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Micronutrients for Attention-Deficit Hyperactivity Disorder in Youth (MADDY) Study (MADDY)

Primary Purpose

Attention Deficit Hyperactivity Disorder

Status
Completed
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Broad Spectrum Micronutrients; a 36-ingredient blend of vitamins, minerals, amino acids, and antioxidants
Placebo
Sponsored by
Oregon Health and Science University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Attention Deficit Hyperactivity Disorder focused on measuring ADHD, ODD, DMDD, Inattention, Impulsivity, Irritability, Anger, Micronutrients, Emotional Dysregulation

Eligibility Criteria

6 Years - 12 Years (Child)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  • Age inclusive of and between 6 and 12 years at the time of enrollment.
  • Verbally willing to swallowing a maximum of 9-12 capsules/day with food, attend all study appointments and complete questionnaires.
  • Meet criteria for ADHD as assessed by the clinical cut-off (6+ questions scored as 2's or 3's, "often," or "very often") on the Category A: ADHD questions from on the Child & Adolescent Symptom Inventory-5 (CASI-5) with at least several symptoms present in more than one setting, based on the Diagnostic and Statistical Manual (DSM) 5 symptom criteria, including significant impairment in functioning socially and/or academically.
  • Demonstrate at least one symptom of irritability or anger as assessed by a score of 2 or 3 on one question from Category B or Rz from the CASI-5.
  • Be medication-free, or washout with medical supervision to be provided by the child's pediatrician or primary care physician, reliant on the parent/guardian to work with that physician, for at least two weeks prior to in-person study assessment. Washout will be recorded as occurring on the date reported by the parent/guardian, with a faxed copy of the progress note, visit summary or signed letter from participant's doctor.

Exclusion Criteria:

  • Neurological disorder involving brain or other central function (e.g., history of or suspected intellectual disability, autism spectrum disorder, epilepsy, multiple sclerosis, narcolepsy) or other major psychiatric condition requiring hospitalization (e.g. significant mood disorder, active suicidal ideation, or psychosis), based on parent/guardian self-report of child's condition and responses to category M on the CASI-5 subscale.
  • Any serious medical condition, including inflammatory bowel disease, history of cancer, kidney or liver disease, hyperthyroidism, diabetes Type I or II.
  • Known allergy to any ingredients of the intervention.
  • Any known abnormality of mineral metabolism (e.g., Wilson's disease, hemochromatosis).
  • Taking any other medication with primarily central nervous system activity, including stimulants, within the last two weeks prior to in-person assessment; participants must be off these medications for a minimum of two weeks prior to the screening.
  • Severe separation anxiety that would preclude separating from parent/guardian to answer study questionnaires.
  • Any disability that would interfere with participant answering questions verbally.
  • Non-English speaking.
  • Pregnancy or sexually active at baseline. Exclusion criteria 1-6 and 9, will be based on parent/guardian self-report of child's condition. If the parent/guardian reports medical exclusion criteria, or concerns about eligibility, data provided by parent/guardian will be confirmed by review of medical records with release of information signed by parent/guardian. Potential participant may be reviewed in-person by a study physician in the case of any concerns about participation.

Sites / Locations

  • The Ohio State University
  • Oregon Health & Science University
  • University of Lethbridge

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Placebo Comparator

Experimental

Arm Label

Intervention

Placebo

Open Label

Arm Description

Capsules of broad spectrum micronutrients: a 36-ingredient blend of vitamins, minerals, amino acids, and antioxidants.

Capsules of inactive placebo.

All participants have the option to participate in an 8-week, naturalistic, open label follow-up in which the child will take the active micronutrient treatment; capsules of broad spectrum micronutrients.

Outcomes

Primary Outcome Measures

CASI-5 Parent-rated Composite Score
Primary outcome measure, defined a priori, reflecting the often-comorbid ADHD symptoms of emotional dysregulation irritable mood, anger or aggression), are the parent-rated Child and Adolescent Symptom Inventory (CASI-5). The CASI-5 is based on the DSM-5 symptom criteria. The subscales of ADHD, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation Disorder (DMDD) and peer conflict that will be combined into a total composite score; range is 0-3 (never, sometimes, often, very often). Higher scores represent a worse outcome.
Clinical Global Impression (CGI) - Number of Participants Considered a Treatment Responder (Score of 1 or 2)
Second primary measure is the blinded clinician-rated CGI-Improvement (CGI-I) is a subscale of the CGI that rates overall improvement of symptoms based on all relevant data. Item range is 1-7 (very much improved, much improved, minimally improved, no change, minimally worse, much worse, very much worse); lower score is better. A treatment responder is defined as a participant who is rated a 1 or 2 on the CGI-I. The CGI-Severity (CGI-S) subscale will also be scored at baseline and week 8, with scores compared at the two time points. Item range is 1-7 (normal, borderline ill, mildly ill, moderately ill, markedly ill, severely ill, among the most extremely ill patients); lower score is better; most participants will be a 4 or 5 at baseline.

