A Phase 3, Open-label, Multicenter, 12-Month Safety and Tolerability Study of SPD489 in Preschool Children Aged 4-5 Years Diagnosed With Attention-deficit / Hyperactivity Disorder
Phase: PHASE3
Conditions: Attention Deficit Hyperactivity Disorder (ADHD)
Sponsor: Shire

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EMERGENCY CONTACT INFORMATION
In the event of an SAE, the investigator must fax or e-mail the Shire Clinical Trial Serious 
Adverse Event Form within 24 hours to the Shire Pharmacovigilance Department.  Applicable 
fax numbers and e-mail address can be found on the form (sent under separate cover).  A copy of 
the Shire Clinical Trial Serious Adverse Event Form must also be sent to the CRO/Shire medical 
monitor by fax or e-mail using the details below.
Fax:  
E-mail address:  
 (electronic query submission site)
For protocol- or safety-related issues during normal business hours 8AM-5PM eastern 
standard time, the investigator must contact the PPD medical monitor:
Phone:
Fax:  
Mobile:  
 (callers will be transferred to the medical monitor’s cell phone)
For protocol- or safety-related issues outside of normal business hours, the investigator 
must contact the PPD medical monitor:
Phone:  
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PRODUCT QUALITY COMPLAINTS
Investigators are required to report investigational product quality complaints to Shire within 
24 hours. This includes any instances wherein the quality or performance of a Shire product 
(marketed or investigational) does not meet expectations (eg, inadequate or faulty closure, 
product contamination) or that the product did not meet the specifications defined in the 
application for the product (eg, wrong product such that the label and contents are different 
products).  For instructions on reporting AEs related to product complaints, see Section 8.
Please use the information below as applicable to report the Product Quality Complaint:
Origin of Product Quality Complaint
E-mail Address
North and South America
European Union and Rest of World
Telephone numbers (provided for reference if needed):
Shire, Lexington, MA (USA)
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TABLE OF CONTENTS
PROTOCOL SIGNATURE PAGE .................................................................................................2
SUMMARY OF CHANGES FROM PREVIOUS VERSION........................................................3
EMERGENCY CONTACT INFORMATION................................................................................5
PRODUCT QUALITY COMPLAINTS..........................................................................................6
LIST OF TABLES.........................................................................................................................12
LIST OF FIGURES .......................................................................................................................12
ABBREVIATIONS .......................................................................................................................13
STUDY SYNOPSIS ......................................................................................................................15
STUDY SCHEDULE(S) ...............................................................................................................19
1
BACKGROUND INFORMATION.......................................................................................22
1.1
Indication and Current Treatment Options...............................................................22
1.2
Product Background and Clinical Information ........................................................24
1.2.1
Preclinical Information ..............................................................................25
1.2.2
Clinical Information...................................................................................25
2
STUDY OBJECTIVES AND PURPOSE ..............................................................................26
2.1
Rationale for the Study.............................................................................................26
2.2
Study Objectives ......................................................................................................26
2.2.1
Primary Objectives.....................................................................................26
2.2.2
Secondary Objectives.................................................................................27
3
STUDY DESIGN ...................................................................................................................27
3.1
Study Design and Flow Chart ..................................................................................27
3.2
Duration and Study Completion Definition .............................................................28
3.3
Sites and Regions .....................................................................................................28
4
STUDY POPULATION.........................................................................................................28
4.1
Inclusion Criteria......................................................................................................28
4.2
Exclusion Criteria.....................................................................................................29
4.3
Reproductive Potential .............................................................................................30
4.3.1
Female Contraception................................................................................30
4.4
Discontinuation of Subjects .....................................................................................31
4.4.1
Management of Blood Pressure and Pulse During the Study....................31
4.4.1.1
Systolic and Diastolic Blood Pressure.......................................................31
4.4.1.2
Pulse...........................................................................................................32
4.4.2
Reasons for Discontinuation......................................................................32
4.4.3
Subjects ‘Lost to Follow-up’ Prior to Last Scheduled Visit......................32
5
PRIOR AND CONCOMITANT TREATMENT ...................................................................32
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5.1
Prior Treatment ........................................................................................................33
5.2
Concomitant Treatment............................................................................................33
5.2.1
Permitted Treatment...................................................................................33
5.2.2
Prohibited Treatment .................................................................................33
6
INVESTIGATIONAL PRODUCT ........................................................................................34
6.1
Identity of Investigational Product...........................................................................34
6.1.1
Blinding the Treatment Assignment..........................................................34
6.2
Administration of Investigational Product(s)...........................................................34
6.2.1
Interactive Response Technology (IRT) for Investigational Product 
Management...............................................................................................34
6.2.2
Allocation of Subjects to Treatment ..........................................................34
6.2.3
Dosing........................................................................................................35
6.2.4
Unblinding the Treatment Assignment......................................................36
6.3
Labeling, Packaging, Storage, and Handling ...........................................................36
6.3.1
Labeling .....................................................................................................36
6.3.2
Packaging...................................................................................................36
6.3.3
Storage .......................................................................................................36
6.4
Drug Accountability.................................................................................................37
6.5
Subject Compliance..................................................................................................38
7
STUDY PROCEDURES........................................................................................................38
7.1
Study Schedule.........................................................................................................38
7.1.1
Screening and Washout Period..................................................................39
7.1.1.1
Screening Visit (Visit -1)...........................................................................39
7.1.1.2
Washout Telephone Call (Visit Phone Call)..............................................40
7.1.1.3
Visit 0.........................................................................................................41
7.1.2
Treatment Period........................................................................................41
7.1.2.1
Dose-optimization Period (Visits 1 to 6) ...................................................41
7.1.2.2
Dose Maintenance Period (Visits 7 to 18/ET)...........................................42
7.1.2.3
End-of-Study Visit (Visit 18/Early Termination)......................................42
7.1.3
Safety Follow-up Period ............................................................................43
7.1.4
Additional Care of Subjects After the Study .............................................43
7.2
Study Evaluations and Procedures ...........................................................................43
7.2.1
Demographic and Other Baseline Characteristics .....................................43
7.2.2
Screening Assessments ..............................................................................43
7.2.2.1
Kiddie – Schedule for Affective Disorders and Schizophrenia for 
School-age Children – Present and Lifetime Version-Diagnostic 
Interview.................................................................................................44
7.2.2.2
Peabody Picture Vocabulary Test-Fourth Edition.....................................44
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7.2.3
Efficacy......................................................................................................44
7.2.3.1
Attention-deficit/Hyperactivity Disorder Rating Scale – IV Preschool 
Version ...................................................................................................44
7.2.3.2
Clinical Global Impressions.......................................................................45
7.2.4
Safety .........................................................................................................45
7.2.4.1
Medical and Medication History ...............................................................46
7.2.4.2
Physical Examination (Including Height and Weight)..............................46
7.2.4.3
Adverse Event Collection ..........................................................................46
7.2.4.4
Vital Signs..................................................................................................47
7.2.4.5
Height and Weight .....................................................................................47
7.2.4.6
Clinical Laboratory Evaluations ................................................................47
7.2.4.7
Electrocardiogram......................................................................................49
7.2.4.8
Children’s Sleep Habits Questionnaire and Sleep Diary...........................49
7.2.4.9
Columbia-Suicide Severity Rating Scale- Pediatric/Cognitively 
Impaired Version....................................................................................50
7.2.4.10
Suitability of the Subject to Remain in the Study......................................50
7.2.5
Volume of Blood to be Drawn From Each Subject...................................51
8
ADVERSE AND SERIOUS ADVERSE EVENTS ASSESSMENT ....................................51
8.1
Definition of Adverse Events, Period of Observation, Recording of Adverse 
Events.......................................................................................................................51
8.1.1
Severity Categorization..............................................................................52
8.1.2
Relationship Categorization.......................................................................52
8.1.3
Outcome Categorization ............................................................................53
8.1.4
Symptoms of the Disease Under Study .....................................................53
8.1.5
Clinical Laboratory and Other Safety Evaluations....................................53
8.1.6
Abuse, Misuse, Overdose, and Medication Error......................................54
8.2
Serious Adverse Event Procedures ..........................................................................54
8.2.1
Reference Safety Information....................................................................54
8.2.2
Reporting Procedures.................................................................................54
8.2.3
Serious Adverse Event Definition .............................................................55
8.2.4
Serious Adverse Event Collection Time Frame.........................................55
8.2.5
Serious Adverse Event Onset and Resolution Dates .................................56
8.2.6
Fatal Outcome............................................................................................56
8.2.7
Regulatory Agency, Institutional Review Board, Ethics Committee, 
and Site Reporting......................................................................................56
9
DATA MANAGEMENT AND STATISTICAL METHODS...............................................56
9.1
Data Collection.........................................................................................................56
9.2
Clinical Data Management.......................................................................................57
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9.3
Data Handling Considerations..................................................................................57
9.4
Statistical Analysis Process......................................................................................57
9.5
Planned Interim Analysis, Adaptive Design, and Data Monitoring Committee......57
9.6
Sample Size Calculation and Power Considerations................................................57
9.7
Study Population ......................................................................................................58
9.8
Efficacy Analyses.....................................................................................................58
9.8.1
Clinician-administered ADHD-RS-IV Preschool Version........................58
9.8.2
Clinical Global Impressions.......................................................................58
9.8.3
Exploratory Efficacy Endpoints.................................................................59
9.9
Safety Analyses........................................................................................................59
9.10
Other Analyses .........................................................................................................59
10 SPONSOR’S AND INVESTIGATOR’S RESPONSIBILITIES...........................................59
10.1
Sponsor’s Responsibilities .......................................................................................59
10.1.1
Good Clinical Practice Compliance...........................................................59
10.1.2
Public Posting of Study Information..........................................................60
10.1.3
Submission of Summary of Clinical Study Report to Competent 
Authorities of Member States Concerned and Ethics Committees............60
10.1.4
Study Suspension, Termination, and Completion......................................60
10.2
Investigator’s Responsibilities .................................................................................60
10.2.1
Good Clinical Practice Compliance...........................................................60
10.2.2
Protocol Adherence and Investigator Agreement......................................61
10.2.3
Documentation and Retention of Records.................................................61
10.2.3.1
Case Report Forms.....................................................................................61
10.2.3.2
Recording, Access, and Retention of Source Data and Study 
Documents..............................................................................................62
10.2.3.3
Audit/Inspection.........................................................................................62
10.2.3.4
Financial Disclosure...................................................................................62
10.2.4
Compliance to all Local, State, and National Controlled-substance 
Biohazard and Infectious Disease Regulations and Legislation................63
10.3
Ethical Considerations..............................................................................................63
10.3.1
Informed Consent.......................................................................................63
10.3.2
Institutional Review Board or Ethics Committee......................................63
10.4
Privacy and Confidentiality......................................................................................64
10.5
Study Results / Publication Policy ...........................................................................64
11 REFERENCES .......................................................................................................................66
12 APPENDICES ........................................................................................................................69
Appendix 1
Protocol History.........................................................................................70
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Appendix 2
Diagnostic Criteria/Disease Classification ................................................71
Appendix 2.1 DSM-IV-TR Criteria for Attention-  Deficit/Hyperactivity Disorder .......72
Appendix 2.2 Blood Pressure Levels for Boys by Age and Height Percentiles...............74
Appendix 2.3 Blood Pressure Levels for Girls by Age and Height PercentileS ..............75
Appendix 2.4 Boys’ Stature-for-Age and Weight-for-Age Percentiles............................76
Appendix 2.5 Girls’ Stature-For-Age and Weight-For-Age Percentiles..........................77
Appendix 3
Scales and Assessments .............................................................................78
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LIST OF TABLES
Table 1:
Schedule of Assessments...............................................................................19
Table 2:
Common Excluded Treatments and Associated Washout Period–
Relative to Visit 0..........................................................................................33
Table 3:
Volume of Blood to be Drawn From Each Subject.......................................51
LIST OF FIGURES
Figure 1:
Chemical Structure of the Active Pharmaceutical Ingredient .......................24
Figure 2:
Study Design Flow Chart ..............................................................................27
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ABBREVIATIONS
AAP
American Academy of Pediatrics
ADHD
attention-deficit/hyperactivity disorder
ADHD-RS-IV
attention-deficit/hyperactivity disorder rating scale- IV
AE
adverse event
ALP
alkaline phosphatase
ALT
alanine transaminase 
AST
aspartate transaminase
CGI-I
clinical global impressions-global improvement
CGI-S
clinical global impressions-severity of illness
CNS
central nervous system
CRA
clinical research associate
CRF
case report form
CRO
contract research organization
CSHQ
children’s sleep habits questionnaire
C-SSRS
Columbia-suicide severity rating scale
DBP
diastolic blood pressure
DMC
data monitoring committee
DSM-IV
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
EC
ethics committee
ECG
Electrocardiogram
EMA
European Medicines Agency
ET
early termination
EU
European Union
FAS
full analysis set
FDA
Food and Drug Administration
GCP
Good Clinical Practice
GGT
gamma glutamyl transferase
HIPAA
Health Insurance Portability and Accountability Act
IB
Investigator’s Brochure
ICH
International Conference on Harmonisation
ICMJE
International Committee of Medical Journal Editors
IRB
Institutional Review Board
IRT
interactive response technology
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IWRS
interactive web response system
LAR
legally authorized representative
MCH
mean corpuscular hemoglobin
MCHC
mean corpuscular hemoglobin concentration
MCV
mean corpuscular volume
PAPA
preschool age psychiatric assessment
PATS
Preschool ADHD Treatment Study
RBC
red blood cell
SAE
serious adverse event
SAP
statistical analysis plan
SBP
systolic blood pressure
T4
thyroxine
TEAE
treatment-emergent adverse event
TSH
thyroid stimulating hormone
UBC
United BioSource, LLC
UK
United Kingdom
US
United States
WBC
white blood cell
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STUDY SYNOPSIS
Protocol number:  SPD489-348
Drug: Lisdexamfetamine dimesylate
Title of the study:  A Phase 3, Open-label, Multicenter, 12-Month Safety and Tolerability  Study of SPD489 in 
Preschool Children Aged 4-5 Years Diagnosed with Attention-deficit/Hyperactivity Disorder
Number of subjects:
Approximately 100 subjects will be enrolled into this study. Subjects will enroll into this study from antecedent 
study SPD489-211 or SPD489-347, or through direct enrollment. 
The sample size was established to provide long-term safety data in this population.
Investigator(s):  Multicenter
Site(s) and Region(s): 
Approximately up to 60 sites in North America.
Study period (planned):
2014-2019
Clinical phase:
3
Objectives:
Primary:  To evaluate the long-term safety of SPD489 administered as a daily morning dose (5, 10, 15, 20, and 
30 mg/day) in preschool children (4-5 years of age inclusive) diagnosed with Attention-deficit/Hyperactivity 
Disorder (ADHD).
The evaluation of safety and tolerability will be based on the occurrence of treatment-emergent adverse events 
(TEAEs), specific evaluation of blood pressure, pulse, weight, height, clinical laboratory evaluations, 
electrocardiogram (ECG) results, and sleep assessments.
Secondary: 
1.
To describe the long-term efficacy of SPD489 using the clinician administered Attention-
deficit/Hyperactivity Disorder Rating Scale-IV Preschool Version (ADHD-RS-IV Preschool Version).
2.
To describe the long-term efficacy of SPD489 using global clinical measures of improvement, as measured 
by the Clinical Global Impressions – Global Improvement (CGI-I).
Rationale:
The purpose of the study is to evaluate the long-term safety of SPD489 in preschool children who are diagnosed 
with ADHD. Based on IMS Health data and discussion at the Food and Drug Administration (FDA) Pediatric 
Advisory Committee in September 2012, it has been noted that there is off-label use of SPD489 in children 
under 5 years old (4%, or approximately 100 000 patients between February 2007 and March 2012).  The lack 
of controlled data regarding the safety and efficacy of SPD489 in the preschool ADHD population, along with 
the prevalence of off-label prescribing of SPD489 supports the need for SPD489 studies in the preschool ADHD 
population.  Importantly, it is not known if the therapeutic effects of stimulant medications in school age 
children with ADHD can be extrapolated to preschool children with ADHD.  There are some indications that the 
effect size may be reduced (Greenhill 2006).  There may also be differences in the safety and pharmacokinetic 
profiles (Wigal 2007; Wigal 2006).
Generating long-term safety data in this population will provide important information on the use of SPD489 in 
the preschool ADHD population.
Investigational product, dose, and mode of administration:
The sponsor will provide SPD489 as 5, 10, 15, 20, and 30 mg strength capsules.
All subjects will be instructed to take 1 capsule daily throughout the study at approximately 7:00AM (±2 hours). 
SPD489 will be administered in one of the following ways: 

