Title

Micronutrients for Attention-Deficit Hyperactivity Disorder in Youth (MADDY) Study
Evaluating the Efficacy of Supplementation With Micronutrients for ADHD in Youth (MADDY) Study
  • Phase

    Phase 1/Phase 2
  • Study Type

    Interventional
  • Study Participants

    135
This proposed research will use randomized control trial (RCT) methodology and compare micronutrients with placebo in 135 children with ADHD.
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.
Study Started
Apr 23
2018
Primary Completion
Jul 10
2020
Study Completion
May 31
2021
Results Posted
Feb 09
2022
Last Update
Feb 08
2023

Combination Product Broad Spectrum Micronutrients; a 36-ingredient blend of vitamins, minerals, amino acids, and antioxidants

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

  • Other names: Daily Essential Nutrients (DEN)

Dietary Supplement Placebo

40% of participants will take 3-4 capsules of inactive placebo three times per day for eight weeks.

Intervention Experimental

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

Placebo Placebo Comparator

Capsules of inactive placebo.

Open Label Experimental

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.

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.

Summary

Intervention

Placebo

Open Label

All Events

Event Type Organ System Event Term Intervention Placebo Open Label

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.

Intervention

Baseline

1.49
score on a scale (Mean)
Standard Error: 0.08

Week 8

1.18
score on a scale (Mean)
Standard Error: 0.08

Placebo

Baseline

1.52
score on a scale (Mean)
Standard Error: 0.08

Week 8

1.23
score on a scale (Mean)
Standard Error: 0.08

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.

Intervention

Placebo

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.

Intervention (Baseline)

Anion gap

10.3
mmol/L (Mean)
Standard Error: 2.83

Carbon dioxide

25.62
mmol/L (Mean)
Standard Error: 0.21

Chloride

105.07
mmol/L (Mean)
Standard Error: 0.96

Potassium

4.1
mmol/L (Mean)
Standard Error: 0.10

Sodium

139.13
mmol/L (Mean)
Standard Error: 0.34

Intervention (Week 8)

Anion gap

10.64
mmol/L (Mean)
Standard Error: 2.83

Carbon dioxide

25.64
mmol/L (Mean)
Standard Error: 0.22

Chloride

104.81
mmol/L (Mean)
Standard Error: 0.97

Potassium

4.06
mmol/L (Mean)
Standard Error: 0.10

Sodium

139.16
mmol/L (Mean)
Standard Error: 0.34

Placebo (Baseline)

Anion gap

10.31
mmol/L (Mean)
Standard Error: 2.83

Carbon dioxide

25.97
mmol/L (Mean)
Standard Error: 0.24

Chloride

104.88
mmol/L (Mean)
Standard Error: 0.97

Potassium

4.09
mmol/L (Mean)
Standard Error: 0.10

Sodium

139.28
mmol/L (Mean)
Standard Error: 0.36

Placebo (Week 8)

Anion gap

10.15
mmol/L (Mean)
Standard Error: 2.84

Carbon dioxide

25.86
mmol/L (Mean)
Standard Error: 0.25

Chloride

105.28
mmol/L (Mean)
Standard Error: 0.98

Potassium

4.0
mmol/L (Mean)
Standard Error: 0.10

Sodium

139.42
mmol/L (Mean)
Standard Error: 0.37

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.

Intervention (Baseline)

Bilirubin total

0.47
mg/dL (Mean)
Standard Error: 0.03

Blood urea nitrogen (BUN)

12.48
mg/dL (Mean)
Standard Error: 0.41

Calcium

9.47
mg/dL (Mean)
Standard Error: 0.20

Creatinine

0.46
mg/dL (Mean)
Standard Error: 0.01

Glucose

82.15
mg/dL (Mean)
Standard Error: 2.36

Intervention (Week 8)

Bilirubin total

0.45
mg/dL (Mean)
Standard Error: 0.03

Blood urea nitrogen (BUN)

