This study will look at the effectiveness of osmotic release oral system (OROS) methylphenidate (Concerta) in treating attention deficit hyperactvity disorder (ADHD) in adults. Concerta has received FDA approval for childhood ADHD and there is documentation that it is effective in adult ADHD. However this trial will explore its effectiveness in treating symptoms not a part of the Diagnostic and Statistical Manual-III (DSM-III) criteria. Subjects will experience one screening visit and one baseline visit. Those who meet admission criteria will enter the double-blind phase. This will involve two 4-week treatment periods one of which will involve the use of Concerta and the other a placebo pill. Subjects who complete the double-blind phase will be allowed to enter a 180-day, open-label Concerta phase designed to assess long-term effects.
ADHD affects from 3 to 5% of children, persists into adolescence 40 to 70% of these children and continues into adulthood in at least 50% of affected adolescents. Pharmacotherapy for ADHD in adults has paralleled that used for children, with generally positive results (Spencer, 1998). Never-the-less, it is not clear that the dimensions of medication response in adults are the same as in children. The extent to which the symptoms change with age remains open to question. This trial is created to include a variety of outcome measures which will enhance the number of symptoms assessed. Methylphenidate was the first medication shown to be effective in treatment for adults with ADHD and continues to be widely used. Several studies have demonstrated the usefulness of methylphenidate in adult ADHD (Wender et al, 1985, Spencer et al, 1995). These studies have not shown any unexpected drawbacks to treatment with methylphenidate. The extended release formulations represent an improvement over the immediate release versions for many patients. This is a double-blind, placebo-controlled, randomized, crossover trial comparing OROS methylphenidate with placebo. The double-blind trial will be preceded by an enrollment period consisting of a screening visit followed by a baseline visit. Patients who continue to meet admission criteria at baseline will be randomized into the first of two 4-week treatment periods. We will attempt to reach the highest tolerated dose size within 2 weeks and then observe the response over the last two weeks of each crossover phase. The double-blind period will be followed by a 180 day open-treatment, flexible-dose phase designed to assess long-term effects.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
TRIPLE
Enrollment
47
Placebo medication appears identical to the active medication OROS methylphenidate
Mood Disorders Clinic
Salt Lake City, Utah, United States
Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS)
This is an investigator rated scale which assessed the 7 domains of the Utah Criteria of Adult ADHD
Time frame: Baseline visit, Double-blind phase Week 4 each arm, Open-Label months 1-6
Clinical Global Impressions-Improvement (CGI-I)
This is a global measure in improvement in symptoms that is a Likert type scale
Time frame: Baseline; Double-blind phase Week 4 each arm: Open-Label months 1-6
Clinical Global Impression - Severity (CGI-S)
This is a general measure of symptom severity assessed using a Likert type scale.
Time frame: Baseline visit; Double-blind phase Week 4 each arm: Open-Label months 1-6
ADHD rating scale (ADHD-RS)
This is an investigator rated scale which assesses the DSM-IV symptoms.
Time frame: Baselinevisit; Double-blind phase Week 4 each arm: Open-Label final visit month 6
Self Report Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS)
This is a patient rated scale that assesses the 7 domains of the Utah Criteria for adult ADHD as well as ODD, Social functioning and Learning difficulties.
Time frame: Baseline; Double-blind phases Week 4 each arm: Final visit of Open-Label period month 6
Wisconsin Personality Inventory - IV (WISPI-IV)
This is a computerized personality inventory completed by the patients. It consists of 214 items which address the 10 DSM-IV personality disorders plus passive aggressive personality disorder.
Time frame: Baseline visit; Final Open-Label visit month 6
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.