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Lab School Day Study for CONCERTA of Older Children With ADHD

The ABC Study: A Double-Blind, Randomized, Placebo-Controlled, Crossover Study Evaluating the Academic, Behavioral, and Cognitive Effects of CONCERTA on Older Children With ADHD

Status
Completed
Phases
Phase 4
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT00799409
Enrollment
78
Registered
2008-11-27
Start date
2008-12-31
Completion date
2009-06-30
Last updated
2014-05-09

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Attention Deficit Hyperactivity Disorder

Keywords

ADHD, Attention Deficit Hyperactivity Disorder

Brief summary

The purpose of this trial is to determine if the study medication, CONCERTA (methylphenidate HCl), is safe and effective in improving academic performance and behavior in children with attention deficit hyperactivity disorder (ADHD), when compared to placebo.

Detailed description

The hypothesis is that CONCERTA (methylphenidate HCl) is safe and effective in improving academic performance and behavior in children with ADHD, when compared to placebo as demonstrated using specified study measures. This is a double-blind (neither participant nor investigator knows the name of the assigned study drug), randomized (study drug assigned by chance), placebo-controlled, crossover study evaluating the academic, behavioral, and cognitive effects of CONCERTA (methylphenidate HCl) on older children with ADHD. This means that all eligible children will receive treatment with methylphenidate HCl throughout the study (the titration and assessment periods) and inactive pill (placebo) on one of the two laboratory classroom days. On the other laboratory classroom day they will receive their regular dose of methylphenidate HCl. The primary efficacy variable in this study is the Permanent Product Math Test (PERMP) attempted score. Secondary Measures include: SKAMP (Swanson, Kotkin, Agler, M-Flynn, and Pelham), tests of inattention, reading fluency and comprehension, and memory. Assessments will be completed during each of the laboratory assessment days (12.5 hours). Participants will be assessed for adverse events throughout the study. Patients will initiate treatment with oral CONCERTA (methylphenidate HCl) 18 mg at baseline and continue morning dosing with increases every 3 to 7 days until an optimal dose is achieved, up to the maximum of 54 mg/day. Eligible patients will remain in the study for a maximum of 8 weeks.

Interventions

DRUGPlacebo/ CONCERTA (methylphenidate HCl)

Placebo once daily on Lab School Day #1 and Optimal Subject Dose (18 mg-54 mg) once daily during Lab School Day #2

DRUGCONCERTA (methylphenidate HCl) / Placebo

Optimal Subject Dose (18 mg-54 mg) once daily during Lab School Day #1 and Placebo once daily on Lab School Day #2

Sponsors

Ortho-McNeil Janssen Scientific Affairs, LLC
Lead SponsorINDUSTRY

Study design

Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)

Eligibility

Sex/Gender
ALL
Age
9 Years to 12 Years
Healthy volunteers
No

Inclusion criteria

* ADHD diagnosis of all subtypes (except Not Otherwise Specified) * Patients with total or subscale Attention Deficit Hyperactivity Disorder Rating Scale (ADHD RS-IV) scores \> =90th percentile relative to the general population of children by age and gender * Patients currently receiving ADHD medication must be inadequately managed on their current stimulant dose and meet this criteria at the screening visit * Ability to read and understand English * Ability to attend school regularly.

Exclusion criteria

* Estimated Full Scale IQ score of 80 or below * Severe Learning Disability * History of, or current, primary diagnosis of: severe anxiety disorder, conduct disorder, psychotic disorders, pervasive developmental disorder, eating disorder, obsessive-compulsive disorder, sleep disorder, major depressive disorder, bipolar disorder, substance use disorder, chronic tic disorder, personal or family history of Tourette's syndrome * Weight \< 3rd percentile for age * History of hospitalization for treatment of a mood, anxiety, or psychotic disorder * History of failed response to methylphenidate.

Design outcomes

Primary

MeasureTime frameDescription
Hour 4 Permanent Product Math Test Attempted Score (PERMP-Attempted)Hour 4 of the of the Lab School Day during Double-Blind Assessment PeriodPERMP (range: 0, 400) is a measure of academic productivity in children up to 14 years of age. These seatwork math tasks provide an objective measure of attention and accuracy in calculations. The level of difficulty is established on a screening math pretest. The subsequent laboratory school day assessments employed a series of 10-minute math tests (5 pages of 80 math problem each for a total of 400 problems available). Children were graded on the number of attempted problems. A higher number of problems attempted was indicative of greater attention to detail (higher score is preferable)
Hour 4 Permanent Product Math Test Correct Score (PERMP-Correct)Hour 4 of the Lab School Day During the Double-Blind Assessment PeriodPERMP (range: 0, 400) is a measure of academic productivity in children up to 14 years of age. These seatwork math tasks provide an objective measure of attention and accuracy in calculations. The level of difficulty is established on a screening math pretest performed at Visit 2. The subsequent laboratory school day assessments employed a series of 10-minute math tests (5 pages of 80 math problem each for a total of 400 problems available). Children were graded on the number of correct problems. A higher number of problems correct, of those attempted, was indicative of greater accuracy.

