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Attention Deficit Disorder With HyperactivityPhase 4NCT02807870

Early Interventions in Children With Attention Deficit/Hyperactivity Disorder

A Phase 4 study testing Methylphenidate, Parental training and Psychoeducational groups for parents in people with Attention Deficit Disorder With Hyperactivity and Preschool Child, run by University of Sao Paulo at 1 site in Brazil.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Introduction: Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders in children and is associated with important negative functional outcomes throughout development. The first signs and symptoms become apparent in preschool age. Read more about this study

Who is it for?
Ages 47 to 71 months
What is being tested?
Methylphenidate, Parental training and Psychoeducational groups for parents
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
153 participants
Where
1 siteBrazil
Study dates
Jun 2016to 30 Jun 2020
Phase
Phase 4
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 47 to 71 months
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Attention deficit hyperactivity disorder DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) diagnosis
  • Score above 32 on the Swanson, Nolan, and Pelham-IV scale
  • Child is registered in a school or day care center
  • Children without the use of stimulants or any psychotropic in the last 30 days

Who cannot join

  • Intelligence quotient <70
  • The presence of clinical condition or history of neurological disorder or head trauma with conscience loss
  • The presence of affective and psychotic disorders, as well as autism spectrum disorders.
  • The absence of a legal representative with the capacity to understand the study objectives and the instructions related to its participation.

Trial locations and contacts

1 site in 1 country.

Brazil1 site
  • Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

    São Paulo, 01060-970

Other trials in Brazil

About this study

Official title: Early Interventions in Children With Attention Deficit/Hyperactivity Disorder: Randomized Controlled Trial Comparing Methylphenidate Parental Training in Treating Preschool Children With Attention Deficit / Hyperactivity Disorder

Introduction: Attention deficit/hyperactivity disorder (ADHD) is one of the most prevalent mental disorders in children and is associated with important negative functional outcomes throughout development. The first signs and symptoms become apparent in preschool age. Therefore, early interventions in this population have the potential of limiting the disorder's negative impact and preventing future impairments in affected individuals. The first-choice medication for treating ADHD is methylphenidate, which has evidence of efficacy and safety in preschool children. However, non-evidence based worries and pressure from the media placed parent training as the first-line treatment for ADHD in clinical guidelines. Parent training is a behavioral intervention implemented with the parents, with weekly sessions for 8 weeks, adequate for treating ADHD dysfunctional symptoms and behaviors. However, the level of evidence for this intervention is reduced. Furthermore, the need of trained therapists in the public health system, added to the difficulties on adherence and comprehension from parents, limit its generalization and raise questions regarding its indications. Until now, no study has compared pharmacological treatment with methylphenidate to parent training in preschool children with ADHD regarding their clinical efficacy and cost-effectiveness. Moreover, no study has evaluated the impact of pharmacological intervention and psychotherapy on neurobiological mechanisms of ADHD, which is crucial for determining their impact on neurodevelopment.

Objectives: This is a double-blind randomized clinical trial that aims to evaluate the efficacy, tolerability, and acceptability of treatment with methylphenidate compared to parental training and placebo in preschool children with ADHD.

Read more

Methods: This study will be a randomized, double-blind, parallel-group, evaluating two active interventions and placebo control group. One hundred and fifty children aged 3 years and 11 months and 5 years and 11 months, diagnosed with ADHD, will be randomized to receive treatment with methylphenidate and information (50 children), parental training and treatment with placebo medication (50 children) or belong to active control group with educational information for parents and placebo treatment with no treatment (active control, 50 children). The treatment will last eight weeks, the neurobiological outcomes will be assessed before and after treatment and clinical outcomes will be assessed at weeks 0, 5 and 9. After the end of treatment, all participants will be invited to participate in a 3 years' annual follow-up. 50 children with typical development will also be evaluated in relation to neurobiological measures.

Implications: This study proposes an innovative and relevant analysis, which will enable the field to advance the knowledge of biological mechanisms related to ADHD and to treatment response. Also, the study will expand the evidence to guide early prevention strategies and early intervention.

