Effectiveness of Combined Medication Treatment for Aggression in Children With Attention Deficit With Hyperactivity Disorder (The SPICY Study)

NCT ID: NCT00794625

Last Updated: 2012-07-16

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

Get a concise snapshot of the trial, including recruitment status, study phase, enrollment targets, and key timeline milestones.

Recruitment Status

UNKNOWN

Clinical Phase

PHASE4

Total Enrollment

270 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-11-30

Study Completion Date

2013-04-30

Brief Summary

Review the sponsor-provided synopsis that highlights what the study is about and why it is being conducted.

This study will determine the advantages and disadvantages of adding one of two different types of drugs to stimulant treatment for reducing aggressive behavior in children with attention deficit with hyperactivity disorder (ADHD).

Detailed Description

Dive into the extended narrative that explains the scientific background, objectives, and procedures in greater depth.

Attention deficit with hyperactivity disorder (ADHD) is a common childhood mental disorder that affects 3% to 5% of all American children. Symptoms of ADHD commonly include inability to focus or exercise normal inhibition, and in some cases, aggressive behavior. Approximately 33% to 50% of children with ADHD develop oppositional defiant disorder (ODD), and about 20% to 40% develop a conduct disorder (CD). These disorders are characterized by defiant, belligerent, and otherwise aggressive behavior. Treatment for ADHD generally includes use of stimulant medications that decrease impulsivity and increase attentiveness, such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine), but these do not always affect aggression. To treat aggression in ADHD, many physicians prescribe additional medications, including the mood stabilizing medication valproate and the antipsychotic medication risperidone.

There is no clinical evidence proving that using multiple types of medications is safe and effective. This study will treat children with ADHD and aggression with a combination of stimulants and antipsychotic or mood stabilizing medications to determine whether the aggressive behaviors and ADHD symptoms are reduced without harmful side effects.

This study has two phases. During the first phase, which will last 3 to 6 weeks, participants will be treated with normal ADHD stimulant medications. During the second phase, those whose aggressive behavior is not effectively suppressed by stimulant medication alone will then be randomly assigned to also receive valproate, risperidone, or placebo for 8 weeks. After 8 weeks, children whose aggression persists will be switched from either valproate to risperidone or risperidone to valproate for another 8 weeks. Those on placebo will not switch medications. All participants will attend weekly monitoring visits for 11 to 16 weeks over the course of the study. At these visits, aggression levels and medication side effects will be assessed. Families will also meet with the researchers to discuss the child's progress and will attend behavioral counseling with a therapist.

Conditions

See the medical conditions and disease areas that this research is targeting or investigating.

Attention Deficit Disorder With Hyperactivity

Keywords

Explore important study keywords that can help with search, categorization, and topic discovery.

Attention-Deficit/Hyperactivity Disorder Aggressive Behavior Oppositional Defiant Disorder Conduct Disorder

Study Design

Understand how the trial is structured, including allocation methods, masking strategies, primary purpose, and other design elements.

Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

Review each arm or cohort in the study, along with the interventions and objectives associated with them.

1

During Phase 1, participants will receive a stimulant medication. If they do not respond to the stimulant, they will add valproate and behavioral family counseling to their treatment during Phase 2. If they do not respond to valproate, they will be switched to risperidone.

Group Type EXPERIMENTAL

Valproate

Intervention Type DRUG

Standard therapeutic doses of valproate, set according to valproic acid blood level, for 8 weeks

Risperidone

Intervention Type DRUG

Standard therapeutic doses of risperidone for 8 weeks

Stimulant medication

Intervention Type DRUG

Stimulant medication standard in the care of ADHD, such as methylphenidate or dextroamphetamine

Behavioral family counseling

Intervention Type BEHAVIORAL

Weekly behavioral counseling with a therapist

2

During Phase 1, participants will receive a stimulant medication. If they do not respond to the stimulant, they will add risperidone and behavioral family counseling to their treatment during Phase 2. If they do not respond to risperidone, they will switch to valproate.

Group Type EXPERIMENTAL

Valproate

Intervention Type DRUG

Standard therapeutic doses of valproate, set according to valproic acid blood level, for 8 weeks

Risperidone

Intervention Type DRUG

Standard therapeutic doses of risperidone for 8 weeks

Stimulant medication

Intervention Type DRUG

Stimulant medication standard in the care of ADHD, such as methylphenidate or dextroamphetamine

Behavioral family counseling

Intervention Type BEHAVIORAL

Weekly behavioral counseling with a therapist

3

During Phase 1, participants will receive a stimulant medication. If they do not respond to the stimulant, they will add placebo and behavioral family counseling to their treatment during Phase 2.

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DRUG

An inactive substance at identical dosing to active treatments for 8 weeks

Stimulant medication

Intervention Type DRUG

Stimulant medication standard in the care of ADHD, such as methylphenidate or dextroamphetamine

Behavioral family counseling

Intervention Type BEHAVIORAL

Weekly behavioral counseling with a therapist

Interventions

Learn about the drugs, procedures, or behavioral strategies being tested and how they are applied within this trial.

