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

Article

Goodwin, A., Jones, E. J. H., Salomone, S., Mason, L., Holman, R., Begum-Ali, J., Hunt, A., Ruddock, M., Vamvakas, G., Robinson, E., Holden, C. J., Taylor, C., Smith, T. J., Sonuga-Barke, E., Bolton, P., Charman, T., Pickles, A., Wass, S., Johnson, M. H. and INTERSTAARS team 2021. INTERSTAARS: Attention training for infants with elevated likelihood of developing ADHD: A proof-of-concept randomised controlled trial. Translational Psychiatry . 11 (Art. 644). https://doi.org/10.1038/s41398-021-01698-9
AuthorsGoodwin, A., Jones, E. J. H., Salomone, S., Mason, L., Holman, R., Begum-Ali, J., Hunt, A., Ruddock, M., Vamvakas, G., Robinson, E., Holden, C. J., Taylor, C., Smith, T. J., Sonuga-Barke, E., Bolton, P., Charman, T., Pickles, A., Wass, S., Johnson, M. H. and INTERSTAARS team
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.

JournalTranslational Psychiatry
Journal citation11 (Art. 644)
ISSN2158-3188
Year2021
PublisherSpringer Nature
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Digital Object Identifier (DOI)https://doi.org/10.1038/s41398-021-01698-9
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Online20 Dec 2021
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Deposited21 May 2025
Copyright holder© 2021 The Authors
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Goodwin, Amy, Salomone, Simona, Bolton, Patrick, Charman, Tony, Jones, Emily J. H., Pickles, Andrew, Robinson, Emily, Smith, Tim, Sonuga-Barke, Edmund J. S., Wass, S. and Johnson, Mark H. 2016. Attention training for infants at familial risk of ADHD (INTERSTAARS): study protocol for a randomised controlled trial. Trials. 17 (1), p. 608. https://doi.org/10.1186/s13063-016-1727-0
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Forssman, Linda and Wass, S. 2017. Training Basic Visual Attention Leads to Changes in Responsiveness to Social‐Communicative Cues in 9‐Month‐Olds. Child Development. 89 (3), pp. e199-e213. https://doi.org/10.1111/cdev.12812
Developmental Psychology: How Social Context Influences Infants’ Attention
Wass, S. and Leong, Victoria 2016. Developmental Psychology: How Social Context Influences Infants’ Attention. Current Biology. 26 (9), pp. R357-R359. https://doi.org/10.1016/j.cub.2016.03.051
Infant Attention Is Dynamically Modulated With Changing Arousal Levels
de Barbaro, Kaya, Clackson, Kaili and Wass, S. 2016. Infant Attention Is Dynamically Modulated With Changing Arousal Levels. Child Development. 88 (2), pp. 629-639. https://doi.org/10.1111/cdev.12689