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Breda V, Cerqueira RO, Ceolin G, Koning E, Fabe J, McDonald A, Gomes FA, Brietzke E. Is there a place for dietetic interventions in adult ADHD? Prog Neuropsychopharmacol Biol Psychiatry 2022; 119:110613. [PMID: 35964708 DOI: 10.1016/j.pnpbp.2022.110613] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/20/2022] [Accepted: 08/08/2022] [Indexed: 10/15/2022]
Abstract
Current treatments for Attention-Deficit/Hyperactivity Disorder (ADHD) in adults are limited by lack of response and side effects in about one third of the individuals. Changes towards a healthier lifestyle could have a positive impact beyond the relief of specific symptoms. However, it is not clear if nutritional interventions influence mental health and cognition. The objective of this study was to summarize the available literature addressing the impact of different diets in ADHD. The most promising dietetic approaches in ADHD are diets considered to be healthy (Mediterranean-type; DASH) and the Few-Foods Diet for children. Studies should take into account the presence of multiple confounders, biases associated with difficulties in blinding participants and researchers, and search for possible mechanisms of action, so we can have better evidence to guide clinical mental care of adults with ADHD.
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Affiliation(s)
- Vitor Breda
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
| | - Raphael O Cerqueira
- Department of Psychiatry, Federal University of São Paulo, Rua Major Maragliano 241, São Paulo, SP 04017-030, Brazil
| | - Gilciane Ceolin
- Postgraduate Program in Nutrition, Federal University of Santa Catarina, Rua Delfino Conti, Campus Trindade, Florianópolis, SC 88040-970, Brazil
| | - Elena Koning
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
| | - Jennifer Fabe
- McMasters Children's Hospital, Hamilton Health Sciences, 1200 Main St W, Hamilton, ON L8N 3Z5, Canada.
| | | | - Fabiano A Gomes
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
| | - Elisa Brietzke
- Department of Psychiatry, Queen's University School of Medicine, 752 King Street West, Kingston, ON K7L 7X3, Canada; Centre for Neuroscience Studies (CNS), Queen's University, 18 Stuart Street, Kingston, ON K7L 3N6, Canada.
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2
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Pinto S, Correia-de-Sá T, Sampaio-Maia B, Vasconcelos C, Moreira P, Ferreira-Gomes J. Eating Patterns and Dietary Interventions in ADHD: A Narrative Review. Nutrients 2022; 14:nu14204332. [PMID: 36297016 PMCID: PMC9608000 DOI: 10.3390/nu14204332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood, affecting ~7% of children and adolescents. Given its adverse health outcomes and high healthcare and societal costs, other treatment options beyond pharmacotherapy have been explored. Case-control studies have shown that dietary patterns may influence the risk of ADHD, and specific dietary interventions have been proposed as coadjuvant treatments in this disorder. These include nutritional supplements, gut microbiome-targeted interventions with biotics, and elimination diets. The purpose of this review is to examine which dietary patterns are most associated with ADHD and to summarize the existing evidence for the clinical use of dietary interventions. The literature showed that non-healthy dietary patterns were positively associated with ADHD, whereas healthy patterns were negatively associated. As for nutritional supplements, only vitamin D and vitamin D + magnesium appeared to improve ADHD symptoms when baseline levels of vitamin D were insufficient/deficient. Regarding biotics, evidence was only found for Lactobacillus rhamnosus GG and for multi-species probiotic supplementation. Elimination diets have scarce evidence and lead to nutritional deficiencies, so caution is advised. Overall, more robust scientific evidence is required for these dietary interventions to be implemented as part of ADHD therapy.
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Affiliation(s)
- Sofia Pinto
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
| | - Teresa Correia-de-Sá
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- INEB—Institute of Biomedical Engineering, University of Porto, 4200-135 Porto, Portugal
- i3S—Institute for Research & Innovation in Health, University of Porto, 4200-135 Porto, Portugal
| | - Benedita Sampaio-Maia
- INEB—Institute of Biomedical Engineering, University of Porto, 4200-135 Porto, Portugal
- i3S—Institute for Research & Innovation in Health, University of Porto, 4200-135 Porto, Portugal
- Faculty of Dental Medicine, University of Porto, 4200-393 Porto, Portugal
| | - Carla Vasconcelos
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
- Nutrition Service, University Hospital Center of São João, 4200-319 Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences, University of Porto, 4150-180 Porto, Portugal
- EPIUnit, Institute of Public Health, University of Porto, 4200-450 Porto, Portugal
- Correspondence: ; Tel.: +351-225-074-320
| | - Joana Ferreira-Gomes
- Department of Biomedicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- i3S—Institute for Research & Innovation in Health, University of Porto, 4200-135 Porto, Portugal
- IBMC—Institute for Molecular and Cell Biology, University of Porto, 4200-135 Porto, Portugal
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PEKMEZEKMEK A. MONOSODYUM GLUTAMAT, LEZZET ARTTIRICI MI, ÖLDÜREN LEZZET Mİ? KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2022. [DOI: 10.17517/ksutfd.1067018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Monosodium glutamat (MSG) 1800’lü yıllardan beri lezzet artırıcı katkı maddesi olarak, işlenmiş ve paketlenmiş tuzlu veya tatlı gıdalarda kullanılmaktadır. Yapılan birçok çalışma MSG kullanımının çok sayıda yapısal ve fonksiyonel bozukluklara yol açabileceğini ortaya çıkarmıştır. Son yıllarda MSG kullanımının çok artması gıda güvenliği konusunda endişelerinde artmasına neden olmuştur.
