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Trial of Propranolol in Adults and Adolescents With ASD and Predictors of Response

Primary Purpose

Autism

Status
Withdrawn
Phase
Not Applicable
Locations
Study Type
Interventional
Intervention
Propranolol
Placebo
Sponsored by
University of Missouri-Columbia
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Autism focused on measuring Propranolol

Eligibility Criteria

15 Years - 30 Years (Child, Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • For participants with autism: High-functioning, native-English speaking subjects with ASD aged 15-30. High-functioning ASD is defined in this study by the DSM-V criteria plus Autism Diagnostic Interview-Revised (ADI-R) criteria for Autism, and Wechsler Abbreviated Scales of Intelligence (WASI) full scale IQ of at least 85.

Exclusion Criteria:

  • For participants with autism: Non-autism learning disability (e.g. dyslexia),
  • major psychiatric diagnosis (e.g. major depression, schizophrenia, bipolar disorder),
  • other neurological diagnosis,
  • major head trauma,
  • any of the following exclusionary criteria related to propranolol (diabetes, reactive airway/pulmonary disease, thyroid disease, bradyarrhythmias, unexplained syncope, narrow angle glaucoma, pregnancy, known hypersensitivity/adverse reaction to beta-blockers),
  • any of the following exclusionary criteria related to placebo (severe allergy to lactose),
  • any of the following exclusionary criteria related to the psychophysiological measurements (history of rash from adhesives).

Sites / Locations

    Arms of the Study

    Arm 1

    Arm 2

    Arm Type

    Experimental

    Placebo Comparator

    Arm Label

    Propranolol arm

    Placebo arm

    Arm Description

    Propranolol will be administered via oral capsule(s) daily for a period of 10 weeks, involving gradual titration up from 40mg to 100mg and subsequent tapering off of the drug. The titration/tapering schedule will be as follows: Week 1: 40 mg propranolol (1 capsule, nightly) Week 2: 80 mg propranolol (2 40mg capsules, morning & night) Weeks 3 - 8: 100 mg propranolol (3 capsules, 40 mg/morning, 20mg/afternoon, & 40mg/night) Week 9: 60 mg propranolol (2 capsules, 40 mg/morning & 20mg/night) Week 10: 20 mg propranolol (1 capsule, nightly) Week 11: no capsules

    Placebo will be administered via lactose-filled oral capsule(s) daily for a period of 10 weeks. The schedule of placebo administration will be as follows: Week 1: 1 capsule, nightly Week 2: 2 capsules, morning & night Weeks 3 - 8: 3 capsules, morning, afternoon, & night Week 9: 2 capsules, morning & night Week 10: 1 capsule, nightly Week 11: no capsules

    Outcomes

    Primary Outcome Measures

    Change in General Social Outcome Measure (GSOM)
    The GSOM is a brief evaluation tool that measures a participant's level of social functioning and how it changes with intervention. There GSOM includes 4 different tasks: conversational reciprocity, ability to recognize facial expressions, social problem solving, affect demonstration, and emotional perspective taking. The experimenter administers each component of the GSOM to the participant and then scores their responses according to a pre-determined scoring rubric. Each component is scored on a 1-5 or 0 - 2 scale, with higher total scores indicating better social functioning. A video camera will be used to record the participant's behavior during GSOM administration for the purposes of having two independent raters score the tasks after the study session is complete. The video camera will be turned off for the remainder of the study session. A camera will also be used during the affect demonstration task of the GSOM.
    Change in Social Responsiveness Scale (SRS)
    This 65-item, parent-report measure asks questions about a participants' social awareness, social information processing, capacity for reciprocal social responses, social anxiety or avoidance, and characteristic autistic preoccupations or traits.

