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Irritable MoodRESISTNCT05528926

RESist Against Irritability Superiority Trial

A study testing Non-Violent Resistance, Parent Management Training and Treatment As Usual in people with Irritable Mood, run by University Hospital, Montpellier at 1 site in France.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

Irritability is defined as developmentally inappropriate proneness to anger. Irritability is a symptom of several mental health conditions in children and adolescents such as attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), depressive disorders, anxiety… Read more about this study

Who is it for?
Ages 6 to 15 years
Conditions the study is for
Irritable Mood
What is being tested?
Non-Violent Resistance, Parent Management Training and Treatment As Usual
Could I receive a placebo?
No, everyone receives an active treatment
How many people
270 participants
Where
1 siteFrance
Study dates
25 Apr 2023to 1 Sep 2026
Phase
Interventional
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 6 to 15 years
  • All sexes
  • No healthy volunteers
  • Child

Who may be able to join

  • Male and female subject between 6 and 15 years-old.
  • Express informed consent f by at least one of the parents or legal representative, and oral consent of the child.
  • A confirmed K-SADS DSM-5 diagnosis of ADHD, ODD, CD, mood/anxiety disorder or DMDD, or a clinical diagnosis of IED. The request of a concomitant mental disorder allows to restrict this intervention to a clinical population.
  • A Parental-rated ARI total score of 4 or above at baseline.
  • A Clinical Global Impression-Severity score (CGI-S) of 4 or above (=at least moderately ill).
  • Persistence of irritability symptoms 6 month or above at baseline (this avoids including children with transitory irritability).
  • stable treatment regimen (pharmacological and non-pharmacological) for 2 weeks prior to inclusion and during the trial
  • RESIST-QUAL : Same inclusion criteria as above with specific informed consent form signed by the participating parent.

Who cannot join

  • Unavailability of parents or legal representative during the study period.
  • Subjects with a DSM-5 diagnosis (clinical presentation or history) that is consistent with Schizophrenia or psychotic disorders or acute manic episodes.
  • Diagnosis of Autism Spectrum Disorder (ASD) in patients who are non-verbal and with IQ lower than 70.
  • Known or estimated IQ<70 or clinical diagnosis of intellectual disability.
  • Subjects with severe irritability that are better accounted for by another factor, e.g.: general medical condition(s) or direct effect of a substance (i.e., medication, illicit drug use), as determined by the clinical judgment of the investigator, or related to child abuse and/or neglect.
  • absence of informed consent give by at least one of the parents or legal representatives, and oral consent of the child
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  • inability to speak and comprehend French
  • deemed unable to comply with the trial protocol
  • participation in a structured parent program during the last 6 months

Trial locations and contacts

1 site in 1 country.

France1 site, 1 recruiting
  • UH of Montpellier

    Montpellier, 34295

    Diane Pr PURPER-OUAKIL, 04.67.33.60.09 ext. +33, d-purper_ouakil@chu-montpellier.fr

    Recruiting

Other trials in France

About this study

Official title: Parent Training for the Treatment of Irritability in Children and Adolescents: a Multisite Randomized Controlled, 3-parallel-group, Evaluator-blinded, Superiority Trial

Irritability is defined as developmentally inappropriate proneness to anger. Irritability is a symptom of several mental health conditions in children and adolescents such as attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), depressive disorders, anxiety disorders.Irritability has been associated with poor functional outcomes across the lifespan and was found to be specifically associated with concurrent and longitudinal emotional disorders, suicidality and impaired academic and socio-professional functioning. Children with high irritability also have distinct physiological profiles with hyper-reactivity to stress and perceived threats.

Despite the high prevalence and health issues related to irritability, there is little treatment research on this topic. Developing evidence-based non-pharmacological treatment options for children suffering from severe, chronic irritability is therefore a particularly important target for clinical research.

Read the detailed description

Irritability is defined as developmentally inappropriate proneness to anger. Irritability is a symptom of several mental health conditions in children and adolescents such as attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), depressive disorders, anxiety disorders. Both tonic (e.g. negative quality of mood) and phasic (e.g. temper outbursts) irritability are criteria of the DSM-5 Disruptive Mood Dysregulation Disorder and the World Health Organization has considered the addition of a specifier to indicate whether ODD presents with chronic irritability and anger in the revision of the International Classification of Disease.

Irritability has been associated with poor functional outcomes across the lifespan and was found to be specifically associated with concurrent and longitudinal emotional disorders, suicidality and impaired academic and socio-professional functioning. Children with high irritability also have distinct physiological profiles with hyper-reactivity to stress and perceived threats.