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Salvat H, Mohammadi MN, Molavi P, Mostafavi SA, Rostami R, Salehinejad MA. Nutrient intake, dietary patterns, and anthropometric variables of children with ADHD in comparison to healthy controls: a case-control study. BMC Pediatr 2022; 22:70. [PMID: 35093041 PMCID: PMC8800296 DOI: 10.1186/s12887-022-03123-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor health behaviors and variables are recently more documented in attention-deficit hyperactivity disorder (ADHD) lifestyle which might be relevant to the pathophysiology of this disorder. The objective of this case-control study was to assess the nutrient intake, dietary patterns, and anthropometric variables in children with ADHD compared to normal peers. METHOD One hundred children diagnosed with ADHD were included and compared to 100 healthy, sex-matched normal children as the control group. Anthropometric indices, macronutrients, and micronutrients were measured and compared in both groups. RESULTS ADHD children were significantly consuming more simple sugars, tea, ready-made meals but less protein, vitamin B1, vitamin B2, vitamin C, zinc and calcium compared to the control group. The body mass index (BMI) and waist circumference of children with ADHD were significantly higher and were related to the severity and type of the disease. CONCLUSION Unhealthy eating behavior is more frequent in children with ADHD, compared to normal children which might warrant lifestyle intervention in this disorder.
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Affiliation(s)
- Habibeh Salvat
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mehriar Nader Mohammadi
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Parviz Molavi
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran.
| | - Seyed Ali Mostafavi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Rostami
- Department of Psychology, University of Tehran, Tehran, Iran
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
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Laue HE, Coker MO, Madan JC. The Developing Microbiome From Birth to 3 Years: The Gut-Brain Axis and Neurodevelopmental Outcomes. Front Pediatr 2022; 10:815885. [PMID: 35321011 PMCID: PMC8936143 DOI: 10.3389/fped.2022.815885] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/10/2022] [Indexed: 12/18/2022] Open
Abstract
The volume and breadth of research on the role of the microbiome in neurodevelopmental and neuropsychiatric disorders has expanded greatly over the last decade, opening doors to new models of mechanisms of the gut-brain axis and therapeutic interventions to reduce the burden of these outcomes. Studies have highlighted the window of birth to 3 years as an especially sensitive window when interventions may be the most effective. Harnessing the powerful gut-brain axis during this critical developmental window clarifies important investigations into the microbe-human connection and the developing brain, affording opportunities to prevent rather than treat neurodevelopmental disorders and neuropsychiatric illness. In this review, we present an overview of the developing intestinal microbiome in the critical window of birth to age 3; and its prospective relationship with neurodevelopment, with particular emphasis on immunological mechanisms. Next, the role of the microbiome in neurobehavioral outcomes (such as autism, anxiety, and attention-deficit hyperactivity disorder) as well as cognitive development are described. In these sections, we highlight the importance of pairing mechanistic studies in murine models with large scale epidemiological studies that aim to clarify the typical health promoting microbiome in early life across varied populations in comparison to dysbiosis. The microbiome is an important focus in human studies because it is so readily alterable with simple interventions, and we briefly outline what is known about microbiome targeted interventions in neurodevelopmental outcomes. More novel examinations of known environmental chemicals that adversely impact neurodevelopmental outcomes and the potential role of the microbiome as a mediator or modifier are discussed. Finally, we look to the future and emphasize the need for additional research to identify populations that are sensitive to alterations in their gut microbiome and clarify how interventions might correct and optimize neurodevelopmental outcomes.
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Affiliation(s)
- Hannah E Laue
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Modupe O Coker
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Rutgers School of Dental Medicine, The State University of New Jersey, Newark, NJ, United States
| | - Juliette C Madan
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Department of Pediatrics and Psychiatry, Children's Hospital at Dartmouth, Lebanon, NH, United States
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Xu YC, Wang JP, Zhu WJ, Li P. Childhood atopic dermatitis as a precursor for developing attention deficit/hyperactivity disorder. Int J Immunopathol Pharmacol 2021; 34:2058738420962902. [PMID: 33045857 PMCID: PMC7557683 DOI: 10.1177/2058738420962902] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Atopic dermatitis (AD) is a skin disease characterized by chronic inflammatory condition that shows hallmark presentations in terms of sleep disturbances, pruritus, and psychological stress, and an association with increased attention deficit/hyperactivity disorder (ADHD) risk. A number of studies have suggested for the co-occurrence of the two diseased conditions. In terms of global prevalence, AD and ADHD almost exhibit a parallel increment according to epidemiological data. In addition, recent reports indicate AD to show a temporal association with later onset of ADHD. Although several studies suggest for the potential link between AD and ADHD, currently there is no definitive answer to this regard. Furthermore, epidemiological evidence of co-occurrence does not ascertain a pathophysiological link between the two conditions. The pathophysiological basis behind the association of AD and ADHD also remain poorly elucidated. The objective of this review is to present an extensive account of AD and associated comorbidities with a special attention toward ADHD as well as to elaborate on the mechanisms underlying their association. The review can provide healthcare providers with the recent updates on AD-ADHD association and help them while dealing with such patients. In general, AD and ADHD show a positive association in majority of the cross-sectional studies. However, large longitudinal studies are required to draw any conclusion on the temporal nature of such association.
