Attention Deficit Hyperactivity Disorder
Conditions
Keywords
ADHD, methylphenidate, children, food effect, Attention-Deficit Hyperactivity Disorder (ADHD) in children
Brief summary
This study evaluated the safety and clinical effect of treatment with methylphenidate under different breakfast conditions (minimal breakfast versus standard continental breakfast) in children with Attention-Deficit Hyperactivity Disorder (ADHD).
Interventions
Sponsors
Study design
Eligibility
Inclusion criteria
* Children aged 6-12 * Diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD) * Current medication with either 20 mg or 40 mg immediate release methylphenidate
Exclusion criteria
* Concomitant psychiatric disorders requiring pharmacological treatment * Concomitant severe somatic disorders * Eating disorders * Addiction disorders * Very high or low body weight according to age * Known hypersensitivity to methylphenidate * Contraindications for methylphenidate Other protocol-defined inclusion/
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Teacher Rating in the Intent-to-Treat (ITT) Population | Friday of each of the 2 treatment weeks | The FBB-ADHS is a 20-item rating scale. Each item describes a typical ADHD symptom. The 20 items are divided into 3 subscales: Attention deficits (9 items), hyperactivity (7 items), and impulsiveness (4 items). Each item is rated on a scale of 0 = not at all up to 3 = very much. The FBB-ADHS was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 20) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD. |
| Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Teacher Rating in the Per Protocol (PP) Population | Friday of each of the 2 treatment weeks | The FBB-ADHS is a 20-item rating scale. Each item describes a typical ADHD symptom. The 20 items are divided into 3 subscales: Attention deficits (9 items), hyperactivity (7 items), and impulsiveness (4 items). Each item is rated on a scale of 0 = not at all up to 3 = very much. The FBB-ADHS was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 20) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Impulsiveness Subscale Teacher Rating | Friday of each of the 2 treatment weeks | Teacher rating of the hyperactivity subscale (4 items), one of 3 subscales in the FBB-ADHS. Each item is rated on a scale of 0 = not at all up to 3 = very much. The rating was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 4) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD. |
| Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Parent Rating | Saturday of each of the 2 treatment weeks | The FBB-ADHS is a 20-item rating scale. Each item describes a typical ADHD symptom. The 20 items are divided into 3 subscales: Attention deficits (9 items), hyperactivity (7 items), and impulsiveness (4 items). Each item is rated on a scale of 0 = not at all up to 3 = very much. The FBB-ADHS was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 20) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD. |
| 10-Minute Math Test - Problems Attempted | Saturday of each of the 2 treatment weeks | The 10-Minute Math Test is a paper and pencil test consisting of several pages of math problems requiring addition, subtraction, multiplication and division calculations presented in ascending order of difficulty during a 10-minute period. Test difficulty was altered for subjects at different skill levels and ages. The number of problems attempted is an objective measure related to academic productivity. The math test was carried out on the Saturday visit at the end of each of the 2 treatment weeks under supervision of a teacher who had been trained on this test. |
| Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Attention Deficit Subscale Teacher Rating | Friday of each of the 2 treatment weeks | Teacher rating of the attention deficit subscale (9 items), one of 3 subscales in the FBB-ADHS. Each item is rated on a scale of 0 = not at all up to 3 = very much. The rating was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 9) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD. |
| Clinical Global Impression Severity (CGI-S) Scale Score - Physician Rating of Severity | Saturday of each of the 2 treatment weeks | The CGI-S is a scale to assess the global severity of illness. The rating is determined by the investigator answering one question: Considering your total clinical experience with this particular population, how mentally ill is the patient at this time? Ratings are on a 7-point scale: 1=normal, not at all ill; 2=borderline mentally ill; 3=mildly ill; 4=moderately ill; 5=markedly ill; 6=severely ill; 7=among the most extremely ill patients. The rating is based upon the average observed and reported symptoms, behavior, and function in the past 7 days. |