swallow SPD489 capsules whole, or

open capsules, empty and mix the entire contents either with yogurt, water, or orange juice.
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The contents should be mixed until completely dispersed. The subject must ingest the entire amount of the 
mixture immediately within 3 minutes. The subject should not take anything less than one capsule per day and a 
single capsule cannot be split. The empty gelatinous capsule should be discarded. 
Methodology:
This study is a Phase 3 long-term, open-label, safety and tolerability study in preschool children (4-5 years 
of age inclusive at the time of consent) from antecedent study or direct enrollment with 
Attention-deficit/Hyperactivity Disorder (ADHD).
The study will have 4 periods: (1) Screening and Washout; (2) Dose-optimization; (3) Dose Maintenance; and 
(4) Safety Follow-up.
The duration of the evaluation phase (Dose-optimization and Maintenance) will be 52 weeks. 
SPD489 will be provided in 5, 10, 15, 20, and 30 mg capsules.
Subjects may be required to visit the site up to 20 times over a 57-week period.
Inclusion and exclusion criteria
Inclusion Criteria:
The subject will not be considered eligible for the study without meeting all of the criteria below (including test 
results).
1.
Subject is male or female aged 4-5 years inclusive at the time of consent from antecedent studies 
SPD489-211 or SPD489-347 or at the time of consent if directly enrolled.
2.
Before completing any study-related procedures, subject’s parent(s) or legally authorized representative 
(LAR) must provide signature of informed consent, and there must be documentation of assent (if 
applicable) by the subject in accordance with the International Conference on Harmonisation (ICH) GCP 
Guideline E6 (1996) and any updates or revisions, and applicable federal or local regulations.
3.
Subject and parent(s)/LAR are willing and able to comply with all of the testing and requirements defined 
in the protocol, including oversight of morning dosing.  Specifically, the parent/LAR should be available at 
approximately 7:00AM (+2 hours) to dispense the dose of investigational product for the duration of the 
study.
4.
Roll-over subjects from antecedent SPD489-347study: 
a.
Subject completed the antecedent SPD489-347 study 
5.
Direct enrolled subjects must meet antecedent study inclusion criteria, as listed below:
a.
Subject must meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition – Text 
Revision (DSM-IV-TR) criteria for a primary diagnosis of ADHD (any subtype) based on a detailed 
psychiatric evaluation conducted by a sponsor-approved clinician
b.
Subject has an ADHD-RS-IV Preschool Version total score at the Baseline Visit (Visit 0) of ≥28 for 
boys and ≥24 for girls. 
c.
Subject has a Clinical Global Impressions – Severity of Illness (CGI-S) score 4 at the Baseline Visit 
(Visit 0). 
d.
Subject has a Peabody Picture Vocabulary Test, Fourth Edition standard score of 70 at the Screening 
Visit (Visit -1). 
e.
Subject has undergone an adequate course of non-pharmacological treatment OR the subject has a 
severe enough condition to consider enrollment without undergoing prior non-pharmacological 
treatment, based on investigator judgment.
f.
Subject has, in the opinion of the investigator, participated in a structured group activity (eg, preschool, 
sports, Sunday school) so as to assess symptoms and impairment in a setting outside the home.
g.
Subject has lived with the same parent(s) or guardian for ≥6 months.
Exclusion Criteria:
Subjects are excluded from the study if any of the following exclusion criteria are met:
1.
Subject was terminated from any antecedent SPD489 study for non-compliance and/or experienced a 
serious adverse event (SAE) or AE resulting in termination.
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2.
Subject is required to or anticipates the need to take prohibited medications or medications that have central 
nervous system effects or have an effect on performance, such as, but not limited to, sedating antihistamines 
and decongestant sympathomimetics, or other monoamine oxidase inhibitors.  Stable use of bronchodilator 
inhalers is not exclusionary.
3.
Subject has a concurrent chronic or acute illness (such as, but not limited to, severe allergic rhinitis or an 
infectious process requiring antibiotics), disability, or other condition that might confound the results of 
safety assessments conducted in the study or that might increase risk to the subject.  Similarly, the subject 
will be excluded if he or she has any additional condition(s) that, in the investigator’s opinion, would 
prohibit the subject from completing the study or would not be in the best interest of the subject.  The 
additional condition(s) would include any significant illness or unstable medical condition that could lead to 
difficulty complying with the protocol.  Mild, stable asthma is not exclusionary.
4.
Subject has a documented allergy, hypersensitivity, or intolerance to amphetamine or to any excipients in 
the investigational product.
5.
Subject has a known family history of sudden cardiac death or ventricular arrhythmia.
6.
Subject has a blood pressure measurement 95th percentile for age, sex, and height at the Screening Visit 
(Visit -1) or the Baseline Visit (Visit 0) or a history of moderate or severe hypertension. 
7.
Subject has a known history of symptomatic cardiovascular disease, unexplained syncope, exertional chest 
pain, advanced arteriosclerosis, structural cardiac abnormality, cardiomyopathy, serious heart rhythm 
abnormalities, coronary artery disease, or other serious cardiac problems placing them at increased 
vulnerability to the sympathomimetic effects of a stimulant drug.
8.
Subject is taking any medication that is excluded per the protocol.
9.
Subject had any clinically significant electrocardiogram (ECG) or clinical laboratory abnormalities at the 
Screening Visit (Visit -1) or the Baseline Visit (Visit 0), based on investigator judgement.
10. Subject has a history of hyperthyroidism, or current abnormal thyroid function, defined as abnormal thyroid 
stimulating hormone (TSH) and thyroxine (T4) at the Screening Visit (Visit -1) or the Baseline Visit 
(Visit 0).  Treatment with a stable dose of thyroid medication for at least 3 months is permitted. 
11. Subject has taken another investigational product or has taken part in a clinical study within 30 days prior to 
the Screening Visit (Visit -1).
12. Subject is well-controlled on his/her current ADHD medication with acceptable tolerability.
13. Subject has glaucoma.
14. Subject has failed to fully respond, based on investigator judgment, to an adequate course of amphetamine 
therapy.
15. Subject has a current, controlled (requiring medication or therapy) or uncontrolled, co-morbid psychiatric 
disorder including but not limited to any of the below co-morbid Axis I disorders and Axis II disorders:
a.
post-traumatic stress disorder (PTSD) or adjustment disorder
b.
bipolar illness, psychosis, or family history of these disorders
c.
pervasive developmental disorder
d.
obsessive-compulsive disorder (OCD) 
e.
psychosis/schizophrenia
f.
a serious tic disorder, or a family history of Tourette’s disorder
g.
subject is currently considered a suicide risk in the opinion of the investigator, has previously made a 
suicide attempt, or has a prior history of, or is currently demonstrating active suicidal ideation. 
h.
a history of physical, sexual, or emotional abuse
i.
any other disorder or agitated state that in the opinion of the investigator, contraindicates SPD489 or 
lisdexamfetamine dimesylate treatment or confound efficacy or safety assessments.
16. Subject has initiated behavioral therapy within 1 month of the baseline visit (Visit 0).  Subject may not 
initiate behavioral therapy during the study.
17. Subject has a height 5th percentile for age and sex at the screening visit (Visit -1).
18. Subject has a weight 5th percentile for age and sex at the screening visit (Visit -1).
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19. Subject lives with anyone who currently abuses stimulants or cocaine.
20. Subject has a history of seizures (other than infantile febrile seizures).
Maximum duration of subject involvement in the study:

Planned duration of screening period: 28 days

Planned duration of treatment period: 52 week period

Planned duration of safety follow-up period: 7 days
Endpoints and statistical analysis:
Subject Populations

The Screened Set will consist of all subjects who have signed informed consent. 

The Enrolled Set will consist of all subjects who have been dispensed SPD489 at the Baseline Visit 
(Visit 0). Screen failures will not be considered enrolled subjects and will not be included in the 
Enrolled Set.

The Safety Analysis Set will consist of all subjects who have taken at least 1 dose of investigational 
product.

