences to parent-reported inhibitory control behaviors in children with ASD. These findings provide support for the hypothesis that differences in brain connectivity may underlie observable behavioral deficits in inhibitory control in children with the disorder.

Hypoactivation of the Right Prefrontal Cortex Underlying Motor‐Related Inhibitory Deficits in Children with Autism Spectrum Disorder: A Functional Near‐Infrared Spectroscopy Study

AbstractAutism spectrum disorder (ASD) and attention‐deficit hyperactivity disorder (ADHD) are believed to share the symptom of neurocognitive dysfunction in executive functions. Regarding the components of executive functions, however, dysfunction of motor‐response inhibitory control in children with ASD remains unclear. Thus, using functional near‐infrared spectroscopy (fNIRS), we investigated whether putative inhibitory brain dysfunctions are applicable to children with ASD by adopting a go/no‐go task, which has robustly evoked activation in typically developing (TD) children but not in ADHD children. Twenty‐four ASD and 24 TD children underwent a go/no‐go task, and their cortical hemodynamics were assessed using fNIRS. Relative to TD participants, ASD participants showed reduced activation in the right inferior frontal gyrus and middle frontal gyrus (IFG/MFG) during go/no‐go tasks. The current finding suggests that hypoactivation in the right IFG/MFG during a go/no‐go task would serve as a potential biomarker for identifying children with ASD.

Child inhibitory control and maternal acculturation moderate effects of maternal parenting on Chinese American children's adjustment.

The goals of this study were to examine: (a) bidirectional associations between maternal parenting (physical punishment and guilt induction) and Chinese American preschool children's psychosocial adjustment and (b) the role of maternal cultural orientation and child temperament in moderating parenting effects. Participants were Chinese American mothers and children (N = 163, Mage = 4.56, 53% boys). Mothers reported on their parenting practices at both Wave 1 (W1) and Wave 2 (W2) and their cultural orientations and children's inhibitory control at W1. Teachers rated children's prosocial, internalizing, and externalizing behaviors at both W1 and W2. A Bayesian approach to path analysis was utilized to investigate how parenting, child inhibitory control, and maternal cultural orientations work together to predict the development of children's prosociality and psychosocial problems. Results showed that for Chinese immigrant mothers who were highly acculturated toward the American culture and for children with low levels of inhibitory control, maternal use of physical punishment predicted more externalizing problems in children. Child inhibitory control and maternal enculturation were directly associated with less W2 child internalizing and externalizing behaviors. Moreover, physical punishment predicted more internalizing behavior, whereas guilt induction predicted less child internalizing behavior. Maternal guilt induction also prospectively predicted more prosocial behavior but only for children with low levels of inhibitory control. Finally, only one child effect was significant: More W1 internalizing behavior predicted less W2 physical punishment. These effects held after controlling for temporal stabilities of the constructs and demographic covariates. Findings are discussed within the cultural context of the study. (PsycINFO Database Record

Effects of Caffeine Administration on Reaction Time, Attention, and Inhibitory Control in Children and Adolescents

Previous studies have shown that caffeine can improve performance on cognitive tasks in adults, but little work has been done in children and adolescents, who use caffeine less habitually. The primary aim of this study was to test the hypothesis that acute caffeine enhances performance on cognitive tasks in children and adolescents. Two secondary aims were to determine if these effects differ as a function of sex, puberty, and menstrual cycle phase and if these effects can be attributed to withdrawal reversal. Children were given a cognitive test battery using the Automated Neurological Assessment Metrics (ANAM) before and 60 min after administration of placebo or caffeine (1 or 2 mg/kg). The number of correct responses and throughput on the Stroop task were increased after caffeine administration. Caffeine also decreased reaction time on the Stroop and decreased the standard deviation of the reaction time on the Go/No-Go task. We further analyzed these data based on presence or absence of withdrawal symptoms and by usual caffeine use and found that the effects of caffeine remained. We found interactions between sex and caffeine for Go/No-Go task time and the standard deviation of the reaction time on the Stroop task and an interaction between caffeine dose and menstrual cycle phase on the standard deviation of the reaction time on the Go/No-Go task. These results are consistent with previous studies showing caffeine facilitates performance on some cognitive tasks and that these improvements are not related to reversal of withdrawal effects. This study is among the first to report sex differences in responses to caffeine on cognitive tasks in children and adolescents.

