Imaging Stimulant and Non Stimulant Treatments for ADHD: A Network Based Approach

NCT ID: NCT01678209

Last Updated: 2020-07-24

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE4
• Total Enrollment: 127 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2012-10-31
• Study Completion Date: 2018-04-30

Brief Summary

The growing number of medications used to treat attention-deficit/hyperactivity disorder (ADHD) raises important questions about whether different medications have similar or different therapeutic mechanisms of action. We have recently shown that the stimulant methylphenidate (MPH) and the non-stimulant atomoxetine (ATX) produce clinical improvement via a common mechanism in motor cortex, and distinct actions in frontostriatal and midline cingulate-precuneus regions. These exciting findings offer a window into the common and unique neurophysiological mechanisms of response to stimulant and non-stimulant treatments. However, the interpretation and clinical utility of these results would be greatly enhanced by in-depth investigation of the impact of the two treatments on relevant neural networks, and analyses which evaluate whether improvement is achieved via normalization or other adaptive changes in brain function.

Detailed Description

The specific aims of this project are to use functional magnetic resonance imaging (fMRI) to determine the significance of activation changes over treatment related to clinical improvement, and the impact of treatment on neural connectivity within and between the anti-correlated frontostriatal 'task-positive' circuit and cingulate-precuneus 'task-negative' network. Our central hypotheses are that clinical improvement is associated with: (i) normalization of reduced connectivity of regions within the 'task-positive' network, with resultant increased inhibition of motor cortex, and (ii) normalization of low task-related connectivity in regions within the task-negative network for MPH and the 'task-positive' network for ATX.

This research proposes to test a model which posits a neurophysiological basis of mechanisms of response to stimulant and non-stimulant medications, and fits with our long term objectives of being able to match treatments to individual patients. Testing this model requires large samples of youth scanned using fMRI before and after treatment, and matched healthy controls also scanned twice. We will use an innovative network-based approach to study the effects of treatment, building on results from our current fMRI treatment study, and incorporating new theoretical approaches to understanding ADHD and its treatment.

Conditions

Attention Deficit Hyperactivity Disorder; ADHD

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: QUADRUPLE

Study Groups

fMRI scans

Healthy Control Group: will receive initial evaluation, and 2 fMRI (functional magnetic resonance imaging) scans each 6-8 weeks apart

Group Type: ACTIVE_COMPARATOR

fMRI scans

Intervention Type: OTHER

2 fMRI scans 6-8 weeks apart

Atomoxetine arm

These subjects will receive initial evaluation and baseline fMRI scan, flexible dose titration with atomoxetine for 6-8 weeks, and fMRI postscan, with optional post study stabilization visits.

Group Type: EXPERIMENTAL

fMRI scans

Intervention Type: OTHER

2 fMRI scans 6-8 weeks apart

Atomoxetine arm

Intervention Type: DRUG

Flexible dose titration with atomoxetine prescribed at weekly visits for 6-8 weeks

Methylphenidate arm

Subjects will receive initial evaluation, baseline fMRI scan, flexible dose titration with methylphenidate (Concerta) for 6-8 weeks, and fMRI scan post treatment.

Group Type: EXPERIMENTAL

fMRI scans

Intervention Type: OTHER

2 fMRI scans 6-8 weeks apart

Methylphenidate arm

Intervention Type: DRUG

Flexible dose titration with methylphenidate for 6-8 weeks, with optional post study stabilization visits.

Interventions

fMRI scans

2 fMRI scans 6-8 weeks apart

Intervention Type: OTHER

Atomoxetine arm

Flexible dose titration with atomoxetine prescribed at weekly visits for 6-8 weeks

Intervention Type: DRUG

Methylphenidate arm

Flexible dose titration with methylphenidate for 6-8 weeks, with optional post study stabilization visits.

Intervention Type: DRUG

Other Intervention Names

Strattera; ATX; Concerta; MPH

Eligibility Criteria

Inclusion Criteria

• aged 7-17 years;
• Wechsler Intelligence Scale for Children (WISC) scores ≥ 75;
• informed consent and assent to study participation.

• diagnosis of ADHD, any subtype, determined by Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Versions (K-SADS-PL);
• ADHD Rating Scale-IV-Parent Version: Investigator Administered (ADHD-RSIV) total score ≥ 1.5 SD above age and gender means for subtype
• Clinical Global Impressions-ADHD-Severity (CGI-S) score > 4;
• ADHD must be the primary diagnosis and focus of treatment, and the treatments offered in the study must not be contraindicated for the comorbid disorder.

Exclusion Criteria

• history of head injury with loss of consciousness or any CNS disease that is likely to affect brain function;
• diagnosis of autism or pervasive developmental, psychotic, major mood, and Tourette's disorder;
• alcohol or drug abuse in the past 3 months or a positive urinary toxic screen on initial evaluation;
• use of psychotropic medication within 2 weeks of the study (8 weeks for fluoxetine);
• pre-existing medical or psychological condition which precludes being in the scanner (e.g., claustrophobia, morbid obesity);
• metal in the body that precludes scanning (e.g., braces, metal plate);
• positive urine pregnancy test.

• previous unsuccessful trial of MPH or ATX that was adequately dosed (≥ 1 mg/kg for MPH or 1.0 mg/kg for ATX) and of adequate duration (≥ 4 weeks);
• abnormal findings on physical exam, or vital signs
• pulse and blood pressure > 95% of age and gender mean;
• inability to swallow capsules;
• weight is < 20 kg or > 85 kg.

• no past history or current diagnosis of any psychiatric disorder, determined by the K-SADS-PL interview;
• ADHD-RS-IV and CBCL scores for each symptom domain ≤ 1 SD of age and gender means.

• Minimum Eligible Age: 7 Years
• Maximum Eligible Age: 17 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

National Institute of Mental Health (NIMH)

NIH

Sponsor Role: collaborator

Icahn School of Medicine at Mount Sinai

OTHER

Sponsor Role: lead

Responsible Party

Jeffrey Newcorn

Director Division of Child and Adolescent Psychiatry, Associate Professor Psychiatry and Pediatrics, Medical Director Center for Excellence for ADHD and Related Disorders

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Jeffrey Newcorn, MD

Role: PRINCIPAL_INVESTIGATOR

Icahn School of Medicine at Mount Sinai

Kurt Schulz, PhD

Role: PRINCIPAL_INVESTIGATOR

Icahn School of Medicine at Mount Sinai

Locations

Icahn School of Medicine at Mount Sinai

New York, New York, United States

Countries

United States

Provided Documents

Document Type: Study Protocol

View Document

Document Type: Statistical Analysis Plan

View Document

Other Identifiers

5R01MH095766-02

Identifier Type: NIH

Identifier Source: secondary_id

View Link

GCO 11-0161

Identifier Type: -

Identifier Source: org_study_id