The Full Analysis Set (FAS) will consist of all subjects in the Safety Analysis Set who have at least 
1 post-dose ADHD-RS-IV Preschool Version Total Score assessment during the study.
Safety Endpoints
Safety assessments include the occurrence of treatment emergent adverse events (TEAEs), specific evaluation of 
blood pressure, pulse, height, weight, clinical laboratory evaluations and electrocardiogram (ECG) results, and 
sleep assessments [(including sleep diary data, and Children’s Sleep Habits Questionnaire (CSHQ)].
Additional safety rating scales utilized in the study will include:
Columbia Suicide Rating Scale (C-SSRS)- Pediatric/Cognitively Impaired Version 
Efficacy Endpoint(s)
The efficacy endpoint is defined as the change from baseline on the clinician-administered ADHD-RS-IV 
Preschool Version Total Score, where subjects that rolled over from an antecedent study, baseline is defined as 
the baseline from the antecedent study, and for subjects that directly enrolled into SPD489-348, baseline is 
defined as baseline of the SPD489-348 study.
The additional efficacy endpoint is the Clinical Global Impression-Improvement Scale (CGI-I): Moreover, the 
CGI-I will be used to determine the proportion of subjects with an “improved” measurement. The CGI-I 
categories of “very much improved” and “much improved” will be classified as “improved” and all other 
assessed categories are grouped together as “not improved”. 
Statistical Methodology for Safety Endpoint(s)
Safety analyses will be summarized using the Safety Analysis Set, and presented by treatment group of the 
antecedent studies, direct-enrolled group and overall for AEs, clinical laboratory results, vital signs, ECGs, 
CSHQ, and sleep diaries.  A listing of the C-SSRS will be provided for subjects with any positive responses.
Statistical Methodology for Efficacy Endpoint(s)
The FAS will be used to report the efficacy data. Descriptive summary statistics will be presented by treatment 
group of the antecedent studies, direct-enrolled group and overall for the observed efficacy variables. Change 
from baseline in total score for the ADHD-RS-IV Preschool Version Total Score at each on-therapy treatment 
visit will be summarized.
Descriptive summary statistics will be presented by treatment group of the antecedent studies, directly enrolled 
group, and overall at each on-treatment visit for CGI-I measurements. Additionally, the number and proportion 
of subjects with an “improved” measurement in CGI-I will be reported at each on-treatment post-dose visit. 
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1
BACKGROUND INFORMATION
Lisdexamfetamine dimesylate capsules (SPD489, previously referred to as NRP104) were 
developed for the once-daily treatment of ADHD.
SPD489 capsules contain 5, 10, 15, 20, or 30 mg of lisdexamfetamine dimesylate, a new 
chemical entity designed for once-daily oral administration. Lisdexamfetamine itself is a 
pharmacologically inactive prodrug. After ingestion it is converted to l-lysine (a naturally 
occurring essential amino acid) and dextroamphetamine (d-amphetamine, responsible for 
pharmacological activity) primarily in the blood.
Amphetamine is a chiral compound that exists as 2 stereoisomers: dextro (d)- and 
levo (l)-amphetamine. Lisdexamfetamine is the l-lysine conjugate of the dextro stereoisomer.  
After oral administration, lisdexamfetamine is rapidly absorbed from the gastrointestinal tract 
and converted primarily in the blood to l-lysine (a naturally occurring amino acid) and 
d-amphetamine, which is responsible for the drug’s pharmacological activity.
Lisdexamfetamine is classified as a psychomotor stimulant.  
Amphetamine appears to exert its pharmacological effects in the CNS by increasing the 
availability of naturally occurring amines that have important functions in nerve terminals. 
Amphetamine increases synaptic levels of dopamine (DA), norepinephrine (NE), and serotonin 
(5-HT) through multiple mechanisms (Hardman et al., 2001). It promotes the release of DA, NE, 
and 5-HT into the extraneuronal space, and also inhibits the reuptake of DA and NE into the 
pre-synaptic nerve terminal resulting in prolonged residency of these neurotransmitters in the 
synaptic cleft. In addition to producing a CNS response, amphetamine treatment is also 
associated with cardiovascular effects such as an increase in SBP and DBP, and pulse. 
Amphetamine may also suppress the appetite.
In addition to the approved indication of ADHD, other indications have been explored.
Additional information can be found in the current IB for SPD489.
1.1
Indication and Current Treatment Options 
Attention-deficit/hyperactivity disorder is a heterogeneous neurobehavioral disorder 
characterized by a pattern of developmentally inappropriate inattentiveness, impulsivity, and 
hyperactivity resulting in clinically significant impairment in social, academic, or occupational 
functioning. Although ADHD was originally thought to be a disorder primarily affecting 
elementary school age children, it is now recognized that ADHD may persist across a lifetime, 
and that ADHD symptoms may manifest several years prior to entry into elementary school. 
While there are hundreds of studies investigating the treatment of ADHD in school-age children, 
there are very few studies exploring the treatment of ADHD in preschoolers.  Although 
diagnosing ADHD in a preschool child can be challenging, reliable diagnostic tools and 
age-appropriate assessments are available, and it is therefore possible to conduct scientifically 
rigorous ADHD studies in this population.  It would be beneficial to provide additional 
evidence-based support for ADHD treatment decisions in the preschool population.  
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Estimates of the prevalence of ADHD in the preschool population vary depending on the 
referral source and the method used to diagnose ADHD; however, it appears that approximately 
4-5% of preschool children are considered to have ADHD.  Using the Preschool-age 
Psychiatric Assessment, an assessment validated for use in the preschool population, the 
prevalence of ADHD in a sample of 1,073 children aged 2-5 years was reported to be 3.9-5.1% 
(Egger et al., 2006a; Egger et al., 2006b; Egger and Angold, 2004; Greenhill et al., 2008).  In 
2007, the National Survey of Children’s Health obtained information from parents of 
73,123 children aged 4-17 years (Centers for Disease Control and Prevention, 2010).  Parents 
reported a current diagnosis of ADHD in 5.5% of 4-10 year olds (Centers for Disease Control 
and Prevention, 2010).  Some reports utilizing a clinic-based sampling frame (versus a 
community based - sampling frame) report the prevalence in males aged 4-11 is roughly 3 times 
greater than in females (Szatmari et al., 1989).  There is acknowledgment, however, that males 
present with more disruptive symptoms and are referred for treatment earlier and more often than 
girls (Hinshaw, 2002), so clinic samples are not likely to represent an accurate reflection of the 
gender distribution of ADHD.
Genetic studies indicate that ADHD has high heritability rates (Faraone and Biederman, 1998; 
Tannock, 1998) with an autosomal rather than sex-linked inheritance pattern (Wallis et al., 2008; 
Thapar, 2002) supporting the gender-based prevalence ratios of 1:1 in the community which is 
consistent with the reported 1:1 male:female prevalence of ADHD in adults.  
Attention-deficit/hyperactivity disorder is characterized by symptoms of inattention, 
hyperactivity, and impulsivity that are “maladaptive and inconsistent with developmental level” 
(DSM-IV).   Preschool children, ages 3-5 years, often exhibit symptoms of hyperactivity and 
impulsivity, so it may be challenging to delineate what is “inconsistent with developmental 
level” for this population (Smith and Corkum, 2007).  Nevertheless, it is possible to diagnose 
ADHD in the preschool population in a reliable fashion (Egger et al., 2006a; Egger et al., 2006b;
McGoey et al., 2007).
The presence of ADHD symptoms that are frequent, severe, and developmentally inappropriate, 
can be used to define ADHD in this population (Connor, 2002; Smith and Corkum, 2007).  In 
addition, impairment in 2 or more settings establishes that the constellation of ADHD symptoms 
is maladaptive and not confined to a specific environment.  The severity of ADHD symptoms in 
a preschool child can be reliably measured using scales such as the PAPA and the ADHD-RS-IV 
Preschool Version that have been validated for this population and include age-appropriate 
questions and prompts (Egger et al., 2006a; McGoey et al., 2007).  
It is appropriate to consider whether an ADHD diagnosis in a preschool child will endure or 
resolve as the child matures.  ADHD has been described in terms of a developmental trajectory 
that can be modified by biologic or environmental factors (Sonuga-Barke and Halperin, 2010;
Sonuga-Barke et al., 2005).  Potential risk factors such as severity of ADHD symptoms, the 
presence of oppositional defiant symptoms, and neuropsychological impairment may affect the 
course of ADHD (Sonuga-Barke and Halperin, 2010).  Although some children may not retain 
the ADHD diagnosis as they grow older, for many children the diagnosis endures beyond their 
preschool years (Lahey et al., 2004; Tandon et al., 2011).  In a sample of 96 children aged 
4-6 years with ADHD, 79% of the children continued to have an ADHD diagnosis 3 years later 
as compared to 3% of the non-ADHD control children (Lahey et al., 2004).  
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This finding was replicated in a sample of 48 children aged 4-6 years with ADHD who were 
followed for 2 years (Tandon et al., 2011).  These results suggest that when an ADHD diagnosis 
is first made in a preschool child, it is likely to be stable over time. 
The constellation of impairments associated with an ADHD diagnosis in preschool children 
suggests a characteristic profile similar to that for individuals diagnosed after the preschool 
period.  Preschool children with ADHD demonstrate impairments in social functioning and 
pre-academic skills (DuPaul et al., 2001; Ghuman et al., 2008).  They are also more likely to be 
aggressive towards others and to sustain an injury (Greenhill et al., 2008; Rappley et al., 1999;
Connor et al., 2003).  In a longitudinal study which followed children from aged 4-21 years, the 
attention span at age 4 years predicted math and reading skills at age 21 years and completion of 
college at age 25 years (McClelland et al., 2013).
Currently, the lack of a robust body of evidence derived from controlled clinical studies in 
preschool children makes it difficult to create reliable treatment recommendations. The 
AAP ADHD Clinical Practice guideline suggests that preschool children with ADHD 
initiate treatment with behavioral therapy prior to using pharmacotherapy (Subcommittee on 
ADHD et al., 2011); however the PATS results indicates that 13% of preschool children have a 
satisfactory response to behavioral therapy (Greenhill et al., 2006). If the preschool child with 
ADHD does not respond to behavioral therapy, the guideline then suggests the use of 
methylphenidate. Of note, methylphenidate does not have an indication for a population less than 
6 years old (Subcommittee on ADHD et al., 2011). Immediate-release Adderall 
(dextroamphetamine saccharate, amphetamine aspartate, dextroamphetamine sulfate, and 
amphetamine sulfate) and dextroamphetamine are approved for children with ADHD as young as 
3 years old. As a result, if a preschool child does not respond to methylphenidate, a trial of an 
amphetamine product is recommended by the AAP. However, the lack of data for amphetamines
in preschool children with ADHD is acknowledged. Clearly, the implementation of additional 
studies in preschool children with ADHD would provide additional evidence in order to inform 
treatment decisions. 
1.2
Product Background and Clinical Information
The active pharmaceutical ingredient of SPD489 is (2S)-2, 6-diamino-N-[(1S)-1-methyl-
2-phenylethyl] hexanamide dimethanesulfonate.
Figure 1 shows the chemical structure of the active pharmaceutical ingredient: 
Figure 1:
Chemical Structure of the Active Pharmaceutical Ingredient
H
N
NH2
O
CH3
NH2
H3C S OH
O
O
2
·
Always refer to the latest version of the SPD489 investigator’s brochure for the overall 
risk/benefit assessment and the most accurate and current information regarding the drug 
metabolism, pharmacokinetics, efficacy and safety of SPD489. 
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1.2.1
Preclinical Information
Lisdexamfetamine is a pharmacologically inactive prodrug. After ingestion, it is converted in the 
blood to d-amphetamine (responsible for pharmacological activity) and l-lysine (a naturally 
occurring essential amino acid).  A comprehensive set of studies has been conducted to evaluate 
the pharmacological and toxicological properties associated with the parent compound 
lisdexamfetamine.  The safety profiles associated with d-amphetamine and l-lysine are well 
established.
All safety and toxicology studies, except the single dose acute toxicity study in rats, were 
conducted in compliance with Good Laboratory Practice.
Complete preclinical information is presented in the current SPD489 IB.
1.2.2
Clinical Information
The pharmacological profile of lisdexamfetamine and the pharmacologically active metabolite 
d-amphetamine have been well characterized in studies enrolling children, healthy adults, and 
adults with a history of stimulant abuse. These studies have demonstrated that oral administration 
of SPD489 resulted in a predictable d-amphetamine pharmacokinetic profile with low 
intra-subject and inter-subject variability. The d-amphetamine AUC0-∞ and Cmax generally 
behaved in a linear, dose-proportional manner. The weight-normalized d-amphetamine AUC0-∞ is 
similar for children and adults, with tmax and t½ consistent across age groups.
In the ADHD Clinical Development Program, the efficacy of SPD489 for the treatment of 
ADHD has been demonstrated for children, adolescents, and adults with ADHD. Substantial 
evidence of efficacy was provided in well-controlled studies, where SPD489 was shown to be 
effective compared to placebo. SPD489 was associated with a statistically significant, clinically 
meaningful improvement in ADHD symptoms, functional outcomes, and health-related quality 
of life compared to placebo, in studies that used a variety of study designs, a variety of validated 
assessments, and a variety of raters.
The well-characterized SPD489 safety profile was consistent with that of other stimulants used 
in the treatment of ADHD. When the safety results from the 35 completed Phase 2-4 clinical 
studies in the ADHD Clinical Development Program were examined, the majority of TEAEs 
were mild or moderate in severity, and no differences due to age or sex were noted. The most 
frequently reported AEs were those typically associated with stimulant therapy (including 
decreased appetite, insomnia, headache, dry mouth, irritability, upper abdominal pain, and 
weight decrease), or potentially attributable to intercurrent illnesses (eg, upper respiratory tract 
infection and nasopharyngitis). These TEAEs were generally non-serious and were considered 
by the investigator to have resolved during study participation.
Stimulant medications like SPD489 cause a modest increase in average blood pressure 
(approximately 2-4 mmHg) and average pulse (approximately 3-6 bpm). Individuals may have 
larger increases.
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Always refer to the latest version of the SPD489 IB for the overall risk/benefit assessment and 
the most accurate and current information regarding the drug metabolism, pharmacokinetics, 
efficacy and safety of SPD489.
2
STUDY OBJECTIVES AND PURPOSE
2.1
Rationale for the Study
Based on IMS Health data and discussion at the FDA Pediatric Advisory Committee in 
September 2012, it has been noted that there is off-label use of SPD489 in children under 5 years 
old (4%, or approximately 100,000 patients between February 2007 and March 2012). The lack 
of controlled data regarding the safety and efficacy of SPD489 in the preschool ADHD 
population, along with the prevalence of off-label prescribing of SPD489 supports the need for 
SPD489 studies in the preschool ADHD population. Importantly, it is not known if the 
therapeutic effects of stimulant medications in school age children with ADHD can be 
extrapolated to preschool children with ADHD. There are some indications that the effect size 
may be reduced (Greenhill et al., 2006). There may also be differences in the safety and 
pharmacokinetic profiles (Wigal et al., 2007; Wigal et al., 2006).
However, recent data from Shire SPD489-211 study preschool aged children with ADHD 
suggests the safety and tolerability profile of SHP489 is similar to that observed in trials with 
children 6 to 12 years old, adolescents and adults. The efficacy results of the SPD489- 211 study, 
were also comparable to older subjects and revealed a mean decrease from baseline of -26.1 
(95% CI: -32.2, -20.0) in the ADHD-RS-IV Preschool Version total score, suggesting a robust 
similar improvement in ADHD symptoms. 
In summary given the abundance of information regarding the safety and efficacy of 
amphetamines; the very well-established PK profile of SPD489; the similar efficacy and safety 
findings between populations with ADHD covering the age span from 6 to 55 years; and the PK, 
safety, and efficacy data from Study SPD489-211 in preschoolers (aged 4-5 years) with ADHD, 
it is expected that findings from previous trials in older age groups can be extrapolated to 
preschool patients with ADHD.
Generating long-term safety data in this population will provide important information on the use 
of SPD489 in the preschool ADHD population.
2.2
Study Objectives
2.2.1
Primary Objectives
The primary objective of this study is to evaluate the long-term safety of SPD489 administered 
as a daily morning dose (5, 10, 15, 20, and 30 mg/day) in preschool children (4-5 years of age 
inclusive) diagnosed with ADHD.
The evaluation of safety and tolerability will be based on the occurrence of TEAEs, specific 
evaluation of blood pressure, pulse, weight, height, clinical laboratory evaluations and ECG 
results, and sleep assessments.
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3.2
Duration and Study Completion Definition
The duration of the evaluation phase (Dose Screening & Washout, Dose Optimization, Dose 
Maintenance, and Safety Follow-up) will be 57 weeks. The subject’s maximum duration of 
participation is expected to be approximately 399 days.  
The Study Completion Date is defined as the date the final subject, across all sites, completes 
their final protocol-defined assessment. Please note that this includes the follow-up visit or 
contact, whichever is later. The Study Completion Date is used to ascertain timing for study 
results posting and reporting.
3.3
Sites and Regions
This study will be conducted in up to 60 sites in North America.
4
STUDY POPULATION
Each subject/parent or LAR must participate in the informed consent process and provide written 
informed consent and/or assent, as per IRB/EC requirements before any procedures specified in 
the protocol are performed.
4.1
Inclusion Criteria
The subject will not be considered eligible for the study without meeting all of the criteria below 
(including test results):
1. Subject is male or female aged 4-5 years inclusive at the time of consent from antecedent 
studies SPD489-211 or SPD489-347 or at the time of consent if directly enrolled. 
2. Before completing any study-related procedures, subject’s parent(s) or LAR must provide 
signature of informed consent, and there must be documentation of assent (if applicable) by 
the subject indicating that the subject is aware of the investigational nature of the study. The 
subject’s parent(s) or LAR should understand that the required procedures and restrictions 
are being conducted in accordance with the International Council of Harmonisation (ICH) 
Good Clinical Practice (GCP) Guideline E6 (1996), any updates or revisions, and applicable 
federal or local regulations.
3. Subject and parent(s)/LAR are willing and able to comply with all of the testing and 
requirements defined in the protocol, including oversight of morning dosing.  Specifically, 
the parent/LAR should be available at approximately 7:00AM (+2 hours) to dispense the 
dose of investigational product for the duration of the study.
4. Roll-over subject from antecedent SPD489-347 study:
a.
Subject completed the antecedent study (SPD489-347)
5. Direct enrolled subjects must meet antecedent study inclusion criteria, as listed below
a.
Subject must meet DSM-IV-TR criteria for a primary diagnosis of ADHD (any subtype) 
based on a detailed psychiatric evaluation conducted by a sponsor-approved clinician
b. Subject has an ADHD-RS-IV Preschool Version total score at the Baseline Visit (Visit 0) 
of 28 for boys and 24 for girls.  
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c.
Subject has a Clinical Global Impressions – Severity of Illness (CGI-S) score 4 at the 
Baseline Visit (Visit 0). 
d. Subject has a Peabody Picture Vocabulary Test, Fourth Edition standard score of 70 at 
the Screening Visit (Visit -1). 
e.
Subject has undergone an adequate course of non-pharmacological treatment based on 
investigator judgment OR the subject has a severe enough condition to consider 
enrollment without undergoing prior non-pharmacological treatment, based on 
investigator judgment.  
f.
Subject has, in the opinion of the investigator, participated in a structured group activity 
(eg, preschool, sports, Sunday school) so as to assess symptoms and impairment in a 
setting outside the home.
g. Subject has lived with the same parent(s) or guardian for 6 months.
4.2
Exclusion Criteria
Subjects are excluded from the study if any of the following exclusion criteria are met:
1. Subject was terminated from an antecedent SPD489 study for non-compliance and/or 
experienced a serious adverse event (SAE) or AE resulting in termination.
2.
Subject is required to or anticipates the need to take medications that have central nervous 
system effects or affect performance, such as, but not limited to, sedating antihistamines and 
decongestant sympathomimetics, or monoamine oxidase inhibitors.  Stable use of 
bronchodilator inhalers is not exclusionary.
3.
Subject has a concurrent chronic or acute illness (such as, but not limited to, severe allergic 
rhinitis or an infectious process requiring antibiotics), disability, or other condition that might 
confound the results of safety assessments conducted in the study or that might increase risk 
to the subject.  Similarly, the subject will be excluded if he or she has any additional 
condition(s) that, in the investigator’s opinion, would prohibit the subject from completing 
the study or would not be in the best interest of the subject.  The additional condition(s) 
would include any significant illness or unstable medical condition that could lead to 
difficulty complying with the protocol.  Mild, stable asthma is not exclusionary.
4. Subject has a documented allergy, hypersensitivity, or intolerance to amphetamine or to any 
excipients in the investigational product.
5. Subject has a known family history of sudden cardiac death or ventricular arrhythmia.
6. Subject has a blood pressure measurement 95th percentile for age, sex, and height at Visit 0 
or a history of moderate or severe hypertension. 
7. Subject has a known history of symptomatic cardiovascular disease, unexplained syncope, 
exertional chest pain, advanced arteriosclerosis, structural cardiac abnormality, 
cardiomyopathy, serious heart rhythm abnormalities, coronary artery disease, or other serious 
cardiac problems placing them at increased vulnerability to the sympathomimetic effects of a 
stimulant drug.
8. Subject is taking any medication that is excluded per the protocol.
9. Subject had any clinically significant electrocardiogram (ECG) or clinical laboratory 
abnormalities at the Screening Visit (Visit -1).
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10. Subject has a history of hyperthyroidism, or current abnormal thyroid function, defined as 
abnormal thyroid stimulating hormone (TSH) and thyroxine (T4) at the Screening Visit 
(Visit -1) or Visit 0.  Treatment with a stable dose of thyroid medication for at least 3 months 
is permitted. 
11. Subject has taken another investigational product or has taken part in a clinical study within 
30 days prior to the Screening Visit (Visit -1).
12. Subject is well-controlled on his/her current ADHD medication with acceptable tolerability.
13. Subject has glaucoma.
14. Subject has failed to fully respond, based on investigator judgment, to an adequate course of 
amphetamine therapy.
15. Subject has a current, controlled (requiring medication or therapy) or uncontrolled, 
co-morbid psychiatric disorder including but not limited to any of the below co-morbid 
Axis I disorders and Axis II disorders:
a.
post-traumatic stress disorder (PTSD) or adjustment disorder
b. bipolar illness, psychosis, or family history of these disorders
c.
pervasive developmental disorder
d. obsessive-compulsive disorder (OCD) 
e.
psychosis/schizophrenia
f.
subject has a history of seizures (other than infantile febrile seizures) or a current 
diagnosis of Tourette’s disorder, or a chronic or current tic disorder that is judged by the 
investigator to be exclusionary 
g. subject is currently considered a suicide risk in the opinion of the investigator, has 
previously made a suicide attempt, or has a prior history of, or is currently demonstrating 
active suicidal ideation. Subjects with intermittent passive suicidal ideation are not 
necessarily excluded based on the assessment of the investigator 
h. a history of physical, sexual, or emotional abuse
i.
any other disorder or agitated state that in the opinion of the investigator, contraindicates 
SPD489 or lisdexamfetamine dimesylate treatment or confound efficacy or safety 
assessments.
16. Subject has initiated behavioral therapy within 1 month of the baseline visit (Visit 0).  
Subject may not initiate behavioral therapy during the study.
17. Subject has a height 5th percentile for age and sex at the screening visit (Visit -1).
18. Subject has a weight 5th percentile for age and sex at the screening visit (Visit -1).
19. Subject lives with anyone who currently abuses stimulants or cocaine.
20. Subject has a history of seizures (other than infantile febrile seizures).
4.3
Reproductive Potential
4.3.1
Female Contraception
Contraception is not applicable as no female subjects in this study are of child bearing potential. 
All female subjects in this study are pre-menarchal, less than age 9 years, and Tanner Stage 1.
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4.4
Discontinuation of Subjects
A subject may withdraw from the study at any time for any reason without prejudice to their 
future medical care by the physician or at the institution. The investigator or sponsor may 
withdraw the subject at any time (eg, in the interest of subject safety). The investigator is 
encouraged to discuss withdrawal of a subject from investigational product with the medical 
monitor when possible.
If investigational product is discontinued, regardless of the reason, the evaluations listed for the 
Safety/Follow-up visit are to be performed as completely as possible.  Whenever possible, all 
discontinued subjects should also undergo the protocol-specified follow-up.  Comments 
(spontaneous or elicited) or complaints made by the subject must be recorded in the source 
documents.  The reason for termination, date of stopping investigational product, and the total 
amount of investigational product taken must be recorded in the CRF and source documents.
4.4.1
Management of Blood Pressure and Pulse During the Study
Potential blood pressure and pulse increases must be further evaluated if they meet any of the 
criteria defined in Section 4.4.1.1 and Section 4.4.1.2. 
4.4.1.1
Systolic and Diastolic Blood Pressure
Blood pressure criteria for further evaluation have been developed based on the normative data 
presented in the National Institutes for Health Fourth Report on the Diagnosis, Evaluation, and 
Treatment of High Blood Pressure in Children and Adolescents (NIH, 2004). 
Increases in blood pressure (both systolic and diastolic) from the 50th to the 95th percentile 
(representative of a change of 2 standard deviations) range from 17-20 mmHg for both boys and 
girls in this age range.  Based on this range, an increase of >15mmHg from Visit 0 was selected 
for this protocol.
Prior to obtaining vital signs (blood pressure and pulse) the subject should be at rest for at least 
5 minutes.  
If any subject’s blood pressure measurements meet either criterion below, the investigator will 
notify the medical monitor.  If any subject’s blood pressure measurements meet either criterion 
below on 3 consecutive visits, the subject should be considered for a dose reduction or potential 
discontinuation based upon the clinical judgment of the investigator and in conjunction with the 
medical monitor. If the dose has been previously decreased, or if the subject is already at the 
lowest dose, then the subject should be discontinued from the study. 
1. Elevations in the average (of 3 readings) sitting systolic blood pressure defined as an increase 
of >15 mmHg from the baseline visit (Visit 0) OR a value >95th percentile for age, sex, and 
height 
2. Elevations in average (of 3 readings) sitting diastolic blood pressure defined as an increase of 
>15 mmHg from the baseline visit (Visit 0) OR a value >95th percentile for age, sex, and 
height 
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4.4.1.2
Pulse
The resting pulse rate criterion for further evaluation has been defined based on the normative 
data presented in the National Health Statistics Report’s “Resting Pulse Rate Reference Data for 
Children, Adolescents, and Adults: United States, 1999-2008”(Ostchega et al., 2011).
Any subject that has a resting, sitting pulse rate >126 bpm (based on the average of 3 readings) 
and or is symptomatic requires further assessment. In this case an unscheduled visit needs to be 
conducted within 1 business day. At the unscheduled visit, if the subject’s pulse rate remains 
>126 bpm (based on the average of 3 readings) or if the subject is symptomatic then the subject’s 
investigator will discuss the findings with the medical monitor. A joint decision between the 
investigator and the medical monitor will be made regarding dose reduction and continued 
participation in the study. If the dose has been previously decreased, or if the subject is already at 
the lowest dose, then the subject will be discontinued from the study. If a visit cannot be 
scheduled the next day, the subject may be discontinued from the study. 
4.4.2
Reasons for Discontinuation
The reason for withdrawal must be determined by the investigator and recorded in the subject’s 
medical record and on the CRF.  If a subject is withdrawn for more than 1 reason, each reason 
should be documented in the source document and the most clinically relevant reason should be 
entered on the CRF.
Reasons for discontinuation include but are not limited to:

Adverse event

Protocol violation

Withdrawal by subject or parent/LAR

Lost to follow-up

Lack of efficacy

Blood pressure and/or pulse criteria met

Other (must be specified).  
4.4.3
Subjects ‘Lost to Follow-up’ Prior to Last Scheduled Visit
A minimum of 3 documented attempts must be made to contact the parent(s) or LAR of any 
subject lost to follow-up at any time point prior to the last scheduled contact (office visit or 
telephone contact).  At least 1 of these documented attempts must include a written 
communication sent to the subject’s last known address via courier or mail (with an 
acknowledgement of receipt request) asking that they return to the site for final safety 
evaluations and return any unused investigational product.
5
PRIOR AND CONCOMITANT TREATMENT
All non-study treatment (including but not limited to herbal treatments, vitamins, behavioral 
treatment, non-pharmacological treatment, such as psychotherapy) received since the subject’s 
last visit in the antecedent study and through the final study contact (including protocol-defined 
follow-up period) must be recorded on the appropriate CRF page. 
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Table 2: Common Excluded Treatments and Associated Washout Period– Relative to 
Visit 0
Minimum Number of Days Before Visit 0
Treatment
7
14
30
Antihistamines (centrally and peripherally-active)
X
Herbal preparations (including melatonin)
X
Investigational compounds (other than the investigational 
compound received during participation in 1 of the respective 
antecedent SPD489 studies).
X
Sedatives, anxiolytics, antipsychotics a
X
Monoamine oxidase inhibitor (MAOIs) a
X
Antidepressants a
X
Clonidine and guanfacine
X
Selective noradrenaline reuptake inhibitors and noradrenaline 
reuptake inhibitors a
X
a These medications may signal that an exclusionary diagnosis is present. The medical monitor should be consulted prior to 
instructing a subject to discontinue one of these medications for this study.
6
INVESTIGATIONAL PRODUCT
6.1
Identity of Investigational Product
The test product is SPD489, which will be provided in 5, 10, 15, 20, and 30 mg capsules. 
Additional information is provided in the current SPD489 IB.
6.1.1
Blinding the Treatment Assignment
Not applicable.
6.2
Administration of Investigational Product(s)
6.2.1
Interactive Response Technology (IRT) for Investigational Product 
Management
An IRT will be employed in this study to manage the tracking and confirmation of shipments, 
supply, inventory, ordering, expiration, site assignments, and dosing of the investigational 
products.
The IRT provider will provide a user manual and training to each site, with detailed instruction 
on the use of the IRT.
6.2.2
Allocation of Subjects to Treatment 
All subjects will receive open-label SPD489 during this study. 
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Subject numbers are assigned to all subjects as they consent to take part in the antecedent study 
or this study if directly enrolled.  Within each site (numbered uniquely within a protocol), the 
subject number is assigned to subjects according to the sequence of presentation for the 
antecedent study participation. 
6.2.3
Dosing
Dosing should begin at approximately 7:00AM (±2 hours) on the morning after Visit 0.  Subjects 
will be instructed to take 1 capsule daily in the morning throughout the study, at approximately 
the same time each day. The same parent/LAR should be available daily to dispense the dose of 
investigational product for the study duration. 
SPD489 will be administered one of the following ways: 

swallow SPD489 capsule whole, or

open capsule, empty and mix the entire contents with either yogurt, water, or orange juice. 
The contents should be mixed until completely dispersed. The subject must ingest the entire 
amount of mixture immediately within 3 minutes. The subject should not take anything less than 
one capsule per day and a single capsule cannot be split. The empty gelatinous capsule should be 
discarded. 
All subjects will begin dosing at 5 mg of SPD489 and should be titrated in a stepwise fashion 
until an optimal dose is reached.  
The objective of dose optimization during the first 6 weeks is to ensure that subjects are titrated 
to an optimal dose of study drug based on TEAEs and clinical criteria.
The investigator will categorize subject response into 1 of the 3 conditions, along with the 
associated actions, below.  Dose optimization should continue during the first 4 weeks until an 
“acceptable response” is achieved.

Intolerable response (ie, subject experiences intolerable side effects): This response 
suggests tapering the subject to a lower dose of investigational product (if available). 
However, if this lower dose also produces an intolerable effect, the subject should be 
discontinued from the study.

Ineffective response (ie, subject has not achieved at least a 30% reduction in ADHD-RS-IV 
Preschool Version Total Score from Baseline (Visit 0) of the antecedent study and a CGI-I 
score of 1 or 2): This response suggests titrating the subject to the next available dose of 
investigational product (if available, provided there are no tolerability issues).

Acceptable response (ie, subject has achieved at least a 30% reduction in ADHD-RS-IV 
Preschool Version Total Score from Baseline (Visit 0) of the antecedent study and a CGI-I 
score of 1 or 2 with tolerable side effects): This response suggests that an optimal dose has 
been achieved and the subject should maintain this dose for the remainder of the study.
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6.2.4
Unblinding the Treatment Assignment
Not applicable.
6.3
Labeling, Packaging, Storage, and Handling
6.3.1
Labeling
Labels containing study information and pack identification are applied to the investigational 
product(s) container. 
All investigational product is labeled with a minimum of the protocol number, medication 
identification number (if applicable), dosage form (including product name and quantity in 
pack), directions for use, storage conditions, expiry date (if applicable), batch number and/or 
packaging reference, the statements ‘For clinical trial use only’, and/or ‘CAUTION: New 
Drug - Limited by Federal (or US) Law to Investigational Use’, ‘Keep out of reach of children’, 
and the sponsor's name and address. Any additional labeling requirements for participating 
countries and/or controlled substances will also be included on the label.
Space is allocated on the label so that the site representative can record a unique subject 
identifier and initials. 
6.3.2
Packaging
Investigational product is packaged in the following labeled containers:
SPD489 capsules are packaged in 10-count and 35-count high density polyethylene bottles with 
child-resistant closures.  
Changes to sponsor-supplied packaging prior to dosing may not occur without full agreement in 
advance by the sponsor.
6.3.3
Storage
The investigator has overall responsibility for ensuring that investigational product is stored in a 
secure, limited-access location.  Limited responsibility may be delegated to the pharmacy or 
member of the study team, but this delegation must be documented.  Investigational products are 
distributed by the pharmacy or nominated member of the study team. The pharmacist/nominated 
team member will enter the unique subject identifier and initials on the investigational product 
bottle/carton labels as they are distributed.
Investigational product must be stored in accordance with labeled storage conditions.  
Temperature monitoring is required at the storage location to ensure that the investigational 
product is maintained within an established temperature range.  The investigator is responsible 
for ensuring that the temperature is monitored throughout the duration of the study and that 
records are maintained; the temperature should be monitored continuously by using either an 
in-house system, a mechanical recording device such as a calibrated chart recorder, or by manual 
means, such that both minimum and maximum thermometric values over a specific time period 
can be recorded and retrieved as required.  
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Such a device (ie, certified min/max thermometer) would require manual resetting upon each 
recording.  The sponsor must be notified immediately upon discovery of any excursion from the 
established range.  Temperature excursions will require site investigation as to cause and 
remediation.  The sponsor will determine the ultimate impact of excursions on the investigational 
product and will provide supportive documentation as necessary.  Under no circumstances 
should the product be dispensed to subjects until the impact has been determined and the product 
is deemed appropriate for use by the sponsor.
The sponsor should be notified immediately if there are any changes to the storage area of the 
investigational product that could affect the integrity of the product(s), eg, fumigation of a 
storage room.
All controlled-substance investigational product for the sponsor’s studies must be stored in a 
securely locked, substantially constructed room or cabinet according to all applicable local, state, 
and/or national laws.  Limited, controlled access to these investigational products must be 
maintained, as well as chain of custody, for all investigational product movement.
6.4
Drug Accountability
Investigators will be provided with sufficient amounts of the investigational product to carry out 
this protocol for the agreed number of subjects.  The investigator or designee will acknowledge 
receipt of the investigational product, documenting shipment content and condition.  Accurate 
records of all investigational product dispensed, used, returned, and/or destroyed must be 
maintained as detailed further in this section.
The investigator has overall responsibility for administering/dispensing investigational product.  
Where permissible, tasks may be delegated to a qualified designee (eg, a pharmacist) who is 
adequately trained in the protocol and who works under the direct supervision of the investigator.  
This delegation must be documented in the applicable study delegation of authority form.
The investigator or his/her designee (as documented by the investigator in the applicable study 
delegation of authority form) will dispense the investigational product only to subjects included 
in this study following the procedures set out in the study protocol.  Each subject will be given 
only the investigational product carrying his/her treatment assignment.  All dispensed medication
will be documented on the CRFs and/or other investigational product record. The investigator is 
responsible for assuring the retrieval of all study supplies from subjects.  
No investigational product stock or returned inventory from a Shire-sponsored study may be 
removed from the site where originally shipped without prior knowledge and consent by the 
sponsor.  If such transfer is authorized by the sponsor, all applicable local, state, and national 
laws must be adhered to for the transfer.
The sponsor or its representatives must be permitted access to review the supplies storage and 
distribution procedures and records.
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At the end of the study, or as instructed by the sponsor, all unused stock, subject-returned 
investigational product, and empty/used investigational product packaging are to be sent to a 
nominated contractor on behalf of the sponsor.  Investigational products being returned to the 
sponsor’s designated contractors must be counted and verified by clinical site personnel and the 
sponsor (or designated CRO).  For unused supplies where the original supplied tamper-evident 
feature is verified as intact, the tamper-evident feature must not be broken and the labeled 
amount is to be documented in lieu of counting.  Shipment return forms, when used, must be 
signed prior to shipment from the site.  Validated electronic return systems (i.e., IRT) do not 
require a shipment form.  Returned investigational products must be packed in a tamper-evident 
manner to ensure product integrity.  Contact the sponsor for authorization to return any 
investigational product prior to shipment.  Shipment of all returned investigational product must 
comply with local, state, and national laws.
Based on entries in the site drug accountability forms, it must be possible to reconcile 
investigational products delivered with those used and returned.  All investigational products 
must be accounted for and all discrepancies investigated and documented to the sponsor’s 
satisfaction.
6.5
Subject Compliance
All investigational product provided to pediatric subjects should be supervised by the 
parent(s)/legally-authorized representative/caregiver.
Subjects’ parent(s)/LAR must be instructed to bring their child’s unused investigational product 
and empty/used investigational product packaging to every visit.  Drug accountability must be 
assessed at the container/packaging level for unused investigational product that is contained 
within the original tamper-evident sealed container (eg, bottles, trays, vials) or at the individual 
count level for opened containers/packaging.  The pharmacist/delegated person will record 
details on the drug accountability form. 
Subjects who have taken 80-100% of the investigational product are regarded as being compliant 
with the study protocol.  Compliance must be assessed by the investigator.
The calculation of medication compliance is as follows: 
Protocol
by
Prescribed
Capsules
100
Taken
Capsules
Total
Compliance


When performing the calculation of medication compliance for investigational product, the total 
capsules taken must also include number of capsules not returned by the subject to the site.
7
STUDY PROCEDURES
7.1
Study Schedule
The Schedule of Assessments (Table 1) details all procedures to be completed at each visit and 
should serve as the primary section of the protocol regarding visit-specific study procedures.
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Clinician-completed rating scales and assessments conducted by the site ie, ADHD-RS-IV 
Preschool Version, CGI-S, CGI-I, CSHQ and Columbia Suicide Rating Scale (C-SSRS)
Pediatric/Cognitively Impaired Version must be completed by the same rater whenever possible.
Throughout the Dose-Optimization Period of the study, visits should be scheduled as outlined 
(days), and throughout the Dose-Maintenance Period of the study, visits should be scheduled 
as outlined (5 days) with reference to Visit 0. The Follow-up Telephone Call should be 
scheduled 7 days post-last dose with a +3 day visit window.
Subjects will be required to visit the site up to 20 times over a 57-week period.
Additional unscheduled visits and/or assessments may occur as needed for safety 
(eg, unscheduled visits for blood pressure and/or pulse measurements will be conducted as 
described in Section 4.4.1) 
7.1.1
Screening and Washout Period
The principal investigator or his/her designee must obtain written informed consent from the 
subject’s parent(s)/LAR prior to any study-related procedures conducted during the Screening 
Visit (Visit -1). There must also be documentation of assent (if required by IRB), indicating that 
the subject is aware of the investigational nature of the study and the required procedures and 
restrictions, prior to the performance of any study-related procedures.
A washout period may be required to discontinue any prohibited medication (see Table 2).  A 
subject cannot be instructed to wash out any medication for this study until after informed 
consent is obtained.
Screening assessments may take place across multiple days to allow enough time to complete all 
procedures and confirm initial study eligibility. Screening procedures and dates should be well 
documented in the source documents and CRF. The screening date is the date the parent(s)/LAR 
and/or subject has signed informed consent for this study. A screen failure is a subject who has 
given informed consent and failed to meet any of the inclusion and/or met at least 1 of the 
exclusion criteria and has not been administered investigational product.
For screen failure subjects, the investigator or assigned site staff designee will access the IWRS 
to record the subject as a screen failure. 
Subjects cannot be rescreened once they have been designated as a screen failure. Reassessment 
of subjects who failed specific inclusion/exclusion criteria is not allowed.
7.1.1.1
Screening Visit (Visit -1) 
Subjects will be screened at Visit -1 to establish eligibility for study participation. For roll-over 
subjects, the EOS visit in the antecedent SPD489-347 study will serve as the Screening visit for 
SPD489-348.
Some screening assessments (vital signs, height, weight, clinical laboratory tests, and ECGs) 
must be repeated prior to Baseline if more than 30 days have elapsed since collection.
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Table 1 details all procedures to be completed at the Screening Visit (Visit -1). Additional 
clarification on the procedures performed during the Screening Visit (Visit -1) is provided 
below:

All AEs occurring after signature of informed consent must be recorded in the source 
documents and CRF. Any AE ongoing at the time of the End of Study Visit from the 
antecedent study must be recorded on the CRF for this study. 

For roll-over subjects, document any new findings on the Medical History CRF with enough 
detail to permit detection of change over time.

Twelve-lead ECG will be performed after approximately 5 minutes of rest.  The investigator 
will perform the initial interpretation of the ECG immediately after collection to ensure the 
safety of each subject.  The ECG tracing will be sent to the central reader for analysis.  Upon 
review of the report from the central reader, the investigator will re-evaluate the clinical 
significance of the ECG in light of other safety data for the subject.  If abnormal and 
significant results are observed following assessment by the central reader, the investigator, 
in consultation with the appointed CRO medical monitor, will confirm the subject’s 
eligibility to participate in this study.

After 5 minutes of rest, blood pressure and pulse will be collected 3 times (with 
approximately 2 minutes in between each collection) during the visit.  The average of each 
set of 3 measurements will be used to determine continued participation in the study (see 
Section 4.4.1).

The “Lifetime Recent” version of the C-SSRS will be administered at the Screening Visit 
(Visit -1) for direct-enrolled subjects.  The “Since Last Visit” version will be administered at 
the Screening Visit (Visit -1) for roll-over subjects.  Record historical/concomitant 
medications as follows:

All lifetime psychoactive medications and lifetime non-pharmacological interventions 
(behavioral therapy) for ADHD

Other medications used during the 30 days prior to the Screening Visit (Visit -1). 
7.1.1.2
Washout Telephone Call (Visit Phone Call) 
The Washout Period should be initiated after clinical laboratory test results and 12-lead ECG 
results have been received and reviewed by the investigator.  For roll-over subjects, the 
follow-up call for the antecedent SPD489-347 study will serve as the wash-out call for the 
SPD489-348 study.  Eligible subjects will be contacted by a member of the site staff and 
provided with instructions on discontinuing any protocol-prohibited medications.  During 
washout, a subject’s current prohibited medications (if applicable) will be discontinued for a 
period of a minimum of 5 times the half-life of the medication.  Washout periods for prohibited 
medications are defined in Table 2.
As part of the Washout Telephone Call, site personnel should perform the following procedures:

Schedule Visit 0

Review the inclusion/exclusion criteria
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
Ask about any concomitant medications that the subject is taking.  If any concomitant 
medications that require washout are noted, instructions for appropriate washout should be 
provided

Determine if any AEs have occurred since the Screening Visit (Visit -1).
If a medication washout is not necessary, the Washout Telephone Call will include all the above 
procedures except providing instructions on discontinuing any current medications.
7.1.1.3
Visit 0
The Baseline visit should be initiated after clinical laboratory test results and 12-lead ECG 
results have been received and reviewed by the investigator.  For subjects with more than 
30 days since the safety measurements at the Screening Visit (Visit -1) were collected, an 
abbreviated physical examination, clinical laboratory tests and 12-lead ECG must be repeated, 
and the results reviewed by the investigator prior to the subject being enrolled.
Inclusion/exclusion criteria must be reviewed during this visit to ensure subjects continue to 
meet all eligibility criteria.
Table 1 outlines all procedures to be conducted during Visit 0 with further clarification provided 
below:

After 5 minutes of rest, blood pressure and pulse will be collected 3 times (with 
approximately 2 minutes in between each collection) during the visit.  The average of each 
set of 3 measurements will be used to determine continued participation in the study (see 
Section 4.4.1). 

