Biomarker Validation in Motor System Physiology in Attention Deficit Hyperactivity Disorder (AMPAIII)

May 14, 2026 updated by: Donald Gilbert, MD, MS, FAAN, FAAP

Anomalous Motor System Physiology in Attention Deficit Hyperactivity Disorder: Biomarker Validation and Modeling Domains of Function

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most commonly diagnosed neurobehavioral disorder in childhood. Children with ADHD struggle in school due to problems with attention and high levels of impulsivity and hyperactivity. They are at substantially increased risk for long-term difficulties into adulthood, including academic underachievement, substance abuse, and criminal behavior. The diagnosis of ADHD, which is based on subjective ratings by parents and teachers, likely results from multiple different, overlapping differences in circuits of the brain responsible for attention and impulse control. However, we do not have any scientific or clinical tests that allow us to understand these circuits. In an effort to improve ADHD outcomes, we have used a technology called Transcranial Magnetic Stimulation (TMS) to identify highly reliable measurements of brain function. We have identified two very promising measures that are abnormal in children with ADHD and, importantly, also predict the severity of ADHD behaviors. The goal of this project is to determine if these two TMS measurements could be used to help better guide ADHD treatment. To do this, we will perform three investigations in 8 to 12 year old children to determine: 1) test-retest reliability; 2) pharmacologic responsiveness; and 3) correlations with two domains of function relevant to ADHD: "Cognitive Control" and "Emotional Valence." Through these investigations, we aim to determine whether these two TMS brain measures are reliable and meaningful enough to be used to help improve precision of individually-targeted and effective ADHD treatments.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

4.2. NARRATIVE STUDY DESCRIPTION

Summary This is a randomized, blinded, placebo-controlled, single-dose crossover study. The objective is to estimate, in a rigorous, unbiased manner, the effect of 10 mg methylphenidate (MPH) on two putative biomarkers of ADHD, measured using Transcranial Magnetic Stimulation (TMS). Two other aims of this larger study, quantifying test-retest reliability and linking TMS biomarkers to RDoC domains of cognitive control and emotional valence, are not directly part of the clinical trial and are fully described in the research strategy.

Doctors use observations and subjective rating scales both to diagnose Attention Deficit Hyperactivity Disorder (ADHD) and to make decisions about medical or behavioral treatments. This study addresses the possibility that in children with ADHD, brain-based measurements, or biomarkers, could be useful for diagnosis and treatment decisions. These biomarkers are Short Interval Cortical Inhibition (SICI) and Task-Related Up-Modulation (TRUM). These biomarkers may allow clinicians to identify that a child has a "type" of ADHD which might respond more effectively to treatments that are precisely and individually targeted. Thus it is important to estimate the effects of commonly prescribed treatments on SICI and TRUM. This protocol aims to determine the effects of a single 10 mg dose of MPH, a stimulant medication widely prescribed to treat ADHD, on SICI and TRUM.

Assignment of participants For each child with ADHD, participation in the study will consist of three visits. Treatment occurs as a single dose on visits 2 and 3. All participants will receive both placebo and 10 mg MPH. Order will be counterbalanced.

Population Sample At the two study sites, Cincinnati Children's Hospital Medical Center (CCHMC) and the Kennedy Krieger Institute (KKI), we will recruit 144 pre-pubescent children, ages 8 years 0 months to 12 years 11 months, with ADHD. We estimate a total of 120 participants will participate in the full study. All recruitment methods will conform to CCHMC Institutional Review Board (IRB) and HIPAA requirements. The study will be approved by the CCHMC Institutional IRB. Children with ADHD will be primarily recruited through community resources, including local chapters of the Children with ADHD (CHADD), local public and private schools, as well as multiple clinics at CCHMC and KKI.

Study Flow During the first study visit, participants will provide informed consent. They will then complete diagnostic and psychoeducational testing. The parent/guardian will complete standardized questionnaires and a comprehensive psychiatric diagnostic interview with a trained and research reliable psychology associate under the supervision of a neuropsychologist at each site.

At visit 1: if determined to be eligible to continue, visits 2 and 3 will be scheduled at 2-week intervals.

At visit 2: participant will undergo pre-dose TMS for measures of SICI and TRUM, receive either MPH or placebo, then undergo post-dose TMS.

At visit 3: participant will undergo pre-dose TMS measures of SICI and TRUM (test/re-test assessment), receive the opposite treatment of either MPH or placebo, then undergo post-dose TMS.

Intervention - MPH versus Placebo Procedures

The MPH and the placebo will be prepared by the study pharmacy at each site so that they appear identical. Neither the child, the parent, nor the investigators will know which treatment is given. The study pharmacy will randomize children into two groups, without disclosing this information to the researchers or participants. Group 1 will receive MPH on the first treatment visit (visit 2 of the study) and placebo the second. Group 2 will receive placebo on the first treatment visit and MPH the second.

Note: for comparison and validation of the study measures, 70 children who are typically developing and do not have ADHD will also be enrolled. These control participants will not receive methylphenidate or placebo, however.