Irritability is included in the negative valence system of RDoC as "frustrative non-reward". According to this neuroscience-based classification, irritability is an excessive response of an individual faced with the impossibility to achieve an expected goal and has been linked to dysregulations of the autonomic nervous system and the reward network. Another pathophysiological line of research conceptualizes irritability as an aberrant response to threat (e.g. irritable individuals may attack more rapidly and in broader contexts).

Despite the high prevalence and health issues related to irritability, there is little treatment research on this topic. Developing evidence-based non-pharmacological treatment options for children suffering from severe, chronic irritability is therefore a particularly important target for clinical research. One of the first steps in achieving this goal includes testing new therapies against extant interventions. Parent training programs decrease aggressive behaviours in children and are therefore good candidates for the improvement of irritability. Low parental warmth, lack of positive parental emotion socialization and high parental Expressed Emotions have been linked with irritability in children and could therefore be targeted in parental programs.

Research on the biological and psychological mechanisms mediating irritability is also needed to further improve specificity of therapeutic actions.

The project includes two ancyllary studies : RESIST-EXP and RESIST-QUAL.

  • RESIST-EXP: Investigate improvement of irritability in both programs throughout emotional testing while collecting ANS functioning measurements.
  • RESIST-QUAL: A qualitative interview planned after treatment completion with parents from both parent programme groups.
Conditions
Irritable Mood
Being tested
Non-Violent Resistance, Parent Management Training, Treatment As Usual
Keywords
Irritability, Parent Management Training (PMT), Non-Violent Resistance (NVR)

What participants receive

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

  • Non-Violent ResistanceOther

    Also called NVR program

    The program's core features are parental self-control and emotional support. In the NVR program, parents recruit supporters to help them deal with their children's problematic behaviours. Developing emotional control means that the parent opposes non-violent resistance to his child's behaviour, not escalating the explosive situation.

    10 sessions (5 sessions per day for 2 consecutive days and two booster sessions at M1 and M3 after completion).

  • Parent Management TrainingOther

    Also called PMT program

    The gold-standard treatment for disruptive behaviour disorder in children and adolescents. The objective is to train parents to cope with the difficult situations they encounter, to teach them effective control strategies that are coherent and adapted to the 'deviant' behaviour of their children to reduce the intensity of events and their repercussions within the family.

    10 sessions (5 sessions per day for 2 consecutive days and two booster sessions at M1 and M3 after completion).

  • Treatment As UsualDrug

    Also called TAU

    The TAU group receives non-pharmacological and pharmacological therapies as usually provided in the participating centres but without having had a structured parent program in the last 6 months assessed at baseline, M1 and M3.

Study groups in NCT05528926
Study groupRoleWhat they receive
Non-Violent Resistance (NVR) programOtherThe Non-Violent Resistance (NVR) parent group-format program has been designed to develop a positive form of authority based on parental presence, a parental support network, strategies of nonviolent responses which avoid escalation and reconciliation gestures.
Receives: Other: Non-Violent Resistance
Parent Management Training (PMT) program based on Barkley's program for defiant childrenOtherThe Parent Management Treatment (PMT) program is an evidence-based treatment for disruptive behaviour disorder in which the child's social environment is modified according to principles of operant conditioning and contingency management. The parental response to the child's behaviour increases or decreases the likelihood of targeted behaviour.
Receives: Other: Parent Management Training
Treatment as usual (TAU)OtherThe TAU group receives non-pharmacological and pharmacological therapies as usually provided in the participating centres but without having had a structured parent program.
Receives: Drug: Treatment As Usual

What is being measured

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

  1. Change from baseline level that measure pleasure and arousal

    Change from baseline at 3 months after completion of the program of the Clinician-rated Affective Rating Scale (CL-ARI) assessed by blinded evaluators.

    This scale gives a range of possible scores from 0 to 12, with frequency and duration of temper outbursts quantified across three different levels of severity: mild, moderate and severe the higher the score.

    Measured: After 3 months follow-up

Secondary outcomes (13)
  1. Secondary efficacy endpoint at 1-month follow-up

    Change from baseline at 1 month after completion of the program of the Clinician-rated Affective Rating Scale (CL-ARI) by blinded evaluators.

    This scale gives a range of possible scores from 0 to 12, with frequency and duration of temper outbursts quantified across three different levels of severity: mild, moderate and severe the higher the score.

    Measured: After 1 month follow-up

  2. Secondary efficacy endpoints at 1 and 3-month follow-up

    Clinical Global Impression Improvement (CGI-I) scale from 1 to 7. the CGI-I 7-point scale to rate the patients' total improvement based on comparison with their baseline assessment from 1 = very much improved to 7 = very much worse.