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Affiliation(s)
- Yang-Chun Xu
- Department of Dermatology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Jin-Peng Wang
- Department of Cardiology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Wen-Jing Zhu
- Department of Dermatology, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Ping Li
- Department of Developmental Pediatrics, the Second Hospital of Jilin University, Changchun, Jilin, China
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Singer AG, Kosowan L, Soller L, Chan ES, Nankissoor NN, Phung RR, Abrams EM. Prevalence of Physician-Reported Food Allergy in Canadian Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:193-199. [DOI: 10.1016/j.jaip.2020.07.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/01/2020] [Accepted: 07/23/2020] [Indexed: 12/25/2022]
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Boga Pekmezekmek A, Emre M, Tunc E, Sertdemir Y. L-Glutamic acid monosodium salt reduces the harmful effect of lithium on the development of Xenopus laevis embryos. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:42124-42132. [PMID: 32705564 DOI: 10.1007/s11356-020-10155-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/15/2020] [Indexed: 06/11/2023]
Abstract
Many xenobiotics in the environment affect the human body in various ways. Among those xenobiotics, lithium chloride (Li, LiCl) and monosodium glutamate (L-glutamic acid monosodium salt, MSG) compounds affect the crucial processes of stem cell differentiation, cell proliferation, developmental gene expression, and overall development in animals. In this study, we aimed to examine the developmental effects of exposure to flavor enhancer MSG and LiCI medicament on Xenopus embryos using the frog embryo teratogenesis assay of Xenopus test. To this purpose, Xenopus laevis embryos were exposed to four different concentrations of MSG (120, 500, 750, 1000 mg/dL) and Li (0.02 g/L) alone and in combinations for a period of 96 h, and then normal, abnormal, and death ratios were determined in all exposure groups. Besides, length values of all groups and membrane potentials of fertilized and non-fertilized oocyte groups treated with 120- and 500-mg/dL MSG doses and 0.02-g/L LiCI dose were measured. Treatment with ADI (acceptable daily intake) dose of MSG alone did not lead to a substantial effect on the development of Xenopus laevis embryos. But, exposure to daily doses exceeding the ADI level (500, 750, 1000 mg/dL) caused significant harmful effects. Besides, Li-involving treatments caused dramatic deleterious effects on embryo development. MSG attenuated harmful effects of Li in MSG+Li combined treatments. Membrane potentials of non-fertilized oocytes and fertilized eggs were significantly changed in all groups that their membrane potentials were measured. Extrapolating these results into humans require similarly designed studies conducted on human embryos.
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Affiliation(s)
- Ayper Boga Pekmezekmek
- Department of Physiology, School of Medicine, Çukurova University, Balcalı, 01330, Adana, Turkey.
| | - Mustafa Emre
- Department of Biophysics, School of Medicine, Çukurova University, Adana, Turkey
| | - Erdal Tunc
- Department of Medical Biology and Genetics, School of Medicine, Çukurova University, Adana, Turkey
| | - Yasar Sertdemir
- Department of Biostatistics, School of Medicine, Çukurova University, Adana, Turkey
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Uldall Torp NM, Thomsen PH. The use of diet interventions to treat symptoms of ADHD in children and adolescents - a systematic review of randomized controlled trials. Nord J Psychiatry 2020; 74:558-568. [PMID: 32513046 DOI: 10.1080/08039488.2020.1769187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: For over forty years diet interventions have been investigated as a treatment of ADHD in children and adolescents and, with the new discoveries of the microbiota-gut-brain axis, this research becomes more relevant than ever. The aim of this systematic review was therefore to investigate the current knowledge of diet interventions as a treatment of ADHD in children and adolescentsMethods: A systematic literature search in PubMed was conducted, identifying randomized controlled trials investigating diet interventions to treat ADHD in children and adolescents.Results: The study populations were generally small and the studies varied in duration and nature of the exposure. Overall 10 out of 12 studies spoke in favour of an elimination diet, 2 out of 6 of eliminating artificial food colourings from the diet and none in favour of eliminating sucrose or aspartame from the diet to treat ADHD.Conclusion: The current evidence is not enough to recommend treating ADHD with diet interventions, but a subgroup of children and adolescents might warrant from elimination of certain food-items. Further investigations of the mechanism and effect of diet interventions to treat ADHD is needed.