Secondary

MeasureTime frameDescription
Hour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Composite (SKAMP-Composite)Hour 4 of the Lab School Day During the Double-Blind Assessment PeriodThe SKAMP scale measures the manifestations of ADHD using an independent observer (teacher) rating of the child's impairment in classroom behavior. A composite score (range: 0, 78) for the SKAMP variable (13 items total) was obtained by summing the SKAMP-D and SKAMP-A subscale scores. A lower score was preferable, as a higher score represented greater behavioral impairment.
Hour 5.5 Test of Variables of Attention (TOVA) ADHD Composite Cutoff ScoreHour 5.5 of the Lab School Day During the Double-Blind Assessment PeriodThe TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicate better performance, lower scores indicate worse performance. Clinical interpretation: an ADHD scores of -1.80 or lower (\<= -1.80) are considered not within normal limits scores above -1.80 (\> -1.80) are considered inconclusive (meaning, neither like-ADHD nor like-normal).
Hour 5.5 Test of Variables of Attention (TOVA) Reaction Time Standard ScoreHour 5.5 of the Lab School Day During the Double-Blind Assessment PeriodThe TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicated better performance, lower scores indicate worse performance. Clinical interpretation: scores below 80 are considered abnormal, 80-85 are considered borderline, and scores above 85 are considered within normal limits.
Hour 5.5 Test of Variables of Attention (TOVA) Reaction Time Variability Standard ScoreHour 5.5 of the Lab School Day During the Double-Blind Assessment PeriodThe TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicated better performance, lower scores indicate worse performance. Clinical interpretation: scores below 80 are considered abnormal, 80-85 are considered borderline, and scores above 85 are considered within normal limits.
Hour 5.5 Wide Range Assessment of Memory and Learning (WRAML-2) Finger Windows BackwardsHour 5.5 of the Lab School Day During the Double-Blind Assessment PeriodWRAML-2 (range: 0, 28) is designed to evaluate a child's ability to learn and to memorize information, consists of 9 subtests from which 4 summary indexes can be calculated: verbal memory index, visual memory index, learning index, and general memory index. During this test the investigator pointed to a longer and longer series of windows on a card at the rate of 1 location per second, and then the child was asked to reproduce the sequence exactly in reverse order. One point was given for each correctly recalled sequence, and the test was discontinued after 3 consecutive errors.
Hour 5.5 Wide Range Assessment of Memory and Learning (WRAML-2) Finger Windows ForwardsHour 5.5 of the Lab School Day During the Double-Blind Assessment PeriodWRAML-2 (range: 0, 28) is designed to evaluate a child's ability to learn and to memorize information, consists of 9 subtests from which 4 summary indexes can be calculated: verbal memory index, visual memory index, learning index, and general memory index. During this test the investigator pointed to a longer and longer series of windows on a card at the rate of 1 location per second, and then the child was asked to reproduce the sequence exactly. One point was given for each correctly recalled sequence, and the test was discontinued after 3 consecutive errors.
Hour 5.5 Test of Variables of Attention (TOVA) Commissions Standard ScoreHour 5.5 of the Lab School Day During the Double-Blind Assessment PeriodThe TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicated better performance, lower scores indicate worse performance. Clinical interpretation: scores below 80 are considered abnormal, 80-85 are considered borderline, and scores above 85 are considered within normal limits.
Hour 5.5 Wechsler Intelligence Scale for Children - 3rd ed. (WISC-III-PI) Digit Span BackwardsHour 5.5 of the Lab School Day During the Double-Blind Assessment PeriodEach child individually was given a sequence of numbers with the sequence becoming progressively longer. The child was then asked to repeat the digits in the same sequence, either forwards or backwards. Each sequence length was attempted twice. The test was complete after failure on both trials of any sequence length. One point was awarded if the participant passed only 1 trial of a sequence length. Zero points were given if the participant failed both trials. The maximum raw scores were 16 forwards and 14 backwards. A higher score was indicative of better recall and attention (range: 0, 14).
Hour 8.75 Gray Silent Reading Test (GSRT) Reading QuotientHour 8.75 of the Lab School Day During the Double-Blind Assessment PeriodGray Silent Reading Test (GSRT)Reading Quotient is a reliable, validated measure of reading comprehension administered in the group setting during the first half hour of the homework session (range: 0,unbounded). A higher score is preferable as it means more questions were answered correctly.
Hour 7.5 Test of Handwriting Skills (Revised) (THS-R) Standard ScoreHour 7.5 of the Lab School Day During the Double-Blind Assessment PeriodThe THS-R (range: unbounded) is a standardized, untimed assessment designed to evaluate neurosensory integration manifested in manuscript and cursive writing. The test includes subtests: writing from memory or dictation the letters of the alphabet in order, single digit-numbers out of order, selected words, and copying selected letters, words, and sentences. Each subtest was scored from zero (poorly formed letters) to 3 (perfectly formed letters). 100 is the normal mean; scores lower than 100 indicate performance worse than normal, scores above 100 indicate performance better than normal.