    Measured: Between 1 and 3-month follow-up

  3. Secondary efficacy endpoints at 1 and 3-month follow-up

    Change from baseline in the Parenting and Familial Adjustement Scale (PAFAS)

    Measured: Between 1 and 3-month follow-up

  4. Secondary efficacy endpoints at 1 and 3-month follow-up

    Change from baseline in Parent-rated ARI and Child-rated Cranky thermometers

    Measured: Between 1 and 3-month follow-up

  5. Exploratory efficacy endpoints and putative moderators and mediators.

    Initial score and change from baseline in expressed emotions and reflexivity during the online five-minute speech sample (FMSS) at 3 months

    Measured: After 3-month follow-up

  6. Exploratory efficacy endpoints and putative moderators and mediators.

    Initial score and change from baseline in The Child Behavior Checklist for Ages 6-18 (CBCL 6-18) (parent-rated)

    Measured: At 1 month and 3 months follow-up

  7. Exploratory efficacy endpoints and putative moderators and mediators.

    Initial scores of personality dimensions assessed with Hierarchical Personality Inventory for Children (HiPIC)

    Measured: After 3 months follow-up

  8. Exploratory efficacy endpoints and putative moderating and mediating variables.

    Initial score and change from baseline in parental expressed emotions and reflexivity rated with the Five-Minute Speech Sample (FMSS).

    The FMSS is scored by considering the following 5 categories: initial statement, relationship, criticism, dissatisfaction and emotional overinvolvement.

    • Initial statement is scored as positive, neutral, or negative
    • Relationship is scored as positive, neutral, or negative
    • Criticism is scored by a frequency count used to score the number of criticisms present in the language sample.
    • Dissatisfaction is scored as present or absent
    • Emotional overinvolvement is based on the following 5 categories:
    • selfsacrificing overprotective behavior ,
    • emotional display ,
    • statements of attitude,
    • excessive detail and/or irrelevant information about the past,
    • excessive praise.

    Measured: At 3 months follow-up

  9. Endpoints of the ancillary study: RESIST-EXP

    These parameters will be measured on a sub-group of patients by a wristband "E4 wristband" permitting real-time physiological data acquisition:

    Blood Volume Pulse (BVP) in L/min

    Measured: At baseline ans at 3 months follow-up

  10. Endpoints of the ancillary study: RESIST-EXP

    These parameters will be measured on a sub-group of patients by a wristband "E4 wristband" permitting real-time physiological data acquisition:

    Motor Activity (in steps/day)

    Measured: At baseline ans at 3 months follow-up

  11. Endpoints of the ancillary study: RESIST-EXP

    These parameters will be measured on a sub-group of patients by a wristband "E4 wristband" permitting real-time physiological data acquisition:

    Skin conductance (in Micro Siemens)

    Measured: At baseline ans at 3 months follow-up

  12. Endpoints of the ancillary study: RESIST-EXP

    These parameters will be measured on a sub-group of patients by a wristband "E4 wristband" permitting real-time physiological data acquisition:

    Skin temperature (in °C)

    Measured: At baseline ans at 3 months follow-up

  13. Endpoints of the ancillary study: RESIST-QUAL

    Acceptability (questionnaire for all parents and qualitative interview in a subsample

    Measured: After 3 months follow-up

Timeline

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

  1. First posted6 Sep 2022
  2. Study start25 Apr 2023
  3. Primary completion1 Sep 2026 (estimated)
  4. Study completion1 Sep 2026 (estimated)

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 N/A
Primary purpose
Other
Allocation
Randomised
Intervention model
Parallel groups
Model description
3 parallel groups to compare: * Non-Violent Resistance parent training (NVR) * Parent Management Training (PMT) * Treatment As Usual (TAU)
Masking
Single blind
Who is masked
Outcomes assessor
Enrolment
270 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05528926
Sponsor's protocol ID
RECHMPL20_0038
Acronym
RESIST
Status last verified
Aug 2023
First submitted
31 Aug 2022
Last updated
14 Aug 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No

Publications

  • Fongaro E, Picot MC, Stringaris A, Belloc C, Verissimo AS, Franc N, Purper-Ouakil D. Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial. BMC Psychol. 2022 Nov 22;10(1):273. doi: 10.1186/s40359-022-00984-5.

    PubMed 36414963

Questions about this trial

What is this clinical trial studying?

A study testing Non-Violent Resistance, Parent Management Training and Treatment As Usual in people with Irritable Mood, run by University Hospital, Montpellier at 1 site in France.

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 8 inclusion and 9 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: status not confirmed, as of the sponsor's last update on 14 Aug 2023. 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 France. 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. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Results are not available in the source record.

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

Contact Diane Pr PURPER-OUAKIL (04.67.33.60.09 ext. +33, d-purper_ouakil@chu-montpellier.fr), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change from baseline level that measure pleasure and arousal (time frame: After 3 months follow-up). 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 NCT05528926, which also lists 1 linked publication.

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 14 Aug 2023.

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