ADHD & Anxiety Study

ADHD and Anxiety Clinical Trial

We are looking for adults to take part in a clinical trial focusing on ADHD and anxiety, assessing new investigational treatments that may help improve symptoms.

Clinical trial participants must be:

Between the ages of 18-65 years
Diagnosed with or have symptoms of ADHD
Have symptoms of anxiety
Have tried at least two (2) prescribed treatments for ADHD and/or anxiety

Participation overview:

Studies are supervised by specially trained doctors and medical staff
Study-related care is provided at no cost
No insurance is needed
Reimbursement to cover costs associated with study participation
Convenient site near you
Limited spots available

Fill out this short questionnaire to determine if you pre-qualify. You’ll be contacted by medical staff who can answer your questions before you decide to participate.

Fields marked with an * are required.

Do you consent to the collection and processing of your personal data (including information about your race and ethnicity (as applicable), and your health information, including symptoms, diagnoses, medications, and treatments and our sharing of this information (“Health Data”) for the purpose of recruitment into clinical research studies, determining your eligibility for studies, and provision of other services you requested, and disclosure to our Research Partners? You may withdraw your consent at any time by contacting us at info@autocruitment.com. Please note that your revocation will not impact any records or health data already collected, disclosed, or processed based on your consent. If you do not consent to the collection and use of your Health Data in this manner, we will not be able to provide you with our services or evaluate your eligibility to participate in the studies. *

Yes

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Do you consent to receive recurring messages at the phone number you provided above, including SMS/MMS text messages, sent by or on behalf of AutoCruitment through the use of an autodialer or artificial intelligence with information about research studies for which you may be eligible. To opt out, reply “STOP” or similar words. Message and data rates may apply. By clicking ”Yes”, you also agree to our SMS Terms. *

yes no

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Personal Information

First Name *

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Last Name *

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Phone Number *

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Email *

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Date of Birth MM/DD/YYYY *

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Zip Code *

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What sex were you assigned at birth? *

Male

Female

Prefer not to say

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Health History

Have you been diagnosed by a doctor with Attention-deficit hyperactivity disorder (ADHD)? *
Please note, ADHD diagnosis is not required for study participation.

Yes – diagnosed by a doctor with ADHD

No

Unsure

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Have you experienced any of the following symptoms of Attention-deficit hyperactivity disorder (ADHD)? *
Select all that apply…

Unable to sit still

Fidgeting

Unable to concentrate on tasks

Short attention span/easily distracted

Forgetfulness

Excessive physical movement

Excessive talking

Impulsiveness

Feeling restless or on edge

None of the above

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Are you currently experiencing any of the following symptoms of anxiety? *
Select all that apply…

Feeling restless/ panic/ nervous/ or tense

Difficulty controlling worry

Difficulty concentrating

Uncontrollable/ obsessive thoughts

Breathing rapidly (hyperventilation)

Having an increased heart rate

Sweating

Trembling

Feeling weak or tired

Having trouble sleeping or staying asleep

Experiencing gastrointestinal (GI) complications

None of the above

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Have you been diagnosed (by a doctor) with any other medical conditions? *
(For Example: Psychosis, bipolar disorder, MDD, PTSD, dementia, OCD, personality disorder, epilepsy).
Please list here or write 'none'. 
Please only include conditions which have been diagnosed by a doctor.

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Have you tried medically prescribed treatments for either your ADHD and/or Anxiety? *

Yes – I have tried treatments for my ADHD and/or Anxiety

No

Unsure

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What medically prescribed treatments have you tried for your ADHD and Anxiety? *
Please select all that apply.

Amphetamines (Adderall®/ Vyvanse®)

Methyphenidates (Ritalin®/ Concerta ®/ Aptensio®)

Atomoxetines (Strattera®)

Monoamine oxidase type B (MAO-B) inhibitors (Eldepry®/ Zelapar™/ Azilect®/ Xadago®)

SSRI and SNRI (Celexa®/ Lexapro®/ Paxil®/ Zoloft®/ Cymbalta®/ Effexor®)

Buspirone (BuSpar®)

Benzodiazepines (Ativan®/ Xanax®/ Valium®)

Other

Unsure

None of the above

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Are you taking any additional medications or treatments for your ADHD, Anxiety, or other health conditions? *
Please list them below or type ‘none’.

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Additional Details

Are you willing to complete a daily e-diary entry for the duration of the study? *
Please note: The total study duration is approximately 8 weeks.

Yes – willing to complete a daily e-diary entry for the duration of the study

No

Unsure

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Are you currently pregnant, breastfeeding, or planning to become pregnant? *

Yes - pregnant / breastfeeding / planning to become pregnant

No

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Which racial or ethnic group(s) do you identify with? *
Capturing information on ethnic backgrounds allows us to better understand how different groups may have different needs.
Please select all that apply.

American Indian or Alaskan Native

Asian

Black or African American

Hispanic Latino or Spanish

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Mediterranean (Greek/Italian/Portuguese/Spanish/etc)

Another race or ethnicity

I prefer not to answer

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What is the best day/time to reach you via telephone (we know you are busy)? *

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The information you are providing here will be processed in accordance with our Privacy Policy, which describes our data privacy practices, including how we share your information with our Research Partners and use your information to send you details about potential clinical trial opportunities. When you submit this information, you consent to AutoCruitment’s use of your data as described in our Privacy Policy. If you have any questions regarding the handling of the information you have provided to AutoCruitment, or if you would like to make any changes or withdraw your consent, please contact us at info@autocruitment.com.

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