    Secondary Outcome Measures

    Change in Anagrams task
    To assess verbal problem solving, participants will be given a set of 20 anagram s (scrambled words, where letters are rearranged to form a word: e.g., IRCKB → BRICK). A maximum of 120 seconds will be allowed for each anagram. Number solved and solution latency (with failed anagrams recorded as 120 seconds) will be recorded.
    Change in Verbal fluency for categories task
    To assess verbal and semantic fluency, participants will be asked to generate as many words as possible within one minute each from three different categories (e.g. animals, things to wear, vegetables). Total number of distinct words (not including proper nouns) will be recorded for each session.
    Change in Spence Children's Anxiety Scale (SCAS)
    To assess anxiety, the SCAS will be completed by the participants. This self-report measure yields a total score in addition to six subscales (separation anxiety, social phobia, obsessive compulsive, panic/agoraphobia, physical injury fears, and generalized anxiety).
    Vertical attention task
    At the initial study visit only, a vertical spatial attention task will be administered to assess whether individuals with ASD display a vertical attention bias. A 4'x 3' board will be hung in the exam room in the landscape orientation, and the experimenter will present a total of 72 lines on the board for the participant to bisect or quadrisect (i.e., "place a mark in the middle of the line" or "place a mark that is one quarter or 25% from the top or bottom of the line") with a pen at one of three spatial positions (above eye level, eye level, below eye level).
    Change in Clinical Global Impression of Change (CGIC) scale
    To assess overall changes in the participant's ASD-related clinical symptoms, the CGIC will be administered. The CGIC consists of a 7-point subjective scale assessing change from baseline. On this scale, scores of 1, 2, and 3 represent marked, moderate, and mild improvement, respectively. A score of 4 represents no change. Scores of 5, 6, and 7 represent mild, moderate, and marked worsening, respectively. CGIC scores from both the parent/caregiver and the blinded PI (licensed physician) will be utilized.
    Change in Autism Impact Measure (AIM)
    The AIM will be administered to assess the frequency and impact of a participant's ASD-related symptoms. A parent/caregiver is asked a series of 41 questions regarding the frequency and the impact, or interference resulting from, a series of autism-associated behaviors. Overall impact and frequency scores, as well as subscale scores, will be obtained from this measure.
    Change in Vineland Adaptive Behavior Scales-II (VABS)
    To assess overall adaptive functioning, the VABS will be administered in the form of a structured interview with the parent/caregiver. The VABS is a well validated assessment used for the full range of our subjects' ages and yields standard scores in Communication, Daily Living Skills, Socialization, and Motor Skills. VABS scores for Communication, Daily Living Skills, and Socialization will be monitored in this study.
    Change in Aberrant Behavior Checklist (ABC)
    To assess overall behavioral disturbances, a parent/caregiver of the participants will complete ABC. This 58-item questionnaire is a well validated, reliable, and widely used assessment tool for interventions for a range of cognitive disorders.
    Change in Clinical Global Impression of Severity (CGIS) scale
    To assess overall severity of a participant's ASD-related clinical symptoms, the CGIS will be administered. The CGIS consists of a 7-point subjective scale assessing symptom severity. On this scale, scores of 1, 2, and 3 represent normal, some presence of symptoms, and mild behavior, respectively. A score of 4 represents moderate behavior. Scores of 5, 6, and 7 represent marked, severe, and among the most severe behavior, respectively. CGIS scores from both the parent/caregiver and the blinded PI (licensed physician) will be utilized.

    Full Information

    First Posted
    March 20, 2015
    Last Updated
    October 3, 2016
    Sponsor
    University of Missouri-Columbia
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    1. Study Identification

    Unique Protocol Identification Number
    NCT02414451
    Brief Title
    Trial of Propranolol in Adults and Adolescents With ASD and Predictors of Response
    Official Title
    Trial of Propranolol in Adults and Adolescents With Autism Spectrum Disorder (ASD) and Predictors of Response
    Study Type
    Interventional

    2. Study Status

    Record Verification Date
    October 2016
    Overall Recruitment Status
    Withdrawn
    Why Stopped
    No need for a pilot study. New study will be opened.
    Study Start Date
    September 2016 (undefined)
    Primary Completion Date
    September 2016 (Actual)
    Study Completion Date
    September 2016 (Actual)

    3. Sponsor/Collaborators

    Responsible Party, by Official Title
    Principal Investigator
    Name of the Sponsor
    University of Missouri-Columbia

    4. Oversight

    Data Monitoring Committee
    No

    5. Study Description

    Brief Summary
    The purpose of this study is to explore the effects of propranolol on social interaction, and secondarily on language, anxiety, adaptive behaviors, and global function in high functioning adults and adolescents with autism in a double-blinded, placebo-controlled pilot trial.
    Detailed Description
    The investigators' specific aim is to examine the effects of serial doses of propranolol on social interaction, and secondarily on language tasks, anxiety, adaptive behaviors, and global function in high functioning adults and adolescents with autism in a double-blinded, placebo-controlled trial. The investigators will also examine whether response to treatment can be predicted based upon markers of autonomic functioning, such as skin conductance and heart rate variability, and whether anxiety predicts treatment response. The investigators' hypothesis is that social functioning and language abilities will benefit from serial doses of propranolol, as the investigators have demonstrated in previous single-dose studies. The investigators also predict that those with the greatest degree of autonomic dysregulation will demonstrate the greatest benefit from the drug.