Hour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Deportment (SKAMP-Deportment)Hour 4 of the Lab School Day During the Double-Blind Assessment PeriodThe SKAMP scale measures the manifestations of ADHD using an independent observer (teacher) rating of the child's impairment in classroom behavior. The SKAMP-Deportment (SKAMP-D) (range: 0, 36) is a sum of ratings on 6 deportment items (interacting with other children, interacting with adults, remaining quiet, staying seated, complying with the teacher's directions, and following the classroom rules). Each item was rated on a 7-point impairment scale (0=normal, 6=maximum impairment), with higher scores indicating more severe symptoms.
Hour 5.5 Wechsler Intelligence Scale for Children - 3rd ed. (WISC-III-PI) Digit Span ForwardsHour 5.5 of the Lab School Day During the Double-Blind Assessment PeriodEach child individually was given a sequence of numbers with the sequence becoming progressively longer. The child was then asked to repeat the digits in the same sequence, either forwards or backwards. Each sequence length was attempted twice. The test was complete after failure on both trials of any sequence length. One point was awarded if the participant passed only 1 trial of a sequence length. Zero points were given if the participant failed both trials. The maximum raw scores were 16 forwards and 14 backwards. A higher score was indicative of better recall and attention (range: 0, 16).
Hour 5.5 Test of Variables of Attention (TOVA) Omissions Standard ScoreHour 5.5 of the Lab School Day During the Double-Blind Assessment PeriodThe TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicated better performance, lower scores indicate worse performance. Clinical interpretation: scores below 80 are considered abnormal, 80-85 are considered borderline, and scores above 85 are considered within normal limits.
Hour 3.0 Grammar TaskHour 3.0 of the Lab School Day During the Double-Blind Assessment PeriodThis task, presented once during a laboratory school day, was designed to index attention to detail by determining how many grammatical mistakes each child could identify and circle in a brief paragraph. The errors were not difficult to identify and were designed to show attention to task, not comprehension. A higher number of errors identified, of those possible, was indicative of better attention - identification of grammatical errors(range: 0, 1 represents correct responses divided by the number of possible responses).
Hour 8.75 Packet Activity Short Story With Questions for ComprehensionHour 8.75 of the Lab School Day During the Double-Blind Assessment PeriodPacket Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).
Hour 8.75 Packet Activity Identify Root WordHour 8.75 of the Lab School Day During the Double-Blind Assessment PeriodPacket Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).
Hour 8.75 Packet Activity Alphabetize List of WordsHour 8.75 of the Lab School Day During the Double-Blind Assessment PeriodPacket Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).
Hour 8.75 Packet Activity Identify Multiple Meanings for WordsHour 8.75 of the Lab School Day During the Double-Blind Assessment PeriodPacket Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).
Hour 8.75 Packet Activity Complete Sentences Using Words ProvidedHour 8.75 of the Lab School Day During the Double-Blind Assessment PeriodPacket Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).
Hour 8.75 Packet Activity Word SearchHour 8.75 of the Lab School Day During the Double-Blind Assessment PeriodPacket Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).
Hour 8.75 Packet Activity Decode the Mystery SentenceHour 8.75 of the Lab School Day During the Double-Blind Assessment PeriodPacket Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).
Hour 3.5 Dynamic Indicators of Basic Early Literacy Skills (DIBELS)Hour 3.5 of the Lab School Day During the Double-Blind Assessment PeriodThe DIBELS (range: 0, 376), used to assess reading fluency, consists of standardized, individually administered measures of early literacy development. These short (1 minute) fluency measures were developed based upon essential early literacy domains to assess development of phonological awareness, alphabetic understanding, and automaticity and fluency. Only the paragraph fluency component of an age/grade-appropriate DIBELS was used. A higher score indicated better performance, as it represented that the subject orally read a greater number of words correctly within the time allowed.
Hour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Attention (SKAMP-Attention)Hour 4 of the Lab School Day During the Double-Blind Assessment PeriodThe SKAMP scale measures the manifestations of ADHD using an independent observer (teacher) rating of the child's impairment in classroom behavior. The SKAMP-Attention (SKAMP-A) (range: 0, 42) is a sum of the ratings on 7 attention items (getting started, sticking with tasks, attending to an activity, making activity transitions, completing assigned tasks, performing work accurately, and being neat and careful while writing or drawing). Each item was rated on a 7-point impairment scale (0=normal, 6=maximum impairment), with higher scores indicating more severe symptoms.

