INTERSTAARS: Attention training for infants with elevated likelihood of developing ADHD: A proof-of-concept randomised controlled trial

Abstract

Attention-deficit/hyperactivity disorder (ADHD) is first diagnosed during middle childhood, when patterns of difficulty are often established. Pre-emptive approaches that strengthen developing cognitive systems could offer an alternative to post-diagnostic interventions. This proof-of-concept randomised controlled trial (RCT) tested whether computerised gaze-based attention training is feasible and improves attention in infants liable to develop ADHD. Forty-three 9- to 16-month-old infants with a first-degree relative with ADHD were recruited (11/2015–11/2018) at two UK sites and randomised with minimisation by site and sex to receive 9 weekly sessions of either (a) gaze-contingent attention training (intervention; n = 20); or (b) infant-friendly passive viewing of videos (control, n = 23). Sessions were delivered at home with blinded outcome assessments. The primary outcome was a composite of attention measures jointly analysed via a multivariate ANCOVA with a combined effect size (ES) from coefficients at baseline, midpoint and endpoint (Registration: ISRCTN37683928). Uptake and compliance was good but intention-to-treat analysis showed no significant differences between 20 intervention and 23 control infants on primary (ES −0.4, 95% CI −0.9 to 0.2; Complier-Average-Causal Effect ES −0.6, 95% CI −1.6 to 0.5) or secondary outcomes (behavioural attention). There were no adverse effects on sleep but a small increase in post-intervention session fussiness. Although feasible, there was no support for short-term effects of gaze-based attention training on attention skills in early ADHD. Longer-term outcomes remain to be assessed. The study highlights challenges and opportunities for pre-emptive intervention approaches to the management of ADHD.

Computerized cognitive training in attention-deficit/hyperactivity disorder (ADHD): a meta-analysis of randomized controlled trials with blinded and objective outcomes

“…Second, because there is greater plasticity earlier in development, the second option could be to focus training on younger age groups than those currently studied (typically between 8 and 14-years or older). For instance, preliminary work has shown gains in neuropsychological and some degree of reduction in ADHD symptoms using play-based interventions for pre-schoolers that train neurocognitive and behavioural domains in real-world settings [54,55]. Although we aimed to measure the effect of CCT in pre-schoolers with ADHD, there were no RCTs with samples of children with a confirmed ADHD diagnosis.…”

Comparative strengths and challenges on face‐to‐face and computer‐based attention tasks in autistic and neurotypical toddlers

“…As such, tapping into these relative strengths, when present, to exploit the brain's plasticity may promote development in areas of relative weakness for the individual through controlled exposure of attentionally demanding tasks across multiple sessions (Goodwin et al, 2016). One such attention training paradigm, developed by Wass and colleagues, has shown promise in strengthening attention skills in NT children (Wass et al, 2011) and siblings of children with attention deficit hyperactivity disorder (ADHD; Goodwin et al, 2021). Technological methods that rely on gaze may be useful to assess or provide intervention for very young children or children with developmental delays.…”

“…The purpose of the present study was measure multiple facets of attention, including selecting stimuli to attend to, sustaining attention toward stimuli in the environment, disengaging from one to attend to a nearby stimulus, and alternating attention between two or more stimuli in NT children and children diagnosed with ASD. Children completed a (non-computerized) joint attention task as well as a series of computer-based attention games that are child friendly, using bright colors and animations to keep children engaged, and target sustained attention (maintaining gaze on a stimulus), disengaging attention (shifting attention from one visual stimulus to another), and cognitive control (alternating attention to learn a new rule; Goodwin et al, 2021). We hypothesized that children in the ASD group would show (1) reduced frequencies of initiating and RJA, (2) reduced ability to maintain attention on an image during a sustained attention task, (3) delays in disengaging attention during a gap-overlap task, and (4) show similar performance on a cognitive control task compared with NT peers.…”

Perspectives on heterogeneity-informed cognitive training for attention-deficit/hyperactivity disorder

“…The question then arises as to how early CT can be performed. A recent study examined the feasibility of CT intervention for infants aged 9–16 months ( 52 ). After easing the concern on feasibility in young children, the question is therefore reduced to how early AD/HD can be reliably diagnosed.…”