Modulating mimicry: Exploring the roles of inhibitory control and social understanding in 5-year-olds' behavioral mimicry.

During adult interactions, behavioral mimicry, the implicit copying of an interaction partner’s postures and mannerisms, communicates liking and affiliation. While this social behavior likely develops during early childhood, it is unclear which factors contribute to its emergence. Here, the roles of inhibitory control and social understanding on 5-year-olds’ behavioral mimicry were investigated. Following a social manipulation in which one experimenter shared a sticker with the child and the other experimenter kept two stickers for herself, children watched a video in which these experimenters each told a story. During this story session, children in the experimental group (n = 28) observed the experimenters perform face and hand rubbing behaviors whereas the control group (n = 23) did not see these behaviors. Children’s inhibitory control was assessed using the day-night task and their social understanding was measured through a parental questionnaire. Surprisingly, group-level analyses revealed that the experimental group performed the behaviors significantly less than the control group (i.e. a negative mimicry effect) for both the sticker-sharer and sticker-keeper. Yet, the hypothesized effects of inhibitory control and social understanding were found. Inhibitory control predicted children’s selective mimicry of the sticker-keeper versus sticker-sharer and children’s overall mimicry was correlated with social understanding. These results provide the first indications to suggest that factors of social and cognitive development dynamically influence the emergence and specificity of behavioral mimicry during early childhood.

Air Pollution Exposure During Fetal Life, Brain Morphology, and Cognitive Function in School-Age Children

BackgroundAir pollution exposure during fetal life has been related to impaired child neurodevelopment, but it is unclear if brain structural alterations underlie this association. The authors assessed whether air pollution exposure during fetal life alters brain morphology and whether these alterations mediate the association between air pollution exposure during fetal life and cognitive function in school-age children. MethodsWe used data from a population-based birth cohort set up in Rotterdam, The Netherlands (2002–2006). Residential levels of air pollution during the entire fetal period were calculated using land-use regression models. Structural neuroimaging and cognitive function were performed at 6 to 10 years of age (n = 783). Models were adjusted for several socioeconomic and lifestyle characteristics. ResultsMean fine particle levels were 20.2 μg/m3 (range, 16.8–28.1 μg/m3). Children exposed to higher particulate matter levels during fetal life had thinner cortex in several brain regions of both hemispheres (e.g., cerebral cortex of the precuneus region in the right hemisphere was 0.045 mm thinner (95% confidence interval, 0.028–0.062) for each 5-μg/m3 increase in fine particles). The reduced cerebral cortex in precuneus and rostral middle frontal regions partially mediated the association between exposure to fine particles and impaired inhibitory control. Air pollution exposure was not associated with global brain volumes. ConclusionsExposure to fine particles during fetal life was related to child brain structural alterations of the cerebral cortex, and these alterations partially mediated the association between exposure to fine particles during fetal life and impaired child inhibitory control. Such cognitive impairment at early ages could have significant long-term consequences.

