ADHD is associated with a "Western" dietary pattern in adolescents

The association between junk foods consumption and attention deficit hyperactivity disorder in children and adolescents: a systematic review and meta-analysis of observational studies

The adverse effects of junk foods on the risk of attention deficit hyperactivity disorder (ADHD) symptoms were reported in several studies. In this meta-analysis, the association between junk food consumption and the risk of ADHD was investigated in children and adolescents. A comprehensive systematic search was conducted to find all relevant literature via four databases, including PubMed, Web of Science, Scopus, and Google scholar, up to September 2022. Two independent authors screened all documents based on inclusion criteria. The overall effect sizes and related 95% confidence interval (CI) were pooled with the random effect approach. Subgroup analysis was done to measure potential sources of heterogeneity between studies. The quality of the included studies was evaluated with The Newcastle-Ottawa scale (NOS). Nine observational studies with 58,296 children /adolescents were eligible to be include in the meta-analysis. According to the random effect model, there was a positive relation between the consumption of junk foods and ADHD symptoms (odds ratio (OR): 1.24, 95%CI 1.15-1.34, P < 0.001, I2: 37.4%, P = 0.085). A similar significant positive association was shown in the subgroups analysis by different junk foods (sweetened beverages/soft drinks, sweets/candies, and other types of junk foods). This meta-analysis finding demonstrated that consuming junk foods, especially sweetened beverages/soft drinks, and sweets/candies is associated with ADHD symptoms.

Harmonizing the CBCL and SDQ ADHD scores by using linear equating, kernel equating, item response theory and machine learning methods

Introduction

A problem that applied researchers and practitioners often face is the fact that different institutions within research consortia use different scales to evaluate the same construct which makes comparison of the results and pooling challenging. In order to meaningfully pool and compare the scores, the scales should be harmonized. The aim of this paper is to use different test equating methods to harmonize the ADHD scores from Child Behavior Checklist (CBCL) and Strengths and Difficulties Questionnaire (SDQ) and to see which method leads to the result.

Methods

Sample consists of 1551 parent reports of children aged 10-11.5 years from Raine study on both CBCL and SDQ (common persons design). We used linear equating, kernel equating, Item Response Theory (IRT), and the following machine learning methods: regression (linear and ordinal), random forest (regression and classification) and Support Vector Machine (regression and classification). Efficacy of the methods is operationalized in terms of the root-mean-square error (RMSE) of differences between predicted and observed scores in cross-validation.

Results and discussion

Results showed that with single group design, it is the best to use the methods that use item level information and that treat the outcome as interval measurement level (regression approach).

The Microbiome in Child and Adolescent Psychiatry

Recent research has increasingly emphasized the function of the microbiome in human health. The gut microbiome is essential for digesting food and seems to play a vital role in mental health as well. This review briefly overviews the gut microbiome and its interplay with the central nervous system. We then summarize some of the latest findings on the possible role of the microbiome in psychiatric disorders in children and adolescents. In particular, we focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, anorexia nervosa, bipolar disorder, and major depressive disorder. Although the role of microbiota in mental development and health still needs to be researched intensively, it has become increasingly apparent that the impact of microbiota must be considered to better understand psychiatric disorders.

A Western Dietary Pattern during Pregnancy is Associated with Neurodevelopmental Disorders in Childhood and Adolescence

Despite the high prevalence of neurodevelopmental disorders, there is a notable gap in clinical studies exploring the impact of maternal diet during pregnancy on child neurodevelopment. This observational clinical study examined the association between pregnancy dietary patterns and neurodevelopmental disorders, as well as their symptoms, in a prospective cohort of 10-year-old children (n=508). Data-driven dietary patterns were derived from self-reported food frequency questionnaires. A Western dietary pattern in pregnancy (per SD change) was significantly associated with attention-deficit / hyperactivity disorder (ADHD) (OR 1.66 [1.21 - 2.27], p=0.002) and autism diagnosis (OR 2.22 [1.33 - 3.74], p=0.002) and associated symptoms (p<0.001). Findings for ADHD were validated in three large (n=59725, n=656, n=348), independent mother-child cohorts. Objective blood metabolome modelling at 24 weeks gestation identified 15 causally mediating metabolites which significantly improved ADHD prediction in external validation. Temporal analyses across five blood metabolome timepoints in two independent mother-child cohorts revealed that the association of Western dietary pattern metabolite scores with neurodevelopmental outcomes was consistently significant in early to mid-pregnancy, independent of later child timepoints. These findings underscore the importance of early intervention and provide robust evidence for targeted prenatal dietary interventions to prevent neurodevelopmental disorders in children.