13.17
mg/dL (Mean)
Standard Error: 0.42

Calcium

9.49
mg/dL (Mean)
Standard Error: 0.20

Creatinine

0.49
mg/dL (Mean)
Standard Error: 0.01

Glucose

83.03
mg/dL (Mean)
Standard Error: 2.39

Placebo (Baseline)

Bilirubin total

0.49
mg/dL (Mean)
Standard Error: 0.03

Blood urea nitrogen (BUN)

12.56
mg/dL (Mean)
Standard Error: 0.46

Calcium

9.47
mg/dL (Mean)
Standard Error: 0.20

Creatinine

0.46
mg/dL (Mean)
Standard Error: 0.01

Glucose

79.45
mg/dL (Mean)
Standard Error: 2.44

Placebo (Week 8)

Bilirubin total

0.46
mg/dL (Mean)
Standard Error: 0.03

Blood urea nitrogen (BUN)

12.13
mg/dL (Mean)
Standard Error: 0.48

Calcium

9.4
mg/dL (Mean)
Standard Error: 0.20

Creatinine

0.46
mg/dL (Mean)
Standard Error: 0.01

Glucose

80.0
mg/dL (Mean)
Standard Error: 2.46

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.

Intervention (Baseline)

Albumin

4.34
g/dL (Mean)
Standard Error: 0.17

Hemoglobin

12.99
g/dL (Mean)
Standard Error: 0.17

Mean cell Hgb concentration

33.82
g/dL (Mean)
Standard Error: 0.13

Total protein

7.15
g/dL (Mean)
Standard Error: 0.63

Intervention (Week 8)

Albumin

4.34
g/dL (Mean)
Standard Error: 0.17

Hemoglobin

12.96
g/dL (Mean)
Standard Error: 0.17

Mean cell Hgb concentration

33.59
g/dL (Mean)
Standard Error: 0.13

Total protein

8.45
g/dL (Mean)
Standard Error: 0.65

Placebo (Baseline)

Albumin

4.29
g/dL (Mean)
Standard Error: 0.17

Hemoglobin

12.99
g/dL (Mean)
Standard Error: 0.18

Mean cell Hgb concentration

33.75
g/dL (Mean)
Standard Error: 0.15

Total protein

7.07
g/dL (Mean)
Standard Error: 0.73

Placebo (Week 8)

Albumin

4.28
g/dL (Mean)
Standard Error: 0.17

Hemoglobin

12.91
g/dL (Mean)
Standard Error: 0.18

Mean cell Hgb concentration

33.47
g/dL (Mean)
Standard Error: 0.15

Total protein

7.06
g/dL (Mean)
Standard Error: 0.76

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.

Intervention (Baseline)

Alkaline phosphatase

255.0
U/L (Mean)
Standard Error: 8.10

ALT

18.67
U/L (Mean)
Standard Error: 3.25

AST

23.58
U/L (Mean)
Standard Error: 1.26

Intervention (Week 8)

Alkaline phosphatase

241.33
U/L (Mean)
Standard Error: 8.15

ALT

26.0
U/L (Mean)
Standard Error: 3.27

AST

27.28
U/L (Mean)
Standard Error: 1.28

Placebo (Baseline)

Alkaline phosphatase

252.21
U/L (Mean)
Standard Error: 9.29

ALT

20.4
U/L (Mean)
Standard Error: 3.37

AST

25.72
U/L (Mean)
Standard Error: 1.42

Placebo (Week 8)

Alkaline phosphatase

257.93
U/L (Mean)
Standard Error: 9.41

ALT

18.09
U/L (Mean)
Standard Error: 3.41

AST

22.79
U/L (Mean)
Standard Error: 1.46

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.

Intervention (Baseline)

Intervention (Week 8)

Placebo (Baseline)

Placebo (Week 8)

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.

