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

Author

Amy Goodwin, Emily J. H. Jones, Simona Salomone, Luke Mason, Rebecca Holman, Jannath Begum-Ali, Anna Hunt, Martin Ruddock, George Vamvakas, Emily Robinson, Catherine J. Holden, Chloë Taylor, Tim J. Smith, Edmund Sonuga-Barke, Patrick Bolton, Tony Charman, Andrew Pickles, Sam Wass, Mark H. Johnson, and and the INTERSTAARS team

Subjects
Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571
Abstract

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.

Published
2021
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2. A comparison of the clinical effectiveness and cost of specialised individually delivered parent training for preschool attention-deficit/hyperactivity disorder and a generic, group-based programme: a multi-centre, randomised controlled trial of the New Forest Parenting Programme versus Incredible Years

Author

Guiqing Lily Yao, Cathy Laver-Bradbury, James Raftery, Joanne Barton, Elvira Perez, Joanna Lockwood, Lisa Gould, James McGuirk, Lisa Jane Shipway, Louise Stanton, David Coghill, Judy Hutchings, Mike Radford, Tom Maishman, Martin Ruddock, David Daley, Edmund J.S. Sonuga-Barke, Louisa Little, Maria Chorozoglou, Michelle Lowe, Margaret Thompson, Pavlina Markomichali, and Louise Lee

Subjects
Male, Parents, medicine.medical_specialty, Comparative effectiveness research, Psychological intervention, Research Diagnostic Criteria, law.invention, 03 medical and health sciences, Incredible Years, 0302 clinical medicine, Randomized controlled trial, law, Surveys and Questionnaires, Developmental and Educational Psychology, medicine, Child and adolescent psychiatry, ADHD, Humans, Attention deficit hyperactivity disorder, 0501 psychology and cognitive sciences, 030212 general & internal medicine, Child, Parenting Programme, Problem Behavior, Parenting, 05 social sciences, Original Contribution, General Medicine, medicine.disease, Mental health, Psychiatry and Mental health, Treatment Outcome, Attention Deficit Disorder with Hyperactivity, New Forest, Child, Preschool, Pediatrics, Perinatology and Child Health, NFPP, Parent training, Family Therapy, Female, IY, Psychology, 050104 developmental & child psychology, Clinical psychology
Abstract

Objective: To compare the efficacy and cost of specialised individually-delivered parent training (PT) for preschool children with attention-deficit/ hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). Design: Multi-centre, three-arm parallel group randomised controlled trial. Research Setting: National Health Service Trusts. Participants: Preschool children (33-54 months) fulfilling ADHD research diagnostic criteria. Interventions: New Forest Parenting Programme (NFPP) – 12 week individual, home-delivered ADHD PT programme; Incredible Years (IY) – 12 week group-based, PT programme initially designed for children with behaviour problems. Main outcome measures: Primary outcome - Parent ratings of child’s ADHD symptoms (Swanson, Nolan & Pelham Questionnaire - SNAP-IV). Secondary outcomes - teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post-treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputation). Intervention and other costs were estimated using standardized approaches. Results: NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms (mean difference -0.009 95%CI [-0.191, 0.173], p=0.921) or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms (-0.189 95%CI [-0.380, 0.003], p=0.053). NFPP significantly reduced parent-rated conduct-problems compared to TAU across scales (p-values.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1,591 versus £2,103). \ud Conclusions: Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually-delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches. \ud Funding: National Institute of Health Research. \ud Trial Registration: Trial name: COPPI Trial; ISRCTN39288126.

Published
2017

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