For eligible subjects, the investigator or assigned study center staff designee will access the 
IRT to enroll the subject and obtain an investigational medicinal product bottle number to 
dispense to the subject.  Subjects will be dispensed a bottle of investigational product to 
cover them until their next regularly scheduled visit.  Subjects will be instructed to take 
1 capsule each day.  Dosing will begin the morning following Visit 0.

The C-SSRS “Since Last Visit” Version should be completed.
7.1.2
Treatment Period 
7.1.2.1
Dose-optimization Period (Visits 1 to 6) 
During the first 6 weeks of treatment, visits will be scheduled every 7 days (±3 days) to assess 
safety, efficacy, and tolerability and to allow investigators to titrate subjects to their optimal dose 
of SPD489 based on TEAEs and the dosing guidelines in Section 6.2.3. 
If the optimal dose is well tolerated and, in the opinion of the investigator, the subject would 
potentially receive additional symptom reduction, the subject may be titrated to the next allowed 
dose.
Throughout the Dose-optimization Period, subjects may attend the clinic for unscheduled visits 
to address any medical needs that arise between scheduled visits.
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See Table 1 for procedures that are completed at Visits 1 to 6.  Further clarification for these 
visits is outlined below:

At each visit during the Dose-optimization Period, subjects must return any empty or unused 
bottles to permit drug accountability and compliance to be assessed.

Subjects will be dispensed a 10-count bottle of investigational product to cover them until 
their next regularly scheduled visit.  Subjects will be instructed to take 1 capsule each day.  
Dosing will begin the morning following each visit.

After 5 minutes of rest, blood pressure and pulse will be collected 3 times (with 
approximately 2 minutes in between each collection) during the visit.  The average of each 
set of 3 measurements will be used to determine continued participation in the study (see 
Section 4.4.1).

Scales should be completed by the same rater whenever possible.

The sleep diary is to be completed by the same parent/LAR, whenever possible.

The C-SSRS “Since Last Visit” Version of the Pediatric/Cognitively Impaired Version 
should be completed during the Optimization Period.
7.1.2.2
Dose Maintenance Period (Visits 7 to 18/ET) 
Following titration to an optimal dose of SPD489, subjects will continue daily morning treatment 
for an additional 48 weeks. Subjects will attend the clinic every 4 weeks for procedures to be 
performed. 
Throughout the Maintenance Period, subjects may attend the clinic for unscheduled visits to 
address any medical needs that arise between scheduled visits.
Table 1 outlines the procedures to be completed at each visit during the Maintenance Period.  
Additional clarification on the procedures to be performed during the Maintenance Period is 
provided below:

Scales are to be completed by the same rater whenever possible

At each visit during the Maintenance Period, subjects must return any empty or unused 
bottles to permit drug accountability and compliance to be assessed.

Subjects will be dispensed a 35-count bottle of investigational product to cover them until 
their next regularly scheduled visit.  Subjects will be instructed to take 1 capsule each day.  
Dosing will begin the morning following each visit

After 5 minutes of rest, blood pressure and pulse will be collected 3 times (with 
approximately 2 minutes in between each collection) during the visit.  The average of each 
set of 3 measurements will be used to determine continued participation in the study (see 
Section 4.4.1).
7.1.2.3
End-of-Study Visit (Visit 18/Early Termination) 
All subjects who complete the study or discontinue early will complete the End-of-Study Visit.
Table 1 lists the procedures to be completed at Visit 18/ET and should serve as the primary point 
of reference regarding visit-specific study procedures.
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Further clarification on the procedures performed during the End-of-Study Visit is provided 
below:
Unused investigational product and empty containers will be collected to calculate medication
compliance.
Blood pressure and pulse will be collected 3 times (with approximately 2 minutes in between 
each collection) during the visit.  The average of each set of 3 measurements will be used to 
determine if additional follow-up is needed (see Section 4.4.1).
7.1.3
Safety Follow-up Period 
The follow-up period for this protocol is 7 days +3 days from the last dose of investigational 
product.
At the end of this period there will be a telephone call initiated by the site to query for any SAE 
follow-up SAEs, AEs, and concomitant treatments.  All AEs and SAEs that are not resolved at 
the time of this contact will be followed to closure (see Section 8.1).
7.1.4
Additional Care of Subjects After the Study
There is no planned care for subjects after this study. The investigator will discuss the available 
ADHD treatment options for subjects. 
7.2
Study Evaluations and Procedures
The individual indicated in each scale description will perform all assessments listed below.  
Assessments are to be performed according to the schedule shown in Table 1.
Care must be taken by the site personnel or the investigator to fully explain the scale prior to 
completion.
If the subject terminates treatment early, all assessments listed in Table 1 for Visit 13/ET or 
Visit 18/ET and the Follow-up Telephone Call should be completed.
Whenever possible, raters (including parent/LAR and the investigator or site designee) observing 
the subject’s behavior, should be consistent from visit to visit throughout the study.
7.2.1
Demographic and Other Baseline Characteristics
Demographic characteristics such as age, sex, weight, height, and BMI will be collected 
throughout the study according to Table 1.
7.2.2
Screening Assessments
Direct-enrolled subjects only.
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7.2.2.1
Kiddie – Schedule for Affective Disorders and Schizophrenia for 
School-age Children – Present and Lifetime Version-Diagnostic Interview
The sponsor-approved clinician at the site who is trained and experienced in the evaluation of 
4- to 5-year-old children with ADHD, will determine a diagnosis of ADHD based on a 
psychiatric interview and mental status examination utilizing the K-SADS-PL using the 
DSM-IV-TR criteria for ADHD.
The K-SADS-PL is a semistructured diagnostic interview designed to assess current and past 
episodes of psychopathology in children and adolescents according to Diagnostic and Statistical 
Manual of Mental Disorders, Third Edition-Revised and DSM-IV-TR criteria. Probes and 
objective criteria are provided to rate individual symptoms. The primary diagnoses assessed with 
the K-SADS-PL include, but are not limited to: major depression, dysthymia, mania, bipolar 
disorders, schizoaffective disorders, panic disorder, agoraphobia, separation anxiety disorder, 
avoidant disorder of childhood and adolescence, simple phobia, social phobia, overanxious 
disorder, generalized anxiety, obsessive compulsive disorder, ADHD, conduct disorder, and 
oppositional defiant disorder.
The K-SADS-PL is administered by interviewing the parent(s)/LAR(s), the subject, and finally 
achieving summary ratings, which include all sources of information (parent/LAR, child, school, 
chart, and other). 
The K-SADS-PL will be administered by an individual experienced with the scale and qualified 
to establish a diagnosis. The site should maintain documentation of the K-SADS-PL training in 
the site’s files. All individuals performing this assessment must be pre-approved by the sponsor 
or delegated vendor. Based on the above criteria, suitable K-SADS-PL administrators may 
include physicians, nurse practitioners, or licensed psychologists.
7.2.2.2
Peabody Picture Vocabulary Test-Fourth Edition
The Peabody Picture Vocabulary Test measures an individual’s receptive (hearing) vocabulary 
for Standard American English and provides a quick estimate of verbal ability or scholastic 
aptitude (Dunn and Dunn, 1997). For purposes of this study, the Peabody Picture Vocabulary 
Test, Fourth Edition, will be used as a proxy for general cognitive ability. 
The Peabody Picture Vocabulary Test should be administered by site personnel with training and 
experience in general psychological testing. All individuals performing this assessment must be 
pre-approved by the sponsor or delegated vendor.
7.2.3
Efficacy
7.2.3.1
Attention-deficit/Hyperactivity Disorder Rating Scale – IV Preschool 
Version
The ADHD-RS-IV Preschool Version (McGoey et al., 2007), the secondary efficacy measure, is 
completed by the Sponsor approved clinician at the site and will be administered at Visit 1 and 
each subsequent visit up to and including the End of Study Visit  to capture the ADHD 
symptoms within each study period.  The ADHD-RS-IV Preschool Version was adapted from 
the ADHD Rating Scale-IV (DuPaul et al., 1998) and provides examples appropriate for the 
developmental level of preschool children.  
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The ADHD-RS-IV Preschool Version is an 18-item questionnaire that requires the respondent to 
rate the frequency of occurrence of ADHD symptoms as defined by DSM-IV-TR criteria.  Each 
item is scored on a 4-point scale ranging from 0 (never or rarely) to 3 (very often) with total 
scores ranging from 0-54.  The 18 items may be grouped into 2 subscales: 
hyperactivity/impulsivity (even numbered items 2-18) and inattentiveness (odd numbered 
items 1-17).
The ADHD-RS-IV Preschool Version will be completed by a clinician trained and experienced 
in the evaluation of preschool children with ADHD.  Since the ADHD-RS-IV Preschool Version 
is used to guide dosing decisions, if it is not completed by the principal investigator or 
subinvestigator who is medically/clinically responsible for the subject, it must be reviewed and 
signed by them. All individuals performing this assessment must be pre-approved by the Sponsor 
or delegated vendor.
The title, version, and date of the ADHD-RS-IV Preschool Version used in this study are 
included in Table 1.
7.2.3.2
Clinical Global Impressions
The CGI Scale (Guy, 1976) permits a global evaluation of the subject’s severity and 
improvement over time.  CGI has been used extensively in clinical studies of ADHD (Michelson 
et al., 2001; Weiss et al., 2005; Wilens et al., 2001).
The investigator will perform the CGI-S to rate the severity of a subject’s condition on a 7-point 
scale ranging from 1 (normal, not at all ill) to 7 (among the most extremely ill subjects) at Visit 0 
of the antecedent study or at Visit 0 of this study for directly enrolled subjects.  The investigator 
should establish 3 target areas of improvement with the subjects and the subject’s parent(s)/LAR.  
To generate the targets, an open-ended question such as “If this program of treatment works for 
your child, what things do you hope he/she will be doing better?” should be asked.  Ratings will 
be completed with respect to ADHD symptoms.
At each visit from Visit 1 up to and including Visit 18/ET the investigator will assess the 
subject’s improvement relative to the 3 target areas of improvement recorded at Visit 0 of the 
antecedent study or Visit 0 of this study for directly enrolled subjects, on the CGI-I, a 7-point 
scale ranging from 1 (very much improved) to 7 (very much worse).
The CGI-S and the CGI-I should be completed by a clinician trained and experienced in the 
evaluation of preschool children with ADHD.  Since the CGI-I is used to guide dosing decisions, 
if it is not completed by the principal investigator or sub investigator who is medically/clinically 
responsible for the subject, it must be reviewed and signed by them. All individuals performing 
this assessment must be pre-approved by the Sponsor or delegated vendor.
The title, version, and date of the CGI-S and CGI-I used in this study are included in Table 1.
7.2.4
Safety
The name and address of each third party vendor (eg, clinical laboratory) used in this study will 
be maintained in the investigator’s and sponsor’s files.
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7.2.4.1
Medical and Medication History
Any new medical history, ie, medical conditions, which arose after the recording of the medical 
history in the antecedent study should be recorded at Visit 0 for roll-over subjects.
7.2.4.2
Physical Examination (Including Height and Weight)
A full physical examination will be performed at the Screening Visit (Visit -1).  Additionally, an 
abbreviated physical examination is required prior to Visit 0 if more than 30 days have elapsed 
since the physical examination was completed as part of the Screening Visit (Visit -1) was 
performed.
A physical examination will be performed by a qualified, licensed individual (eg, physician, 
physician assistant or a nurse practitioner).
A full physical examination is composed of a review of the following body systems:

General appearance

Skin

Head, Eyes, Ears, Nose, and Throat

Spine/Neck/Thyroid

Respiratory

Cardiovascular

Abdomen (including liver and kidneys)

Musculoskeletal

Neurological.
If an abbreviated physical examination is required prior to Visit 0, a review of the body systems 
will include the following:

General Appearance

Respiratory

Cardiovascular.
Abnormalities identified at the Screening Visit (Visit -1) will be documented as AEs.  Changes 
after the Screening Visit (Visit -1) will be captured as AEs on the AE CRF page, as deemed by 
the investigator.
7.2.4.3
Adverse Event Collection
At each study visit, subjects will be questioned in a general way to ascertain if AEs have 
occurred since the previous visit (eg, “Have you had any health problems since your last visit?”).  
Adverse events are collected from the time informed consent is signed. Any AE ongoing from 
the antecedent study must be entered. Any AE ongoing from the antecedent study must be 
recorded on the CRF for this study. (Please refer to Section 8, Adverse and Serious Adverse 
Events Assessment.)
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7.2.4.4
Vital Signs
Measurements of oral or tympanic temperature and sitting respiratory rate will be performed at 
the Screening Visit (Visit -1). Measurements of sitting systolic and diastolic blood pressure and 
pulse will be performed at each visit to the site. Blood pressure, pulse, and respiratory rate will 
be determined after subjects have remained seated for a minimum of 5 minutes.
Blood pressure will be determined by manual cuff (the same equipment and the same arm should 
be used throughout the study). A blood pressure cuff appropriate for the subject’s arm length 
and girth should be used for all blood pressure measurements.  The cuff should be approximately 
two-thirds the length/width of the subject’s arm (from elbow to shoulder).  All blood pressure 
measurements should be performed throughout the study using a manual cuff and should be 
performed by the same study center personnel (if possible) throughout the study.  Three 
measurements should be obtained using the manual cuff while sitting and the subject has been at 
rest for a minimum of 5 minutes, with approximately 2 minutes in between each collection for 
blood pressure and pulse and report the average of the 3 measurements for each parameter.  The 
3 individual measurements and the averaged reading should be recorded in the source and CRF.
Any clinically significant deviations from Baseline (Visit 0) vital signs which are deemed 
clinically significant in the opinion of the investigator are to be recorded as an AE.
7.2.4.5
Height and Weight
Height will be captured at each visit for all subjects. A calibrated stadiometer must be used for 
all height measurements.  Height should be measured in inches or centimeters without shoes with 
the subject standing on a flat surface and with chin parallel to the floor. The body should be 
straight but not rigid.
Weight will be captured at each visit to the site. The same calibrated scale must be used for all 
weight measurements. Weight should be measured in pounds or kilograms without shoes.
7.2.4.6
Clinical Laboratory Evaluations
All clinical laboratory assays will be performed according to the laboratory’s normal procedures.  
Reference ranges are to be supplied by the laboratory and will be used to assess the clinical 
laboratory data for clinical significance and out-of-range pathological changes.  The investigator 
should assess out-of-range clinical laboratory values for clinical significance, indicating if the 
value(s) is/are not clinically significant or clinically significant.  Abnormal clinical laboratory 
values, which are unexpected or not explained by the subject’s clinical condition, may, at the 
discretion of the investigator or sponsor, be repeated as soon as possible until confirmed, 
explained, or resolved.
Clinical laboratory assessments will be performed at the Screening Visit (Visit -1), Visit 9, 
Visit 16, and Visit 18/ET.  Additionally, clinical laboratory tests are required to be repeated prior 
to Visit 0 with results reviewed before enrolling the subject in the study if more than 30 days 
have elapsed since the clinical laboratory assessments completed as part of the Screening Visit 
(Visit -1) were performed.
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Subjects will have the option for laboratory assessments to be collected by a home health care 
nurse, managed by United Biosource, LLC (UBC) at their residence. 
The following clinical laboratory assessments will be performed: 
Biochemistry and Endocrinology
A blood sample (~5mL) for biochemistry will be taken to assess the following parameters:
Total Cholesterol
Calcium
AST
Uric Acid
Phosphorus
Blood Urea Nitrogen
ALT
Total Bilirubin
Sodium
Creatinine
ALP
Glucose
Potassium
Albumin
GGT
Total Protein
TSH
Lactate Dehydrogenase
Free T4
Hematology
A blood sample (~4mL) for hematology will be taken to assess the following parameters:
Hemoglobin
Neutrophils
Hematocrit
Lymphocytes
RBC
Monocytes
Platelet count
Eosinophils
WBC count – total and differential 
Basophils
MCH
Bands
MCHC
MCV
Urinalysis
A urine sample (~10mL) for urinalysis will be collected to assess the following parameters:
Glucose
pH
Specific Gravity
Urobilinogen
Blood
Color
Ketones
Leukocyte Esterase
Protein
Nitrate
Bilirubin
If urinalysis detects protein and/or blood, a microscopic examination will be conducted.  The 
microscopic examination will consist of RBC, WBC, casts, and bacteria.
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7.2.4.7
Electrocardiogram
A 12-lead ECG will be performed at the Screening Visit (Visit -1), Visit 0, Visit 1-6, and Visit 8, 
Visit 11, Visit 14, Visit 17, and Visit 18/ET. Additionally, a 12-lead ECG is required to be 
repeated prior to Visit 0 with results reviewed before enrolling the subject in the study if more 
than 30 days have elapsed since the 12-lead ECG completed as part of the Screening Visit 
(Visit -1) was performed. Additional ECGs may be performed during the study at the 
investigator’s discretion.
The mean interval values of the 3 ECGs is used to establish the subject’s baseline intervals. All 
ECGs will be performed after 5 minutes of rest using the central ECG provider’s equipment and 
will be sent to the central ECG provider electronically.
The initial interpretation of the ECG, normal or abnormal and clinical significance, will be 
performed immediately after collection by the investigator.  The ECG tracing will then be 
evaluated by a cardiologist at the central ECG reading vendor (Cardiocore) for analysis and 
returned to the site with a determination of normal or abnormal.  Upon review of the report from 
Cardiocore, the investigator will reevaluate the clinical significance of the ECG while taking into 
consideration all other safety data available for the subject.
Although a central ECG reader is being used for this study, the eligibility of the subject is based 
on the investigator’s assessment of the ECG.  If abnormal and significant results are observed 
following assessment by the central reader, the investigator, in consultation with the appointed 
CRO medical monitor, reconfirms subject eligibility to continue.
All ECGs must be transmitted to the central ECG reader and all ECGs will be analyzed.  If the 
central ECG reader receives multiple ECGs, the first readable ECGs will be analyzed as the 
scheduled ECG. Every ECG transmitted to the central ECG reader will have corresponding CRF 
data collected. No ECG should be deleted by study site personnel. All ECGs must be transmitted 
to the central provider regardless of quality, results, or number of ECGs taken at a respective 
visit.
7.2.4.8
Children’s Sleep Habits Questionnaire and Sleep Diary 
The CSHQ is designed to screen for the most common sleep problems in children, and consists 
of 33 items for scoring and several extra items intended to provide administrators with other 
potentially useful information about respondents. The instrument evaluates the child’s sleep 
based on behavior within 8 different subscales: bedtime resistance, sleep-onset delay, sleep 
duration, sleep anxiety, night wakings, parasomnias, sleep-disordered breathing, and daytime 
sleepiness. The CSHQ will be completed at every visit to the site and will be completed by the 
subject’s parent/LAR. 
The subject’s parent/LAR will complete a sleep diary to log daytime napping, bedtime and wake 
time.
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7.2.4.9
Columbia-Suicide Severity Rating Scale- Pediatric/Cognitively Impaired 
Version
The C-SSRS (Posner, 2007) is a semi-structured interview that captures the occurrence, severity, 
and frequency of suicide-related thoughts and behaviors during the assessment period.  The 
interview includes definitions and suggested questions to solicit the type of information needed 
to determine if a suicide-related thought or behavior occurred.
The C-SSRS contains 2 required items pertaining to suicidal ideation, 4 required items pertaining 
to suicidal behavior, and 1 required item pertaining to non-suicidal self-injurious behavior.  
There are 8 additional suicidal ideation items and 2 additional suicidal behavior items which are 
completed in cases of positive responses for other items, as well as 2 items for completed suicide 
and suicide behavior present during the interview.  Thus, there is a maximum of 19 items to be 
completed.
The C-SSRS must be performed by an individual who is trained and certified and is preapproved 
by the sponsor or delegated vendor and the site investigator. 
The Pediatric/Cognitively Impaired Version of the scale will be used in the study. There are two 
versions of the C-SSRS. 
If the subject participated in an antecedent study:

The “Since Last Visit” version will be completed for all subjects at each visit in this study.
If the subject is directly enrolled in this study and did not participate in an antecedent study:

The “Lifetime recent” version will be administered at the Screening Visit (Visit -1).

The “Since Last Visit” version will be completed for all study visits after the Screening Visit 
(Visit -1).
The title, version, and date of the C-SSRS “Lifetime recent” version and the C-SSRS “Since Last 
Visit” version used in this study are included in Table 1.
7.2.4.10
Suitability of the Subject to Remain in the Study
At each visit (except for Visit 18/ET) starting with Visit 1, the investigator will assess the 
subject’s ability to continue in the study.  As part of the assessment of the subject’s suitability to 
remain in the study the investigator should assess the subject’s current potential for suicide, 
suicidal ideation, self-harm, or harm to others, as well as psychiatric disorders.  The investigator 
should make this assessment by conducting a clinical interview with the subject and by 
reviewing of all other relevant sources available, including results of the C-SSRS.  The 
investigator should also ensure that there is appropriate documentation of this assessment in the 
subject’s source notes.  As part of this assessment, if appropriate, the investigator should discuss 
risk factors for suicide with the subject.  Where a subject has suffered an accidental injury, the 
investigator should ensure that this was a true accidental injury, rather than an episode of 
self-harming or a suicide attempt.
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The subject’s source notes should clearly document that the assessment of continued suitability 
including an assessment of the subject’s current potential risk of suicide, suicidal ideation, 
feelings of hopelessness, drug use, self-harm, or harm to others has taken place and should 
contain the decision on whether the subject is suitable to continue in the study.
Any subject who has 1 or more positive responses must undergo further evaluation to ensure that 
they are not in any way at risk.  The evaluation and decision should also be clearly documented 
in the subject’s source notes.
7.2.5
Volume of Blood to be Drawn From Each Subject
Table 3: Volume of Blood to be Drawn From Each Subject
Assessment
Sample Volume 
(mL)
Number of Samples 
Total Volume (mL) 
Safetya
Biochemistry 
5
5
25
Hematology
4
5
20
Total mL
45
aBiochemistry and hematology clinical laboratory tests will be performed prior to Baseline if 30 days or longer have 
elapsed since the Screening visit.
During this study, it is expected that approximately 45mL of blood will be drawn from each 
subject. Subjects will have the option for blood draws to be collected by a qualified home health 
care professional at their home. Routine laboratory home draws have a + 1 day window from the 
study visit date, with the exception of the last visit/early termination draw which has a -1 day 
window.
Note: The amount of blood to be drawn for each assessment is an estimate.  The amount of blood 
to be drawn may vary according to the instructions provided by the manufacturer or laboratory 
for an individual assessment; however, the total volume drawn over the course of the study 
should be approximately 45mL.  When more than 1 blood assessment is to be done at the time 
point/period, if they require the same type of tube, the assessments may be combined.  
8
ADVERSE AND SERIOUS ADVERSE EVENTS ASSESSMENT
8.1
Definition of Adverse Events, Period of Observation, Recording of Adverse Events
An AE is any untoward medical occurrence in a clinical investigation subject administered a 
pharmaceutical product and that does not necessarily have a causal relationship with this 
treatment.  An AE can therefore be any unfavorable and unintended sign (including an abnormal 
laboratory finding), symptom, or disease temporally associated with the use of a medicinal 
(investigational) product, whether or not related to the medicinal (investigational) product (ICH 
Guidance E2A 1995).  
All AEs are collected from the time the informed consent is signed until the defined follow-up 
period stated in Section 7.1.3.  This includes events occurring during the screening phase of the 
study, regardless of whether or not investigational product is administered.  
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Where possible, a diagnosis rather than a list of symptoms should be recorded.  If a diagnosis has 
not been made, then each symptom should be listed individually.  All AEs should be captured on 
the appropriate AE pages in the CRF and in source documents.  In addition to untoward AEs, 
unexpected benefits outside the investigational product indication should also be captured on the 
AE CRF.
All AEs must be followed to closure (the subject’s health has returned to his/her baseline status 
or all variables have returned to normal), regardless of whether the subject is still participating in 
the study.  Closure indicates that an outcome is reached, stabilization achieved (the investigator 
does not expect any further improvement or worsening of the event), or the event is otherwise 
explained.  When appropriate, medical tests and examinations are performed so that resolution of 
event(s) can be documented.
8.1.1
Severity Categorization
The severity of AEs must be recorded during the course of the event including the start and stop 
dates for each change in severity.  An event that changes in severity should be captured as a new 
event.  Worsening of pre-treatment events, after initiation of investigational product, must be 
recorded as new AEs (for example, if a subject experiences mild intermittent dyspepsia prior to 
dosing of investigational product, but the dyspepsia becomes severe and more frequent after first 
dose of investigational product has been administered, a new AE of severe dyspepsia [with the 
appropriate date of onset] is recorded on the appropriate CRF).
The medical assessment of severity is determined by using the following definitions:
Mild: A type of AE that is usually transient and may require only minimal treatment or 
therapeutic intervention.  The event does not generally interfere with usual activities of daily 
living.
Moderate: A type of AE that is usually alleviated with specific therapeutic intervention.  The 
event interferes with usual activities of daily living, causing discomfort but poses no significant 
or permanent risk of harm to the research subject.
Severe: A type of AE that interrupts usual activities of daily living, or significantly affects 
clinical status, or may require intensive therapeutic intervention.
8.1.2
Relationship Categorization
A physician/investigator must make the assessment of relationship to investigational product for 
each AE.  The investigator should decide whether, in his or her medical judgment, there is a 
reasonable possibility that the event may have been caused by the investigational product.  If 
there is no valid reason for suggesting a relationship, then the AE should be classified as “not 
related”.  Otherwise, if there is any valid reason, even if undetermined or untested, for suspecting 
a possible cause-and-effect relationship between the investigational product and the occurrence 
of the AE, then the AE should be considered “related”.  The causality assessment must be 
documented in the source document.
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The following additional guidance may be helpful:
Term
Relationship Definition
Related
The temporal relationship between the event and the administration of the 
investigational product is compelling and/or follows a known or suspected response 
pattern to that product, and the event cannot be explained by the subject’s medical 
condition, other therapies, or accident.
Not Related
The event can be readily explained by other factors such as the subject’s underlying 
medical condition, concomitant therapy, or accident and no plausible temporal or 
biologic relationship exists between the investigational product and the event.
8.1.3
Outcome Categorization
The outcome of AEs must be recorded during the course of the study on the CRF.  Outcomes are 
as follows:

Fatal

Not Recovered/Not Resolved

Recovered/Resolved

Recovered/Resolved With Sequelae 

Recovering/Resolving

Unknown.
8.1.4
Symptoms of the Disease Under Study
Symptoms of the disease under study should not be classed as AEs as long as they are within the 
normal day-to-day fluctuation or expected progression of the disease and are part of the efficacy 
data to be collected in the study; however, significant worsening of the symptoms should be 
recorded as an AE.
8.1.5
Clinical Laboratory and Other Safety Evaluations
Clinical laboratory assessments, vital sign, and ECG assessments are performed at the Screening 
Visit (Visit 1) and Visit 8/ET. The Investigator is required to review these assessments prior to 
determining subject eligibility.  A change in the value of a clinical laboratory, vital sign, or ECG 
assessment can represent an AE if the change is clinically relevant or if, during treatment with 
the investigational product, a shift of a parameter is observed from a normal value to an 
abnormal value, or a further worsening of an already abnormal value.  When evaluating such 
changes, the extent of deviation from the reference range, the duration until return to the 
reference range, either while continuing treatment or after the end of treatment with the 
investigational product, and the range of variation of the respective parameter within its 
reference range, must be taken into consideration.
If, at the end of the treatment phase, there are abnormal clinical laboratory, vital sign, or ECG 
values which were not present at the pre-treatment value observed closest to the start of study 
treatment, further investigations should be performed until the values return to within the 
reference range or until a plausible explanation (eg, concomitant disease) is found for the 
abnormal values.
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The investigator should decide, based on the above criteria and the clinical condition of a 
subject, whether a change in a clinical laboratory, vital sign, or ECG parameter is clinically 
significant and therefore represents an AE.
8.1.6
Abuse, Misuse, Overdose, and Medication Error
Abuse, misuse, overdose, or medication error (as defined below) must be reported to the sponsor 
according to the SAE reporting procedure whether or not they result in an AE/SAE as described 
in Section 8.2.  Note: The 24-hour reporting requirement for SAEs does not apply to reports of 
abuse, misuse, overdose, or medication errors unless these result in an SAE. 
The categories below are not mutually exclusive; the event can meet more than 1 category.

Abuse – Persistent or sporadic intentional intake of investigational product when used for a 
non-medical purpose (eg, to alter one’s state of consciousness or get high) in a manner that 
may be detrimental to the individual and/or society

Misuse – Intentional use of investigational product other than as directed or indicated at 
any dose (Note: this includes a situation where the investigational product is not used as 
directed at the dose prescribed by the protocol)

Overdose – Intentional or unintentional intake of a dose of an investigational product 
exceeding a pre-specified total daily dose of 30 mg of the product

Medication Error – An error made in prescribing, dispensing, administration, and/or use 
of an investigational product.  For studies, medication errors are reportable to the sponsor 
only as defined below.
Cases of subjects missing doses of the investigational product are not considered reportable as 
medication errors.
Medication errors should be collected/reported for all products under investigation.
The administration and/or use of an expired investigational product should be considered as a 
reportable medication error.
All investigational product provided to pediatric subjects should be supervised by the 
parent/legally-authorized representative/caregiver.
8.2
Serious Adverse Event Procedures
8.2.1
Reference Safety Information
The reference for safety information for this study is the IB which the sponsor has provided 
under separate cover to all investigators.
8.2.2
Reporting Procedures
All initial and follow-up SAE reports must be reported by the investigator to the Shire 
Pharmacovigilance Department (GlobalPharmacovigilance@shire.com) and the CRO/Shire 
medical monitor within 24 hours of the first awareness of the event.  
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Note: The 24-hour reporting requirement for SAEs does not apply to reports of abuse, misuse, 
overdose, or medication errors (see Section 8.1.6) unless they result in an SAE. 
The investigator must complete, sign, and date the Shire Clinical Trial Serious Adverse Event 
Form and verify the accuracy of the information recorded on the form with the corresponding 
source documents (Note:  Source documents are not to be sent unless requested) and fax or 
e-mail the form to the Shire Pharmacovigilance Department. A copy of the Shire Clinical Trial 
Serious Adverse Event Form (and any applicable follow-up reports) must also be sent to the 
CRO/Shire medical monitor using the details specified in the emergency contact information 
section of the protocol.
8.2.3
Serious Adverse Event Definition
An SAE is any untoward medical occurrence (whether considered to be related to investigational 
product or not) that at any dose:

Results in death

Is life-threatening.  Note: The term ‘life-threatening’ in the definition of “serious” refers to 
an event in which the subject was at risk of death at the time of the event; it does not refer to 
an event which hypothetically might have caused death if it was more severe.

Requires inpatient hospitalization or prolongation of existing hospitalization.  Note: 
Hospitalizations, which are the result of elective or previously scheduled surgery for 
pre-existing conditions, which have not worsened after initiation of treatment, should not be 
classified as SAEs.  For example, an admission for a previously scheduled ventral hernia 
repair would not be classified as an SAE; however, complication(s) resulting from a 
hospitalization for an elective or previously scheduled surgery that meet(s) serious criteria 
must be reported as SAE(s).

