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Clinical Trials/NCT04349917
NCT04349917
Completed
Phase 4

Large-scale Brain Organization During Cognitive Control in ADHD

University of North Carolina, Chapel Hill1 site in 1 country37 target enrollmentDecember 16, 2016

Overview

Phase
Phase 4
Intervention
Methylphenidate
Conditions
Attention Deficit Hyperactivity Disorder
Sponsor
University of North Carolina, Chapel Hill
Enrollment
37
Locations
1
Primary Endpoint
Resting State Brain Network Organization
Status
Completed
Last Updated
5 years ago

Overview

Brief Summary

The purpose of this study is to test whether children with attention-deficit/hyperactivity disorder (ADHD) are impaired in the ability to flexibly adapt brain network organization in response to shifting cognitive demands during the exertion of cognitive control, by assessing changes in network dynamics resulting from stimulant administration in children with ADHD, and how those changes relate to behavioral and symptom improvements. Subjects will be children with ADHD aged 8-12. Subjects will participate in multiple testing sessions that include: diagnosis and eligibility screening, neuropsychological and behavioral testing, and, if eligible, MRI scans and a medication challenge. Children with ADHD who are enrolled in the medication challenge will undergo one MRI scan on placebo and one MRI scan on stimulant medication, counterbalanced and double-blind. Functional connectivity will be measured using functional MRI and innovative graph theoretical analytic tools will be implemented. Network metrics will be related to symptomatology and behavioral testing measures. It is hypothesized that stimulant administration in children with ADHD will increase flexibility in network reconfiguration in response to changing cognitive control demands as compared to when they are on placebo. It is further hypothesized that the degree to which brain network organization is changed will be related to the degree of improvement in cognitive control performance.

Registry
clinicaltrials.gov
Start Date
December 16, 2016
End Date
March 14, 2020
Last Updated
5 years ago
Study Type
Interventional
Study Design
Crossover
Sex
All

Investigators

Responsible Party
Sponsor

Eligibility Criteria

Inclusion Criteria

  • Between 8-12 years old
  • Diagnosis of ADHD (for ADHD group); ADHD group only can have comorbid Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) diagnoses of oppositional defiant disorder, conduct disorder, depressive disorders, or anxiety disorders
  • ADHD subjects must never have been treated with medication for their ADHD

Exclusion Criteria

  • Wechsler Intelligence Scale for Children-Fifth Edition Full-Scale Intelligence Quotient (IQ) \< 80
  • Wechsler Individual Achievement Test-Third Edition Word Reading \< 85
  • Any neurologic or developmental disabilities
  • Any reading or learning disabilities
  • Visual impairment that cannot be corrected-to-normal
  • Color blindness
  • Documented hearing impairment greater than 25 decibels (dB) loss in either year
  • Have already gone through puberty (Tanner Stage II or higher)
  • Medical contraindication to MRI
  • Any psychoactive medication

Arms & Interventions

Placebo, then Methylphenidate

All children with ADHD in this study will receive one dose of methylphenidate and one dose of placebo over the course of two sessions approximately one week apart (order randomized and double-blind).

Intervention: Methylphenidate

Placebo, then Methylphenidate

All children with ADHD in this study will receive one dose of methylphenidate and one dose of placebo over the course of two sessions approximately one week apart (order randomized and double-blind).

Intervention: Placebo

Methylphenidate, then Placebo

All children with ADHD in this study will receive one dose of methylphenidate and one dose of placebo over the course of two sessions approximately one week apart (order randomized and double-blind).

Intervention: Methylphenidate

Methylphenidate, then Placebo

All children with ADHD in this study will receive one dose of methylphenidate and one dose of placebo over the course of two sessions approximately one week apart (order randomized and double-blind).

Intervention: Placebo

Outcomes

Primary Outcomes

Resting State Brain Network Organization

Time Frame: 1 to 3 hours after administration of intervention

Assessment of network topology during a resting state using functional connectivity estimates. Modularity will be determined by applying graph theoretical methods to functional connectivity estimates acquired during functional magnetic resonance imaging (fMRI) scans. Modularity is measured on a -1 to 1 scale, with higher scores indicating stronger community structure, or a stronger tendency of clusters of brain regions to separate into distinct, highly interconnected networks with sparse connections across networks. The optimal modularity value depends on the context. For example, during complex tasks lower modularity is better, while during basic, automatic tasks higher modularity is better.

Task-Based Brain Network Organization

Time Frame: 1 to 3 hours after administration of intervention

Assessment of network topology during the Go/No-go (GNG) regular and GNG reward tasks. Subjects see a series of sports balls and are told to respond to most balls (go trials), but not to some specific balls (no-go trials). GNG tasks are identical, except in the rewarded task, correct fast go responses and correct withholding on no-go trials are rewarded with 1 cent and 5 cents respectively. Graph theoretical methods are applied to functional connectivity estimates from fMRI scans to determine modularity during each task. Modularity (-1 to 1 scale) measures the degree to which the whole-brain system separates into distinct communities, such that greater modularity reflects stronger community structure, or stronger tendency of brain regions to separate into distinct, highly interconnected networks with few connections across networks. Optimal modularity value depends on context. During complex tasks lower modularity is better, while higher modularity is better for basic tasks.

Rest-Task Reconfiguration

Time Frame: 1 to 3 hours after administration of intervention

Assessment of reconfiguration of network topology between the GNG regular task and the resting state and GNG reward task and resting state. In the GNG tasks, subjects see a series of sports balls and are told to respond to most of the balls (go trials), but not to some specific balls (no-go trials). GNG tasks are identical, except in the rewarded task, correct fast go responses and correct withholding on no-go trials are rewarded with 1 cent and 5 cents respectively. Normalized mutual information will be determined by applying the same graph theoretical methods to functional connectivity estimates acquired during fMRI scans for each rest-task pair. Normalized mutual information is measured on a 0 to 1 scale, with higher scores indicating more similarity in network structure across task and rest conditions.

Drug-induced Normalization

Time Frame: 1 to 3 hours after administration of intervention

Assessment of how changes in brain network topology relate to improvements in behavioral performance on the GNG regular and reward tasks, in which subjects respond to go stimuli and withhold responses to no-go stimuli. GNG tasks are identical, except subjects are rewarded for good performance on the reward task. Brain measures include change in modularity during rest, GNG regular, and GNG reward (Outcome Measures 1, 2); behavioral measures include change in commission rate, omission rate, and coefficient of variation of response time during GNG tasks (Outcome Measures 5-7). Pearson correlations are used to relate change in brain measures with change in behavioral measures from the placebo to the methylphenidate scans. Positive correlations indicate that subjects with greater change in the brain measure had greater change in the behavioral measure. Negative correlations indicate that subjects with less change in the brain measure had greater change in the behavioral measure.

Secondary Outcomes

  • Go/No-go (GNG) Commission Rate(1 to 3 hours after administration of intervention)
  • Go/No-go (GNG) Omission Rate(1 to 3 hours after administration of intervention)
  • Go/No-go (GNG) Response Time Variability(1 to 3 hours after administration of intervention)

Study Sites (1)

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