Countries

United States

Participant flow

Participants by arm

ArmCount
Not Randomized
Children who started dose adjustment period, but were not randomized
7
Placebo/Concerta
Children randomized to receive Placebo at lab school day 1 and an individualized, optimal dose of Concerta (18mg, 36mg, or 54mg tablet) once daily at lab school day 2
36
Concerta/Placebo
Children randomized to receive an individualized, optimal dose of Concerta (18mg, 36mg, or 54mg tablet) once daily at lab school day 1 and Placebo at lab school day 2
35
Total78

Withdrawals & dropouts

PeriodReasonFG000FG001FG002
Overall StudyDid not attend lab school day 1100
Overall StudyFailure to follow study protocol)100
Overall StudyLost to Follow-up100
Overall Studymedication compliance100
Overall StudyOptimal Dose Not Achieved200
Overall StudyWithdrawal by Subject100

Baseline characteristics

CharacteristicNot RandomizedPlacebo/ConcertaConcerta/PlaceboTotal
Age, Continuous9.9 years
STANDARD_DEVIATION 0.69
10.3 years
STANDARD_DEVIATION 1.07
10.0 years
STANDARD_DEVIATION 1.14
10.1 years
STANDARD_DEVIATION 1.08
Region of Enrollment
USA
7 participants36 participants35 participants78 participants
Sex: Female, Male
Female
3 Participants14 Participants6 Participants23 Participants
Sex: Female, Male
Male
4 Participants22 Participants29 Participants55 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
EG002
affected / at risk
deaths
Total, all-cause mortality
— / —— / —— / —
other
Total, other adverse events
1 / 710 / 7134 / 78
serious
Total, serious adverse events
0 / 710 / 710 / 78

Outcome results

Primary

Hour 4 Permanent Product Math Test Attempted Score (PERMP-Attempted)

PERMP (range: 0, 400) is a measure of academic productivity in children up to 14 years of age. These seatwork math tasks provide an objective measure of attention and accuracy in calculations. The level of difficulty is established on a screening math pretest. The subsequent laboratory school day assessments employed a series of 10-minute math tests (5 pages of 80 math problem each for a total of 400 problems available). Children were graded on the number of attempted problems. A higher number of problems attempted was indicative of greater attention to detail (higher score is preferable)

Time frame: Hour 4 of the of the Lab School Day during Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point. Intent-to-Treat for Placebo and Concerta columns in the primary and secondary results are comprised of the 36 children randomized to Placebo/CONCERTA (lab day 1/lab day 2) plus the 35 children randomized to CONCERTA/Placebo

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 4 Permanent Product Math Test Attempted Score (PERMP-Attempted)74.8 Problems attemptedStandard Deviation 42.05
ConcertaHour 4 Permanent Product Math Test Attempted Score (PERMP-Attempted)103.5 Problems attemptedStandard Deviation 38.51
p-value: <0.000195% CI: [-35, -22.3]Mixed Models Analysis
Primary

Hour 4 Permanent Product Math Test Correct Score (PERMP-Correct)

PERMP (range: 0, 400) is a measure of academic productivity in children up to 14 years of age. These seatwork math tasks provide an objective measure of attention and accuracy in calculations. The level of difficulty is established on a screening math pretest performed at Visit 2. The subsequent laboratory school day assessments employed a series of 10-minute math tests (5 pages of 80 math problem each for a total of 400 problems available). Children were graded on the number of correct problems. A higher number of problems correct, of those attempted, was indicative of greater accuracy.