Results in persistent or significant disability/incapacity

Is a congenital abnormality/birth defect

Is an important medical event.  Note: Important medical events that may not result in death, 
be life-threatening, or require hospitalization may be considered an SAE when, based upon 
appropriate medical judgment, they may jeopardize the subject and may require medical or 
surgical intervention to prevent 1 of the outcomes listed in this definition.  Examples of such 
medical events include allergic bronchospasm requiring intensive treatment in an emergency 
room or at home; blood dyscrasias or convulsions that do not result in inpatient 
hospitalization; or the development of drug dependency or drug abuse.  
8.2.4
Serious Adverse Event Collection Time Frame
All SAEs (regardless of relationship to study) are collected from the time the subject signs the 
informed consent until the defined follow-up period stated in Section 7.1.3, and must be reported 
to the Shire Pharmacovigilance Department and the CRO/Shire medical monitor within 24 hours 
of the first awareness of the event. 
In addition, any SAE(s) considered “related” to the investigational product and discovered by the 
investigator at any interval after the study has completed must be reported to the Shire 
Pharmacovigilance Department within 24 hours of the first awareness of the event.
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8.2.5
Serious Adverse Event Onset and Resolution Dates
The onset date of the SAE is defined as the date the event meets serious criteria.  The resolution 
date is the date the event no longer meets serious criteria, the date the symptoms resolve, or the 
event is considered chronic.  In the case of hospitalizations, the hospital admission and discharge 
dates are considered the onset and resolution dates, respectively.
In addition, any signs or symptoms experienced by the subject after signing the informed consent 
form, or leading up to the onset date of the SAE, or following the resolution date of the SAE, 
must be recorded as an AE, if appropriate.
8.2.6
Fatal Outcome
Any SAE that results in the subject’s death (ie, the SAE was noted as the primary cause of death) 
must have fatal checked as an outcome with the date of death recorded as the resolution date.  
For all other events ongoing at the time of death that did not contribute to the subject’s death, the 
outcome should be considered not resolved, without a resolution date recorded.
For any SAE that results in the subject’s death or any ongoing events at the time of death, the 
action taken with the investigational product should be recorded as “dose not changed” or “not 
applicable” (if the subject never received investigational product).
8.2.7
Regulatory Agency, Institutional Review Board, Ethics Committee, and Site 
Reporting
The sponsor and the clinical CRO are responsible for notifying the relevant regulatory authorities
and US central IRBs of related, unexpected SAEs.
In addition the sponsor and clinical CRO are responsible for notifying active sites of all related, 
unexpected SAEs occurring during all interventional studies across the SPD489 program.  
The investigator is responsible for notifying the local IRB/EC/REB, or the relevant local 
regulatory authority of all SAEs that occur at his or her site as required.
9
DATA MANAGEMENT AND STATISTICAL METHODS
9.1
Data Collection
The investigators’ authorized site personnel must enter the information required by the protocol 
on the CRF.  A study monitor will visit each site in accordance with the monitoring plan and 
review the CRF data against the source data for completeness and accuracy.  Discrepancies 
between source data and data entered on the CRF will be addressed by qualified site personnel.  
When a data discrepancy warrants correction, the correction will be made by authorized site 
personnel.  Data collection procedures will be discussed with the site at the site initiation visit 
and/or at the investigator’s meeting.  Once a subject is randomized, it is expected that site 
personnel will complete the CRF entry within approximately 3 business days of the subject’s 
visit.
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9.2
Clinical Data Management
Data are to be entered into a clinical database as specified in the CRO’s data management plan.  
Quality control and data validation procedures are applied to ensure the validity and accuracy of 
the clinical database.
Data are to be reviewed and checked for omissions, errors, and values requiring further 
clarification using computerized and manual procedures.  Data queries requiring clarification are 
to be communicated to the site for resolution.  Only authorized personnel will make corrections 
to the clinical database, and all corrections are documented in an auditable manner.
9.3
Data Handling Considerations
Not applicable. 
9.4
Statistical Analysis Process
The study will be analyzed by the sponsor or its agent.  
The SAP will provide the statistical methods and definitions for the analysis of the efficacy and 
safety data, as well as describe the approaches to be taken for summarizing other study 
information such as subject disposition, demographics and baseline characteristics, 
investigational product exposure, and prior and concomitant medications.  The SAP will also 
include a description of how missing, unused and spurious data will be addressed.
To preserve the integrity of the statistical analysis and study conclusions, the SAP will be 
finalized prior to database lock.
All statistical analyses will be performed using SAS(SAS Institute, Cary, NC 27513). 
9.5
Planned Interim Analysis, Adaptive Design, and Data Monitoring Committee
There is no planned interim analysis or adaptive design for this study.
A DMC will be involved in the management of this study.  The purpose of the DMC is to 
monitor safety and tolerability of the investigational product and to protect the interests of 
patients in the study and of those still to be entered. Data will be provided to the DMC by an 
independent statistical and reporting group not assigned to the study. The data provided to the 
DMC will not be considered ‘clean’ until the database is locked.
Further details regarding the DMC can be found in the DMC charter, which will be available 
prior to the administration of investigational product.  
9.6
Sample Size Calculation and Power Considerations
Approximately 100 subjects will be enrolled into this study to ensure that at least 50 subjects are 
exposed to SPD489 for one year and complete the study. 
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Subjects will enroll into this study from antecedent study SPD489-211 or SPD489-347 or 
directly enroll into this study without participating in either antecedent study. 
The sample size for this study is not based on statistical considerations. 
9.7
Study Population
The Screened Set will consist of all subjects who have signed an informed consent.
The Enrolled Set will consist of all subjects who have been dispensed SPD489 at the Baseline 
Visit (Visit 0). Screen failures will not be considered enrolled subjects and will not be included 
in the Enrolled Set.
The Safety Analysis Set will consist of all subjects who have taken at least 1 dose of 
investigational product. 
The FAS will consist of all subjects in the Safety Set who have at least 1 post-dose ADHD-RS-
IV Preschool Version Total Score assessment during the study.
9.8
Efficacy Analyses
The FAS will be used to summarize the efficacy data. 
9.8.1
Clinician-administered ADHD-RS-IV Preschool Version 
The efficacy endpoint for the ADHD-RS-IV Preschool Version is defined as the change from 
baseline on the clinician-administered ADHD-RS-IV Preschool Version Total Score. Where 
subjects that rolled over from an antecedent study, baseline is defined as the baseline from the 
antecedent study, and for subjects that directly enrolled into SPD489-348, baseline is defined as 
baseline of the SPD489-348 study. 
The observed and change from baseline ADHD-RS-IV Preschool Version Total Score will be 
summarized at each  visit as well as the last on-treatment visit using descriptive summary 
statistics of number of subjects, mean, standard deviation, median, minimum, and maximum 
values by treatment group of the antecedent studies, directly enrolled group and overall.
9.8.2
Clinical Global Impressions 
The efficacy endpoint for the CGI-I will be analyzed by a method similar to that used for the 
ADHD-RS-IV total scores. In addition, CGI-I, will also be analyzed using the proportion of 
subjects with an “improved” CGI-I measurement at the last on-treatment visit. The CGI-I 
categories of “very much improved” and “much improved” will be classified as “improved” and 
all other assessed categories will be grouped together as “not improved”.  
Descriptive summary statistics will be presented by treatment group of the antecedent studies, 
directly enrolled group and overall for the CGI-I scores at each visit as well as the last 
on-treatment assessment. 
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The change from baseline and observed dichotomized CGI-I values will be summarized at each 
visit as well as the last on-treatment visit using number of subjects and percentages.
9.8.3
Exploratory Efficacy Endpoints
Not applicable.
9.9
Safety Analyses
The Safety Analysis Set will be used to report the safety data. 
Safety analyses will be presented by treatment group of the antecedent studies, directly enrolled 
and overall for the occurrence of TEAEs, clinical laboratory results, vital signs, ECG results, and 
sleep assessments including sleep diary data and CSHQ. 
Adverse events will be coded using the Medical Dictionary for Regulatory Activities.  The 
number of events, incidence, and percentage of TEAEs will be calculated overall, by system 
organ class and, by preferred term.  Treatment-emergent adverse events will be further 
summarized by severity and relationship to investigational product.  Adverse events related to 
investigational product, AEs leading to withdrawal, SAEs, and deaths will be similarly 
summarized/listed.
Clinical laboratory tests, vital signs, and ECG findings will be summarized by visit and overall. 
Potentially clinically important findings will also be summarized and listed.
The CSHQ will be summarized using appropriate descriptive statistics at each visit. 
The C-SSRS data will be listed for all subjects with any positive response. 
9.10
Other Analyses
No other analyses are planned in this study.
10
SPONSOR’S AND INVESTIGATOR’S RESPONSIBILITIES
This study is conducted in accordance with current applicable regulations, ICH and any updates 
or revisions, and local ethical and legal requirements. 
The name and address of each third party vendor (eg, CRO) used in this study will be maintained 
in the investigator’s and sponsor’s files, as appropriate.
10.1
Sponsor’s Responsibilities
10.1.1
Good Clinical Practice Compliance
The study sponsor and any third party to whom aspects of the study management or monitoring 
have been delegated will undertake their assigned roles for this study in compliance with all 
applicable industry regulations, ICH GCP Guideline E6 (1996), any updates or revisions, as well 
as all applicable national and local laws and regulations.
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Visits to sites are conducted by representatives of the study sponsor and/or the company 
organizing/managing the research on behalf of the sponsor to inspect study data, subjects’ 
medical records, and CRFs in accordance with current GCP and the respective local and 
(inter)national government regulations and guidelines.  Records and data may additionally be 
reviewed by auditors or by regulatory authorities.
The sponsor ensures that local regulatory authority requirements are met before the start of the 
study. The sponsor (or a nominated designee) is responsible for the preparation, submission, and 
confirmation of receipt of any regulatory authority approvals required prior to release of 
investigational product for shipment to the site.
10.1.2
Public Posting of Study Information
The sponsor is responsible for posting appropriate study information on applicable websites. 
Information included in clinical study registries may include participating investigators’ names 
and contact information.
10.1.3
Submission of Summary of Clinical Study Report to Competent Authorities 
of Member States Concerned and Ethics Committees
The sponsor will provide a summary of the clinical study report to the competent authority of the 
member state(s) concerned as required by regulatory requirement(s) and to comply with the 
Community guideline on GCP.  This requirement will be fulfilled within 6 months of the end of 
the study completion date for pediatric studies and within 1 year for non-pediatric studies as per 
guidance.  
10.1.4
Study Suspension, Termination, and Completion
The sponsor may suspend or terminate the study, or part of the study, at any time for any reason.  
If the study is suspended or terminated, the sponsor will ensure that applicable sites, regulatory 
agencies and IRBs/ECs are notified as appropriate.  Additionally, the discontinuation of a 
registered clinical study which has been posted to a designated public website will be updated 
accordingly.
10.2
Investigator’s Responsibilities
10.2.1
Good Clinical Practice Compliance
The investigator must undertake to perform the study in accordance with ICH GCP Guideline E6 
(1996), any updates or revisions, and applicable regulatory requirements and guidelines.
It is the investigator’s responsibility to ensure that adequate time and appropriately trained 
resources are available at the site prior to commitment to participate in this study.  The 
investigator should also be able to estimate or demonstrate a potential for recruiting the required 
number of suitable subjects within the agreed recruitment period.
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The investigator will maintain a list of appropriately qualified persons to whom the investigator 
has delegated significant study-related tasks, and shall, upon request of the sponsor, provide 
documented evidence of any licenses and certifications necessary to demonstrate such 
qualification.  Curriculum vitae for investigators and subinvestigators are provided to the study 
sponsor (or designee) before starting the study.
If a potential research subject has a primary care physician, the investigator should, with the 
subject’s parent(s)/LAR consent, inform them of the subject’s participation in the study.
A coordinating principal investigator is appointed to review the final clinical study report for 
multicenter studies.  Agreement with the final clinical study report is documented by the signed 
and dated signature of the principal investigator (single-site study) or coordinating principal 
investigator (multicenter study), in compliance with Directive 2001/83/EC as amended by 
Directive 2003/63/EC and ICH Guidance E3 (1995). 
10.2.2
Protocol Adherence and Investigator Agreement
The investigator and any subinvestigators must adhere to the protocol as detailed in this 
document.  The investigator is responsible for enrolling only those subjects who have met 
protocol eligibility criteria.  Investigators are required to sign an investigator agreement to 
confirm acceptance and willingness to comply with the study protocol.
If the investigator suspends or terminates the study at their site, the investigator will promptly 
inform the sponsor and the IRB/EC and provide them with a detailed written explanation.  The 
investigator will also return all investigational product, containers, and other study materials to 
the sponsor.  Upon study completion, the investigator will provide the sponsor, IRB/EC, and 
regulatory agency with final reports and summaries as required by (inter)national regulations.
Communication with local IRBs/ECs, to ensure accurate and timely information is provided at 
all phases during the study, may be done by the sponsor, applicable CRO, investigator, or for 
multicenter studies, the coordinating principal investigator according to national provisions and 
will be documented in the investigator agreement.
10.2.3
Documentation and Retention of Records
10.2.3.1
Case Report Forms
Case report forms are supplied by the CRO and should be handled in accordance with 
instructions from the sponsor.
The investigator is responsible for maintaining adequate and accurate medical records from 
which accurate information is recorded onto CRFs, which have been designed to record all 
observations and other data pertinent to the clinical investigation.  Case report forms must be 
completed by the investigator or designee as stated in the site delegation log.
All data will have separate source documentation; no data will be recorded directly onto the 
CRF.
All data sent to the sponsor must be endorsed by the investigator.
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The clinical research associate CRA/study monitor will verify the contents against the source 
data per the monitoring plan.  If the data are unclear or contradictory, queries are sent for 
corrections or verification of data.
10.2.3.2
Recording, Access, and Retention of Source Data and Study Documents
Original source data to be reviewed during this study will include, but are not limited to: 
subject’s medical file, subject sleep diary cards and original clinical laboratory reports.
All key data must be recorded in the subject’s medical records.
The investigator must permit authorized representatives of the sponsor, the respective national, 
local, or foreign regulatory authorities, the IRB/EC, and auditors to inspect facilities and to have 
direct access to original source records relevant to this study, regardless of media.
The CRA/study monitor (and auditors, IRB/EC or regulatory inspectors) may check the CRF 
entries against the source documents.  The consent form includes a statement by which the 
subject agrees to the monitor/auditor from the sponsor or its representatives, national or local 
regulatory authorities, or the IRB/EC, having access to source data (eg, subject’s medical file, 
appointment books, original laboratory reports, X-rays etc).  
These records must be made available within reasonable times for inspection and duplication, if 
required, by a properly authorized representative of any regulatory agency (eg, the US FDA) or 
an auditor.
Essential documents must be maintained according to ICH GCP requirements and may not be 
destroyed without written permission from the sponsor.
10.2.3.3
Audit/Inspection
To ensure compliance with relevant regulations, data generated by this study must be available 
for inspection upon request by representatives of, for example, the US FDA (as well as other US 
national and local regulatory authorities), other regulatory authorities, the sponsor or its 
representatives, and the IRB/EC for each site.
10.2.3.4
Financial Disclosure
The investigator is required to disclose any financial arrangement during the study and for 1 year 
after, whereby the outcome of the study could be influenced by the value of the compensation for 
conducting the study, or other payments the investigator received from the sponsor.  The 
following information is collected: any significant payments from the sponsor or subsidiaries 
such as a grant to fund ongoing research, compensation in the form of equipment, retainer for 
ongoing consultation or honoraria; any proprietary interest in investigational product; any 
significant equity interest in the sponsor or subsidiaries as defined in 21 CFR 54 2(b) (1998).
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10.2.4
Compliance to all Local, State, and National Controlled-substance 
Biohazard and Infectious Disease Regulations and Legislation
When using controlled substances, biohazardous material, or substances for infectious diseases, 
the investigator must at all times comply with all local, state, and national laws pertaining to 
registration and reporting with the appropriate regulatory body and control and handling of such 
substances.
10.3
Ethical Considerations
10.3.1
Informed Consent
It is the responsibility of the investigator to obtain written informed consent and assent from all 
study subjects and their parent(s)/LAR prior to any study-related procedures including screening 
assessments.  All consent and assent documentation must be in accordance with applicable 
regulations and GCP.  Each subject, parent(s), or the subject’s legally-authorized representative, 
as applicable, is requested to sign and date the subject informed consent form or a certified 
translation if applicable, after the subject, parent(s), or LAR has received and read (or been read) 
the written subject information and received an explanation of what the study involves, including 
but not limited to: the objectives, potential benefits and risk, inconveniences, and the subject’s 
rights and responsibilities.  A copy of the informed consent and assent documentation, as 
