Attention training for infants at familial risk of ADHD (INTERSTAARS): study protocol for a randomised controlled trial
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Amy Goodwin1, Simona Salomone2, Patrick Bolton3,4,5
1Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK. amy.goodwin@kcl.ac.uk.
Insights
This study tests early cognitive training for infants at risk of ADHD. The INTERSTAARS trial uses eye-tracking to train attention, aiming to prevent later symptoms and impairment.
Area of Science:
- Neuroscience
- Developmental Psychology
- Clinical Psychology
Background:
- Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder impacting quality of life.
- Executive function deficits, including attention and working memory, are characteristic of ADHD.
- Current cognitive training for ADHD has limited value when implemented after the disorder is established.
Purpose of the Study:
- To evaluate a novel intervention for infants at familial risk of ADHD.
- To test the efficacy of early cognitive training as a preventive measure for ADHD.
- To enhance early executive skills, increase resilience, and reduce later ADHD symptoms.
Main Methods:
- The INTERSTAARS trial is a randomized controlled trial involving 50 infants aged 10-14 months.
- Infants are randomized to an intervention group receiving gaze-contingent attention training or a control group viewing videos.
- Intervention involves nine weekly home-based sessions using eye-tracking technology and animated games.
Main Results:
- The primary outcome is a composite of eye-tracking tasks assessing infant attention skills.
- Secondary outcomes include emerging ADHD symptoms at 2 and 3 years of age.
- Neurophysiological and parent-report measures will also assess attention control.
Conclusions:
- This is the first randomized controlled trial investigating cognitive training as a preventive strategy for infants at familial risk of ADHD.
- If successful, INTERSTAARS could provide a new avenue for early ADHD intervention.
- Early intervention may mitigate the long-term impact of ADHD.
Background:
Attention 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/Design:
Fifty 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.
Discussion:
This 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 Registration:
International Standard Randomised Controlled Trial registry: ISRCTN37683928 . Registered on 22 June 2015.
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