INTERSTAARS: Attention training for infants with elevated likelihood of developing ADHD: A proof-of-concept randomised controlled trial
Amy Goodwin1, Emily J H Jones2, Simona Salomone3,4
1Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. amy.l.goodwin@kcl.ac.uk.
Insights
This study tested computerised gaze-based attention training for infants at risk of attention-deficit/hyperactivity disorder (ADHD). While feasible, the training did not show significant short-term improvements in attention skills for early ADHD detection.
Area of Science:
- Developmental neuroscience
- Pediatric psychology
- Clinical trial methodology
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is typically diagnosed in middle childhood.
- Early intervention strategies are being explored to strengthen cognitive development before diagnosis.
- Pre-emptive approaches may offer an alternative to traditional post-diagnostic interventions.
Purpose of the Study:
- To assess the feasibility of computerised gaze-based attention training in infants at high risk for ADHD.
- To determine if this training improves attention skills in infants with a familial predisposition to ADHD.
- To evaluate the potential of early, pre-emptive interventions for ADHD.
Main Methods:
- A proof-of-concept randomised controlled trial (RCT) involving 43 infants (9-16 months old) with a first-degree relative with ADHD.
- Infants were randomised to receive 9 weekly sessions of either gaze-contingent attention training or passive video viewing (control).
- Outcomes were assessed using a composite of attention measures, with intention-to-treat and complier-average-causal effect analyses.
Main Results:
- Good uptake and compliance were observed for the attention training intervention.
- No significant differences were found between the intervention and control groups on primary or secondary attention outcomes.
- No adverse effects on infant sleep were noted, though a slight increase in fussiness occurred post-session.
Conclusions:
- Computerised gaze-based attention training is feasible for infants at risk of ADHD.
- The study did not find evidence of short-term efficacy for this intervention in improving attention skills.
- Further research is needed to assess longer-term outcomes and refine pre-emptive ADHD intervention strategies.
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.