applicable (ie, a complete set of subject information sheets and fully executed signature pages) 
must be given to the subject, parent(s) or the subject’s legally-authorized representative, as 
applicable.  This document may require translation into the local language.  Signed consent 
forms must remain in each subject’s study file and must be available for verification at any time.
Within the source documents, site personnel should document instruction of and understanding 
by the parent(s)/legally-authorized representative/caregiver of the safe, responsible storage and 
administration of investigational product to the study subject.
The principal investigator provides the sponsor with a copy of the consent form and assent form, 
as applicable which was reviewed by the IRB/EC and which received their favorable 
opinion/approval.  A copy of the IRB/EC’s written favorable opinion/approval of these 
documents must be provided to the sponsor, prior to the start of the study unless it is agreed to 
and documented (abiding by regulatory guidelines and national provisions) prior to study start 
that another party (ie, sponsor or coordinating principal investigator) is responsible for this 
action.  Additionally, if the IRB/EC requires modification of the sample subject information and 
consent document provided by the sponsor, the documentation supporting this requirement must 
be provided to the sponsor.
10.3.2
Institutional Review Board or Ethics Committee
It is the responsibility of the investigator to submit this protocol, the informed consent document 
(approved by the sponsor or their designee), relevant supporting information and all types of 
subject recruitment information to the IRB/EC for review, and all must be approved prior to site 
initiation.
Responsibility for coordinating with IRBs/ECs is defined in the investigator agreement.
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Prior to implementing changes in the study, the sponsor and the IRB/EC must approve any 
revisions of all informed consent documents and amendments to the protocol unless there is a 
subject safety issue.
Investigational product supplies will not be released until the CRO has received written IRB/EC 
approval of and copies of revised documents.
The investigator is responsible for keeping the IRB/EC apprised of the progress of the study and 
of any changes made to the protocol, but in any case at least once a year. The investigator must 
also keep the local IRB/EC informed of any serious and significant AEs.
10.4
Privacy and Confidentiality
All sites and laboratories or entities providing support for this study, must, where applicable, 
comply with HIPAA of 1996 and any other local privacy requirements.  A site that is not a 
covered entity as defined by HIPAA must provide documentation of this fact to the CRO.
The confidentiality of records that may be able to identify subjects will be protected in 
accordance with applicable laws, regulations, and guidelines.
After subjects have consented to take part in the study, the sponsor and/or its representatives 
reviews their medical records and data collected during the study.  These records and data may, 
in addition, be reviewed by others including the following: independent auditors who validate the 
data on behalf of the sponsor; third parties with whom the sponsor may develop, register, or 
market SPD489; national or local regulatory authorities; and the IRB(s)/EC(s) which gave 
approval for the study to proceed.  The sponsor and/or its representatives accessing the records 
and data will take all reasonable precautions in accordance with applicable laws, regulations, and 
guidelines to maintain the confidentiality of subjects’ identities.
Subjects are assigned a unique identifying number; however, their initials and date of birth may 
also be collected and used to assist the sponsor to verify the accuracy of the data (eg, to confirm 
that laboratory results have been assigned to the correct subject).
The results of studies–containing subjects’ unique identifying number, relevant medical records, 
and possibly initials and dates of birth–will be recorded.  They may be transferred to, and used 
in, other countries which may not afford the same level of protection that applies within the 
countries where this study is conducted.  The purpose of any such transfer would include: to 
support regulatory submissions, to conduct new data analyses to publish or present the study 
results, or to answer questions asked by regulatory or health authorities.
10.5
Study Results / Publication Policy
Shire will endeavor to publish the results of all qualifying, applicable, and covered studies 
according to external guidelines in a timely manner regardless of whether the outcomes are 
perceived as positive, neutral, or negative.  Additionally, Shire adheres to external guidelines (eg, 
Good Publication Practices 2) when forming a publication steering committee, which is done for 
large, multicenter Phase 2-4 and certain other studies as determined by Shire.  
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The purpose of the publication steering committee is to act as a non-commercial body that 
advises or decides on dissemination of scientific study data in accordance with the scope of this 
policy.
All publications relating to Shire products or projects must undergo appropriate technical and 
intellectual property review, with Shire agreement to publish prior to release of information.  The 
review is aimed at protecting the sponsor’s proprietary information existing either at the 
commencement of the study or generated during the study.  To the extent permitted by the 
publisher and copyright law, the principal investigator will own (or share with other authors) the 
copyright on his/her publications.  To the extent that the principal investigator has such sole, 
joint or shared rights, the principal investigator grants the sponsor a perpetual, irrevocable, 
royalty-free license to make and distribute copies of such publications.
The term “publication” refers to any public disclosure including original research articles, review 
articles, oral presentations, abstracts and posters at medical congresses, journal supplements, 
letters to the editor, invited lectures, opinion pieces, book chapters, electronic postings on 
medical/scientific websites, or other disclosure of the study results, in printed, electronic, oral or 
other form.
Subject to the terms of the paragraph below, the investigator shall have the right to publish the 
study results, and any background information provided by the sponsor that is necessary to 
include in any publication of study results, or necessary for other scholars to verify such study 
results.  Notwithstanding the foregoing, no publication that incorporates the sponsor’s 
confidential information shall be submitted for publication without the sponsor’s prior written 
agreement to publish, and shall be given to the sponsor for review at least 60 days prior to 
submission for publication.  If requested in writing by Shire, the institution and principal 
investigator shall withhold submission of such publication for up to an additional 60 days to 
allow for filing of a patent application.
If the study is part of a multicenter study, the first publication of the study results shall be made 
by the sponsor in conjunction with the sponsor’s presentation of a joint, multicenter publication 
of the compiled and analyzed study results.  If such a multicenter publication is not submitted to 
a journal for publication by the sponsor within an 18-month period after conclusion, 
abandonment, or termination of the study at all sites, or after the sponsor confirms there shall be 
no multicenter study publication of the study results, an investigator may individually publish the 
study results from the specific site in accordance with this section.  The investigator must, 
however, acknowledge in the publication the limitations of the single-site data being presented.
Unless otherwise required by the journal in which the publication appears, or the forum in which 
it is made, authorship will comply with the ICMJE current standards.  Participation as an 
investigator does not confer any rights to authorship of publications.
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11
REFERENCES
Centers for Disease Control and Prevention 2010. Increasing prevalence of parent-reported 
attention-deficit/hyperactivity disorder among children --- United States, 2003 and 2007. 
MMWR Morb Mortal Wkly Rep, 59, 1439-43.
Connor, D. F. 2002. Preschool attention deficit hyperactivity disorder: a review of prevalence, 
diagnosis, neurobiology, and stimulant treatment. J Dev Behav Pediatr, 23, S1-9.
Connor, D. F., Edwards, G., Fletcher, K. E., Baird, J., Barkley, R. A. & Steingard, R. J. 2003. 
Correlates of comorbid psychopathology in children with ADHD. J Am Acad Child 
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Dunn, L. M. & Dunn, L. M. 1997. Peabody Picture Vocabulary Test, third edition. J Psychoeduc 
Assess, 16, 334-8.
DuPaul, G., Power, T., Anastopoulos, A. & Reed, R. 1998. The ADHD rating scale IV: 
checklists, norms and clinical interpretation, New York, Guilford Press.
DuPaul, G. J., McGoey, K. E., Eckert, T. L. & VanBrakle, J. 2001. Preschool children with 
attention-deficit/hyperactivity disorder: impairments in behavioral, social, and school 
functioning. J Am Acad Child Adolesc Psychiatry, 40, 508-15.
Egger, H. L. & Angold, A. 2004. The preschool age psychiatric assessment (PAPA): a structured 
parent interview for diagnosing psychiatric disorders in preschool children. In:
DelCarmen-Wiggins, R. & Carter, A. (eds.) Handbook of infant, toddler, and preschool 
mental assessment. New York: Oxford University Press.
Egger, H. L., Erkanli, A., Keeler, G., Potts, E., Walter, B. K. & Angold, A. 2006a. Test-Retest 
Reliability of the Preschool Age Psychiatric Assessment (PAPA). J Am Acad Child 
Adolesc Psychiatry, 45, 538-49.
Egger, H. L., Kondo, D. & Angold, A. 2006b. The epidemiology and diagnostic issues in 
preschool attention-deficit/hyperactivity disorder: a review. Infants Young Child, 19, 109-
22.
Faraone, S. V. & Biederman, J. 1998. Neurobiology of attention-deficit hyperactivity disorder. 
Biol Psychiatry, 44, 951-8.
Ghuman, J. K., Arnold, L. E. & Anthony, B. J. 2008. Psychopharmacological and other 
treatments in preschool children with attention-deficit/hyperactivity disorder: current 
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Greenhill, L., Kollins, S., Abikoff, H., McCracken, J., Riddle, M., Swanson, J., McGough, J., 
Wigal, S., Wigal, T., Vitiello, B., Skrobala, A., Posner, K., Ghuman, J., Cunningham, C., 
Davies, M., Chuang, S. & Cooper, T. 2006. Efficacy and safety of immediate-release 
methylphenidate treatment for preschoolers with ADHD. J Am Acad Child Adolesc 
Psychiatry, 45, 1284-93.
Greenhill, L. L., Posner, K., Vaughan, B. S. & Kratochvil, C. J. 2008. Attention deficit 
hyperactivity disorder in preschool children. Child Adolesc Psychiatr Clin N Am, 17,
347-66, ix.
Guy, W. (ed.) 1976. Clinical Global Impression (CGI), Rockville, MD: US Department of 
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Hardman, J. G., Limbird, L. E. & Gilman, A. G. 2001. Goodman & Gillman’s The 
Pharmacological Basis of Therapeutics, 10th Edition, New York, NY, McGraw-Hill.
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Hinshaw, S. P. 2002. Preadolescent girls with attention-deficit/hyperactivity disorder: I. 
Background characteristics, comorbidity, cognitive and social functioning, and parenting 
practices. J Consult Clin Psychol, 70, 1086-98.
Lahey, B. B., Pelham, W. E., Loney, J., Kipp, H., Ehrhardt, A., Lee, S. S., Willcutt, E. G., 
Hartung, C. M., Chronis, A. & Massetti, G. 2004. Three-year predictive validity of DSM-
IV attention deficit hyperactivity disorder in children diagnosed at 4-6 years of age. Am J 
Psychiatry, 161, 2014-20.
McClelland, M. M., Acock, A. C., Piccinin, A., Rhea, S. A. & Stallings, M. C. 2013. Relations 
between Preschool Attention Span-Persistence and Age 25 Educational Outcomes. Early 
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McGoey, K. E., DuPaul, G. J., Haley, E. & Shelton, T. L. 2007. Parent and teacher ratings of 
attention-deficit/hyperactivity disorder in preschool: the ADHD rating scale-IV preschool 
version. J Psychopathol Behav Assess, 29, 269-76.
Michelson, D., Faries, D., Wernicke, J., Kelsey, D., Kendrick, K., Sallee, F. R. & Spencer, T. 
2001. Atomoxetine in the treatment of children and adolescents with attention-
deficit/hyperactivity disorder: a randomized, placebo-controlled, dose-response study. 
Pediatrics, 108, E83.
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in children and adolescents. Pediatrics, 114, 555-76.
Ostchega, Y., Porter, K. S., Hughes, J., Dillon, C. F. & Nwankwo, T. 2011. Resting pulse rate 
reference data for children, adolescents, and adults: United States, 1999-2008. Natl 
Health Stat Report, 1-16.
Posner, K. Suicidality Issues in Clinical Trials: Columbia Suicidal Adverse Event Identification 
in FDA Safety Analyses Division of Metabolism and Endocrinology Products Advisory 
Committee Meeting, Food and Drug Administration, 2007.
Rappley, M. D., Mullan, P. B., Alvarez, F. J., Eneli, I. U., Wang, J. & Gardiner, J. C. 1999. 
Diagnosis of attention-deficit/hyperactivity disorder and use of psychotropic medication 
in very young children. Arch Pediatr Adolesc Med, 153, 1039-45.
Smith, K. G. & Corkum, P. 2007. Systematic review of measures used to diagnose attention-
deficit/hyperactivity disorder in research on preschool children. TEC, 27, 164-73.
Sonuga-Barke, E. J., Auerbach, J., Campbell, S. B., Daley, D. & Thompson, M. 2005. Varieties 
of preschool hyperactivity: multiple pathways from risk to disorder. Dev Sci, 8, 141-50.
Sonuga-Barke, E. J. & Halperin, J. M. 2010. Developmental phenotypes and causal pathways in 
attention deficit/hyperactivity disorder: potential targets for early intervention? J Child 
Psychol Psychiatry, 51, 368-89.
Subcommittee on ADHD, Management., S. C. o. Q. I. a., Wolraich, M., Brown, L., Brown, R. 
T., DuPaul, G., Earls, M., Feldman, H. M., Ganiats, T. G., Kaplanek, B., Meyer, B., 
Perrin, J., Pierce, K., Reiff, M., Stein, M. T. & Visser, S. 2011. ADHD: clinical practice 
guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity 
disorder in children and adolescents. Pediatrics, 128, 1007-22.
Szatmari, P., Offord, D. R. & Boyle, M. H. 1989. Ontario Child Health Study: prevalence of 
attention deficit disorder with hyperactivity. J Child Psychol Psychiatry, 30, 219-30.
Tandon, M., Si, X. & Luby, J. 2011. Preschool onset attention-deficit/hyperactivity disorder: 
course and predictors of stability over 24 months. J Child Adolesc Psychopharmacol, 21,
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Tannock, R. 1998. Attention deficit hyperactivity disorder: advances in cognitive, 
neurobiological, and genetic research. J Child Psychol Psychiatry, 39, 65-99.
Thapar, A. 2002. Attention deficit hyperactivity disorder: new genetic findings, new directions, 
Washington, DC, US, American Psychological Association.
Wallis, D., Russell, H. F. & Muenke, M. 2008. Review: Genetics of attention 
deficit/hyperactivity disorder. J Pediatr Psychol, 33, 1085-99.
Weiss, M., Tannock, R., Kratochvil, C., Dunn, D., Velez-Borras, J., Thomason, C., Tamura, R., 
Kelsey, D., Stevens, L. & Allen, A. J. 2005. A randomized, placebo-controlled study of 
once-daily atomoxetine in the school setting in children with ADHD. J Am Acad Child 
Adolesc Psychiatry, 44, 647-55.
Wigal, S. B., Gupta, S., Greenhill, L., Posner, K., Lerner, M., Steinhoff, K., Wigal, T., 
Kapelinski, A., Martinez, J., Modi, N. B., Stehli, A. & Swanson, J. 2007. 
Pharmacokinetics of methylphenidate in preschoolers with attention-deficit/hyperactivity 
disorder. J Child Adolesc Psychopharmacol, 17, 153-64.
Wigal, T., Greenhill, L., Chuang, S., McGough, J., Vitiello, B., Skrobala, A., Swanson, J., Wigal, 
S., Abikoff, H., Kollins, S., McCracken, J., Riddle, M., Posner, K., Ghuman, J., Davies, 
M., Thorp, B. & Stehli, A. 2006. Safety and tolerability of methylphenidate in preschool 
children with ADHD. J Am Acad Child Adolesc Psychiatry, 45, 1294-303.
Wilens, T. E., Spencer, T. J., Biederman, J., Girard, K., Doyle, R., Prince, J., Polisner, D., 
Solhkhah, R., Comeau, S., Monuteaux, M. C. & Parekh, A. 2001. A controlled clinical 
trial of bupropion for attention deficit hyperactivity disorder in adults. Am J Psychiatry,
158, 282-8.
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APPENDICES
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APPENDIX 2 DIAGNOSTIC CRITERIA/DISEASE CLASSIFICATION
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APPENDIX 2.1
DSM-IV-TR CRITERIA FOR ATTENTION-
DEFICIT/HYPERACTIVITY DISORDER
A. Either (1) or (2):
(1)
six (or more) of the following symptoms of inattention have persisted for at 
least 
6 months to a degree that is maladaptive and inconsistent with developmental level:
Inattention
a)
often fails to give close attention to details or makes careless mistakes in 
schoolwork, work or other activities
b)
often has difficulty sustaining attention in tasks or play activities
c)
often does not seem to listen when spoken to directly
d)
often does not follow through on instructions and fails to finish schoolwork, 
chores, or duties in the workplace (not due to oppositional behavior or failure to 
understand instructions)
e)
often has difficulty organizing tasks and activities
f)
often avoids, dislikes, or is reluctant to engage in tasks that require sustained 
mental effort (such as schoolwork or homework)
g)
often loses things necessary for tasks or activities (eg, toys, school assignments, 
pencils, books, or tools)
h)
is often easily distracted by extraneous stimuli
i)
is often forgetful in daily activities
(2)
six (or more) of the following symptoms of hyperactivity-impulsivity have 
persisted for at least 6 months to a degree that is maladaptive and inconsistent with 
developmental level:
Hyperactivity
(a)
often fidgets with hands or feet or squirms in seat
(b)
often leaves seat in classroom or in other situations in which remaining seated is 
expected
(c)
often runs about or climbs excessively in situations in which it is inappropriate 
(in adolescents or adults, may be limited to subjective feelings of restlessness)
(d)
often has difficulty playing or engaging in leisure activities quietly
(e)
is often “on the go” or often acts as if “driven by a motor”
(f)
often talks excessively
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Impulsivity
(g)
often blurts out answers before questions have been completed
(h)
often has difficulty awaiting turn
(i)
often interrupts or intrudes on others (eg, butts into conversations or games)
B. 
Some hyperactive-impulsive or inattentive symptoms that caused impairment were 
present before age 7 years.
C. 
Some impairment from the symptoms is present in 2 or more settings (eg, at school 
[or work] and at home).
D. 
There must be clear evidence of clinically significant impairment in social, academic, 
or occupational functioning.
E.
The symptoms do not occur exclusively during the course of a Pervasive Development 
Disorder, Schizophrenia, or other Psychotic Disorder and are not better accounted for 
by another mental disorder (eg, Mood Disorder, Anxiety Disorder, Dissociative 
Disorder, or a Personality Disorder).
Code based on type:
314.01 Attention-Deficit/Hyperactivity Disorder, Combined Type:
if both Criteria A1 and A2 are met for the past 6 months
314.00 Attention-Deficit/Hyperactivity Disorder, Predominately Inattentive Type:
if Criterion A1 is met but Criterion A2 is not met for the past 6 months
314.01 Attention-Deficit/Hyperactivity Disorder, Predominately Hyperactive-Impulsive 
Type: if Criterion A2 is met but Criterion A1 is not met for the past 6 months
From the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994 
American Psychiatric Association
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APPENDIX 2.4
BOYS’ STATURE-FOR-AGE AND WEIGHT-FOR-AGE 
PERCENTILES
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APPENDIX 2.5
GIRLS’ STATURE-FOR-AGE AND WEIGHT-FOR-AGE 
PERCENTILES
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APPENDIX 3 SCALES AND ASSESSMENTS
The following scales/assessments will be utilized in this study:
Full Title of Scale/Assessment
Version Number
Date Issued
ADHD Rating Scale – IV Preschool Version
N/A
2007
Clinical Global Impressions – Global 
Improvement and Clinical Global 
Impressions – Severity of Illness 
N/A
1976
Columbia-Suicide Severity Rating Scale 
Baseline
Since Last Visit
Baseline 1/14/09 
Since Last Visit 1/14/09
Children’s Sleep Habits Questionnaire
N/A
2009
A separate master file containing each scale/assessment listed above will be provided to the site.  
Updates to scales/assessments during the study (if applicable) will be documented in the table 
above and a new master file containing the revised scale/assessment will be provided to the site. 
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