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Training attention control of very preterm infants: protocol for a feasibility study of the Attention Control Training (ACT).

Perra, O., Wass, S., McNulty, A., Sweet, D., Papageorgiou, K., Johnston, M., ... & Alderdice, F. 2020. Pilot and Feasibility Studies

Background: Children born preterm may display cognitive, learning, and behaviour difficulties as they grow up. In
particular, very premature birth (gestation age between 28 and less than 32 weeks) may put infants at increased risk
of intellectual deficits and attention deficit disorder. Evidence suggests that the basis of these problems may lie in
difficulties in the development of executive functions. One of the earliest executive functions to emerge around 1
year of age is the ability to control attention. An eye-tracking-based cognitive training programme to support this
emerging ability, the Attention Control Training (ACT), has been developed and tested with typically developing
infants. The aim of this study is to investigate the feasibility of using the ACT with healthy very preterm (VP) infants
when they are 12 months of age (corrected age). The ACT has the potential to address the need for supporting
emerging cognitive abilities of VP infants with an early intervention, which may capitalise on infants’ neural plasticity.
Methods/design: The feasibility study is designed to investigate whether it is possible to recruit and retain VP infants
and their families in a randomised trial that compares attention and social attention of trained infants against those
that are exposed to a control procedure. Feasibility issues include the referral/recruitment pathway, attendance, and
engagement with testing and training sessions, completion of tasks, retention in the study, acceptability of outcome
measures, quality of data collected (particularly, eye-tracking data). The results of the study will inform the development
of a larger randomised trial.
Discussion: Several lines of evidence emphasise the need to support emerging cognitive and learning abilities of
preterm infants using early interventions. However, early interventions with preterm infants, and particularly very
preterm ones, face difficulties in recruiting and retaining participants. These problems are also augmented by the
health vulnerability of this population. This feasibility study will provide the basis for informing the implementation of
an early cognitive intervention for very preterm infants.

Very preterm infants engage in an intervention to train their control of attention: results from the feasibility study of the Attention Control Training (ACT) randomised trial.

Perra, O., Wass, S., McNulty, A., Sweet, D., Papageorgiou, K. A., Johnston, M., ... & Alderdice, F. 2021. Pilot and Feasibility Studies

Background: Very premature birth (gestational age between 28 and 31 + 6 weeks) is associated with increased risk
of cognitive delay and attention deficit disorder, which have been linked to anomalies in the development of
executive functions (EFs) and their precursors. In particular, very preterm (VP) infants display anomalies in
controlling attention and gathering task-relevant information. Early interventions that support attention control may
be pivotal in providing a secure base for VP children’s later attainments. The Attention Control Training (ACT) is a
cognitive training intervention that targets infants’ abilities to select visual information according to varying task
demands but had not been tested in VP infants. We conducted a feasibility study to test the processes we intend
to use in a trial delivering the ACT to VP infants.
Methods and design: We tested recruitment and retention of VP infants and their families in a randomised trial, as
well as acceptability and completion of baseline and outcome measures. To evaluate these aims, we used
descriptive quantitative statistics and qualitative methods to analyse feedback from infants’ caregivers. We also
investigated the quality of eye-tracking data collected and indicators of infants’ engagement in the training, using
descriptive statistics. Results: Twelve VP infants were recruited, and 10 (83%) completed the study. Participants’ parents had high
education attainment. The rate of completion of baseline and outcome measures was optimal. VP infants
demonstrated engagement in the training, completing on average 84 min of training over three visits, and
displaying improved performance during this training. Eye-tracking data quality was moderate, but this did not
interfere with infants’ engagement in the training.