Read the detailed description

The recruitment of participants will be performed through social media divulgation, on our official website and through contact with preschools in the city of Sao Paulo. The participants that have been selected on the telephonic pre-screening are called for a diagnostic evaluation and an eligibility criteria verification performed by a child and adolescence psychiatrist and neuropsychologists. The psychiatric care and the outcomes evaluation sessions will be conducted by trained professionals, under the principal investigator's supervision.

The children will be randomized using the website randomization.com to one of the three groups: drug treatment with methylphenidate and educational information, parental training and placebo medication, or active control group with educational information and placebo medication. After the eight-week intervention, the participants can receive treatments not previously offered according to a clinical decision.

All selected participants for the clinical trial will be evaluated and accompanied by a child and adolescent psychiatrist before the study and bi-weekly until its completion. Furthermore, a blind evaluator will be responsible for the outcomes measures evaluation.

The clinical evaluator (child and adolescent psychiatrist) and the research assistant responsible for the questionnaires application will be blind towards the modality of treatment that the participant undergoes.

All of the study's evaluation protocol and monitoring is done on the platform Research Electronic Data Capture - REDCap, a software developed by Vanderbilt University - Tennessee, which is hosted in The Clinics Hospital of the University of São Paulo Medical School server. REDCap presents three main functions: a) electronic data collection; b) data management; c) study flow management. This data bank complies with the international policies of data's privacy and security on health area. In addition to the collection and storage structure, validation, auditing and data exporting tools of the system itself are also used.

The efficacy analysis will be made from treatment intention (data from all randomized patients will be included in the analysis). The outcomes (clinical measures of efficacy and tolerability) will be analyzed through mixed effects analyses, with individual models for each outcome. This model assumes that missing data occurs at random and avoids potential biases associated with the analysis only of the individuals who completed the observations or using the strategy to carry the last observation made. The model will include fixed effects for treatment (three levels), time (0, 5 and 9 weeks), time-treatment interaction and randomization effect for the participants. Effect sizes will be calculated by subtracting of the modification of each of the outcomes between the patients in the active groups versus active group control, and between both active treatments, divided by the standard deviation of the entire sample.

Being tested
Methylphenidate, Parental training, Psychoeducational groups for parents, Placebo pill
Keywords
Parental training, Preschool age, Attention Deficit/Hyperactivity Disorder (ADHD)
Medical subject headings
Attention Deficit Disorder with Hyperactivity

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • MethylphenidateDrug

    Methylphenidate treatment with a initial dosage of 0,3 mg/kg per day (weekly dosage adjustments).

  • Parental trainingBehavioural

    Weekly parental training conducted by behavioral psychologists.

  • Psychoeducational groups for parentsOther

    Weekly psychoeducational groups conducted by educators.

  • Placebo pillDrug

    Placebo pill during 8 weeks.

Study groups in NCT02807870
Study groupRoleWhat they receive
Methylphenidate-psychoeducational groupExperimentalMethylphenidate treatment with a initial dosage of 0,3 mg/kg per day (weekly dosage adjustments) and weekly psychoeducational groups for parents during 8 weeks.
Receives: Drug: Methylphenidate; Other: Psychoeducational groups for parents
Parental training-placebo pillExperimentalWeekly parental training conducted by behavioral psychologists and placebo pill during 8 weeks.
Receives: Behavioral: Parental training; Drug: Placebo pill
Psychoeducational group-placebo pillPlacebo comparatorWeekly psychoeducational groups for parents and placebo pill during 8 weeks.
Receives: Other: Psychoeducational groups for parents; Drug: Placebo pill

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in attention deficit and hyperactivity symptoms

    The child will be assessed with the Swanson, Nolan and Pelham (SNAP) scale.

    Measured: Baseline, after 8 weeks (post intervention) and follow-up 1, 2 and 3 years after the end of the intervention

  2. Change in symptom severity

    The child will be assessed by a blinded rater with the Clinical Global Impressions Scale (CGI).

