title: Melatonin in Youth: N-of-1 trials in a stimulant-treated ADHD Population (MYNAP): study protocol for a randomized controlled trial.
abstract: Attention-deficit/hyperactivity disorder (ADHD) is a common neurological disorder affecting 5 % of children worldwide. A prevalent problem for children with ADHD is initial insomnia. The gold standard treatment to manage ADHD symptoms is stimulant medications, which may exacerbate the severity of existing initial insomnia. Currently, no gold standard treatment option exists for initial insomnia for these children. Melatonin, a hormone and a popular natural health product, is commonly provided to children by parents and recommended by healthcare providers, but high quality pediatric evidence is lacking.
  
  
  
  This trial is a multicenter randomized triple-blind, placebo-controlled, parallel-group, randomized, controlled trial (RCT), in which each participant is offered an N-of-1 trial. An N-of-1 trial is a multiple-crossover, randomized, controlled trial conducted in a single individual. For the N-of-1 trial, each participant will undergo three pairs of treatment/placebo periods; each period is 1 week in length. Half the participants will have melatonin in the first period, the other half will start with placebo, and this will make up the parallel-group RCT. The primary outcome will be mean difference in sleep onset latency as measured by sleep diaries. A comparison of treatment effects yielded by the RCT data versus the aggregated N-of-1 trial data will also be assessed.
  
  
  
  This trial will provide rigorous evidence for the effectiveness of melatonin in children with ADHD on stimulants who experience initial insomnia. Further, this study will provide the first prospectively planned head-to-head comparison of RCT data with pooled data from a series of N-of-1 trials. Aggregated N-of-1 trials may be a powerful tool to produce high quality clinical trial evidence.
  
  
  
  ClinicalTrials.gov, NCT02333149 . Registered on 16 December 2014. Australian New Zealand Clinical Trials Registry, ACTRN12614000542695 . Registered on 21 May 2014.
authors.affiliation: Complementary and Alternative Research Education (CARE) Program, Department of Pediatrics, University of Alberta, #1702 College Plaza, 8512-112 Street NW, Edmonton, Alberta, T6G 2C8, Canada.
authors.forename: Salima
authors.initials: S
authors.lastname: Punja
authors.affiliation: Center for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Nikles
authors.affiliation: College of Health, Massey University, Auckland, New Zealand.|Discipline of General Practice, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Hugh
authors.initials: H
authors.lastname: Senior
authors.affiliation: Discipline of General Practice, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Mitchell
authors.affiliation: Department of Biostatistics and Center for Evidence Based Medicine, School of Public Health, Brown University, Providence, Rhode Island, USA.
authors.forename: Christopher H
authors.initials: CH
authors.lastname: Schmid
authors.affiliation: Lady Cilento Children's Hospital, Brisbane, Australia.
authors.forename: Helen
authors.initials: H
authors.lastname: Heussler
authors.affiliation: Alberta Health Services, Edmonton, Alberta, Canada.
authors.forename: Manisha
authors.initials: M
authors.lastname: Witmans
authors.affiliation: Complementary and Alternative Research Education (CARE) Program, Department of Pediatrics, University of Alberta, #1702 College Plaza, 8512-112 Street NW, Edmonton, Alberta, T6G 2C8, Canada. svohra@ualberta.ca.
authors.forename: Sunita
authors.identifier: 0000-0002-6210-7933
authors.initials: S
authors.lastname: Vohra
mesh_terms: D006801:Humans; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D000697:Central Nervous System Stimulants / Q000009:adverse effects; D018592:Cross-Over Studies; D008550:Melatonin / Q000627:therapeutic use; D011446:Prospective Studies; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D015337:Multicenter Studies as Topic
chemical_list: D000697:Central Nervous System Stimulants; D008550:Melatonin
keywords: ADHD; Initial insomnia; Melatonin; N-of-1 trial; Randomized controlled trial