Research and Clinical Trials

The most common medicine for ADHD in children is methylphenidate (MPH). There is an enzyme in the body called CES1 that plays an important role in how the body uses this medicine. A gene also called CES1 controls the enzyme. This study is designed to see how differences in the CES1 gene affect a child’s response to MPH. Children in the study have an ADHD evaluation. If they have the kind of CES1 gene we are studying, they have the option to take part in a test to see how MPH affects them.

LEAP is a 9-session program for parents focused on supporting their child with ADHD. The goal is to improve healthy behaviors that help with focus. These include exercising, reducing screen time and getting enough sleep. Parents and children in LEAP wore fitness trackers and worked toward weekly step goals together each week. Our 5-year study showed that families participated well in all parts of the program and the children’s ADHD symptoms, behavior and executive functions improved.

Many genes play a part in a child’s risk of acquiring ADHD. In the PRAT study, we are finding out how many of these genes a child has (called their polygenic risk score). Then, we’re checking if there’s any link between the number and how well treatment works for them. Children who have been diagnosed with ADHD provide a DNA sample using a saliva swab. They also answer questions online about their ADHD symptoms and treatment. The goal of the study is to see if we can use a child’s genes to predict how they will respond to treatment.

Symptoms of ADHD include being more active and impulsive than typical and getting distracted more easily. Circuits and chemicals in the nervous system regulate these symptoms. Some of the same circuits and chemicals relate to the trigeminal nerve. This is a nerve that comes from the brain and branches into parts of the head and face.

Previous research has shown that ADHD symptoms may improve if we stimulate the trigeminal nerve with very mild electricity at night. The ADHD GEMS study is testing how well this works and how safe it is in a large group of youth with ADHD. (For example, some children say they got a tingling feeling from the stimulation, and some have gotten a mild rash.) Children in the study get the treatment (trigeminal nerve stimulation, or TNS) at home for 4 weeks. Researchers will compare their results to results from a group that gets briefer stimulation. They will also study how the treatment works on the nervous system and how it affects behavior.

So far, the research has confirmed families are interested in ADHD treatment options other than medicines and most children are comfortable wearing the TNS device at night.

Nearly 20% of teens will be diagnosed with depression, and it’s often a challenge to get high-quality, evidence-based therapy. Dr. Jessica Jenness is working with a team of researchers in Psychiatry and Behavioral Medicine and the University of Washington Human-Centered Design & Engineering Department to develop and test an app, called ActivaTeen, to support depression therapy for teens. ActivaTeen has several innovative features. They include:

• In-the-moment tracking of mood and activity. This can help teens and their therapists better understand treatment goals and progress.
• Help using therapy skills outside of therapy sessions.
• Built-in peer support.
• Access to send messages to therapists.

So far, results show that teens and mental health therapists support using ActivaTeen. Jenness and her team are doing a larger clinical trial to test ActivaTeen as a therapy support tool at Seattle Children’s.

The ASSIST study compares 3 ways to manage the risk of suicide in adolescents ages 11 to 17.

• Collaborative Assessment and Management of Suicide (CAMS) (PDF). This approach focuses on treating suicidal thoughts.
• Safety planning intervention with follow-up. A healthcare provider works with a child to plan strategies and resources they can use to lower the risk of suicide. The child also gets some ongoing therapy.
• Enhanced usual care. The family continues with the recommended care they received from an acute care setting, like an emergency department or a medical or psychiatric unit in a hospital. They take part in 5 assessments over 1 year.

By comparing these treatment options, researchers are looking to learn which option works best and how each option works. They are also interested in understanding what, if anything, makes a treatment more effective for some children than for others.

When teens or young adults are in a suicidal crisis, it’s important to help them and their families quickly. The SOARS study is testing several methods together so we can learn what works best. Families in the study get evidence-based treatment that includes 4 parts:

• Care focused on treating suicidal thoughts, called Collaborative Assessment and Management of Suicidality (CAMS) (PDF)
• Skills training to help youth manage their distress
• Skill building for parents and caregivers to help them communicate with their child and manage their child’s behavior
• Restricting access to items, like guns and medicines, which raise the risk that a suicide attempt will lead to death

Seattle Children’s researchers are studying these methods in patients ages 13 to 21 and their families. We hope to find the strongest set of methods to reduce suicidal thoughts and behaviors.