Time frame: Hour 4 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 4 Permanent Product Math Test Correct Score (PERMP-Correct)69.0 Problems correctStandard Deviation 41.02
ConcertaHour 4 Permanent Product Math Test Correct Score (PERMP-Correct)97.4 Problems correctStandard Deviation 38.99
p-value: <0.000195% CI: [-34.4, -22.2]Mixed Models Analysis
Secondary

Hour 3.0 Grammar Task

This task, presented once during a laboratory school day, was designed to index attention to detail by determining how many grammatical mistakes each child could identify and circle in a brief paragraph. The errors were not difficult to identify and were designed to show attention to task, not comprehension. A higher number of errors identified, of those possible, was indicative of better attention - identification of grammatical errors(range: 0, 1 represents correct responses divided by the number of possible responses).

Time frame: Hour 3.0 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 3.0 Grammar Task0.241 Units on a scaleStandard Deviation 0.1704
ConcertaHour 3.0 Grammar Task0.327 Units on a scaleStandard Deviation 0.2204
p-value: 0.000295% CI: [-0.13, -0.04]ANCOVA
Secondary

Hour 3.5 Dynamic Indicators of Basic Early Literacy Skills (DIBELS)

The DIBELS (range: 0, 376), used to assess reading fluency, consists of standardized, individually administered measures of early literacy development. These short (1 minute) fluency measures were developed based upon essential early literacy domains to assess development of phonological awareness, alphabetic understanding, and automaticity and fluency. Only the paragraph fluency component of an age/grade-appropriate DIBELS was used. A higher score indicated better performance, as it represented that the subject orally read a greater number of words correctly within the time allowed.

Time frame: Hour 3.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 3.5 Dynamic Indicators of Basic Early Literacy Skills (DIBELS)106.2 Units on a scaleStandard Deviation 35.15
ConcertaHour 3.5 Dynamic Indicators of Basic Early Literacy Skills (DIBELS)112.0 Units on a scaleStandard Deviation 35.51
p-value: 0.009295% CI: [-10.04, -1.47]ANCOVA
Secondary

Hour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Attention (SKAMP-Attention)

The SKAMP scale measures the manifestations of ADHD using an independent observer (teacher) rating of the child's impairment in classroom behavior. The SKAMP-Attention (SKAMP-A) (range: 0, 42) is a sum of the ratings on 7 attention items (getting started, sticking with tasks, attending to an activity, making activity transitions, completing assigned tasks, performing work accurately, and being neat and careful while writing or drawing). Each item was rated on a 7-point impairment scale (0=normal, 6=maximum impairment), with higher scores indicating more severe symptoms.

Time frame: Hour 4 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Attention (SKAMP-Attention)11.8 Units on a scaleStandard Deviation 6.48
ConcertaHour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Attention (SKAMP-Attention)6.7 Units on a scaleStandard Deviation 5.03
p-value: <0.000195% CI: [3.8, 6.5]Mixed Models Analysis
Secondary

Hour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Composite (SKAMP-Composite)

The SKAMP scale measures the manifestations of ADHD using an independent observer (teacher) rating of the child's impairment in classroom behavior. A composite score (range: 0, 78) for the SKAMP variable (13 items total) was obtained by summing the SKAMP-D and SKAMP-A subscale scores. A lower score was preferable, as a higher score represented greater behavioral impairment.

Time frame: Hour 4 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Composite (SKAMP-Composite)20.8 Units on a scaleStandard Deviation 11.23
ConcertaHour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Composite (SKAMP-Composite)9.9 Units on a scaleStandard Deviation 7.44
p-value: <0.000195% CI: [8.7, 13.3]Mixed Models Analysis
Secondary

Hour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Deportment (SKAMP-Deportment)

The SKAMP scale measures the manifestations of ADHD using an independent observer (teacher) rating of the child's impairment in classroom behavior. The SKAMP-Deportment (SKAMP-D) (range: 0, 36) is a sum of ratings on 6 deportment items (interacting with other children, interacting with adults, remaining quiet, staying seated, complying with the teacher's directions, and following the classroom rules). Each item was rated on a 7-point impairment scale (0=normal, 6=maximum impairment), with higher scores indicating more severe symptoms.