The role of paternal mind‐mindedness in preschoolers' self‐regulated conduct

AbstractThis study examined the prospective links between paternal mind‐mindedness (MM) and 2 indices of preschoolers' self‐regulated conduct, namely, inhibitory control and rule‐compatible conduct. Ninety‐two families (47 boys) participated in 2 assessments. Paternal MM was assessed with a 10‐min father–child free‐play session when children were aged 18 months. Children's rule‐compatible conduct was reported by mothers when children reached 3 years of age, and inhibitory control was measured with a Snack Delay task, also administered at 3 years. The results suggested that after accounting for the contribution of child temperament (social fearfulness), paternal MM was positively related to children's inhibitory control. In contrast, the relation between paternal MM and mother‐reported rule‐compatible conduct was not significant. The results are interpreted in light of the mechanisms that may account for the links between paternal MM and preschoolers' emerging capacity to voluntarily control their behaviour.Highlights This study examines the prospective links between paternal mind-mindedness and two indices of preschoolers' subsequent self‐regulated conduct. Paternal mind‐mindedness was assessed with father‐child free‐play, and self‐regulated conduct with an inhibitory control task and a mother questionnaire. The results suggest that paternal mind‐mindedness is positively related to children's inhibitory control.

Early inhibitory control and working memory abilities of children prenatally exposed to methadone

BackgroundMethadone maintenance is the most common method of treating opioid-dependent pregnant women. However, little is known about the impact of prenatal methadone exposure on child neurocognitive development. AimsTo examine the early executive functioning of children born to methadone-maintained mothers, and to assess relations between executive functioning and later emotional and behavioral adjustment. Study designProspective longitudinal study. ParticipantsThe sample consisted of 68 methadone-exposed children and 88 non-methadone-exposed children. Outcome measuresAt age 2years, children's inhibitory control and working memory were assessed using the Snack Delay and Three Boxes tasks. At 2 and 4.5years, their emotional and behavioral adjustment was assessed using the caregiver-completed Strengths and Difficulties Questionnaire. ResultsMethadone-exposed children had poorer inhibitory control than non-exposed children (p<0.0001). These differences were explained by maternal education and prenatal benzodiazepine use. With respect to working memory, although both groups performed similarly on the first trial set, non-exposed children significantly improved their performance on the second trial set (p=0.002), while methadone-exposed children did not (p=0.92). Inhibitory control at age 2years was predictive of higher conduct (p=0.001), hyperactivity (p=0.0001), peer relationship (p=0.02), and total (p<0.0001) problems at 4.5years even after adjustment for behavioral problems at 2years. ConclusionsMethadone-exposed children demonstrate difficulties with inhibitory control and possibly sustained attention/learning. These difficulties were explained by factors correlated with maternal prenatal methadone use. Longer-term follow-up of these children is needed to understand the effects of prenatal methadone exposure and related maternal factors on executive functioning and behavioral adjustment.

An event-related potential investigation of the acute effects of aerobic and coordinative exercise on inhibitory control in children with ADHD

The current body of evidence suggests that an aerobic exercise session has a beneficial effect on inhibitory control, whereas the impact of coordinative exercise on this executive function has not yet been examined in children with ADHD. Therefore, the present study aims to investigate the acute effects of aerobic and coordinative exercise on behavioral performance and the allocation of attentional resources in an inhibitory control task.Using a cross-over design, children with ADHD-combined type and healthy comparisons completed a Flanker task before and after 20 min moderately-intense cycling exercise, coordinative exercise and an inactive control condition. During the task, stimulus-locked event-related potentials were recorded with electroencephalography.Both groups showed an increase of P300 amplitude and decrease of reaction time after exercise compared to the control condition. Investigating the effect of exercise modality, aerobic exercise led to greater increases of P300 amplitude and reductions in reaction time than coordinative exercise in children with ADHD.The findings suggest that a single exercise bout improves inhibitory control and the allocation of attentional resources. There were some indications that an aerobic exercise session seems to be more efficient than coordinative exercise in reducing the inhibitory control deficits that persist in children with ADHD.

