ADHD - Combined Type, Kbg Syndrome
Conditions
Brief summary
The goal of this clinical trial\] is to learn about the effect of methylphenidate in children and adolescents with KBG syndrome. The main question it aims to answer is: • What is the effectiveness of methylphenidate on attention deficit and ADHD-related symptoms in children and adolescents with KBG syndrome? Participants will receive multiple blocks of treatment with methylphenidate and placebo and fill out various questionnaires.
Detailed description
KBG syndrome (KBGS) is a neurodevelopmental disorder (NDD) characterized by developmental delay and/or intellectual disability, typical facial features, skeletal and congenital anomalies. Behavioural issues are a frequent feature, reported in 50-94% of persons with KBGS.The behavioural problems are diverse, and include attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), obsessive-compulsive disorder, anxiety, and difficulties in social situations. Van Dongen et al. systematically investigated the behavioural and cognitive phenotype of KBGS patients. This study showed a high level of distractibility, impulsivity and restless behaviour in KBGS patients. As a tertiary reference centre for KBGS in the Netherlands, the investigators notice there is an unmet need for evidence-based interventions for the behavioral problems related to KBGS. A previous survey amongst KBGS caretakers confirmed that (features of) attention-deficit/hyperactivity disorder (ADHD) are the most frequently reported behavioural problems in children with KBGS. Furthermore, the study results indicate that methylphenidate (MPH) has a good effect on ADHD-related symptoms in KBGS, as this is reported by most parents. The promising results from this first exploration on MPH in KBGS indicate that it seems even more effective than in the general population of children with ADHD. However, evidence-based data on optimal dosing and adverse events are lacking. Remarkably, only 2/12 KBGS patients who were treated with stimulants such as MPH had an official ADHD diagnosis. This indicates that patients with ADHD-related symptoms fitting with a probability diagnosis of ADHD, but who do not necessarily fit all the Diagnostic and statistical manual 5 (DSM-5) criteria for ADHD, may also benefit from drug treatment. The investigators will examine the effectiveness of MPH in children and adolescents with KBGS and (a probability diagnosis of) ADHD, using an N-of-1 series (aggregated N-of-1) trial design.
Interventions
DRUGMethylphenidate Hydrochloride
Methylphenidate hydrochloride in capsules
DRUGPlacebo
Microcrystalline cellulose in capsules
Sponsors
Radboud University Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
QUADRUPLE (Subject, Caregiver, Investigator, Outcomes Assessor)
Masking description
Placebo
Intervention model description
N-of-1 series (aggregated N-of-1 trial)
Eligibility
Sex/Gender
ALL
Age
6 Years to 20 Years
Healthy volunteers
No
Inclusion criteria
* Age 6-20 years * Molecularly confirmed diagnosis of KBG syndrome (pathogenic ANKRD11 variant or a chromosome 16q24 deletion including ANKRD11) * Attention deficit or ADHD-related symptoms or a formal ADHD diagnosis, with a significant impact on daily life\* * Presence of a subject's caregiver or supervisor for proxy-reports
Exclusion criteria
* Family history of acute cardiac death that warrants further cardiac investigation * Cardiovascular disease in medical history (severe hypertension, heart failure, arterial occlusive disease, potentially life-threatening arrythmias, angina pectoris, hemodynamically significant congenital heart defect, cardiomyopathy, myocardial infarction and channelopathy) * Current or previous presence of hyperthyroidism, glaucoma or pheochromocytoma * Use of (psychotropic/stimulant) drugs which interact with MPH * Schizophrenic or psychotic disorder in medical history * Unstable epilepsy (not controlled with medication) * History of frequent drug and/or alcohol abuse * Excessive alcohol/drug use and/or intoxication with one or both during the study * Pregnant or lactating women * Inability to understand or speak Dutch
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Strenghts and difficulties questionnaire, ADHD subscale | Baseline, and daily in week 1,3,5,7,9,11 | Minimum score 1, maximum score 10 (higher score is worse outcome). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Strenghts and difficulties questionnaire, emotional problems subscale | Baseline, and daily in week 1,3,5,7,9,11 | Minimum score 1, maximum score 10 (higher score is worse outcome). |
| Dutch shortened version of the Emotion Dysregulation Inventory (EDI) reactivity index | Baseline, and daily in week 1,3,5,7,9,11 | Minimum score 0, maximum score 28 (higher score is worse outcome) |
| Goal Attainment Scoring (GAS) | Baseline, and at the end of week 1,3,5,7,9,11 | Personal goals, no minimum or maximum score |
| Personal Questionnaire (PQ) | Baseline, and at the end of week 1,3,5,7,9,11 | Personal goals, no minimum or maximum score |
| Adverse Effects checklist for methylphenidate | Baseline, and daily in week 1,3,5,7,9,11 | Checklist of adverse effects |
| McMaster Family assessment device (FAD), subscale General Functioning | Baseline, and at the end of week 1,3,5,7,9,11 | 10 items, 4 point scale, maximum score 40 |
| Autism diagnostic observation scale (ADOS-2) | Baseline | Minimum score 15, maximum score 60 (cut-off score for autism is 30) |
Countries
Netherlands
Contacts
CONTACTCharlotte Ockeloen, MD
Outcome results
None listed