Secondary Outcome Measures

Sodium, Potassium, Chloride, Carbon Dioxide, and Anion Gap in mmol/L
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Calcium, Blood Urea Nitrogen, Creatinine, Glucose, Bilirubin Total in mg/dL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Albumin, Total Protein, Hemoglobin, Mean Cell Hgb in g/dL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
AST, ALT, Alkaline in U/L
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
RBC Count in Cells/mcL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Hematocrit, RBC Distribution, Immature Grans, Lymphocyte, Monocyte, Eosinophil in Percent
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Mean Cell Volume in fL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Iron in ug/dL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
WBC Count, Absolute Monocyte, Absolute Eosinophil, Platelet Count in Cells/mcL
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Clinical Global Impression (CGI)
Second primary measure is the blinded clinician-rated CGI-Improvement (CGI-I) is a subscale of the CGI that rates overall improvement of symptoms based on all relevant data. Item range is 1-7 (very much improved, much improved, minimally improved, no change, minimally worse, much worse, very much worse); lower score is better. A treatment responder is defined as a participant who is rated a 1 or 2 on the CGI-I. The CGI-Severity (CGI-S) subscale will also be scored at baseline and week 8, with scores compared at the two time points. Item range is 1-7 (normal, borderline ill, mildly ill, moderately ill, markedly ill, severely ill, among the most extremely ill patients); lower score is better; most participants will be a 4 or 5 at baseline.
CASI-5 Parent Report
Primary outcome measure, defined a priori, reflecting the often-comorbid ADHD symptoms of emotional dysregulation irritable mood, anger or aggression), are the parent-rated Child and Adolescent Symptom Inventory (CASI-5) subscales of ADHD, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation Disorder (DMDD) and peer conflict. The CASI-5 is based on the DSM-5 symptom criteria. Item range is 0-3 (never, sometimes, often, very often). Higher scores represent a worse outcome. The subscales for ADHD, ODD, and DMD will be composite scores.

Full Information

First Posted
July 26, 2017
Last Updated
January 11, 2023
Sponsor
Oregon Health and Science University
Collaborators
Ohio State University, University of Lethbridge, National University of Natural Medicine, Foundation for Excellence in Mental Health Care, Waterloo Foundation
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1. Study Identification

Unique Protocol Identification Number
NCT03252522
Brief Title
Micronutrients for Attention-Deficit Hyperactivity Disorder in Youth (MADDY) Study
Acronym
MADDY
Official Title
Evaluating the Efficacy of Supplementation With Micronutrients for ADHD in Youth (MADDY) Study
Study Type
Interventional

2. Study Status

Record Verification Date
January 2023
Overall Recruitment Status
Completed
Study Start Date
April 23, 2018 (Actual)
Primary Completion Date
July 10, 2020 (Actual)
Study Completion Date
May 31, 2021 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Oregon Health and Science University
Collaborators
Ohio State University, University of Lethbridge, National University of Natural Medicine, Foundation for Excellence in Mental Health Care, Waterloo Foundation

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This proposed research will use randomized control trial (RCT) methodology and compare micronutrients with placebo in 135 children with ADHD.
Detailed Description
This study examines a broad spectrum micronutrient treatment for children with ADHD. The goal is to broaden the scope of evidence-based treatments, and to address the public desire for non-pharmacological treatment options. This study will use a randomized controlled trial design, comparing micronutrients with placebo in 135 children, ages 6-12, with ADHD plus irritability or anger based on parent-report of symptoms. The study will also collect biological samples (saliva, stool, urine, hair, and blood) from the children to examine physiological mechanisms of micronutrient effects. If the micronutrient treatment successfully diminishes symptoms, the clinical implication is to offer this as a legitimate non-pharmacological alternative to stimulant medication.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Attention Deficit Hyperactivity Disorder
Keywords
ADHD, ODD, DMDD, Inattention, Impulsivity, Irritability, Anger, Micronutrients, Emotional Dysregulation

