The Effects of Vyvanse(TM) on Brain Hemodynamics and Reading
Condition: Attention Deficit/Hyperactivity Disorder
MeSH terms: Hyperkinesis; Attention Deficit Disorder with Hyperactivity
Study type: Interventional
Phase: Phase 4

Summary: 
      This is a single-blind, Investigator Initiated study to evaluate the safety and efficacy of
      Vyvanse™ and provide pilot data in two areas: (1) on the use of Near-Infrared Spectroscopy to
      detect medication effects in children with ADHD; and (2) on the influence of Vyvanse ™ on
      reading fluency and comprehension, over a period of approximately 6-8 weeks. Subjects will be
      between the ages of 6 and 12 at the beginning of the study.
    

Detailed description: 
      This is a single-blind study to evaluate the safety and efficacy of Vyvanse™ and provide
      pilot data in two areas: (1) on the use of Near-Infrared Spectroscopy to detect medication
      effects in children with ADHD; and (2) on the influence of Vyvanse ™ on reading fluency and
      comprehension over a period of approximately 6 weeks. Subjects will be between the ages of 6
      and 12 at the beginning of the study.

      The study will consist of periods detailed below:

      Screening and Washout. Subjects will be screened up to four weeks prior to baseline. The
      washout period will be 3 days for most ADHD stimulant medication (the half life is around 3-5
      hours and the washout is at least 5 half-lives in duration). Other medication will be
      discussed during the visit.

      The Screening Visit will occur at the UCI Child Development Center and will allow for the
      determination of appropriateness of each subject's inclusion into the study. The Principal
      Investigator or his/her designee must obtain written signed and dated consent for the subject
      to participate in the study from the subject's parent(s)/legally authorized representative
      and assent must be given by the subject, prior to any study related procedures being
      performed. This visit is expected to last 3-4 hours and may take place across more than one
      day.

      The following procedures will be conducted during the Screening Visit:

        -  Informed Consent/Assent obtained

        -  Psychiatric evaluation that utilizes the Kiddie-Schedule for Affective Disorders and
           Schizophrenia-Present and Lifetime Version (K-SADS-PL) and according to DSM-IV-TR™
           criteria

        -  Inclusion/Exclusion criteria confirmed

        -  Demographics collected

        -  Medical and Medication History

        -  Physical Examination including height (using a calibrated stadiometer), weight (using a
           calibrated scale)

        -  Sitting Vital Signs after 5 minutes of rest (oral or tympanic temperature, pulse, blood
           pressure, and respiratory rate)

        -  12-Lead ECG after 5 minutes of rest

        -  Kaufman Brief Intelligence Test 2 (KBIT2): used to assess both verbal and non-verbal
           cognitive ability.

        -  Concomitant Medications reviewed

        -  Adverse Events reviewed

      In addition, the subject will be asked to give a small blood sample, for safety screening
      purposes, for laboratory procedures (approximately 2 teaspoons).The following lab procedures
      will be performed:

        -  Hematology with complete blood count (CBC)

        -  Serum Chemistry

        -  Urinalysis and microscopic examination (if protein and/or blood are detected during
           urinalysis)

        -  Serum Pregnancy Test for all FOCP - A negative serum pregnancy test must be documented
           for inclusion into this study

        -  Urine drug test Baseline Procedures. After all Screening and washout procedures have
           been completed, subjects will return to the site for the Baseline Visit, which will last
           approximately 5-6 hours.

      Subjects will be provided with a one-week supply of VyvanseTM 30mg/day. Subjects will begin
      treatment the morning of the baseline visit and continue on the same dose for the next week.
      The first dose of medication will be administered on site and subsequent dosing will be given
      to the subject's parent(s)/legally authorized representative who will be required to
      administer study drug to the subject upon awakening. During the visit subjects will perform
      the Attention Task while the NIRS is recording and they will also be given the Gray's Oral
      Reading Test before the medication is administered. After the medication is administered the
      subject will stay on site until the second NIRS measurement can be taken a second time. They
      will be provided food and activities during the waiting period.

