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

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and the INTERSTAARS team

Original languageEnglish
Article number644
JournalTranslational psychiatry
Issue number1
Early online date20 Dec 2021
E-pub ahead of print20 Dec 2021
PublishedDec 2021

Bibliographical note

Funding Information: The INTERSTAARS trial is funded by the charity MQ: Transforming Mental Health (MQ14PP83) and MRC (MR/K021389/1). The funders had no role in study design, data collection, data analysis, data interpretation, or writing the report. Any views expressed are those of the author(s) and not necessarily those of the funders. AG was supported by an Institute of Psychiatry, Psychology & Neuroscience PhD studentship. AP is partially supported by National Institute of Health Research NF-SI-0617-10120 and Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the UK NHS, NIHR, or the Department of Health and Social Care. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. Funding Information: This research was supported by awards from the Medical Research Council (MR/ K021389/1; MHJ, TC), and MQ (MQ14PP83; MJ, EJ, TC, SW, PB, TS, ESB). The INTERSTAARS team is: Eleanor Braithwaite, Samuele Cortese, Laurel Fish, Chelsea Hobbs, Sarah Kalwarowsky, Anna Kolesnik, Irina Manneraak, Ceri Peck, Giulia Pecora, Abigail Runicles, Elle Scott, Salomé Silva, Harsharon Kaur Sondh, Megan Tongs. We thank the study families for the time and effort involved in participation and Professors Christopher Hollis (University of Nottingham), Richard Ashcroft (Queen Mary University), and Daniel Almirall (University of Michigan) for serving on the Independent Data Monitoring and Ethics Committee. Creation of the original training games was conducted by SW, supervised by MJ and Dr Kaska Porayska-Pomsta, funded by a Bloomsbury consortium scholarship and a program grant to MJ from the Medical Research Council. Additional development work on the games was funded by an MRC Centenary Award to SW and MRC intra-mural funding awarded via the MRC Cognition and Brain Sciences unit. The extra training games needed for this study were programmed by Dr Daniel Mitchell and designed by SW, EJ, and TS, supervised by MJ. Extra games were needed to cover the full intervention period. The creation of these extra games was part funded by a Birkbeck Commercial Development grant awarded to TS and SW. Publisher Copyright: © 2021, The Author(s).

King's Authors


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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