Time frame: Hour 4 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Deportment (SKAMP-Deportment)9.0 Units on a scaleStandard Deviation 6.68
ConcertaHour 4 Swanson, Kotkin, Alger, M-Flynn and Pelham Scale for Deportment (SKAMP-Deportment)3.1 Units on a scaleStandard Deviation 4.1
p-value: <0.000195% CI: [4.3, 7.4]Mixed Models Analysis
Secondary

Hour 5.5 Test of Variables of Attention (TOVA) ADHD Composite Cutoff Score

The TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicate better performance, lower scores indicate worse performance. Clinical interpretation: an ADHD scores of -1.80 or lower (\<= -1.80) are considered not within normal limits scores above -1.80 (\> -1.80) are considered inconclusive (meaning, neither like-ADHD nor like-normal).

Time frame: Hour 5.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 5.5 Test of Variables of Attention (TOVA) ADHD Composite Cutoff Score-4.39 Units on a scaleStandard Deviation 3.31
ConcertaHour 5.5 Test of Variables of Attention (TOVA) ADHD Composite Cutoff Score-1.34 Units on a scaleStandard Deviation 3.43
p-value: <0.000195% CI: [-3.72, -2.59]ANCOVA
Secondary

Hour 5.5 Test of Variables of Attention (TOVA) Commissions Standard Score

The TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicated better performance, lower scores indicate worse performance. Clinical interpretation: scores below 80 are considered abnormal, 80-85 are considered borderline, and scores above 85 are considered within normal limits.

Time frame: Hour 5.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 5.5 Test of Variables of Attention (TOVA) Commissions Standard Score86.42 Units on a scaleStandard Deviation 33.261
ConcertaHour 5.5 Test of Variables of Attention (TOVA) Commissions Standard Score92.58 Units on a scaleStandard Deviation 34.545
p-value: 0.109195% CI: [-14.05, 1.44]ANCOVA
Secondary

Hour 5.5 Test of Variables of Attention (TOVA) Omissions Standard Score

The TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicated better performance, lower scores indicate worse performance. Clinical interpretation: scores below 80 are considered abnormal, 80-85 are considered borderline, and scores above 85 are considered within normal limits.

Time frame: Hour 5.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 5.5 Test of Variables of Attention (TOVA) Omissions Standard Score25.98 Units on a scaleStandard Deviation 126.281
ConcertaHour 5.5 Test of Variables of Attention (TOVA) Omissions Standard Score64.07 Units on a scaleStandard Deviation 88.77
p-value: 0.000295% CI: [-59.7, -19.39]ANCOVA
Secondary

Hour 5.5 Test of Variables of Attention (TOVA) Reaction Time Standard Score

The TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicated better performance, lower scores indicate worse performance. Clinical interpretation: scores below 80 are considered abnormal, 80-85 are considered borderline, and scores above 85 are considered within normal limits.

Time frame: Hour 5.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 5.5 Test of Variables of Attention (TOVA) Reaction Time Standard Score73.80 Units on a scaleStandard Deviation 23.74
ConcertaHour 5.5 Test of Variables of Attention (TOVA) Reaction Time Standard Score89.72 Units on a scaleStandard Deviation 21.32
p-value: <0.000195% CI: [-19.99, -12.06]ANCOVA
Secondary

Hour 5.5 Test of Variables of Attention (TOVA) Reaction Time Variability Standard Score

The TOVA (range: unbounded) is a computerized, visual continuous performance test providing a measure of attention. The stimulus, presented for 100 milliseconds (ms) at the rate of 30 per minute, is a computer-presented square containing a square hole near the top (target) or bottom (non-target) edge. Higher scores indicated better performance, lower scores indicate worse performance. Clinical interpretation: scores below 80 are considered abnormal, 80-85 are considered borderline, and scores above 85 are considered within normal limits.

Time frame: Hour 5.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 5.5 Test of Variables of Attention (TOVA) Reaction Time Variability Standard Score62.87 Units on a scaleStandard Deviation 33.789
ConcertaHour 5.5 Test of Variables of Attention (TOVA) Reaction Time Variability Standard Score85.14 Units on a scaleStandard Deviation 34.906
p-value: <0.000195% CI: [-27.43, -17.47]ANCOVA
Secondary

Hour 5.5 Wechsler Intelligence Scale for Children - 3rd ed. (WISC-III-PI) Digit Span Backwards

Each child individually was given a sequence of numbers with the sequence becoming progressively longer. The child was then asked to repeat the digits in the same sequence, either forwards or backwards. Each sequence length was attempted twice. The test was complete after failure on both trials of any sequence length. One point was awarded if the participant passed only 1 trial of a sequence length. Zero points were given if the participant failed both trials. The maximum raw scores were 16 forwards and 14 backwards. A higher score was indicative of better recall and attention (range: 0, 14).