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Affiliation(s)
| | - Per Hove Thomsen
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.,Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
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Alessi MG, Bennett JM. Mental health is the health of the whole body: How psychoneuroimmunology & health psychology can inform & improve treatment. J Eval Clin Pract 2020; 26:1539-1547. [PMID: 32171052 DOI: 10.1111/jep.13386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/12/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Converging and accumulating evidence for the cross-communication among the nervous, immune, and endocrine systems, a field of study known as psychoneuroimmunology, implicates immunological dysfunction as a shared and common mechanism of both mental and physical illness. For example, psychiatric disorders like schizophrenia, bipolar disorder, major depression, and anxiety disorders have higher prevalence rates across a spectrum of autoimmune conditions compared to the general population. Additionally, subclinical immunological abnormalities are observed in a variety of psychiatric conditions, with chronic inflammation most extensively studied in the pathophysiology of depression. These observations blur the historical distinctions between mental and physical illness, yet clinical practice remains fragmented and primarily focused on differentially treating individual symptoms. PROPOSED THESIS Therapeutically targeting inflammation offers translational opportunities for integrating mental and physical healthcare, a key niche of the interdisciplinary field of health psychology. CONCLUSION Utilizing a psychoneuroimmunological lens, health psychologists and clinicians can reconceptualize healthcare through integrative treatment approaches and advocacy for comprehensive policy-level reform at both the individual-level of care as well as community-wide prevention approaches.
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Affiliation(s)
- Maria G Alessi
- Health Psychology PhD Program, UNC Charlotte, Charlotte, North Carolina, USA
| | - Jeanette M Bennett
- Health Psychology PhD Program, UNC Charlotte, Charlotte, North Carolina, USA.,Department of Psychological Science, UNC Charlotte, Charlotte, North Carolina, USA
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Abstract
Objective: The objective of the study is to examine whether children aged 7 to 11 years with very well-characterized ADHD, recruited from the community, have a similar number of healthy lifestyle behaviors as compared with typically developing children from the same community. Method: Parents of children with (n = 184) and without (n = 104) ADHD completed a lifestyle questionnaire asking about water intake, sweetened beverage consumption, multivitamin/supplement use, reading, screen time, physical activity, and sleep. A lifestyle index was formed from these seven domains (0-7), and multivariable ordered logistic regression was used to examine the association of ADHD status and total healthy lifestyle behaviors. Results: Children with ADHD were almost twice as likely to have fewer healthy behaviors, even after adjustment for age, sex, intelligence quotient (IQ), ADHD medication use, household income, and four comorbid psychiatric disorders (odds ratio [OR] [95% confidence interval] = 1.95 [1.16, 3.30], p = .01). Conclusion: Future research is needed to assess the effects of a combined lifestyle intervention in this group.
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Affiliation(s)
| | - Joel T. Nigg
- Oregon Health & Science University, Portland, OR, USA
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Dölp A, Schneider-Momm K, Heiser P, Clement C, Rauh R, Clement HW, Schulz E, Fleischhaker C. Oligoantigenic Diet Improves Children's ADHD Rating Scale Scores Reliably in Added Video-Rating. Front Psychiatry 2020; 11:730. [PMID: 32973571 PMCID: PMC7468497 DOI: 10.3389/fpsyt.2020.00730] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 07/10/2020] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The influence of food intake on behavioural disorders was already described in the early 20th century. Elimination of individually allergenic food items from individual diets ["oligoantigenic diet" (OD)] showed promise to improve attention-deficit/hyperactivity disorder (ADHD) symptoms. However, only few of the positive results were evaluated by blinded symptom rating. Therefore the present study's purpose was to evaluate the reliability of a non-blinded rating of the ADHD Rating Scale IV (ARS) for the assessment of OD effects in comparison to a blinded rating of the ARS based on pseudonymized video recordings. METHODS Ten children (8m/2f) aged 8 to 14 with ADHD according to ICD-10 participated in an uncontrolled, open-label dietary intervention study. Food items, commonly related to intolerances, were eliminated for four weeks. Participants with > 40% improvement in the ARS between T1 (before the diet) and T2 (after the diet) were defined as responders. Nutrients with individual relevance to ADHD symptoms were identified in a following reintroduction phase (T3-T4) lasting 8-16 weeks. The ARS was completed by a non-blinded child and adolescent psychiatrist (T0-T4). Sessions were recorded on video, pseudonymized, and evaluated by three blinded raters. Complete data were captured for eight children. The inter-rater reliability between the non-blinded therapist and every blinded rater was determined by the intra-class correlation coefficient (ICC). Correlations according to Pearson and Spearman between the non-blinded and blinded rating were calculated for each rater. RESULTS Two blinded raters and the non-blinded rater considered 5 of 8 (62.5%) children as responders, whereas one blinded rater disagreed as to the success of one case thus considering only 4 of 8 children as responders to the diet. Inter-rater reliability was assessed after each rater having scored 33 videos: The intra-class coefficients were >.9 for all raters (rater 1: ICC=.997, rater 2: ICC=.996, rater 3: ICC=.996) and the Spearman rho between the raters were high (n=33; rater 1: rho =.989, p<.0001, rater 2: rho=.987, p<.0001, rater 3: rho=.984, p<.0001), respectively. DISCUSSION As both, blinded and non-blinded ratings of the ARS, revealed relevant significant improvement of ADHD scores in children following an OD in this uncontrolled trial, Randomized controlled trials appear as highly desirable in order to replicate these improvements and to establish reliable and unbiased effect sizes thereby fostering further more objective confirmatory measurements.
