Characterization and Brain Mechanisms of Frustration in Youth With Severe Irritability or Attention Deficit Hyperactivity Disorder (ADHD)

Characterization and Pathophysiology of Frustration in Pediatric Irritability

Background:

Irritability is an elevated proneness to anger. Children with irritability have difficulty tolerating frustration. They get angry and have temper outbursts more easily than their others their age. Irritability is a symptom of DMDD and ADHD. (DMDD is disruptive mood dysregulation disorder. ADHD is attention deficit/hyperactivity disorder.) Yet the reasons why some children get irritated easily are not well understood.

Objective:

To use brain imaging methods to study responses to frustration in youth.

Eligibility:

Youth aged 8 to 17 years with severe irritability (including those diagnosed with DMDD) and/or ADHD. Healthy volunteers are also needed. All participants are already enrolled in studies 02-M-0021 or 01-M-0192.

Design:

Participants will visit the clinic 3 times. The second and third visits will be 3 to 4 weeks apart.

The first visit will be an enrollment visit. They will receive training on the tasks they will do during the study. Participants and their parents will take surveys. They will answer questions about their moods and feelings.

Participants will train for an MRI scan. They will lie in a mock scanner tube and hear the noises an MRI makes.

On the second and third visits, participants will have real MRI scans. They will play a computer game or watch a movie during each scan. The scans will last about 1 hour.

The week after each scan, participants will wear a device on their wrist to measure their heart rate and activity level. Participants and their parent will use a smartphone to answer questions about how they are feeling and acting. Participants who do not have smartphones will be given one to use during the study.

Study Overview

• Status: Withdrawn
• Conditions: Attention Deficit Hyperactivity Disorder; Normal Physiology; Disruptive Mood Dysregulation Disorder
• Intervention / Treatment: Behavioral: Affective Posner fMRI frustration induction task

Detailed Description

Study Description:

Participants in this study will be drawn from those enrolled in Protocol 02-M-0021 or 01-M-0192. This protocol uses detailed clinical phenotyping and a frustration induction task, coupled with pre- and post-frustration resting state scans, to study brain mechanisms mediating severe irritability in youth. The primary objective is to identify brain networks contributing to reconfiguration during and after frustration, and to test the ability of brain network metrics obtained using a frustration induction task to predict irritability. The secondary objective is to test whether these predictions are strengthened by the addition of structural connectivity measures and deeper clinical phenotyping.

Objectives:

Primary Objective:

To use multi-modal functional magnetic resonance imaging (fMRI), including a frustration induction task, coupled with resting state functional connectivity (rsFC) pre- and post-frustration, to elucidate neural mechanisms mediating frustration and how aberrant responses to frustration contribute to severe irritability in youth. Specifically, we will identify brain networks contributing to reconfiguration during and after frustration and test the ability of brain network metrics to predict irritability.

Secondary Objectives:

To test whether the prediction of irritability can be improved by the addition of structural brain connectivity measures obtained using diffusion tensor imaging (DTI), and clinical measures i.e., real-time, ecologically valid measures of mood and behavior obtained using ecological momentary assessment (EMA).

Endpoints:

Primary Endpoints:

Global efficiency (Eglob) of brain modules during resting state after frustration, which we hypothesize will predict irritability. Variance of information (VIn) measures, which we hypothesize will demonstrate that anterior DMN-temporal-limbic (aDMN-TL) and fronto-parietal (FP) modules make the largest contributions to network reconfiguration throughout frustration.

Secondary Endpoints:

Measures of structural connectivity obtained using DTI, and EMA measures of mood and behavior, which we hypothesize will improve the prediction of irritability.

• Study Type: Interventional
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Maryland
    • Bethesda, Maryland, United States, 20892
      • National Institutes of Health Clinical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 8 years to 17 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

• INCLUSION CRITERIA:

This study will include patients (i.e., youth with DMDD subthreshold DMDD, and/or ADHD) and healthy volunteers. All subjects will have already been enrolled in 02-M-0021 or 01-M-0192.

Inclusion criteria for patients:

• Enrolled in 02-M-0021.
• Aged 8-17 at the time of recruitment.

Healthy Volunteer Children

• Enrolled in 02-M-0021 or 01-M-0192 as a healthy volunteer.
• Aged 8-17 at the time of recruitment.

EXCLUSION CRITERIA:

-An individual who has contraindications for scanning will be excluded.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: frustration and control fMRI tasks; all subjects complete one scanning session with frustration induction and one scanning session with the control task.	Behavioral: Affective Posner fMRI frustration induction task; During the frustration induction paradigm, children play a game with monetary reward. The game is rigged, thus inducing frustration. The control task does not have any reward component. All participants complete both the control task scanning session and the frustration induction scanning session.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
prediction of irritability ratings by global efficiency	global efficiency of brain modules in resting state after frustration will be used to predict irritability ratings obtained throughout the one week after each of two scanning sessions	one week after each of two scanning sessions, when ecological momentary assessment ratings are completed. The two scanning sessions will be 2-5 weeks apart.
Variance of information (VIn) measures	VIn metric will be used to identify the brain modules making the largest contribution to network reconfiguration throughout frustration	data are obtained throughout each of the two scanning sessions. The two scanning sessions will be 2-5 weeks apart.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
ecological momentary assessment (EMA) measures	Remote digital phenotyping will be used to assess mood and behavior throughout the week following each of the two scanning sessions. These EMA measures will be included in a machine learning model to test whether their inclusion can improve the prediction of irritability ratings.	for one week after each of the two scanning sessions
Diffusion tensor imaging (DTI) metrics	Standard DTI metrics will be included in a machine learning model to test whether their inclusion can improve the prediction of irritability ratings.	during first scanning session

Collaborators and Investigators

• Sponsor: National Institute of Mental Health (NIMH)

Publications and helpful links

Helpful Links

• NIH Clinical Center Detailed Web Page

Study record dates

Study Major Dates

• Study Start (Actual): January 5, 2023
• Primary Completion (Actual): January 5, 2023
• Study Completion (Actual): January 5, 2023

Study Registration Dates

• First Submitted: April 29, 2022
• First Submitted That Met QC Criteria: May 2, 2022
• First Posted (Actual): May 3, 2022

Study Record Updates

• Last Update Posted (Estimate): January 10, 2023
• Last Update Submitted That Met QC Criteria: January 8, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Keywords: Magnetic Resonance Imaging; Resting State; Task Based
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Nervous System Diseases; Neurologic Manifestations; Dyskinesias; Attention Deficit and Disruptive Behavior Disorders; Neurodevelopmental Disorders; Disease; Attention Deficit Disorder with Hyperactivity; Hyperkinesis
• Other Study ID Numbers: 10000774; 000774-M

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: .This study will comply with the NIH Data Sharing Policy and Policy on the Dissemination of NIH-Funded Clinical Trial Information and the Clinical Trials Registration and Results Information Submission rule. As such, this trial will be registered at ClinicalTrials.gov, and results information from this trial will be submitted to ClinicalTrials.gov. In addition, every attempt will be made to publish results in peer-reviewed journals.
• IPD Sharing Time Frame: Starting six months after publication and ending five years later
• IPD Sharing Access Criteria: All data will be available that are allowable based on IRB-approved procedures.(SqrRoot)
• IPD Sharing Supporting Information Type: Study Protocol; Statistical Analysis Plan (SAP); Informed Consent Form (ICF); Analytic Code

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No