Short-term effects of an elimination diet and healthy diet in children with attention-deficit/hyperactivity disorder: a randomized-controlled trial

An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5-12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED-but not HD-participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably 'easier to treat' than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 ( https://www.onderzoekmetmensen.nl/en/trial/25997 ).

Association of healthy eating index (2015) with depression and anxiety symptoms among Iranian adolescent girls

Adolescence is a period of rapid growth, with changes in body composition and cognitive and psychosocial development. Teenagers who eat properly and participate in daily physical activities have a healthy lifestyle. Healthy living promotes optimal growth and performance at school and in the workplace and minimizes the risk of chronic nutrient-related diseases. Therefore, the present study was conducted to determine the relationship between the healthy eating index (2015) (HEI-2015) and depression and anxiety among Iranian adolescent girls. This cross-sectional study was designed based on the updated version of HEI-2015. The study population consisted of 412 high school girls aged 12-17 years old. Data were collected about the diet, sociodemographic, and anthropometric characteristics of the participants. HEI and anthropometric characteristics of the participants were measured. The depression, anxiety, and stress scale 42 (DASS-42) questionnaire was used to detect adolescents suffering from depression and anxiety. The relationships of the HEI and anthropometric measures with depression and anxiety were also assessed. The results showed that the HEI is inversely correlated with depression and anxiety in Iranian adolescent girls. HEI was greater in the healthy participants than in those suffering from depression and anxiety (P < 0.0001).

Treatment response to supplemental nutrients for ADHD is independent of diet quality: the MADDY Study RCT

OBJECTIVES

The 8-week Micronutrients for ADHD in Youth (MADDY) randomized controlled trial (N = 126, age 6-12) of broad-spectrum multinutrients for ADHD with emotional dysregulation found 3 times as many responders with multinutrients (54%) compared to placebo (18%) by Clinical Global Impression-Improvement (CGI-I). Our primary aim for this analysis tests the hypothesis that those with poor overall diet quality at baseline benefit more. The second aim is to explore whether specific components of diet quality moderate treatment response.

METHODS

124 children (69 multinutrients, 55 placebo) had diet quality assessed using the Healthy Eating Index-2015 (HEI-2015). For each potential moderator, the outcome CGI-I at week 8 (RCT-end), was modeled two ways: (1) as a dichotomous variable: responder/non-responder, with responders defined by a rating of 1 or 2 'very much' or 'much improved,' all else equals non-responder using logistic regression, and (2) as a dimensional improvement outcome from 1 = very much improved to 7 = very much worse, using linear regression.

RESULTS

HEI-2015 total score did not moderate treatment response [odds ratio = 1.00 (95% CI: 0.90,1.10), p = 0.984] or improvement [β = -0.01 (95% CI: -0.06,0.04), p = 0.648]. However, total vegetable intake moderated level of improvement in exploratory analysis [β = -0.48 (95% CI: -0.82, -0.13), p = 0.007]: those with higher baseline vegetable intake showed greater benefit from multinutrients compared to placebo.

CONCLUSIONS

Multinutrients may benefit children with ADHD and irritability regardless of overall diet quality. The finding that higher baseline vegetable intake may improve response to multinutrients deserves further exploration, including dietary effect on gut microbiota and absorption of multinutrients and parental factors.

Unhealthy diets increase the likelihood of being overweight or obese among African migrant students in China, but not among African non-migrant students: a cross-sectional study

Background

The impact of non-communicable diseases (NCDs) is disproportionately felt by immigrants from low- to medium-income countries (LMICs), partly due to their dietary habits. To thrive in their new environment, migrants either omit or consume certain food items, which could lead to nutritional deficits. As a result, most migrants experience more NCDs than their compatriots in their native countries. Therefore, we evaluated the difference in dietary habits, quality, and the influencing factors of overweight or obesity among African migrant students in Nanjing (China) and non-migrant students in Africa using cross-sectional data.

Methods

The researchers used the food frequency questionnaire and the global diet quality score metrics to assess food intake and quality, respectively. Then, cross-tabulation was employed to explore the differences between the groups in meal skipping, eating habits, and diet quality. Finally, the factors associated with overweight or obesity were assessed with binary logistic regression stratified by African students in Nanjing and students in their native countries.