Growth in inhibitory control among low-income, ethnic-minority preschoolers: A group-based modeling approach

The emergence of self-regulation skills such as inhibitory control in children is an important developmental process associated with adjustment across multiple domains. Individual differences in inhibitory control are associated with family socioeconomic status but have not been studied in relation to variations in risk found within a low-income (i.e., high risk) sample (N=407). Using a group-based modeling approach, change in inhibitory control was examined from 30 to 42 months of age in a sample of low-income Hispanic and African-American children. Patterns of change in inhibitory control were examined in relation to cumulative risk and child externalizing behavior using the Child Behavior Checklist measured at 42 months. A three-group solution was identified as optimally fitting the data, representing patterns of change in inhibitory control: a normative group, exhibiting increasing inhibitory control (48%); a low-stable group (40%); and a high-stable group (12%). Group membership did not differ by child ethnicity or gender. Higher cumulative risk was found among the children in the low-stable group than in the other groups. Mothers reported more externalizing problems at 42 months for children in the low-stable group than in the other groups, even controlling for the effect of cumulative risk. Intervention and policy implications are discussed.

Attentional control and executive functioning in school-aged children: Linking self-regulation and parenting strategies

Good parenting strategies can shape children’s neurocognitive development, yet little is known about the nature of this relation in school-aged children and whether this association shifts with age. We aimed to investigate the relation between parenting strategies observed during a home visit and children’s performance-based attentional control and executive functioning (N=98, aged 4–8years). Linear and curvilinear regression analyses showed that children of parents who were more supportive, were less intrusive, and asked more open-ended questions displayed better inhibitory control. In addition, children of parents who asked relatively more open-ended than closed-ended questions showed better performance on inhibition, working memory, and cognitive flexibility tasks. Curvilinear relations indicated the presence of an optimal amount of closed-ended and elaborative questions by parents—that is, not too few and not too many—which is linked to increased performance on attentional and inhibitory control in children. Higher parental intrusiveness and more frequent elaborative questioning were associated with decreased inhibitory control in younger children, whereas no such negative associations were present in older children. These results suggest that susceptibility to certain parenting strategies may shift with age. Our findings underscore the importance of adaptive parenting strategies to both the age and needs of school-aged children, which may positively affect their self-regulation skills.

Associated movements and inhibitory control in children between 2 and 6 years are related

Background: Motor development refers to the development of movement abilities and includes the ability of children to selectively activate certain muscles and inhibit those that are not supporting a specific movement. Up to 6 years, this inhibition is still limited and associated movements (AMs) are frequent in complex motor tasks. In parallel, evidence is accumulating that other inhibitory processes (i.e., inhibitory control) more related to psychological functioning are also still developing. It was the aim of this study to focus on the associations between the amount of AMs and inhibitory control in children below 6.

Effectiveness of a universal classroom-based preventive intervention (PAX GBG): A research protocol for a matched-pair cluster-randomized controlled trial.

IntroductionThe PAX Good Behavior Game (PAX GBG) is a universal classroom-based program that promotes children's mental health. In Estonia, the intervention is delivered to first grade students (aged seven to eight) within the regular school curriculum. The current work describes a protocol for a cluster-randomized controlled trial (RCT) of the PAX GBG conducted in Estonia.Design and methodsThis is an ongoing, pragmatic, two-year, matched-pair, cluster-RCT conducted in Estonian elementary schools. Schools were matched to pairs based on their geographical location and number of students per classroom. One school in each pair was randomly selected to receive the intervention and the other placed on a wait-list as a control. 42 schools provided baseline data during the autumn of 2016. Data is collected at two more points in time – seven months and 19 months post-baseline. Outcomes of children's mental health and behavior are measured by the teacher- and parent-rated Strengths and Difficulties Questionnaire, parent-rated Swanson, Nolan, and Pelham – IV Questionnaire and the Go/No-Go task completed by children. Teachers also rate their self-efficacy and overall classroom behavior.DiscussionThis study aims to test the effectiveness of the intervention in Estonian classrooms with a newer version of the rigorously tested GBG program. To our knowledge, this study is the first to measure the effects of the intervention on children's inhibitory control, which has been associated with externalizing problems in the literature. The results from this trial will provide further understanding into how the program influences children's well-being and self-control.Trial registrationClinicalTrials.gov registry (NCT02865603).