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Placebo-controlled; randomization created by statistician, all involved in the study and assessment are blinded
Allocation
Randomized
Enrollment
135 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Intervention
Arm Type
Experimental
Arm Description
Capsules of broad spectrum micronutrients: a 36-ingredient blend of vitamins, minerals, amino acids, and antioxidants.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Capsules of inactive placebo.
Arm Title
Open Label
Arm Type
Experimental
Arm Description
All participants have the option to participate in an 8-week, naturalistic, open label follow-up in which the child will take the active micronutrient treatment; capsules of broad spectrum micronutrients.
Intervention Type
Combination Product
Intervention Name(s)
Broad Spectrum Micronutrients; a 36-ingredient blend of vitamins, minerals, amino acids, and antioxidants
Other Intervention Name(s)
Daily Essential Nutrients (DEN)
Intervention Description
60% of participants will take 3-4 capsules of broad spectrum micronutrients three times per day for eight weeks. Following the initial 8 weeks (of the RCT), all participants will have the option to participate in an open label extension, during which time the child would take the active micronutrient treatment for 8 weeks
Intervention Type
Dietary Supplement
Intervention Name(s)
Placebo
Intervention Description
40% of participants will take 3-4 capsules of inactive placebo three times per day for eight weeks.
Primary Outcome Measure Information:
Title
CASI-5 Parent-rated Composite Score
Description
Primary outcome measure, defined a priori, reflecting the often-comorbid ADHD symptoms of emotional dysregulation irritable mood, anger or aggression), are the parent-rated Child and Adolescent Symptom Inventory (CASI-5). The CASI-5 is based on the DSM-5 symptom criteria. The subscales of ADHD, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation Disorder (DMDD) and peer conflict that will be combined into a total composite score; range is 0-3 (never, sometimes, often, very often). Higher scores represent a worse outcome.
Time Frame
Baseline and week 8
Title
Clinical Global Impression (CGI) - Number of Participants Considered a Treatment Responder (Score of 1 or 2)
Description
Second primary measure is the blinded clinician-rated CGI-Improvement (CGI-I) is a subscale of the CGI that rates overall improvement of symptoms based on all relevant data. Item range is 1-7 (very much improved, much improved, minimally improved, no change, minimally worse, much worse, very much worse); lower score is better. A treatment responder is defined as a participant who is rated a 1 or 2 on the CGI-I. The CGI-Severity (CGI-S) subscale will also be scored at baseline and week 8, with scores compared at the two time points. Item range is 1-7 (normal, borderline ill, mildly ill, moderately ill, markedly ill, severely ill, among the most extremely ill patients); lower score is better; most participants will be a 4 or 5 at baseline.
Time Frame
Week 8
Secondary Outcome Measure Information:
Title
Sodium, Potassium, Chloride, Carbon Dioxide, and Anion Gap in mmol/L
Description
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time Frame
Baseline and Week 8
Title
Calcium, Blood Urea Nitrogen, Creatinine, Glucose, Bilirubin Total in mg/dL
Description
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time Frame
Baseline and Week 8
Title
Albumin, Total Protein, Hemoglobin, Mean Cell Hgb in g/dL
Description
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time Frame
Baseline and Week 8
Title
AST, ALT, Alkaline in U/L
Description
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time Frame
Baseline and Week 8
Title
RBC Count in Cells/mcL
Description
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time Frame
Baseline and Week 8
Title
Hematocrit, RBC Distribution, Immature Grans, Lymphocyte, Monocyte, Eosinophil in Percent
Description
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time Frame
Baseline and Week 8
Title
Mean Cell Volume in fL
Description
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time Frame
Baseline and Week 8
Title
Iron in ug/dL
Description
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time Frame
Baseline and Week 8
Title
WBC Count, Absolute Monocyte, Absolute Eosinophil, Platelet Count in Cells/mcL
Description
Collect blood and urine samples at two time points. The samples are being collected per a request from the FDA for safety screening.
Time Frame
Baseline and Week 8
Title
Clinical Global Impression (CGI)
Description
Second primary measure is the blinded clinician-rated CGI-Improvement (CGI-I) is a subscale of the CGI that rates overall improvement of symptoms based on all relevant data. Item range is 1-7 (very much improved, much improved, minimally improved, no change, minimally worse, much worse, very much worse); lower score is better. A treatment responder is defined as a participant who is rated a 1 or 2 on the CGI-I. The CGI-Severity (CGI-S) subscale will also be scored at baseline and week 8, with scores compared at the two time points. Item range is 1-7 (normal, borderline ill, mildly ill, moderately ill, markedly ill, severely ill, among the most extremely ill patients); lower score is better; most participants will be a 4 or 5 at baseline.
Time Frame
16 weeks
Title
CASI-5 Parent Report
Description
Primary outcome measure, defined a priori, reflecting the often-comorbid ADHD symptoms of emotional dysregulation irritable mood, anger or aggression), are the parent-rated Child and Adolescent Symptom Inventory (CASI-5) subscales of ADHD, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation Disorder (DMDD) and peer conflict. The CASI-5 is based on the DSM-5 symptom criteria. Item range is 0-3 (never, sometimes, often, very often). Higher scores represent a worse outcome. The subscales for ADHD, ODD, and DMD will be composite scores.
Time Frame
Week 16