| Clinical Global Impression (CGI-I) Scale Score - Physician Rating of Improvement (Change in State) | Saturday of each of the 2 treatment weeks | The CGI-I is a scale to assess improvement (change in state) of illness. The rating is based on the investigator answering one question: Compared to the patient's condition prior to medication, this patient's condition is: 1=very much improved since the initiation of treatment; 2=much improved; 3=minimally improved; 4=no change from baseline (the initiation of treatment); 5=minimally worse; 6= much worse; 7=very much worse since the initiation of treatment. The investigator compares the patient's overall clinical condition to the 1 week period just prior to the initiation of medication. |
| 10-Minute Math Test - Problems Solved | Saturday of each of the 2 treatment weeks | The 10-Minute Math Test is a paper and pencil test consisting of several pages of math problems requiring addition, subtraction, multiplication and division calculations presented in ascending order of difficulty during a 10-minute period. Test difficulty was altered for subjects at different skill levels and ages. The number of problems attempted is an objective measure related to academic productivity. The math test was carried out on the Saturday visit at the end of each of the 2 treatment weeks under supervision of a teacher who had been trained on this test. |
| Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Hyperactivity Subscale Teacher Rating | Friday of each of the 2 treatment weeks | Teacher rating of the hyperactivity subscale (7 items), one of 3 subscales in the FBB-ADHS. Each item is rated on a scale of 0 = not at all up to 3 = very much. The rating was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 7) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD. |
Countries
Germany
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Very Light Breakfast (VLB) Then Standard Breakfast (SB) Very light breakfast (VLB) for one week then crossover to standard breakfast (SB) for one week while taking either 20 mg or 40 mg capsules of methylphenidate once daily based on the dosage the child had taken in the month prior to study start. VLB is defined as 150 kcal for children age 6-9 and 180 kcal for children age 10-12. SB is defined as 450 kcal for girls age 6-9, 490 kcal for boys age 6-9, 550 kcal for girls age 10-12, and 600 kcal for boys age 10-12. | 80 |
| Standard Breakfast (SB) Then Very Light Breakfast (VLB) Standard breakfast (SB) for one week then crossover to very light breakfast (VLB) for one week while taking either 20 mg or 40 mg capsules of methylphenidate once daily based on the dosage the child had taken in the month prior to study start. SB is defined as 450 kcal for girls age 6-9, 490 kcal for boys age 6-9, 550 kcal for girls age 10-12, and 600 kcal for boys age 10-12. VLB is defined as 150 kcal for children age 6-9 and 180 kcal for children age 10-12. | 70 |
| Total | 150 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Lack of Efficacy | 1 | 3 |
| Overall Study | Lost to Follow-up | 0 | 1 |
Baseline characteristics
| Characteristic | Very Light Breakfast (VLB) Then Standard Breakfast (SB) | Standard Breakfast (SB) Then Very Light Breakfast (VLB) | Total |
|---|---|---|---|
| Age Continuous | 9.6 years STANDARD_DEVIATION 1.6 | 9.7 years STANDARD_DEVIATION 1.5 | 9.7 years STANDARD_DEVIATION 1.6 |
| Sex: Female, Male Female | 25 Participants | 13 Participants | 38 Participants |
| Sex: Female, Male Male | 55 Participants | 57 Participants | 112 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 148 | 0 / 149 |
| serious Total, serious adverse events | 0 / 148 | 0 / 149 |
Outcome results
Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Teacher Rating in the Intent-to-Treat (ITT) Population
The FBB-ADHS is a 20-item rating scale. Each item describes a typical ADHD symptom. The 20 items are divided into 3 subscales: Attention deficits (9 items), hyperactivity (7 items), and impulsiveness (4 items). Each item is rated on a scale of 0 = not at all up to 3 = very much. The FBB-ADHS was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 20) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD.
Time frame: Friday of each of the 2 treatment weeks
Population: Intent to treat (ITT) population: All randomized patients with at least one post-baseline measurement of the primary endpoint in both study periods.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Teacher Rating in the Intent-to-Treat (ITT) Population | 0.97 Units on a scale | Standard Deviation 0.63 |
| Standard Breakfast (SB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Teacher Rating in the Intent-to-Treat (ITT) Population | 1.01 Units on a scale | Standard Deviation 0.63 |
Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Teacher Rating in the Per Protocol (PP) Population
The FBB-ADHS is a 20-item rating scale. Each item describes a typical ADHD symptom. The 20 items are divided into 3 subscales: Attention deficits (9 items), hyperactivity (7 items), and impulsiveness (4 items). Each item is rated on a scale of 0 = not at all up to 3 = very much. The FBB-ADHS was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 20) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD.