Time frame: Hour 5.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 5.5 Wechsler Intelligence Scale for Children - 3rd ed. (WISC-III-PI) Digit Span Backwards5.1 Correct TrialsStandard Deviation 1.97
ConcertaHour 5.5 Wechsler Intelligence Scale for Children - 3rd ed. (WISC-III-PI) Digit Span Backwards5.4 Correct TrialsStandard Deviation 2.12
p-value: 0.265395% CI: [-0.7, 0.2]ANCOVA
Secondary

Hour 5.5 Wechsler Intelligence Scale for Children - 3rd ed. (WISC-III-PI) Digit Span Forwards

Each child individually was given a sequence of numbers with the sequence becoming progressively longer. The child was then asked to repeat the digits in the same sequence, either forwards or backwards. Each sequence length was attempted twice. The test was complete after failure on both trials of any sequence length. One point was awarded if the participant passed only 1 trial of a sequence length. Zero points were given if the participant failed both trials. The maximum raw scores were 16 forwards and 14 backwards. A higher score was indicative of better recall and attention (range: 0, 16).

Time frame: Hour 5.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 5.5 Wechsler Intelligence Scale for Children - 3rd ed. (WISC-III-PI) Digit Span Forwards9.2 Correct TrialsStandard Deviation 1.88
ConcertaHour 5.5 Wechsler Intelligence Scale for Children - 3rd ed. (WISC-III-PI) Digit Span Forwards9.3 Correct TrialsStandard Deviation 1.7
p-value: 0.919595% CI: [-0.37, 0.33]ANCOVA
Secondary

Hour 5.5 Wide Range Assessment of Memory and Learning (WRAML-2) Finger Windows Backwards

WRAML-2 (range: 0, 28) is designed to evaluate a child's ability to learn and to memorize information, consists of 9 subtests from which 4 summary indexes can be calculated: verbal memory index, visual memory index, learning index, and general memory index. During this test the investigator pointed to a longer and longer series of windows on a card at the rate of 1 location per second, and then the child was asked to reproduce the sequence exactly in reverse order. One point was given for each correctly recalled sequence, and the test was discontinued after 3 consecutive errors.

Time frame: Hour 5.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 5.5 Wide Range Assessment of Memory and Learning (WRAML-2) Finger Windows Backwards11.2 Correct SequencesStandard Deviation 4.25
ConcertaHour 5.5 Wide Range Assessment of Memory and Learning (WRAML-2) Finger Windows Backwards12.2 Correct SequencesStandard Deviation 3.57
p-value: 0.1895% CI: [-1.69, -0.16]ANCOVA
Secondary

Hour 5.5 Wide Range Assessment of Memory and Learning (WRAML-2) Finger Windows Forwards

WRAML-2 (range: 0, 28) is designed to evaluate a child's ability to learn and to memorize information, consists of 9 subtests from which 4 summary indexes can be calculated: verbal memory index, visual memory index, learning index, and general memory index. During this test the investigator pointed to a longer and longer series of windows on a card at the rate of 1 location per second, and then the child was asked to reproduce the sequence exactly. One point was given for each correctly recalled sequence, and the test was discontinued after 3 consecutive errors.

Time frame: Hour 5.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 5.5 Wide Range Assessment of Memory and Learning (WRAML-2) Finger Windows Forwards12.9 Correct SequencesStandard Deviation 3.96
ConcertaHour 5.5 Wide Range Assessment of Memory and Learning (WRAML-2) Finger Windows Forwards14.3 Correct SequencesStandard Deviation 3.64
p-value: 0.005795% CI: [-2.25, -0.4]ANCOVA
Secondary

Hour 7.5 Test of Handwriting Skills (Revised) (THS-R) Standard Score

The THS-R (range: unbounded) is a standardized, untimed assessment designed to evaluate neurosensory integration manifested in manuscript and cursive writing. The test includes subtests: writing from memory or dictation the letters of the alphabet in order, single digit-numbers out of order, selected words, and copying selected letters, words, and sentences. Each subtest was scored from zero (poorly formed letters) to 3 (perfectly formed letters). 100 is the normal mean; scores lower than 100 indicate performance worse than normal, scores above 100 indicate performance better than normal.

Time frame: Hour 7.5 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 7.5 Test of Handwriting Skills (Revised) (THS-R) Standard Score93.6 Units on a scaleStandard Deviation 20.77
ConcertaHour 7.5 Test of Handwriting Skills (Revised) (THS-R) Standard Score98.3 Units on a scaleStandard Deviation 21.81
p-value: 0.000195% CI: [-6.96, -2.53]ANCOVA
Secondary

Hour 8.75 Gray Silent Reading Test (GSRT) Reading Quotient

Gray Silent Reading Test (GSRT)Reading Quotient is a reliable, validated measure of reading comprehension administered in the group setting during the first half hour of the homework session (range: 0,unbounded). A higher score is preferable as it means more questions were answered correctly.