    Measured: Baseline, after 8 weeks (post intervention) and follow-up 1, 2 and 3 years after the end of the intervention

  3. Change in social and psychiatric functioning

    The child will be assessed with the Children's Global Assessment Scale (CGAS).

    Measured: Baseline, after 8 weeks (post intervention) and follow-up 1, 2 and 3 years after the end of the intervention

Secondary outcomes (6)
  1. Change in executive functions

    The child will be assessed with the Continuous Performance Test (CPT).

    Measured: Baseline, after 8 weeks (post intervention) and follow-up 1, 2 and 3 years after the end of the intervention

  2. Adverse effects of the treatment

    The caregiver will be assessed by an adverse effects scale.

    Measured: Along 8 weeks.

  3. Evaluate ADHD symptoms that may influence treatment response and adherence

    The caregiver will be assessed by Adult ADHD Self-Report Scale (ASRS).

    Measured: Baseline, after 8 weeks (post intervention) and follow-up 1, 2 and 3 years after the end of the intervention

  4. Evaluate Depression symptoms that may influence treatment response and adherence

    The caregiver will be assessed with Beck Depression Inventory (BDI-II)

    Measured: Baseline, after 8 weeks (post intervention) and follow-up 1, 2 and 3 years after the end of the intervention

  5. Changes in irritability symptoms

    The child will be assessed with the Affective Reactivity Index (ARI) scale.

    Measured: Baseline and after 8 weeks (post intervention) and follow-up 1, 2 and 3 years after the end of the intervention

  6. Changes in disruptive behavior symptoms

    The child will be assessed with the Multidimensional Assessment Profile of Disruptive Behavior (MAP-DB)

    Measured: Baseline, after 8 weeks (post intervention) and follow-up 1, 2 and 3 years after the end of the intervention

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted21 Jun 2016 (estimated)
  2. Study startJun 2016
  3. Primary completionDec 2019
  4. Study completion30 Jun 2020

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase 4
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Quadruple blind
Who is masked
Participant, Care provider, Investigator, Outcomes assessor
Enrolment
153 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT02807870
Sponsor's protocol ID
466859/2014-7
Status last verified
Aug 2020
First submitted
9 Jun 2016
Last updated
18 Aug 2020
Results posted
No
Data monitoring committee
No
Individual data sharing
No

Publications

  • Farhat LC, Sugaya LS, Bloch MH, Childress A, Cortese S, Fatori D, Salum GA, Rohde LA, Polanczyk GV. Individual Participant Data Meta-Analysis: Moderators of Response to Stimulants for Preschool Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 2026 Jun;65(6):781-792. doi: 10.1016/j.jaac.2025.09.012. Epub 2025 Sep 18.

    PubMed 40975435
  • Sugaya LS, Salum GA, de Sousa Gurgel W, de Morais EM, Del Prette G, Pilatti CD, Dalmaso BB, Leibenluft E, Rohde LA, Polanczyk GV. Efficacy and safety of methylphenidate and behavioural parent training for children aged 3-5 years with attention-deficit hyperactivity disorder: a randomised, double-blind, placebo-controlled, and sham behavioural parent training-controlled trial. Lancet Child Adolesc Health. 2022 Dec;6(12):845-856. doi: 10.1016/S2352-4642(22)00279-6. Epub 2022 Oct 26.

    PubMed 36306807

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Methylphenidate, Parental training and Psychoeducational groups for parents in people with Attention Deficit Disorder With Hyperactivity and Preschool Child, run by University of Sao Paulo at 1 site in Brazil.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 18 Aug 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Brazil. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

What does this phase mean?

Phase 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in attention deficit and hyperactivity symptoms (time frame: Baseline, after 8 weeks (post intervention) and follow-up 1, 2 and 3 years after the end of the intervention). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT02807870, which also lists 2 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Aug 2020.

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