      The following procedures will be conducted during the Baseline Visit:

        -  Confirmation of continued eligibility (i.e., with respect to inclusion/exclusion
           criteria and medication history)

        -  Sitting Vital Signs (oral or tympanic temperature, pulse, blood pressure and respiratory
           rate)

        -  Attention-Deficit/Hyperactivity Disorder Rating Scale-IV-Parent: Investigator
           Administered and Scored (ADHDRS-IV-Parent:Inv): The primary efficacy measure, used to
           assess the 18 symptoms of ADHD.

        -  Clinical Global Impressions Severity scale (CGI-S): This measure is used to assess the
           severity of the subject's symptoms.

        -  Concomitant Medications will be reviewed with the subject.

        -  Adverse Events

        -  Medication administered on-site

        -  Near Infrared Spectroscopy and Attention Task performed twice, once at before medication
           and again 3-4 hours after first exposure to medication.

        -  Administer the Gray Oral Reading Test-4 (GORT-4), which used to test oral reading rate,
           accuracy, fluency, and comprehension, before exposure to medication.

        -  Distribute Open-Label Study Drug - A one-week supply of VyvanseTM 30mg capsules will be
           dispensed, including the dose administered on site.

      Dose Optimization. During the dose optimization period, subjects will visit the office once
      per week so that the study doctor can determine if the subject is tolerating the study
      medication and if she/he is seeing any benefit. These visits will last approximately 45
      minutes. The Investigator will review AEs, ADHD-RS-IV, and CGI-I scores, and use clinical
      judgment to ensure that subjects are titrated to an acceptable dose of VyvanseTM for
      evaluation.

      The following procedures will be conducted at each dose optimization visit:

        -  Sitting Vital Signs (oral or tympanic temperature, pulse, blood pressure and respiratory
           rate)

        -  Subject Weight (using a calibrated scale)

        -  Investigator Dose Assessment

        -  ADHD-RS-IV

        -  Clinical Global Impressions Improvement Scale (CGI-I).

        -  Study Drug Accountability and Compliance Assessment Performed

        -  Distribute Open-Label Study Drug

        -  Concomitant Medications

        -  Adverse Events Dose Optimized NIRS and GORT Testing

      This visit will be similar to the baseline visit. Subjects will arrive early in the morning
      and medication will be administered on-site. They will remain on site for the next 4 hours so
      that the dose will be at peak effect before administering the GORT or NIRS. The following
      procedures will happen during this visit:

        -  Sitting Vital Signs after 5 minutes of rest (oral and tympanic temperature, pulse, blood
           pressure and respiratory rate)

        -  Subject weight (using a calibrated scale)

        -  An electrocardiogram will be performed.

        -  Serum Pregnancy Test for all FOCP - A negative serum pregnancy test must be documented
           for the end of the study.

        -  ADHD-RS-IV

        -  CGI-I

        -  Study Drug Accountability and Compliance Assessment Performed

        -  Concomitant Medications

        -  Adverse Events

        -  Medication administered on-site

        -  Near Infrared Spectroscopy and Attention Task performed once.

        -  Administer the Gray's Oral Reading Test.

        -  Physical examination including height (using a calibrated stadiometer)

        -  12 Lead ECG 30-day Follow-up Phone Call
    

Intervention name(s): Vyvanse
Intervention type(s): Drug
Intervention description(s): Subjects will participate in an open-label dose optimization period and successful titration to an optimal dose of Vyvanse™, subjects will take their optimized dose of Vyvanse™ (30, 50 or 70 mg/day) during the week leading up to their final visit. During the study subjects will take their prescribed dose once a day in the morning with breakfast.
Other intervention name(s): lisdexamfetamine dimesylate
Intervention MeSH terms: Lisdexamfetamine Dimesylate
Intervention model: Single Group Assignment
Masking: Single
Primary purpose: Basic Science
Keywords: Attention Deficit Hyperactivity Disorder; ADHD; ADD; reading; brain hemodynamics; brain imaging; attention; Near-Infrared Spectroscopy; NIRS; MSIT