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Affiliation(s)
- Anna Dölp
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katja Schneider-Momm
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philip Heiser
- Clinic of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, SuedharzHospital Nordhausen, Nordhausen, Germany
| | - Christina Clement
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Reinhold Rauh
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hans-Willi Clement
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eberhard Schulz
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christian Fleischhaker
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Eltokhi A, Janmaat IE, Genedi M, Haarman BCM, Sommer IEC. Dysregulation of synaptic pruning as a possible link between intestinal microbiota dysbiosis and neuropsychiatric disorders. J Neurosci Res 2020; 98:1335-1369. [PMID: 32239720 DOI: 10.1002/jnr.24616] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/16/2020] [Accepted: 02/26/2020] [Indexed: 02/06/2023]
Abstract
The prenatal and early postnatal stages represent a critical time window for human brain development. Interestingly, this window partly overlaps with the maturation of the intestinal flora (microbiota) that play a critical role in the bidirectional communication between the central and the enteric nervous systems (microbiota-gut-brain axis). The microbial composition has important influences on general health and the development of several organ systems, such as the gastrointestinal tract, the immune system, and also the brain. Clinical studies have shown that microbiota alterations are associated with a wide range of neuropsychiatric disorders including autism spectrum disorder, attention deficit hyperactivity disorder, schizophrenia, and bipolar disorder. In this review, we dissect the link between these neuropsychiatric disorders and the intestinal microbiota by focusing on their effect on synaptic pruning, a vital process in the maturation and establishing efficient functioning of the brain. We discuss in detail how synaptic pruning is dysregulated differently in the aforementioned neuropsychiatric disorders and how it can be influenced by dysbiosis and/or changes in the intestinal microbiota composition. We also review that the improvement in the intestinal microbiota composition by a change in diet, probiotics, prebiotics, or fecal microbiota transplantation may play a role in improving neuropsychiatric functioning, which can be at least partly explained via the optimization of synaptic pruning and neuronal connections. Altogether, the demonstration of the microbiota's influence on brain function via microglial-induced synaptic pruning addresses the possibility that the manipulation of microbiota-immune crosstalk represents a promising strategy for treating neuropsychiatric disorders.
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Affiliation(s)
- Ahmed Eltokhi
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tubingen, Tubingen, Germany
| | - Isabel E Janmaat
- Department of Biomedical Sciences, Cells & Systems, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Mohamed Genedi
- Department of Biomedical Sciences, Cells & Systems, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Bartholomeus C M Haarman
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Iris E C Sommer
- Department of Biomedical Sciences, Cells & Systems, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Kirkland AE, Langan MT, Holton KF. Artificial food coloring affects EEG power and ADHD symptoms in college students with ADHD: a pilot study. Nutr Neurosci 2020; 25:159-168. [PMID: 32116139 DOI: 10.1080/1028415x.2020.1730614] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Removing artificial food coloring (AFC) is a common dietary intervention for children with Attention-Deficit/Hyperactivity Disorder (ADHD), but has not been tested in young adults. This pilot study examined the effects of AFC on ADHD symptoms and electroencephalography (EEG) in college students with and without ADHD.Methods: At baseline, control and ADHD participants completed the Adult ADHD Self-Report Scale (ASRS), simple and complex attention measures, and resting-state EEG recordings. ADHD participants (n = 18) and a subset of controls (extended control group or EC, n = 11) avoided AFC in their diet for 2 weeks and then were randomized to a double-blind, placebo-controlled crossover challenge. Subjects received either 225 mg AFC disguised in chocolate cookies or placebo chocolate cookies for 3 days each week, with testing on the third day each week. Baseline comparisons were made using Student's t-test or Wilcoxon rank sum tests and challenge period analyses were run using General Linear Modeling.Results: The ADHD group had significantly greater scores on the ASRS (p < 0.001), confirming a symptom differential between groups; however, there were no differences in attentional measures or EEG at baseline. The AFC challenge resulted in an increase in posterior mean gamma power (p = 0.05), a decrease in posterior relative alpha power (p = 0.04), and a marginal increase in inattentive symptoms (p = 0.08) in the ADHD group. There were no effects of AFC in the EC group.Discussion: This study indicates that AFC exposure may affect brainwave activity and ADHD symptoms in college students with ADHD. Larger studies are needed to confirm these findings.