10. Eligibility

Sex
All
Minimum Age & Unit of Time
6 Years
Maximum Age & Unit of Time
12 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age inclusive of and between 6 and 12 years at the time of enrollment. Verbally willing to swallowing a maximum of 9-12 capsules/day with food, attend all study appointments and complete questionnaires. Meet criteria for ADHD as assessed by the clinical cut-off (6+ questions scored as 2's or 3's, "often," or "very often") on the Category A: ADHD questions from on the Child & Adolescent Symptom Inventory-5 (CASI-5) with at least several symptoms present in more than one setting, based on the Diagnostic and Statistical Manual (DSM) 5 symptom criteria, including significant impairment in functioning socially and/or academically. Demonstrate at least one symptom of irritability or anger as assessed by a score of 2 or 3 on one question from Category B or Rz from the CASI-5. Be medication-free, or washout with medical supervision to be provided by the child's pediatrician or primary care physician, reliant on the parent/guardian to work with that physician, for at least two weeks prior to in-person study assessment. Washout will be recorded as occurring on the date reported by the parent/guardian, with a faxed copy of the progress note, visit summary or signed letter from participant's doctor. Exclusion Criteria: Neurological disorder involving brain or other central function (e.g., history of or suspected intellectual disability, autism spectrum disorder, epilepsy, multiple sclerosis, narcolepsy) or other major psychiatric condition requiring hospitalization (e.g. significant mood disorder, active suicidal ideation, or psychosis), based on parent/guardian self-report of child's condition and responses to category M on the CASI-5 subscale. Any serious medical condition, including inflammatory bowel disease, history of cancer, kidney or liver disease, hyperthyroidism, diabetes Type I or II. Known allergy to any ingredients of the intervention. Any known abnormality of mineral metabolism (e.g., Wilson's disease, hemochromatosis). Taking any other medication with primarily central nervous system activity, including stimulants, within the last two weeks prior to in-person assessment; participants must be off these medications for a minimum of two weeks prior to the screening. Severe separation anxiety that would preclude separating from parent/guardian to answer study questionnaires. Any disability that would interfere with participant answering questions verbally. Non-English speaking. Pregnancy or sexually active at baseline. Exclusion criteria 1-6 and 9, will be based on parent/guardian self-report of child's condition. If the parent/guardian reports medical exclusion criteria, or concerns about eligibility, data provided by parent/guardian will be confirmed by review of medical records with release of information signed by parent/guardian. Potential participant may be reviewed in-person by a study physician in the case of any concerns about participation.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Jeanette Johnstone
Organizational Affiliation
Oregon Health and Science University
Official's Role
Principal Investigator
Facility Information:
Facility Name
The Ohio State University
City
Columbus
State/Province
Ohio
ZIP/Postal Code
43210
Country
United States
Facility Name
Oregon Health & Science University
City
Portland
State/Province
Oregon
ZIP/Postal Code
97239
Country
United States
Facility Name
University of Lethbridge
City
Lethbridge
State/Province
Alberta
ZIP/Postal Code
AB T1K 6T5
Country
Canada

12. IPD Sharing Statement

Plan to Share IPD
No
Citations:
PubMed Identifier
35770861
Citation
Leung BMY, Srikanth P, Gracious B, Hatsu IE, Tost G, Conrad V, Johnstone JM, Arnold LE. Paediatric adverse event rating scale: a measure of safety or efficacy? Novel analysis from the MADDY study. Curr Med Res Opin. 2022 Sep;38(9):1595-1602. doi: 10.1080/03007995.2022.2096333. Epub 2022 Jul 11.
Results Reference
derived
PubMed Identifier
34303786
Citation
Johnstone JM, Hatsu I, Tost G, Srikanth P, Eiterman LP, Bruton AM, Ast HK, Robinette LM, Stern MM, Millington EG, Gracious BL, Hughes AJ, Leung BMY, Arnold LE. Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. J Am Acad Child Adolesc Psychiatry. 2022 May;61(5):647-661. doi: 10.1016/j.jaac.2021.07.005. Epub 2021 Jul 22. Erratum In: J Am Acad Child Adolesc Psychiatry. 2022 May 6;: J Am Acad Child Adolesc Psychiatry. 2023 May;62(5):607. J Am Acad Child Adolesc Psychiatry. 2023 Aug 3;:
Results Reference
derived
PubMed Identifier
31763491
Citation
Johnstone JM, Leung B, Gracious B, Perez L, Tost G, Savoy A, Hatsu I, Hughes A, Bruton A, Arnold LE. Rationale and design of an international randomized placebo-controlled trial of a 36-ingredient micronutrient supplement for children with ADHD and irritable mood: The Micronutrients for ADHD in Youth (MADDY) study. Contemp Clin Trials Commun. 2019 Oct 26;16:100478. doi: 10.1016/j.conctc.2019.100478. eCollection 2019 Dec.
Results Reference
derived

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Micronutrients for Attention-Deficit Hyperactivity Disorder in Youth (MADDY) Study

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