Time frame: Hour 8.75 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 8.75 Gray Silent Reading Test (GSRT) Reading Quotient85.9 Units on a scaleStandard Deviation 23.6
ConcertaHour 8.75 Gray Silent Reading Test (GSRT) Reading Quotient91.9 Units on a scaleStandard Deviation 18.49
p-value: 0.003895% CI: [-10.81, -2.17]ANCOVA
Secondary

Hour 8.75 Packet Activity Alphabetize List of Words

Packet Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).

Time frame: Hour 8.75 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 8.75 Packet Activity Alphabetize List of Words0.676 Units on a scaleStandard Deviation 0.34
ConcertaHour 8.75 Packet Activity Alphabetize List of Words0.676 Units on a scaleStandard Deviation 0.3369
p-value: 0.99895% CI: [-0.08, 0.08]ANCOVA
Secondary

Hour 8.75 Packet Activity Complete Sentences Using Words Provided

Packet Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).

Time frame: Hour 8.75 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 8.75 Packet Activity Complete Sentences Using Words Provided0.652 Units on a scaleStandard Deviation 0.3251
ConcertaHour 8.75 Packet Activity Complete Sentences Using Words Provided0.741 Units on a scaleStandard Deviation 0.3221
p-value: 0.004395% CI: [-0.15, -0.03]ANCOVA
Secondary

Hour 8.75 Packet Activity Decode the Mystery Sentence

Packet Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).

Time frame: Hour 8.75 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 8.75 Packet Activity Decode the Mystery Sentence0.960 Units on a scaleStandard Deviation 0.1566
ConcertaHour 8.75 Packet Activity Decode the Mystery Sentence0.987 Units on a scaleStandard Deviation 0.0501
p-value: 0.096595% CI: [-0.06, 0.01]ANCOVA
Secondary

Hour 8.75 Packet Activity Identify Multiple Meanings for Words

Packet Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).

Time frame: Hour 8.75 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 8.75 Packet Activity Identify Multiple Meanings for Words0.694 Units on a scaleStandard Deviation 0.3123
ConcertaHour 8.75 Packet Activity Identify Multiple Meanings for Words0.795 Units on a scaleStandard Deviation 0.3019
p-value: 0.015195% CI: [-0.19, -0.02]ANCOVA
Secondary

Hour 8.75 Packet Activity Identify Root Word

Packet Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).

Time frame: Hour 8.75 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 8.75 Packet Activity Identify Root Word0.744 Units on a scaleStandard Deviation 0.3058
ConcertaHour 8.75 Packet Activity Identify Root Word0.760 Units on a scaleStandard Deviation 0.3054
p-value: 0.626295% CI: [-0.09, 0.05]ANCOVA
Secondary

Hour 8.75 Packet Activity Short Story With Questions for Comprehension

Packet Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).

Time frame: Hour 8.75 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 8.75 Packet Activity Short Story With Questions for Comprehension0.609 Units on a scaleStandard Deviation 0.2449
ConcertaHour 8.75 Packet Activity Short Story With Questions for Comprehension0.629 Units on a scaleStandard Deviation 0.2843
p-value: 0.462595% CI: [-0.07, 0.03]ANCOVA
Secondary

Hour 8.75 Packet Activity Word Search

Packet Activities: Assessment of ability to organize, listen to instructions, initiate task, complete task, and distractibility, by completing a word search, reading a short story for comprehension on a multiple choice test, reading a longer story for comprehension on a true/false test, decoding a mystery sentence, and completing various vocabulary assessments (word choice, homophones; base/root words, alphabetic order) (range: 0, 1 represents correct responses divided by the number of possible responses).

Time frame: Hour 8.75 of the Lab School Day During the Double-Blind Assessment Period

Population: Intent-to-Treat Analysis Set. Not randomized children were excluded from this time point.

ArmMeasureValue (MEAN)Dispersion
PlaceboHour 8.75 Packet Activity Word Search0.935 Units on a scaleStandard Deviation 0.1952
ConcertaHour 8.75 Packet Activity Word Search0.979 Units on a scaleStandard Deviation 0.1123
p-value: 0.037195% CI: [-0.08, 0]ANCOVA

Source: ClinicalTrials.gov · Data processed: Mar 29, 2026