    6. Conditions and Keywords

    Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
    Autism
    Keywords
    Propranolol

    7. Study Design

    Primary Purpose
    Treatment
    Study Phase
    Not Applicable
    Interventional Study Model
    Crossover Assignment
    Masking
    ParticipantCare ProviderInvestigator
    Allocation
    Randomized
    Enrollment
    0 (Actual)

    8. Arms, Groups, and Interventions

    Arm Title
    Propranolol arm
    Arm Type
    Experimental
    Arm Description
    Propranolol will be administered via oral capsule(s) daily for a period of 10 weeks, involving gradual titration up from 40mg to 100mg and subsequent tapering off of the drug. The titration/tapering schedule will be as follows: Week 1: 40 mg propranolol (1 capsule, nightly) Week 2: 80 mg propranolol (2 40mg capsules, morning & night) Weeks 3 - 8: 100 mg propranolol (3 capsules, 40 mg/morning, 20mg/afternoon, & 40mg/night) Week 9: 60 mg propranolol (2 capsules, 40 mg/morning & 20mg/night) Week 10: 20 mg propranolol (1 capsule, nightly) Week 11: no capsules
    Arm Title
    Placebo arm
    Arm Type
    Placebo Comparator
    Arm Description
    Placebo will be administered via lactose-filled oral capsule(s) daily for a period of 10 weeks. The schedule of placebo administration will be as follows: Week 1: 1 capsule, nightly Week 2: 2 capsules, morning & night Weeks 3 - 8: 3 capsules, morning, afternoon, & night Week 9: 2 capsules, morning & night Week 10: 1 capsule, nightly Week 11: no capsules
    Intervention Type
    Drug
    Intervention Name(s)
    Propranolol
    Other Intervention Name(s)
    Inderal
    Intervention Description
    Week 1: 40 mg propranolol (1 capsule, nightly) Week 2: 80 mg propranolol (2 40mg capsules, morning & night) Weeks 3 - 8: 100 mg propranolol (3 capsules, 40 mg/morning, 20mg/afternoon, & 40mg/night) Week 9: 60 mg propranolol (2 capsules, 40 mg/morning & 20mg/night) Week 10: 20 mg propranolol (1 capsule, nightly) Week 11: no capsules
    Intervention Type
    Drug
    Intervention Name(s)
    Placebo
    Intervention Description
    Placebo will be administered via lactose-filled oral capsule(s) daily for a period of 10 weeks. The schedule of placebo administration will be as follows: Week 1: 1 capsule, nightly Week 2: 2 capsules, morning & night Weeks 3 - 8: 3 capsules, morning, afternoon, & night Week 9: 2 capsules, morning & night Week 10: 1 capsule, nightly Week 11: no capsules
    Primary Outcome Measure Information:
    Title
    Change in General Social Outcome Measure (GSOM)
    Description
    The GSOM is a brief evaluation tool that measures a participant's level of social functioning and how it changes with intervention. There GSOM includes 4 different tasks: conversational reciprocity, ability to recognize facial expressions, social problem solving, affect demonstration, and emotional perspective taking. The experimenter administers each component of the GSOM to the participant and then scores their responses according to a pre-determined scoring rubric. Each component is scored on a 1-5 or 0 - 2 scale, with higher total scores indicating better social functioning. A video camera will be used to record the participant's behavior during GSOM administration for the purposes of having two independent raters score the tasks after the study session is complete. The video camera will be turned off for the remainder of the study session. A camera will also be used during the affect demonstration task of the GSOM.
    Time Frame
    Week 1, Week 4, Week 8, Week 12, Week 15, Week 19
    Title
    Change in Social Responsiveness Scale (SRS)
    Description
    This 65-item, parent-report measure asks questions about a participants' social awareness, social information processing, capacity for reciprocal social responses, social anxiety or avoidance, and characteristic autistic preoccupations or traits.
    Time Frame
    Week 1, Week 4, Week 8, Week 12, Week 15, Week 19
    Secondary Outcome Measure Information:
    Title
    Change in Anagrams task
    Description
    To assess verbal problem solving, participants will be given a set of 20 anagram s (scrambled words, where letters are rearranged to form a word: e.g., IRCKB → BRICK). A maximum of 120 seconds will be allowed for each anagram. Number solved and solution latency (with failed anagrams recorded as 120 seconds) will be recorded.
    Time Frame
    Week 1, Week 4, Week 8, Week 12, Week 15, Week 19
    Title
    Change in Verbal fluency for categories task
    Description
    To assess verbal and semantic fluency, participants will be asked to generate as many words as possible within one minute each from three different categories (e.g. animals, things to wear, vegetables). Total number of distinct words (not including proper nouns) will be recorded for each session.
    Time Frame
    Week 1, Week 4, Week 8, Week 12, Week 15, Week 19
    Title
    Change in Spence Children's Anxiety Scale (SCAS)
    Description
    To assess anxiety, the SCAS will be completed by the participants. This self-report measure yields a total score in addition to six subscales (separation anxiety, social phobia, obsessive compulsive, panic/agoraphobia, physical injury fears, and generalized anxiety).
    Time Frame
    Week 1, Week 4, Week 8, Week 12, Week 15, Week 19
    Title
    Vertical attention task
    Description
    At the initial study visit only, a vertical spatial attention task will be administered to assess whether individuals with ASD display a vertical attention bias. A 4'x 3' board will be hung in the exam room in the landscape orientation, and the experimenter will present a total of 72 lines on the board for the participant to bisect or quadrisect (i.e., "place a mark in the middle of the line" or "place a mark that is one quarter or 25% from the top or bottom of the line") with a pen at one of three spatial positions (above eye level, eye level, below eye level).
    Time Frame
    Week 1
    Title
    Change in Clinical Global Impression of Change (CGIC) scale
    Description
    To assess overall changes in the participant's ASD-related clinical symptoms, the CGIC will be administered. The CGIC consists of a 7-point subjective scale assessing change from baseline. On this scale, scores of 1, 2, and 3 represent marked, moderate, and mild improvement, respectively. A score of 4 represents no change. Scores of 5, 6, and 7 represent mild, moderate, and marked worsening, respectively. CGIC scores from both the parent/caregiver and the blinded PI (licensed physician) will be utilized.
    Time Frame
    Week 4, Week 8, Week 12, Week 15, Week 19
    Title
    Change in Autism Impact Measure (AIM)
    Description
    The AIM will be administered to assess the frequency and impact of a participant's ASD-related symptoms. A parent/caregiver is asked a series of 41 questions regarding the frequency and the impact, or interference resulting from, a series of autism-associated behaviors. Overall impact and frequency scores, as well as subscale scores, will be obtained from this measure.
    Time Frame
    Week 1, Week 4, Week 8, Week 12, Week 15, Week 19
    Title
    Change in Vineland Adaptive Behavior Scales-II (VABS)
    Description
    To assess overall adaptive functioning, the VABS will be administered in the form of a structured interview with the parent/caregiver. The VABS is a well validated assessment used for the full range of our subjects' ages and yields standard scores in Communication, Daily Living Skills, Socialization, and Motor Skills. VABS scores for Communication, Daily Living Skills, and Socialization will be monitored in this study.
    Time Frame
    Week 1, Week 4, Week 8, Week 12, Week 15, Week 19
    Title
    Change in Aberrant Behavior Checklist (ABC)
    Description
    To assess overall behavioral disturbances, a parent/caregiver of the participants will complete ABC. This 58-item questionnaire is a well validated, reliable, and widely used assessment tool for interventions for a range of cognitive disorders.
    Time Frame
    Week 1, Week 4, Week 8, Week 12, Week 15, Week 19
    Title
    Change in Clinical Global Impression of Severity (CGIS) scale
    Description
    To assess overall severity of a participant's ASD-related clinical symptoms, the CGIS will be administered. The CGIS consists of a 7-point subjective scale assessing symptom severity. On this scale, scores of 1, 2, and 3 represent normal, some presence of symptoms, and mild behavior, respectively. A score of 4 represents moderate behavior. Scores of 5, 6, and 7 represent marked, severe, and among the most severe behavior, respectively. CGIS scores from both the parent/caregiver and the blinded PI (licensed physician) will be utilized.
    Time Frame
    Week 1, Week 4, Week 8, Week 12, Week 15, Week 19

