Can Cognitive Training Prevent ADHD in Infants?

Researchers suspect cognitive training can prevent the development attention-deficit/hyperactivity disorder (ADHD) in infants.

Researchers are planning to study whether cognitive training in infants at familial risk for attention-deficit/hyperactivity disorder (ADHD) can prevent the condition from developing, according to a recently announced study protocol.

Mark H. Johnson, PhD, director of the Center for Brain and Cognitive Development, Birkbeck at the University of London and colleagues will conduct the clinical trial as a component of the Studying Autism and ADHD Risks (STAARS) project in the United Kingdom, applying the acronym INTERSTAARS for the proposed intervention study.

"INTERSTAARS is a departure from previous cognitive training approaches for ADHD as it represents the first attempt to use cognitive training to target and strengthen executive control networks in infancy with individuals at risk, but not yet manifesting, the later development of ADHD," Johnson and colleagues announced.

Fifty infants between 10 and 14 months having a parent or older sibling with ADHD will be enrolled, with exclusion for medical or developmental conditions or uncorrected vision or hearing problems. They will be randomly assigned to either receive the cognitive training sessions, or to the control group receiving a passive viewing condition. Training sessions will be separated by periods of assessment, conducted by staff blinded to the group assignment. The children will receive follow-up assessments at two and three years of age to determine whether ADHD symptoms have manifested.

The researchers anticipate that cognitive training, with controlled exposures to cognitively demanding tasks over multiple training sessions, can exploit the brain's plasticity to improve network functions, and mitigate the risk for ADHD. Their approach with infants would involve weekly, home-based attention training with gaze-contingent animations that operate with eye tracking to gauge target attention.

Although clinical trials of cognitive training approaches for ADHD in children have had disappointing results, Johnson and colleagues consider the rationale for applying it for ADHD to be sound. They believed the therapeutic effect might not have been demonstrated because the interventions were implemented too late in development, after deficits were already established.

The researchers cite evidence that atypical attention patterns may be detected early in individuals who later manifest symptoms of ADHD. In longitudinal studies, children with symptoms of inattention and hyperactivity at three years of age had exhibited shorter eye-fixations on a screen-based task, and shorter durations of focused attention in naturalistic settings as infants. Such findings suggest to Johnson and colleagues that there may be continuity in the developmental pathway from the executive attention skills in infancy to symptoms of ADHD emerging at preschool age.

"Accordingly, it may be crucial for cognitive training to be implemented as early as is feasible during development," Johnson and colleagues suggest, "perhaps even prior to the emergence of early signs of the disorder."

The researchers acknowledge that their cohort is too small to definitively test the efficacy of the intervention, as not all the infants would be expected to develop ADHD regardless of the training. Instead, they hope to provide an indication of effect, which may prompt larger studies, and possibly studies of attention training with infants at risk for other conditions such as autism spectrum disorders.

The study protocol was “Attention Training for Infants at Familial Risk of ADHD (INTERSTARS): Study Protocol for a Randomized Controlled Trial,” described online in the journal, Trials.

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