Results

Approximately 678 responses were received, mainly between 18-25 years (46.7%) and 26-36 years (45.4 %). The majority of them (52.3%) were international students. The non-migrant African students' diets lacked citrus fruits (22.2%), deep orange fruits (15.4%), deep orange vegetables (18%), cruciferous vegetables (24.6%), and dark leafy vegetables (26.5%). While the African migrant students consumed more high-fat dairy (50.7%), processed meats (23.9%), sweets and ice creams (51.3%), sugar-sweetened beverages (40.5%), and juice (61.5%), p < 0.001. Furthermore, consuming late-night meals constantly [Exp (B) = 39.607, p = 0.049], eating twice a day [Exp (B) = 6.527, p = 0.036], consuming red meat [Exp (B) = 29.287, p = 0.001], processed meats [Exp (B) = 719.979, p = 0.0011], refined grains and baked foods [Exp (B) = 15.752, p = 0.013], and sweets and ice cream [Exp (B) = 193.633, p = 0.006] were factors inducing overweight or obesity among only African migrant students.

Conclusion

Controlling the what (Western diet and nature of late-night meals) and the when of eating can drastically reduce their influence on obesogenic condition formation in African migrant students in China and elsewhere.

Randomised controlled trial of the effects of kefir on behaviour, sleep and the microbiome in children with ADHD: a study protocol

INTRODUCTION

Current interventions for children with attention-deficit/hyperactivity disorder (ADHD) are primarily medication, behavioural therapy and parent training. However, research suggests dietary manipulations may provide therapeutic benefit for some. There is accumulating evidence that the gut microbiome may be atypical in ADHD, and therefore, manipulating gut bacteria in such individuals may help alleviate some of the symptoms of this condition. The aim of this study is to explore the effects of supplementation with kefir (a fermented dairy drink) on ADHD symptomatology, sleep, attention and the gut microbiome in children diagnosed with ADHD.

METHODS AND ANALYSIS

A 6-week randomised, double-blind, placebo-controlled trial in 70 children aged 8-13 years diagnosed with ADHD. Participants will be recruited throughout the UK, through support groups, community groups, schools, social media and word of mouth. Children will be randomised to consume daily either dairy kefir or a placebo dairy drink for 6 weeks. The primary outcome, ADHD symptomatology, will be measured by The Strengths and Weakness of ADHD-symptoms and Normal-behaviour scale. Secondary outcomes will include gut microbiota composition (using shotgun metagenomic microbiome sequencing), gut symptomatology (The Gastrointestinal Severity Index questionnaire), sleep (using 7-day actigraphy recordings, The Child's Sleep Habits Questionnaire and Sleep Self Report questionnaire), inattention and impulsivity (with a computerised Go/NoGo test). Assessments will be conducted prior to the intervention and at the end of the intervention. Interaction between time (preintervention/postintervention) and group (probiotic/placebo) is to be analysed using a Mixed Model Analysis of Variances.

ETHICS AND DISSEMINATION

Ethical approval for the study was granted by St Mary's University Ethics Committee. Results will be disseminated through peer-reviewed publications, presentations to the scientific community and support groups.

TRIAL REGISTRATION NUMBER

NCT05155696.

Effectiveness of lifestyle interventions for improving the physical health of children and adolescents taking antipsychotic medications: protocol for a systematic review and meta-analysis

INTRODUCTION

Children and adolescents are increasingly prescribed antipsychotic medications off-label in the treatment of behavioural disorders. While antipsychotic medications are effective in managing behavioural issues, they carry a significant risk of adverse events that compromise ongoing physical health. Of particular concern is the negative impact antipsychotic medications have on cardiometabolic health. Interventions that aim to modify lifestyle habits have the potential to alleviate the adverse effects of antipsychotic medication by enhancing weight management, increasing physical activity, promoting better nutritional practices, improving dietary habits and promoting healthier sleep patterns and sleep hygiene. However, a comprehensive review has not been performed to ascertain the effectiveness of lifestyle interventions for children and adolescents who are at increased risk of antipsychotic-induced compromises to their physical health.

