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

Goodwin, A. and Jones, Emily J.H. and Salomone, S. and Mason, Luke and Holman, Rebecca and Begum Ali, Jannath and Hunt, A. and Ruddock, M. and Vamvakas, G. and Robinson, E. and Holden, Catherine and Taylor, Chloe and Smith, Tim J. and Sonuga-Barke, E. and Bolton, P. and Charman, T. and Pickles, A. and Wass, S. and Johnson, Mark H. (2021) INTERSTAARS: Attention training for infants with elevated likelihood of developing ADHD: a proof-of-concept randomised controlled trial. Translational Psychiatry 11 (1), ISSN 2158-3188.

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.

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