Attention training for infants at familial risk of ADHD (INTERSTAARS): study protocol for a randomised controlled trial

Abstract

BackgroundAttention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that can negatively impact on an individual’s quality of life. It is pathophysiologically complex and heterogeneous with different neuropsychological processes being impaired in different individuals. Executive function deficits, including those affecting attention, working memory and inhibitory control, are common. Cognitive training has been promoted as a treatment option, based on the notion that by strengthening the neurocognitive networks underlying these executive processes, ADHD symptoms will also be reduced. However, if implemented in childhood or later, when the full disorder has become well-established, cognitive training has only limited value. INTERSTAARS is a trial designed to test a novel approach to intervention, in which cognitive training is implemented early in development, before the emergence of the disorder. The aim of INTERSTAARS is to train early executive skills, thereby increasing resilience and reducing later ADHD symptoms and associated impairment.Methods/designFifty 10–14-month-old infants at familial risk of ADHD will participate in INTERSTAARS. Infants will be randomised to an intervention or a control group. The intervention aims to train early attention skills by using novel eye-tracking technology and gaze-contingent training paradigms. Infants view animated games on a screen and different events take place contingent on where on the screen the infant is looking. Infants allocated to the intervention will receive nine weekly home-based attention training sessions. Control group infants will also receive nine weekly home visits, but instead of viewing the training games during these visits they will view non-gaze-contingent age-appropriate videos. At baseline and post treatment, infant attention control will be assessed using a range of eye-tracking, observational, parent-report and neurophysiological measures. The primary outcome will be a composite of eye-tracking tasks used to assess infant attention skills. Follow-up data will be collected on emerging ADHD symptoms when the infants are 2 and 3 years old.DiscussionThis is the first randomised controlled trial to assess the potential efficacy of cognitive training as a prevention measure for infants at familial risk of ADHD. If successful, INTERSTAARS could offer a promising new approach for developing early interventions for ADHD.Trial registrationInternational Standard Randomised Controlled Trial registry: ISRCTN37683928. Registered on 22 June 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1727-0) contains supplementary material, which is available to authorized users.

Shared and distinct developmental pathways to ASD and ADHD phenotypes among infants at familial risk

“…Our study had several strengths including the inclusion of a group of infants at familial risk for ADHD, a population that has rarely been studied (but see Auerbach et al, 2008; Goodwin et al, 2016; Sullivan et al, 2015), the use of a person-centered approach, and careful behavioral characterization of the constructs of interest. However, it is not without limitations.…”

Attentional abilities constrain language development: A cross‐syndrome infant/toddler study

“…The possible clinical implications should not be overlooked, because parent‐mediated intervention has been reported to improve attentional disengagement (measured using the gap‐overlap task) in infants at high risk of autism (Green et al, 2015). This suggests that attentional disengagement is amenable to attentional training in at least one group of atypically developing children (see Goodwin et al, 2016 for details of a randomized controlled trial involving another group: infants at risk of ADHD). It is important to know whether ameliorating the visual attention impairment in infants/toddlers with DS will result in better language outcomes.…”

Future Directions for Infant Identification and Intervention for Autism Spectrum Disorder from a Transdiagnostic Perspective

“…Such an approach would be consistent with transdiagnostic, process-focused research into early markers of neurodevelopmental disorders and child psychopathology. As an example, some have begun to test whether attention training among infants at risk for disrupted attentional processing (i.e., infants at familial risk for ADHD, infants at familial risk for ASD, infants who are born preterm) is feasible and effective (Forssman & Wass, 2018;Goodwin et al, 2016;Perra et al, 2020). These types of mechanisms-or process-focused approaches have shown initial evidence of generalizability to non-trained dimensions such as social communication among infants who are JOURNAL OF CLINICAL CHILD & ADOLESCENT PSYCHOLOGY not at known risk, at least in the short term (Forssman & Wass, 2018).…”