METHODS AND ANALYSIS

This systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Four databases will be searched without any year constraints to identify randomised controlled trials that are published in the English language and report a lifestyle intervention compared with usual care with any physical health outcome measure. Trial registers and results repositories will be scoured to identify additional studies. Two reviewers will independently conduct screening, data extraction and quality assessment and compare the results. Quantitative data will be synthesised, where appropriate, through a random-effects meta-analysis model. Otherwise, data will be reported in a qualitative (narrative) synthesis. Heterogeneity will be quantified using the I2 statistic. The Cochrane Risk of Bias 2 tool will be used for risk of bias assessment. The Grading of Recommendations, Assessment, Development and Evaluation system will be used to evaluate the cumulative body of evidence.

ETHICS AND DISSEMINATION

Ethics approval is not required. The publication plan will target high-impact, peer-reviewed journals that fall under the scope of Psychiatry and Mental Health.

PROSPERO REGISTRATION NUMBER

CRD42022380277.

The short and long-term effects of a lifestyle intervention in children with mental illnesses: a randomized controlled trial (Movementss study)

BACKGROUND

A lifestyle including poor diet, physical inactivity, excessive gaming and inadequate sleep hygiene is frequently seen among Dutch children. These lifestyle behaviors can cause long-term health problems later in life. Unhealthy lifestyle and poor physical health are even more prevalent among children with mental illness (MI) such as autism, attention-deficit/hyperactivity disorder, depression, and anxiety. However, research on lifestyle interventions among children with MI is lacking. As a result, there are currently no guidelines, or treatment programs where children with MI and poor lifestyle can receive effective support. To address these issues and to provide insight into the effectiveness of lifestyle interventions in children with MI and their families, the Movementss study was designed. This paper describes the rationale, study design, and methods of an ongoing randomized controlled trial (RCT) comparing the short-term (12 weeks) and long-term (1 year) effects of a lifestyle intervention with care as usual (CAU) in children with MI and an unhealthy lifestyle.

METHODS

A total of 80 children (6-12 years) with MI according to DSM-V and an unhealthy lifestyle are randomized to the lifestyle intervention group or CAU at a specialized child and adolescent mental hospital. The primary outcome measure is quality of life measured with the KIDSCREEN. Secondary outcomes include emotional and behavior symptoms, lifestyle parameters regarding diet, physical activity, sleep, and screen time, cognitive assessment (intelligence and executive functions), physical measurements (e.g., BMI), parenting styles, and family functioning, prior beliefs, adherence, satisfaction, and cost-effectiveness. Assessments will take place at the start of the study (T0), after 12 weeks (T1), six months (T2), and 12 months of baseline (T3) to measure long-term effects.

DISCUSSION

This RCT will likely contribute to the currently lacking knowledge on lifestyle interventions in children with MI.

TRIAL REGISTRATION

trialsearch.who.int/ NL9822. Registered at November 2nd, 2021.

Fruit and vegetable intake is inversely associated with severity of inattention in a pediatric population with ADHD symptoms: the MADDY Study

OBJECTIVES

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a U.S. pediatric prevalence of 8-10%. It presents with inattention and hyperactivity/impulsivity; frequently associated with emotional dysregulation (ED) symptoms common in Oppositional Defiant Disorder and Disruptive Mood Dysregulation Disorder. The etiology of ADHD is multi-factorial; symptom severity is associated with diet. This study examines the association of diet quality with ADHD and ED symptoms within a pediatric research cohort.

METHODS

Baseline data were analyzed for 134 children aged 6-12 years with symptoms of ADHD and ED enrolled in an RCT of multinutrient supplementation. Diet quality was based on Healthy Eating Index-2015 (HEI-2015). ADHD and ED symptoms were assessed using Child and Adolescent Symptom Inventory-5 and Strengths and Difficulties Questionnaire. Linear regression models, adjusting for covariates when necessary, determined association.

RESULTS

The mean HEI Total Score of 63.4 (SD = 8.8) was not significantly associated with any outcome symptoms. However, after adjusting for covariates, HEI component scores for total fruit intake (β =  -0.158, p = .037) and total vegetable intake (β =  -0.118, p = .004) were negatively associated with inattention.

CONCLUSIONS

The lack of association with total diet quality could be explained by the relatively good baseline diet quality and mild symptom severity in this sample, along with measurement error from dietary intake estimates and relatively small sample size. These findings suggest that dietary intake may impact inattention in children with ADHD and ED: those eating less fruits and vegetables were likely to have more severe symptoms of inattention. Causality is not established by this cross-sectional analysis.