Time frame: Friday of each of the 2 treatment weeks
Population: Per protocol (PP) population: All patients in the ITT population who (a) met the inclusion/exclusion criteria liable to affect the efficacy assessment and (b) did not violate the protocol in a manner liable to affect the efficacy assessment.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Teacher Rating in the Per Protocol (PP) Population | 0.93 Units on a scale | Standard Deviation 0.62 |
| Standard Breakfast (SB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Teacher Rating in the Per Protocol (PP) Population | 1.0 Units on a scale | Standard Deviation 0.63 |
10-Minute Math Test - Problems Attempted
The 10-Minute Math Test is a paper and pencil test consisting of several pages of math problems requiring addition, subtraction, multiplication and division calculations presented in ascending order of difficulty during a 10-minute period. Test difficulty was altered for subjects at different skill levels and ages. The number of problems attempted is an objective measure related to academic productivity. The math test was carried out on the Saturday visit at the end of each of the 2 treatment weeks under supervision of a teacher who had been trained on this test.
Time frame: Saturday of each of the 2 treatment weeks
Population: Intent to treat (ITT) population includes all randomized patients with at least one post-baseline measurement of the primary endpoint in both study periods. Following the intent-to-treat principle, patients were analyzed according to the treatment they were assigned to at randomization.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | 10-Minute Math Test - Problems Attempted | 116.3 Problems attempted | Standard Deviation 56.14 |
| Standard Breakfast (SB) Treatment Group | 10-Minute Math Test - Problems Attempted | 118.1 Problems attempted | Standard Deviation 57.74 |
10-Minute Math Test - Problems Solved
The 10-Minute Math Test is a paper and pencil test consisting of several pages of math problems requiring addition, subtraction, multiplication and division calculations presented in ascending order of difficulty during a 10-minute period. Test difficulty was altered for subjects at different skill levels and ages. The number of problems attempted is an objective measure related to academic productivity. The math test was carried out on the Saturday visit at the end of each of the 2 treatment weeks under supervision of a teacher who had been trained on this test.
Time frame: Saturday of each of the 2 treatment weeks
Population: Intent to treat (ITT) population: All randomized patients with at least one post-baseline measurement of the primary endpoint in both study periods.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | 10-Minute Math Test - Problems Solved | 106.7 Problems solved | Standard Deviation 58.34 |
| Standard Breakfast (SB) Treatment Group | 10-Minute Math Test - Problems Solved | 108.6 Problems solved | Standard Deviation 60.67 |
Clinical Global Impression (CGI-I) Scale Score - Physician Rating of Improvement (Change in State)
The CGI-I is a scale to assess improvement (change in state) of illness. The rating is based on the investigator answering one question: Compared to the patient's condition prior to medication, this patient's condition is: 1=very much improved since the initiation of treatment; 2=much improved; 3=minimally improved; 4=no change from baseline (the initiation of treatment); 5=minimally worse; 6= much worse; 7=very much worse since the initiation of treatment. The investigator compares the patient's overall clinical condition to the 1 week period just prior to the initiation of medication.
Time frame: Saturday of each of the 2 treatment weeks
Population: Intent to treat (ITT) population includes all randomized patients with at least one post-baseline measurement of the primary endpoint in both study periods. Following the intent-to-treat principle, patients were analyzed according to the treatment they were assigned to at randomization.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | Clinical Global Impression (CGI-I) Scale Score - Physician Rating of Improvement (Change in State) | 3.49 Units on a scale | Standard Deviation 1.08 |
| Standard Breakfast (SB) Treatment Group | Clinical Global Impression (CGI-I) Scale Score - Physician Rating of Improvement (Change in State) | 3.56 Units on a scale | Standard Deviation 1.18 |
Clinical Global Impression Severity (CGI-S) Scale Score - Physician Rating of Severity
The CGI-S is a scale to assess the global severity of illness. The rating is determined by the investigator answering one question: Considering your total clinical experience with this particular population, how mentally ill is the patient at this time? Ratings are on a 7-point scale: 1=normal, not at all ill; 2=borderline mentally ill; 3=mildly ill; 4=moderately ill; 5=markedly ill; 6=severely ill; 7=among the most extremely ill patients. The rating is based upon the average observed and reported symptoms, behavior, and function in the past 7 days.
