Pediatric ADHD Study

Is your child struggling to focus and a has low attention span, fidgeting, constantly needing movement?

Would you like to try a new investigational medication for children with signs of ADHD at no cost to you?

Sign up and we will notify you of clinical trials in your area that need pediatric participants with ADHD.

No health insurance is required to participate. All study-related care, including the study medicine is provided at no cost. The study will involve visits to a study center in your area.

What happens if I sign up?

Your child may be eligible for an ADHD clinical research study, also known as a clinical trial in your area. Someone from the study team or study center conducting the trial will contact you to explain more about this research study before you make your decision about participating. If after talking to the study team you decide to participate in the study, you will be asked to read and sign a consent form which provides detailed information including your rights, risks, benefits and requirements of the study.

Sign Up

Fields marked with an * are required.

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. By providing your phone number and clicking “Submit” below, you consent to receive messages, including SMS/MMS text messages, sent by or on behalf of AutoCruitment, with information about research studies for which you may be eligible. By clicking Submit, you also agree to our SMS Terms. 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.

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 for the purpose of recruitment into clinical research studies, determining your eligibility for studies, and provision of other services you requested? *
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.

Yes

Please fill out the below questionnaire on behalf of the child in your care so that they may be considered for the study.

Who are you interested in this study for? *

First Name of Potential Participant *

Last Name of Potential Participant *

Date of Birth MM/DD/YYYY of Potential Participant *

Zip Code or Postal Code of Potential Participant *

What is the Potential Participant’s sex assigned at birth?

Does the Potential Participant have ADHD, or exhibit symptoms of ADHD (e.g., difficulty keeping attention, seeming to not listen when spoken to directly, not follow through when given directions, difficulty organizing tasks and activities, lose things necessary for tasks or activities, easily distracted by noise or stimuli, forgetful in daily activities)? *

Has the Potential Participant been diagnosed (by a doctor) with any other medical conditions? *
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.

Is the Potential Participant taking any medications for ADHD or other health conditions? *
Please list them here or write 'none'.

Please, select the Potential Participant’s height from the dropdown below *

How much does the Potential Participant weigh in Lbs (pounds)? *

Name of caregiver/parent to contact *

Phone Number of caregiver/parent to contact *

Email of caregiver/parent to contact

We know you are busy, so what is the best day/time to reach you via telephone? *