Measuring Attention in the Developing Brain: The AtHENS Study
July 10, 2026
Heather M. Joseph, DO, associate professor of psychiatry and pediatrics, University of Pittsburgh School of Medicine, studies how attention-deficit/hyperactivity disorder (ADHD) develops during the earliest years of life. Her long-term goal is not to diagnose children earlier, but to identify those at highest risk before behavioral difficulties become established, creating opportunities for earlier intervention during a period when brain development remains highly adaptable.
Many of the behaviors associated with ADHD, including high activity levels, impulsivity, and short attention spans are also common features of normal early childhood development. Distinguishing children who are following a typical developmental trajectory from those who may be at elevated risk for ADHD is one of the field's central challenges.
The Attention, Hyperactivity, and Early Neurodevelopment Study (AtHENS) approaches this problem by looking at more than a child’s behavior. Using functional near-infrared spectroscopy (fNIRS), Dr. Joseph and colleagues are studying how the brain's attention networks develop during the preschool years to see if they can identify objective biological markers of elevated ADHD risk before a diagnosis would ordinarily be possible.
Current diagnosis depends a lot on behavioral observations relative to children of the same age. Dr. Joseph's research asks if combining those observations with objective biological measures could improve the ability to identify children who may benefit from early intervention.
"My goal is never to diagnose infants or toddlers," Dr. Joseph says. "My goal is to intervene with children who are maybe at high risk."
Through the Pittsburgh ADHD Risk in Infancy Study (PARIS) and related cohorts, Dr. Joseph and colleagues examined infant temperament, attention tasks, and parent-child interactions as potential early indicators of ADHD risk. AtHENS extends this work by adding a direct measure of the developing brain.
fNIRS is a noninvasive neuroimaging technique that uses light to measure activity within the cerebral cortex. Participants wear a lightweight cap containing optical sensors while completing age-appropriate attention tasks. Because fNIRS does not involve radiation or the need for prolonged stillness that other neuroimaging methods require, it is well suited for studies involving young children.
Dr. Joseph and colleagues are examining how the brain's attention networks mature during early childhood. The study focuses on the frontal and parietal cortices where attention and executive function networks develop to see if children at elevated risk for ADHD demonstrate delayed patterns of functional connectivity.
"What we are seeing are delays in brain development," Dr. Joseph says. "That's what I'm looking at. Is the attention network delayed in its connectivity and not functioning as well for kids who are at risk for ADHD?"
Following Brain Development Over Time
AtHENS is a longitudinal observational study that will enroll 210 children between 3 and 4 years of age together with their primary caregivers. Participants return approximately two years later, allowing Dr. Joseph to follow the development of attention networks in the brain over time.
Approximately two-thirds of enrolled children have elevated symptoms of inattention or hyperactivity, while one-third serve as comparison participants. This approach will allow Dr. Joseph to examine how brain development differs in children with varying levels of ADHD risk rather than comparing children only after a formal diagnosis has been established.
Each study visit combines neuroimaging with behavioral and neurocognitive assessments as well as parent-child interactions. Children complete a series of fNIRS attention tasks, while their caregivers provide information about child behavior, parenting practices, and their own mental health.
From Measurement Toward Intervention
Although AtHENS is designed to better understand how attention networks develop, the study is a step toward earlier intervention rather than earlier diagnosis.
One of the study's features is its dyadic design. During selected activities, the caregiver and child wear fNIRS headsets while completing shared tasks. Measuring both participants simultaneously allows Dr. Joseph to see how parent-child interactions may influence the developing attention network.
The study also explores resilience. One of the questions is whether certain parenting behaviors are associated with stronger attention network development and if those behaviors might eventually become targets for intervention.
"Could we identify specific types of parent behavior that could help strengthen the developing brain?" Dr. Joseph asks. "Are there parenting behaviors that might increase attention and tap into the child's attention network in a way that we can strengthen neuroconnectivity? That is a future goal of our research."
Contact Information
The AtHENS study is currently enrolling. Clinicians can learn more at yfrp.pitt.edu/AtHENS, by phone or text at 412-420-8309, or by email at AtHENSstudy@upmc.edu.