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Affiliation(s)
- Anna E Kirkland
- Department of Psychology, American University, Washington, DC, USA
| | | | - Kathleen F Holton
- Department of Health Studies, American University, Washington, DC, USA.,Center for Behavioral Neuroscience, American University, Washington, DC, USA
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15
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Shrestha M, Lautenschleger J, Soares N. Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Transl Pediatr 2020; 9:S114-S124. [PMID: 32206589 PMCID: PMC7082245 DOI: 10.21037/tp.2019.10.01] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a very common neurobehavioral disorder that affects children and adolescents with impact that persists beyond adolescence into adulthood. Medication and non-pharmacological treatments are evidence-based interventions for ADHD in various age groups, and this article will elaborate on the psychosocial, physical and integrative medicine interventions that have been studied in ADHD.
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Affiliation(s)
- Mahesh Shrestha
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | | | - Neelkamal Soares
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Chang TH, Tai YH, Dai YX, Chang YT, Chen TJ, Chen MH. Risk of Atopic Diseases among Siblings of Patients with Attention-Deficit Hyperactivity Disorder: A Nationwide Population-Based Cohort Study. Int Arch Allergy Immunol 2019; 180:37-43. [PMID: 31207596 DOI: 10.1159/000500831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Increasing evidence suggests a positive association between attention-deficit hyperactivity disorder (ADHD) and atopic diseases. However, the risk of atopic diseases in unaffected siblings of patients with ADHD has not been investigated. OBJECTIVE To investigate the risk of developing atopic diseases among unaffected siblings of ADHD probands. METHODS Using data from the Taiwan National Health Insurance Research Database, 20,170 unaffected siblings of patients with ADHD born between 1980 and 2000 and 80,680 age-, birth time-, and residence-matchedcontrols were included in this study. Diagnoses of atopic diseases, including asthma, atopic dermatitis, allergic rhinitis, and allergic conjunctivitis, were ascertained from 1996 or the birth time until the end of 2011. RESULTS Breslow-Cox proportional hazard regression analyses with adjustment for demographic data showed that compared with the controls, unaffected siblings of patients with ADHD had a higher risk of developing asthma (relative risk [RR], 1.19; 95% confidence interval [CI], 1.15-1.24), atopic dermatitis (RR, 1.10; 95% CI, 1.04-1.16), allergic rhinitis (RR, 1.17; 95% CI, 1.14-1.21), allergic conjunctivitis (RR, 1.13; 95% CI, 1.09-1.17), and any of these atopic diseases (RR, 1.13; 95% CI, 1.10-1.15). CONCLUSION The unaffected siblings of ADHD probands were more likely to develop atopic diseases compared with the controls, suggesting shared risk factors for both diseases.
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Affiliation(s)
- Tsung-Hsien Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ying-Hsuan Tai
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ying-Xiu Dai
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mu-Hong Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, .,Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan,
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17
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Dietary and Micronutrient Treatments for Children with Neurodevelopment Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0150-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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18
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Affiliation(s)
- Joy A Weydert
- Department of Pediatrics, University of Kansas Health System, 3901 Rainbow Boulevard, Kansas City, KS 66160, USA.
| | - Melanie L Brown
- Department of Pediatrics, University of Minnesota Medical School, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Suite 32-T5, Minneapolis, MN 55304, USA
| | - Hilary McClafferty
- Department of Medicine, Center for Integrative Medicine, University of Arizona, PO Box 245153, Tucson, AZ 85724, USA
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Abstract
Increasing scientific evidence suggests potential adverse effects on children's health from synthetic chemicals used as food additives, both those deliberately added to food during processing (direct) and those used in materials that may contaminate food as part of packaging or manufacturing (indirect). Concern regarding food additives has increased in the past 2 decades in part because of studies that increasingly document endocrine disruption and other adverse health effects. In some cases, exposure to these chemicals is disproportionate among minority and low-income populations. This report focuses on those food additives with the strongest scientific evidence for concern. Further research is needed to study effects of exposure over various points in the life course, and toxicity testing must be advanced to be able to better identify health concerns prior to widespread population exposure. The accompanying policy statement describes approaches policy makers and pediatricians can take to prevent the disease and disability that are increasingly being identified in relation to chemicals used as food additives, among other uses.
