This proposed research will use randomized control trial (RCT) methodology and compare micronutrients with placebo in 135 children with ADHD.
This study examines a broad spectrum micronutrient treatment for children with ADHD. The goal is to broaden the scope of evidence-based treatments, and to address the public desire for non-pharmacological treatment options. This study will use a randomized controlled trial design, comparing micronutrients with placebo in 135 children, ages 6-12, with ADHD plus irritability or anger based on parent-report of symptoms. The study will also collect biological samples (saliva, stool, urine, hair, and blood) from the children to examine physiological mechanisms of micronutrient effects. If the micronutrient treatment successfully diminishes symptoms, the clinical implication is to offer this as a legitimate non-pharmacological alternative to stimulant medication.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
QUADRUPLE
Enrollment
135
60% of participants will take 3-4 capsules of broad spectrum micronutrients three times per day for eight weeks. Following the initial 8 weeks (of the RCT), all participants will have the option to participate in an open label extension, during which time the child would take the active micronutrient treatment for 8 weeks
40% of participants will take 3-4 capsules of inactive placebo three times per day for eight weeks.
The Ohio State University
Columbus, Ohio, United States
Oregon Health & Science University
Portland, Oregon, United States
University of Lethbridge
Lethbridge, Alberta, Canada
CASI-5 Parent-rated Composite Score
Primary outcome measure, defined a priori, reflecting the often-comorbid ADHD symptoms of emotional dysregulation irritable mood, anger or aggression), are the parent-rated Child and Adolescent Symptom Inventory (CASI-5). The CASI-5 is based on the DSM-5 symptom criteria. The subscales of ADHD, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation Disorder (DMDD) and peer conflict that will be combined into a total composite score; range is 0-3 (never, sometimes, often, very often). Higher scores represent a worse outcome.
Time frame: Baseline and week 8
Clinical Global Impression (CGI) - Number of Participants Considered a Treatment Responder (Score of 1 or 2)
Second primary measure is the blinded clinician-rated CGI-Improvement (CGI-I) is a subscale of the CGI that rates overall improvement of symptoms based on all relevant data. Item range is 1-7 (very much improved, much improved, minimally improved, no change, minimally worse, much worse, very much worse); lower score is better. A treatment responder is defined as a participant who is rated a 1 or 2 on the CGI-I. The CGI-Severity (CGI-S) subscale will also be scored at baseline and week 8, with scores compared at the two time points. Item range is 1-7 (normal, borderline ill, mildly ill, moderately ill, markedly ill, severely ill, among the most extremely ill patients); lower score is better; most participants will be a 4 or 5 at baseline.
Time frame: Week 8
Sodium, Potassium, Chloride, Carbon Dioxide, and Anion Gap in mmol/L
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time frame: Baseline and Week 8
Calcium, Blood Urea Nitrogen, Creatinine, Glucose, Bilirubin Total in mg/dL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
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Time frame: Baseline and Week 8
Albumin, Total Protein, Hemoglobin, Mean Cell Hgb in g/dL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time frame: Baseline and Week 8
AST, ALT, Alkaline in U/L
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time frame: Baseline and Week 8
RBC Count in Cells/mcL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time frame: Baseline and Week 8
Hematocrit, RBC Distribution, Immature Grans, Lymphocyte, Monocyte, Eosinophil in Percent
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time frame: Baseline and Week 8
Mean Cell Volume in fL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time frame: Baseline and Week 8
Iron in ug/dL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time frame: Baseline and Week 8
WBC Count, Absolute Monocyte, Absolute Eosinophil, Platelet Count in Cells/mcL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time frame: Baseline and Week 8
Clinical Global Impression (CGI)
Second primary measure is the blinded clinician-rated CGI-Improvement (CGI-I) is a subscale of the CGI that rates overall improvement of symptoms based on all relevant data. Item range is 1-7 (very much improved, much improved, minimally improved, no change, minimally worse, much worse, very much worse); lower score is better. A treatment responder is defined as a participant who is rated a 1 or 2 on the CGI-I. The CGI-Severity (CGI-S) subscale will also be scored at baseline and week 8, with scores compared at the two time points. Item range is 1-7 (normal, borderline ill, mildly ill, moderately ill, markedly ill, severely ill, among the most extremely ill patients); lower score is better; most participants will be a 4 or 5 at baseline.
Time frame: 16 weeks
CASI-5 Parent Report
Primary outcome measure, defined a priori, reflecting the often-comorbid ADHD symptoms of emotional dysregulation irritable mood, anger or aggression), are the parent-rated Child and Adolescent Symptom Inventory (CASI-5) subscales of ADHD, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation Disorder (DMDD) and peer conflict. The CASI-5 is based on the DSM-5 symptom criteria. Item range is 0-3 (never, sometimes, often, very often). Higher scores represent a worse outcome. The subscales for ADHD, ODD, and DMD will be composite scores.
Time frame: Week 16