Training attention control of very preterm infants: protocol for a feasibility study of the Attention Control Training (ACT)

Abstract

Background: Children born preterm may display cognitive, learning, and behaviour difficulties as they grow up. In particular, very premature birth (gestation age between 28 and less than 32 weeks) may put infants at increased risk of intellectual deficits and attention deficit disorder. Evidence suggests that the basis of these problems may lie in difficulties in the development of executive functions. One of the earliest executive functions to emerge around 1 year of age is the ability to control attention. An eye-tracking-based cognitive training programme to support this emerging ability, the Attention Control Training (ACT), has been developed and tested with typically developing infants. The aim of this study is to investigate the feasibility of using the ACT with healthy very preterm (VP) infants when they are 12 months of age (corrected age). The ACT has the potential to address the need for supporting emerging cognitive abilities of VP infants with an early intervention, which may capitalise on infants' neural plasticity. Methods/design: The feasibility study is designed to investigate whether it is possible to recruit and retain VP infants and their families in a randomised trial that compares attention and social attention of trained infants against those that are exposed to a control procedure. Feasibility issues include the referral/recruitment pathway, attendance, and engagement with testing and training sessions, completion of tasks, retention in the study, acceptability of outcome measures, quality of data collected (particularly, eye-tracking data). The results of the study will inform the development of a larger randomised trial.Discussion: Several lines of evidence emphasise the need to support emerging cognitive and learning abilities of preterm infants using early interventions. However, early interventions with preterm infants, and particularly very preterm ones, face difficulties in recruiting and retaining participants. These problems are also augmented by the health vulnerability of this population. This feasibility study will provide the basis for informing the implementation of an early cognitive intervention for very preterm infants. Trial registration: Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov).

Cognitive flexibility in 12-month-old preterm and term infants is associated with neurobehavioural development in 18-month-olds

“…In addition, some recent studies have shown that early training of attentional control in infancy can have short-term effects on emergent EF 42,74,75 . Therefore, it is possible that interventions including oculomotor response shifting tasks, especially those which involve inhibiting perseverative www.nature.com/scientificreports/ looking, have positive effects on the subsequent neurobehavioural development in preterm children 76 . Given the potential cascade of early negative effects on neurobehavioural outcomes in high-risk preterms 71,77 , it is important to consider whether such intervention reduces the risk of long-term executive dysfunction.…”

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).…”

Gaze-Contingent Eye-Tracking Training in Brain Disorders: A Systematic Review

“…The majority of the included studies are described in this section (14/24). In particular, ET-based training programs were developed to address the following populations: typically developing infants [ 44 , 45 ]; infants at familial risk for ADHD [ 41 ] or with an overt diagnosis of ADHD [ 30 , 31 , 37 , 42 ]; children with RS [ 34 , 35 , 39 ]; children with ASD [ 25 , 36 ]; and very preterm infants [ 40 , 49 ].…”

“…The Attention Control Training proposed by Perra and colleagues [ 40 , 49 ] employed three types of tasks, presented by means of interactive cartoons, in order to train the following abilities: search for a target among distractors; visual short-term memory for objects embedded in scenes; and maintaining a goal.…”

“…All the described programs proved to be effective in improving the target cognitive abilities in both passive [ 31 , 40 , 41 , 49 ] and active control groups [ 37 ]. In particular, the study by Garcia-Baos and colleagues [ 37 ] supported the idea that the gaze-contingent element of the training program is a crucial aspect for its effectiveness on attentional systems.…”