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Affiliation(s)
- Leonardo Trasande
- Departments of Pediatrics, Environmental Medicine, and Health Policy, School of Medicine, New York University, New York, New York
| | - Rachel M. Shaffer
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle, Washington
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20
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Ramalho R, Pereira AC, Vicente F, Pereira P. Docosahexaenoic acid supplementation for children with attention deficit hyperactivity disorder: A comprehensive review of the evidence. Clin Nutr ESPEN 2018; 25:1-7. [PMID: 29779801 DOI: 10.1016/j.clnesp.2018.03.126] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 03/22/2018] [Accepted: 03/28/2018] [Indexed: 12/27/2022]
Abstract
Attention deficit hyperactivity disorder (ADHD) is considered the most common behavioural disorder in school-age children. ADHD is a complex and multifactorial disorder characterised by a variety of symptoms, including concentration problems, excessive motor activity and impulsivity which interferes with execution of simple school tasks. Diagnosis has been essentially subjective, since no specific laboratory tests are available. However, ADHD remains overdiagnosed, probably due to social pressures for children to be successful in school from an early age, which leads parents to seek medical support. Although therapeutic approaches for ADHD have been essentially pharmacologic, in recent years several studies were performed to investigate the role of nutrition, especially omega 3 polyunsaturated fatty acid (omega 3-PUFA), in the development and treatment of this disorder. In this review, the authors gathered the most relevant evidence regarding omega 3-PUFA, mainly docosahexaenoic acid, as coadjutant or as a single therapy, in the management of ADHD symptoms. The authors also reviewed this disorder's current medical and therapeutic features.
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Affiliation(s)
- Renata Ramalho
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal.
| | - Ana Colaço Pereira
- Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
| | - Filipa Vicente
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
| | - Paula Pereira
- Instituto Superior de Ciências da Saúde Egas Moniz (ISCSEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal; Grupo de Estudos em Nutrição Aplicada (GENA), Campus Universitário Quinta da Granja, Monte de Caparica, 2829-511, Caparica, Portugal
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21
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Bora S, Rindfleisch JA. The Elimination Diet. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00086-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Tandon M, Pergjika A. Attention Deficit Hyperactivity Disorder in Preschool-Age Children. Child Adolesc Psychiatr Clin N Am 2017; 26:523-538. [PMID: 28577607 DOI: 10.1016/j.chc.2017.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Attention deficit hyperactivity disorder is a neurodevelopmental disorder marked by age-inappropriate deficits in attention or hyperactivity/impulsivity that interfere with functioning or development. It is highly correlated with other disorders, such as oppositional defiant disorder, conduct disorder, and mood symptoms. The etiology is multifactorial, and neuroimaging findings are nonspecific. Although assessment tools exist, there is variability among them, and historically, parent-teacher agreement has not been consistent. Treatment algorithm for attention deficit hyperactivity disorder in preschoolers includes behavioral interventions first followed by psychopharmacologic treatment when behavioral therapies fail. Other nonpharmacologic and nonbehavioral interventions are discussed including the role of exercise and nutrition.
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Affiliation(s)
- Mini Tandon
- Division of Child and Adolescent Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St Louis, MO 63110, USA
| | - Alba Pergjika
- Division of Child and Adolescent Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8134, St Louis, MO 63110, USA.
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23
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Pelsser LM, Frankena K, Toorman J, Rodrigues Pereira R. Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet Interventions on the Behavior of Children with ADHD. PLoS One 2017; 12:e0169277. [PMID: 28121994 PMCID: PMC5266211 DOI: 10.1371/journal.pone.0169277] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 12/14/2016] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Attention-deficit/hyperactivity disorder (ADHD) is a debilitating mental health problem hampering the child's development. The underlying causes include both genetic and environmental factors and may differ between individuals. The efficacy of diet treatments in ADHD was recently evaluated in three reviews, reporting divergent and confusing conclusions based on heterogeneous studies and subjects. To address this inconsistency we conducted a systematic review of meta-analyses of double-blind placebo-controlled trials evaluating the effect of diet interventions (elimination and supplementation) on ADHD. METHODS Our literature search resulted in 14 meta-analyses, six of which confined to double-blind placebo-controlled trials applying homogeneous diet interventions, i.e. artificial food color (AFC) elimination, a few-foods diet (FFD) and poly-unsaturated fatty acid (PUFA) supplementation. Effect sizes (ES) and Confidence intervals (CI) of study outcomes were depicted in a forest plot. I2 was calculated to assess heterogeneity if necessary and additional random effects subgroup meta-regression was conducted if substantial heterogeneity was present. RESULTS The AFC ESs were 0.44 (95% CI: 0.16-0.72, I2 = 11%) and 0.21 (95% CI: -0.02-0.43, I2 = 68%) [parent ratings], 0.08 (95% CI: -0.07-0.24, I2 = 0%) [teacher ratings] and 0.11 (95% CI: -0.13-0.34, I2 = 12%) [observer ratings]. The FFD ESs were 0.80 (95% CI: 0.41-1.19, I2 = 61%) [parent ratings] and 0.51 (95% CI: -0.02-1.04, I2 = 72%) [other ratings], while the PUFA ESs were 0.17 (95% CI: -0.03-0.38, I2 = 38%) [parent ratings], -0.05 (95% CI: -0.27-0.18, I2 = 0%) [teacher ratings] and 0.16 (95% CI: 0.01-0.31, I2 = 0%) [parent and teacher ratings]. Three meta-analyses (two FFD and one AFC) resulted in high I2 without presenting subgroup results. The FFD meta-analyses provided sufficient data to perform subgroup analyses on intervention type, resulting in a decrease of heterogeneity to 0% (diet design) and 37.8% (challenge design). CONCLUSION Considering the small average ESs PUFA supplementation is unlikely to provide a tangible contribution to ADHD treatment, while further research is required for AFC elimination before advising this intervention as ADHD treatment. The average FFD ES is substantial, offering treatment opportunities in subgroups of children with ADHD not responding to or too young for medication. Further FFD research should focus on establishing the underlying mechanisms of food (e.g. incrimination of gut microbiota) to simplify the FFD approach in children with ADHD.