Time frame: Saturday of each of the 2 treatment weeks
Population: Intent to treat (ITT) population: All randomized patients with at least one post-baseline measurement of the primary endpoint in both study periods.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | Clinical Global Impression Severity (CGI-S) Scale Score - Physician Rating of Severity | 2.75 Units on a scale | Standard Deviation 1.45 |
| Standard Breakfast (SB) Treatment Group | Clinical Global Impression Severity (CGI-S) Scale Score - Physician Rating of Severity | 2.74 Units on a scale | Standard Deviation 1.48 |
Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Attention Deficit Subscale Teacher Rating
Teacher rating of the attention deficit subscale (9 items), one of 3 subscales in the FBB-ADHS. Each item is rated on a scale of 0 = not at all up to 3 = very much. The rating was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 9) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD.
Time frame: Friday of each of the 2 treatment weeks
Population: Intent to treat (ITT) population: All randomized patients with at least one post-baseline measurement of the primary endpoint in both study periods.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Attention Deficit Subscale Teacher Rating | 1.19 Units on a scale | Standard Deviation 0.68 |
| Standard Breakfast (SB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Attention Deficit Subscale Teacher Rating | 1.23 Units on a scale | Standard Deviation 0.69 |
Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Hyperactivity Subscale Teacher Rating
Teacher rating of the hyperactivity subscale (7 items), one of 3 subscales in the FBB-ADHS. Each item is rated on a scale of 0 = not at all up to 3 = very much. The rating was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 7) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD.
Time frame: Friday of each of the 2 treatment weeks
Population: Intent to treat (ITT) population: All randomized patients with at least one post-baseline measurement of the primary endpoint in both study periods.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Hyperactivity Subscale Teacher Rating | 0.72 Units on a scale | Standard Deviation 0.7 |
| Standard Breakfast (SB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Hyperactivity Subscale Teacher Rating | 0.75 Units on a scale | Standard Deviation 0.69 |
Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Impulsiveness Subscale Teacher Rating
Teacher rating of the hyperactivity subscale (4 items), one of 3 subscales in the FBB-ADHS. Each item is rated on a scale of 0 = not at all up to 3 = very much. The rating was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 4) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD.
Time frame: Friday of each of the 2 treatment weeks
Population: Intent to treat (ITT) population: All randomized patients with at least one post-baseline measurement of the primary endpoint in both study periods.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Impulsiveness Subscale Teacher Rating | 0.93 Units on a scale | Standard Deviation 0.92 |
| Standard Breakfast (SB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Impulsiveness Subscale Teacher Rating | 0.99 Units on a scale | Standard Deviation 0.9 |
Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Parent Rating
The FBB-ADHS is a 20-item rating scale. Each item describes a typical ADHD symptom. The 20 items are divided into 3 subscales: Attention deficits (9 items), hyperactivity (7 items), and impulsiveness (4 items). Each item is rated on a scale of 0 = not at all up to 3 = very much. The FBB-ADHS was completed by teachers on Friday afternoon of each week of the study. A total score (sum of all items divided by 20) was calculated. The total score can range from 0 to 3. A lower score indicates more ADHD.
Time frame: Saturday of each of the 2 treatment weeks
Population: Intent to treat (ITT) population: All randomized patients with at least one post-baseline measurement of the primary endpoint in both study periods.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Very Light Breakfast (VLB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Parent Rating | 1.15 Units on a scale | Standard Deviation 0.6 |
| Standard Breakfast (SB) Treatment Group | Fremdbeurteilungsbogen für Aufmerksamkeitsdefizit-Hyperaktivitätsstörungen (FBB-AHDS) Parent Rating | 1.11 Units on a scale | Standard Deviation 0.55 |