Intervention (Baseline)

Eosinophil

3.82
percent (Mean)
Standard Error: 0.63

Hematocrit

38.4
percent (Mean)
Standard Error: 0.52

Immature grans

0.2
percent (Mean)
Standard Error: 0.02

Lymphocyte

43.63
percent (Mean)
Standard Error: 1.65

Monocyte

8.03
percent (Mean)
Standard Error: 0.34

RBC distribution

25.03
percent (Mean)
Standard Error: 8.76

Intervention (Week 8)

Eosinophil

4.03
percent (Mean)
Standard Error: 0.64

Hematocrit

38.6
percent (Mean)
Standard Error: 0.52

Immature grans

0.18
percent (Mean)
Standard Error: 0.02

Lymphocyte

43.53
percent (Mean)
Standard Error: 1.66

Monocyte

8.29
percent (Mean)
Standard Error: 0.34

RBC distribution

25.17
percent (Mean)
Standard Error: 8.76

Placebo (Baseline)

Eosinophil

6.49
percent (Mean)
Standard Error: 0.73

Hematocrit

38.5
percent (Mean)
Standard Error: 0.55

Immature grans

0.24
percent (Mean)
Standard Error: 0.02

Lymphocyte

40.25
percent (Mean)
Standard Error: 1.80

Monocyte

7.78
percent (Mean)
Standard Error: 0.38

RBC distribution

25.29
percent (Mean)
Standard Error: 8.76

Placebo (Week 8)

Eosinophil

5.71
percent (Mean)
Standard Error: 0.75

Hematocrit

38.6
percent (Mean)
Standard Error: 0.55

Immature grans

0.19
percent (Mean)
Standard Error: 0.03

Lymphocyte

40.65
percent (Mean)
Standard Error: 1.84

Monocyte

8.35
percent (Mean)
Standard Error: 0.38

RBC distribution

25.02
percent (Mean)
Standard Error: 8.76

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.

Intervention (Baseline)

82.7
fL (Mean)
Standard Error: 0.44

Intervention (Week 8)

83.0
fL (Mean)
Standard Error: 0.45

Placebo (Baseline)

83.74
fL (Mean)
Standard Error: 0.49

Placebo (Week 8)

83.85
fL (Mean)
Standard Error: 0.50

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.

Intervention (Baseline)

99.1
ug/dL (Mean)
Standard Error: 4.65

Intervention (Week 8)

90.7
ug/dL (Mean)
Standard Error: 4.69

Placebo (Baseline)

100.5
ug/dL (Mean)
Standard Error: 5.35

Placebo (Week 8)

95.5
ug/dL (Mean)
Standard Error: 5.49

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.

Intervention (Baseline)

Absolute eosinophil

210.0
cells/mcL (Mean)
Standard Error: 0.04

Absolute monocyte

460.0
cells/mcL (Mean)
Standard Error: 0.02

Platelet count

WBC count

Intervention (Week 8)

Absolute eosinophil

230.0
cells/mcL (Mean)
Standard Error: 0.04

Absolute monocyte

470.0
cells/mcL (Mean)
Standard Error: 0.02

Platelet count

WBC count

Placebo (Baseline)

Absolute eosinophil

390.0
cells/mcL (Mean)
Standard Error: 0.04

Absolute monocyte

460.0
cells/mcL (Mean)
Standard Error: 0.02

Platelet count

WBC count

Placebo (Week 8)

Absolute eosinophil

340.0
cells/mcL (Mean)
Standard Error: 0.05

Absolute monocyte

480.0
cells/mcL (Mean)
Standard Error: 0.02

Platelet count

WBC count

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.

Open Label (Week 8 to Week 16)

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.

Open Label (Week 8 to Week 16)

Week 12

1.14
score on a scale (Mean)
Standard Error: 0.04

Week 16

0.99
score on a scale (Mean)
Standard Error: 0.05

Total

135
Participants

Age, Categorical

Race/Ethnicity, Customized

Race/Ethnicity, Customized

Region of Enrollment

Sex: Female, Male

Phase 1: Intervention & Placebo

Intervention

Placebo

Phase 2: Open Label

Open Label

Drop/Withdrawal Reasons

Intervention

Placebo

Open Label