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Affiliation(s)
| | - Klaas Frankena
- Quantitative Veterinary Epidemiology group, Wageningen University & Research, Wageningen, the Netherlands
| | - Jan Toorman
- Retired paediatrician, previously Catharina Hospital, Eindhoven, the Netherlands
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24
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Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, Rohde LA, Sonuga-Barke EJS, Tannock R, Franke B. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2015; 1:15020. [PMID: 27189265 DOI: 10.1038/nrdp.2015.20] [Citation(s) in RCA: 798] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a persistent neurodevelopmental disorder that affects 5% of children and adolescents and 2.5% of adults worldwide. Throughout an individual's lifetime, ADHD can increase the risk of other psychiatric disorders, educational and occupational failure, accidents, criminality, social disability and addictions. No single risk factor is necessary or sufficient to cause ADHD. In most cases ADHD arises from several genetic and environmental risk factors that each have a small individual effect and act together to increase susceptibility. The multifactorial causation of ADHD is consistent with the heterogeneity of the disorder, which is shown by its extensive psychiatric co-morbidity, its multiple domains of neurocognitive impairment and the wide range of structural and functional brain anomalies associated with it. The diagnosis of ADHD is reliable and valid when evaluated with standard criteria for psychiatric disorders. Rating scales and clinical interviews facilitate diagnosis and aid screening. The expression of symptoms varies as a function of patient developmental stage and social and academic contexts. Although there are no curative treatments for ADHD, evidenced-based treatments can markedly reduce its symptoms and associated impairments. For example, medications are efficacious and normally well tolerated, and various non-pharmacological approaches are also valuable. Ongoing clinical and neurobiological research holds the promise of advancing diagnostic and therapeutic approaches to ADHD. For an illustrated summary of this Primer, visit: http://go.nature.com/J6jiwl.
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Affiliation(s)
- Stephen V Faraone
- Departments of Psychiatry and of Neuroscience and Physiology, State University of New York (SUNY) Upstate Medical University, Syracuse, New York 13210, USA
- K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, 5020 Bergen, Norway
| | - Philip Asherson
- Social Genetic and Developmental Psychiatry, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Joseph Biederman
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jan K Buitelaar
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Cognitive Neuroscience and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - Josep Antoni Ramos-Quiroga
- ADHD Program, Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clinicas de Porto Alegre, Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
- National Institute of Developmental Psychiatry for Children and Adolescents, Sao Paulo, Brazil
| | - Edmund J S Sonuga-Barke
- Department of Psychology, University of Southampton, Southampton, UK
- Department of Experimental Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Rosemary Tannock
- Neuroscience and Mental Health Research Program, Research Institute of The Hospital for Sick Children, Toronto, Canada
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Barbara Franke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Departments of Human Genetics and Psychiatry, Nijmegen, The Netherlands
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Complementary and Alternative Therapies for Autism Spectrum Disorder. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:258589. [PMID: 26064157 PMCID: PMC4439475 DOI: 10.1155/2015/258589] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 03/23/2015] [Accepted: 03/30/2015] [Indexed: 01/05/2023]
Abstract
Background. Complementary and alternative medicine (CAM) represents a popular therapeutic option for patients with autism spectrum disorder (ASD). Unfortunately, there is a paucity of data regarding the efficacy of CAM in ASD. The aim of the present systematic review is to investigate trials of CAM in ASD. Material and Methods. We searched the following databases: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, CINAHL, Psychology and Behavioral Sciences Collection, Agricola, and Food Science Source. Results. Our literature search identified 2687 clinical publications. After the title/abstract screening, 139 publications were obtained for detailed evaluation. After detailed evaluation 67 studies were included, from hand search of references we retrieved 13 additional studies for a total of 80. Conclusion. There is no conclusive evidence supporting the efficacy of CAM therapies in ASD. Promising results are reported for music therapy, sensory integration therapy, acupuncture, and massage.
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Sonuga-Barke EJS. Editorial: Diet and children's behaviour problems--disentangling urban myth from clinical reality. J Child Psychol Psychiatry 2015; 56:497-9. [PMID: 25846603 DOI: 10.1111/jcpp.12418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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27
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Oxidative and nitrosative stress in ADHD: possible causes and the potential of antioxidant-targeted therapies. ACTA ACUST UNITED AC 2015; 7:237-47. [DOI: 10.1007/s12402-015-0170-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 04/07/2015] [Indexed: 12/22/2022]
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