Study Type

Interventional

Enrollment (Estimated)

214

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • United States
    • Maryland
      • Baltimore, Maryland, United States, 21205
    • Ohio
      • Cincinnati, Ohio, United States, 45229
        • Recruiting
        • Cincinnati Children's Hospital Medical Center
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

8 years to 12 years (Child)

Accepts Healthy Volunteers

Yes

Description

Inclusion Criteria:

  • Either gender, any race, ethnicity or socioeconomic status
  • Currently between 8 years 0 months and 12 years, 11 months, 30 days
  • Willing to answer questions about ADHD and related diagnoses
  • For children with ADHD prescribed stimulant medications, willing to suspend taking medications as specified in the study procedures
  • For children with ADHD, willing to participate in the single dose, randomized crossover study to probe acute effects of methylphenidate on biomarkers
  • Right hand dominant (predominately right-handed)
  • Able to participate in and sign an informed consent
  • ADHD inclusion: The diagnosis of ADHD will be based on Diagnostic and Statistical Manual version 5 (DSM-5) criteria using standard rating scales and a structured diagnostic interview. Oppositional Defiant Disorder is permitted; Conduct disorder is excluded.
  • Typically Developing (healthy control) inclusion: Free of ADHD or other developmental or psychiatric disorders based on DSM-5 criteria using standard rating scales and a structured diagnostic interview.

Exclusion Criteria:

  • Known diagnosis of mental retardation, cerebral palsy, Autism Spectrum Disorder, traumatic brain injury, brain tumor, epilepsy, or other serious neurological disorder.
  • Major Depression, Bipolar Disorder, Conduct Disorder, Adjustment Disorder, other Anxiety Disorders, or other developmental psychiatric diagnoses.
  • For females, onset of menses, pregnancy.
  • Current use of antidepressants, non-stimulant ADHD medications, dopamine blocking agents, mood stabilizers.
  • Implanted brain stimulator, vagal nerve stimulator, ventriculo-peritoneal shunt, cardiac pacemaker, or implanted medication port.
  • Diagnosis of a speech/language disorder or a Reading Disability (RD).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Other
  • Allocation: Randomized
  • Interventional Model: Crossover Assignment
  • Masking: Triple

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Attention Deficit Hyperactivity Disorder (ADHD)
8 to 12 year old children diagnosed with ADHD. Randomized, blinded, single dose, placebo controlled, crossover trial.
Drug: Methylphenidate
In ADHD participants only: blinded, randomized, placebo-controlled single dose, crossover on separate days separated by at least one week.
Other Names:
  • Ritalin
Drug: Placebo
In ADHD participants only: blinded, randomized, placebo-controlled, single dose, crossover on separate days separated by at least one week.
No Intervention: Typically developing controls (TDC)
Typically developing controls - 8 to 12 year old children

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Transcranial Magnetic Stimulation (TMS)-evoked Short Interval Cortical Inhibition (SICI) Test-Retest Reliability
Time Frame: less than one month
A ratio of amplitudes of motor evoked potentials from paired (inhibitory) and single TMS pulses, obtained from dominant motor cortex with hand at rest
less than one month
Transcranial Magnetic Stimulation (TMS)-evoked Task Related Up Modulation (TRUM) Test-Retest Reliability
Time Frame: less than one month
A ratio of amplitudes of motor evoked potentials during engagement in a response inhibition task versus rest, obtained from dominant motor cortex
less than one month

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Donald Gilbert, MD, MS, FAAN, FAAP

Collaborators

Hugo W. Moser Research Institute at Kennedy Krieger, Inc.

Investigators

  • Principal Investigator: Donald L Gilbert, MD, Children's Hospital Medical Center, Cincinnati
  • Principal Investigator: Stewart H Mostofsky, MD, Hugo W. Moser Research Institute at Kennedy Krieger, Inc.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

September 1, 2020

Primary Completion (Actual)

February 9, 2026

Study Completion (Estimated)

July 1, 2026

Study Registration Dates

First Submitted

June 4, 2020

First Submitted That Met QC Criteria

June 4, 2020

First Posted (Actual)

June 9, 2020

Study Record Updates

Last Update Posted (Actual)

May 15, 2026

Last Update Submitted That Met QC Criteria

May 14, 2026

Last Verified

May 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • CHMC IRB 2020-0297

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Sharing of individual participant data (IPD) will occur through the National Institute of Mental Health (NIMH) Data Archive, consistent with the NIMH Data Sharing Policy. This includes all raw and analyzed data, including clinical, phenotypic, and neurophysiological biomarker data, which will be de-identified and deposited in the NIMH Data Archive (NDA). Data from research subjects will include Required Data Elements: 1) NDA Global Unique Identifier assigned to participants (GUID); 2) the study's internal subject identifier (Src_subject_id); 3) interview age in months (interview_age); 4) data collection date (interview_date); and 5) birth sex.

IPD Sharing Time Frame

Data uploads to the NIMH Data Archive from the study will occur every 6 months, consistent with the NIMH Data Sharing Policy.

IPD Sharing Access Criteria

Determined by NIMH.

IPD Sharing Supporting Information Type

  • STUDY_PROTOCOL
  • SAP

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

Yes

Studies a U.S. FDA-regulated device product

No

product manufactured in and exported from the U.S.

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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