Valproate

Standard therapeutic doses of valproate, set according to valproic acid blood level, for 8 weeks

Intervention Type DRUG

Risperidone

Standard therapeutic doses of risperidone for 8 weeks

Intervention Type DRUG

Placebo

An inactive substance at identical dosing to active treatments for 8 weeks

Intervention Type DRUG

Stimulant medication

Stimulant medication standard in the care of ADHD, such as methylphenidate or dextroamphetamine

Intervention Type DRUG

Behavioral family counseling

Weekly behavioral counseling with a therapist

Intervention Type BEHAVIORAL

Other Intervention Names

Discover alternative or legacy names that may be used to describe the listed interventions across different sources.

Depakote Valproic acid Risperdal Inactive substance "Sugar pill" Ritalin Dexedrine

Eligibility Criteria

Check the participation requirements, including inclusion and exclusion rules, age limits, and whether healthy volunteers are accepted.

Inclusion Criteria

* Presence of ADHD
* Presence of persistent, clinically significant aggression
* Presence of ODD or CD

Exclusion Criteria

* Presence of psychosis
* Presence of a major developmental disability
* Presence of a major mood disorder
* Contraindications to stimulant, valproate, or risperidone treatment
Minimum Eligible Age

6 Years

Maximum Eligible Age

12 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

Meet the organizations funding or collaborating on the study and learn about their roles.

University of Texas

OTHER

Sponsor Role collaborator

Northwell Health

OTHER

Sponsor Role collaborator

Joseph Blader

NIH

Sponsor Role lead

Responsible Party

Identify the individual or organization who holds primary responsibility for the study information submitted to regulators.

Joseph Blader

Associate Professor of Psychiatry, Stony Brook State University of New York

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

Learn about the lead researchers overseeing the trial and their institutional affiliations.

Joseph C. Blader, PhD, MSc

Role: PRINCIPAL_INVESTIGATOR

Stony Brook University School of Medicine, State University of New York

Locations

Explore where the study is taking place and check the recruitment status at each participating site.

North Shore - LIJ Health System, Zucker Hillside Hospital

Glen Oaks, New York, United States

Site Status RECRUITING

Stony Brook University Medical Center

Stony Brook, New York, United States

Site Status RECRUITING

University of Texas Health Science Center at San Antonio

San Antonio, Texas, United States

Site Status RECRUITING

Countries

Review the countries where the study has at least one active or historical site.

United States

Central Contacts

Reach out to these primary contacts for questions about participation or study logistics.

Joseph C. Blader, PhD, MSc

Role: CONTACT

Phone: 631-632-8317

Email: [email protected]

Lauren M. Chorney, PhD

Role: CONTACT

Phone: 631-632-8317

Email: [email protected]

Facility Contacts

Find local site contact details for specific facilities participating in the trial.

Ingrid S Fuentes, BA

Role: primary

Allison Berest, BA

Role: backup

Lauren M Chorney, PhD

Role: primary

Gabrielle A Carlson, MD

Role: backup

Candy Rhine

Role: primary

Maria Silva

Role: backup

References

Explore related publications, articles, or registry entries linked to this study.

Blader JC, Pliszka SR, Kafantaris V, Foley CA, Carlson GA, Crowell JA, Bailey BY, Sauder C, Daviss WB, Sinha C, Matthews TL, Margulies DM. Stepped Treatment for Attention-Deficit/Hyperactivity Disorder and Aggressive Behavior: A Randomized, Controlled Trial of Adjunctive Risperidone, Divalproex Sodium, or Placebo After Stimulant Medication Optimization. J Am Acad Child Adolesc Psychiatry. 2021 Feb;60(2):236-251. doi: 10.1016/j.jaac.2019.12.009. Epub 2020 Jan 30.

Reference Type DERIVED
PMID: 32007604 (View on PubMed)

Blader JC, Pliszka SR, Kafantaris V, Sauder C, Posner J, Foley CA, Carlson GA, Crowell JA, Margulies DM. Prevalence and Treatment Outcomes of Persistent Negative Mood Among Children with Attention-Deficit/Hyperactivity Disorder and Aggressive Behavior. J Child Adolesc Psychopharmacol. 2016 Mar;26(2):164-73. doi: 10.1089/cap.2015.0112. Epub 2016 Jan 8.

Reference Type DERIVED
PMID: 26745211 (View on PubMed)

Blader JC, Pliszka SR, Kafantaris V, Foley CA, Crowell JA, Carlson GA, Sauder CL, Margulies DM, Sinha C, Sverd J, Matthews TL, Bailey BY, Daviss WB. Callous-unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2013 Dec;52(12):1281-93. doi: 10.1016/j.jaac.2013.08.024. Epub 2013 Sep 25.

Reference Type DERIVED
PMID: 24290461 (View on PubMed)

Other Identifiers

Review additional registry numbers or institutional identifiers associated with this trial.

DSIR 84-CTM

Identifier Type: -

Identifier Source: secondary_id

R01MH080050

Identifier Type: NIH

Identifier Source: org_study_id

View Link