Attention training for infants at familial risk of ADHD (INTERSTAARS): study protocol for a randomised controlled trial

Background: Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder that can negatively impact on an individual’s quality of life. It is pathophysiologically complex and heterogeneous with different neuropsychological processes being impaired in different individuals. Executive function deficits, including those affecting attention, working memory and inhibitory control, are common. Cognitive training has been promoted as a treatment option, based on the notion that by strengthening the neurocognitive networks underlying these executive processes, ADHD symptoms will also be reduced. However, if implemented in childhood or later, when the full disorder has become well-established, cognitive training has only limited value. INTERSTAARS is a trial designed to test a novel approach to intervention, in which cognitive training is implemented early in development, before the emergence of the disorder. The aim of INTERSTAARS is to train early executive skills, thereby increasing resilience and reducing later ADHD symptoms and associated impairment. Methods/design: Fifty 10–14-month-old infants at familial risk of ADHD will participate in INTERSTAARS. Infants will be randomised to an intervention or a control group. The intervention aims to train early attention skills by using novel eye-tracking technology and gaze-contingent training paradigms. Infants view animated games on a screen and different events take place contingent on where on the screen the infant is looking. Infants allocated to the intervention will receive nine weekly home-based attention training sessions. Control group infants will also receive nine weekly home visits, but instead of viewing the training games during these visits they will view non-gaze-contingent age-appropriate videos. At baseline and post treatment, infant attention control will be assessed using a range of eye-tracking, observational, parent-report and neurophysiological measures. The primary outcome will be a composite of eye-tracking tasks used to assess infant attention skills. Follow-up data will be collected on emerging ADHD symptoms when the infants are 2 and 3 years old. Discussion: This is the first randomised controlled trial to assess the potential efficacy of cognitive training as a prevention measure for infants at familial risk of ADHD. If successful, INTERSTAARS could offer a promising new approach for developing early interventions for ADHD. Trial registration: International Standard Randomised Controlled Trial registry: ISRCTN37683928. Registered on 22 June 2015

Diatom-inferred late Pleistocene and Holocene palaeolimnological changes in the Ioannina basin, northwest Greece

The character and impact of climate change since the last glacial maximum (LGM) in the eastern Mediterranean region remain poorly understood. Here, two new diatom records from the Ioannina basin in northwest Greece are presented alongside a pre-existing record and used to infer past changes in lake level, a proxy for the balance between precipitation and evaporation. Comparison of the three records indicates that lake-level fluctuations were the dominant driver of diatom assemblage composition change, whereas productivity variations had a secondary role. The reconstruction indicates low lake levels during the LGM. Late glacial lake deepening was underway by 15.0 cal kyr BP, implying that the climate was becoming wetter. During the Younger Dryas stadial, a lake-level decline is recorded, indicating arid climatic conditions. Lake Ioannina deepened rapidly in the early Holocene, but long-term lake-level decline commenced around 7.0 cal kyr BP. The pattern of lake-level change is broadly consistent with an existing lake-level reconstruction at Lake Xinias, central Greece. The timing of the apparent change, however, is different, with delayed early Holocene deepening at Xinias. This offset is attributed to uncertainties in the age models, and the position of Xinias in the rain shadow of the Pindus Mountains