    10. Eligibility

    Sex
    All
    Minimum Age & Unit of Time
    15 Years
    Maximum Age & Unit of Time
    30 Years
    Accepts Healthy Volunteers
    No
    Eligibility Criteria
    Inclusion Criteria: For participants with autism: High-functioning, native-English speaking subjects with ASD aged 15-30. High-functioning ASD is defined in this study by the DSM-V criteria plus Autism Diagnostic Interview-Revised (ADI-R) criteria for Autism, and Wechsler Abbreviated Scales of Intelligence (WASI) full scale IQ of at least 85. Exclusion Criteria: For participants with autism: Non-autism learning disability (e.g. dyslexia), major psychiatric diagnosis (e.g. major depression, schizophrenia, bipolar disorder), other neurological diagnosis, major head trauma, any of the following exclusionary criteria related to propranolol (diabetes, reactive airway/pulmonary disease, thyroid disease, bradyarrhythmias, unexplained syncope, narrow angle glaucoma, pregnancy, known hypersensitivity/adverse reaction to beta-blockers), any of the following exclusionary criteria related to placebo (severe allergy to lactose), any of the following exclusionary criteria related to the psychophysiological measurements (history of rash from adhesives).
    Overall Study Officials:
    First Name & Middle Initial & Last Name & Degree
    David Q Beversdorf, MD
    Organizational Affiliation
    University of Missouri-Columbia
    Official's Role
    Principal Investigator

    12. IPD Sharing Statement

    Learn more about this trial

    Trial of Propranolol in Adults and Adolescents With ASD and Predictors of Response

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