Complementary and Integrative Treatments for Attention-Deficit/Hyperactivity Disorder in Youth

First-line psychopharmacologic and psychosocial treatments for attention-deficit/hyperactivity disorder in children are effective but limited by tolerability and accessibility problems. Many complementary and integrative strategies have been investigated as alternative or adjunctive treatments for the disorder, and the literature has progressed to meta-analyses for several. Although heterogeneity of study methods and risk of bias pervades the literature, we conclude that Omega-3 supplementation, dietary restriction of artificial food colorings, and physical activity can be considered evidence-based. Additionally, meditation, yoga, and sleep hygiene are safe, partially effective, cost effective and sensible adjunctive treatment strategies.

Implication of saturated fats in the aetiology of childhood attention deficit/hyperactivity disorder - A narrative review

Attention Deficit/Hyperactivity Disorder (ADHD) is the most common mental health disorder in the paediatric population. ADHD is highly comorbid with obesity, and has also been associated with poor dietary patterns such as increased consumption of refined carbohydrates and saturated fats. Although ADHD in children was associated with high consumption of saturated fats, so far there has been no evidence-based attempt to integrate dietary strategies controlling for intake of saturated fats into the etiological framework of the disorder. Evidence from human studies and animal models has shown that diets high in saturated fats are detrimental for the development of dopaminergic neurocircuitries, synthesis of neurofactors (e.g. brain derived neurotrophic factor) and may promote brain inflammatory processes. Notably, animal models provide evidence that early life consumption of a high saturated fats diet may impair the development of central dopamine pathways. In the present paper, we review the impact of high saturated fats diets on neurobiological processes in human studies and animal models, and how these associations may be relevant to the neuropathophysiology of ADHD in children. The validation of this relationship and its underlying mechanisms through future investigative studies could have implications for the prevention or exacerbation of ADHD symptoms, improve the understanding of the pathogenesis of the disorder, and help design future dietary studies in patients with ADHD.

Eating Patterns and Dietary Interventions in ADHD: A Narrative Review

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.

Gut metagenomic characteristics of ADHD reveal low Bacteroides ovatus-associated host cognitive impairment

Attention-deficit/hyperactivity disorder (ADHD) is a highly heterogeneous psychiatric disorder that can have three phenotypical presentations: inattentive (I-ADHD), hyperactive-impulsive (HI-ADHD), and combined (C-ADHD). Environmental factors correlated with the gut microbiota community have been implicated in the development of ADHD. However, whether different ADHD symptomatic presentations are associated with distinct microbiota compositions and whether patients could benefit from the correction of aberrant bacterial colonization are still largely unclear. We carried out metagenomic shotgun analysis with 207 human fecal samples to characterize the gut microbial profiles of patients with ADHD grouped according to their phenotypical presentation. Then, we transplanted the candidate low-abundance bacteria identified in patient subgroups into ADHD rats and evaluated ADHD-associated behaviors and neuronal activation in these rats. Patients with C-ADHD had a different gut microbial composition from that of healthy controls (HCs) (p = .02), but not from that of I-ADHD patients. Eight species became progressively attenuated or enriched when comparing the compositions of HCs to those of I-ADHD and C-ADHD; in particular, the abundance of Bacteroides ovatus was depleted in patients with C-ADHD. In turn, Bacteroides ovatus supplementation ameliorated spatial working memory deficits and reversed θ electroencephalogram rhythm alterations in ADHD rats. In addition, Bacteroides ovatus induced enhanced neuronal activation in the hippocampal CA1 subregion. These findings indicate that gut microbial characteristics that are unique to patients with C-ADHD may be masked when considering a more heterogeneous group of patients. We link the gut microbiota to brain function in an ADHD animal model, suggesting the relevance of testing a potential bacteria-based intervention for some aspects of ADHD.

Attention-deficit/hyperactive disorder updates

Background

Attention-deficit/hyperactive disorder (ADHD) is a neurodevelopmental disorder that commonly occurs in children with a prevalence ranging from 3.4 to 7.2%. It profoundly affects academic achievement, well-being, and social interactions. As a result, this disorder is of high cost to both individuals and society. Despite the availability of knowledge regarding the mechanisms of ADHD, the pathogenesis is not clear, hence, the existence of many challenges especially in making correct early diagnosis and provision of accurate management.

Objectives

We aimed to review the pathogenic pathways of ADHD in children. The major focus was to provide an update on the reported etiologies in humans, animal models, modulators, therapies, mechanisms, epigenetic changes, and the interaction between genetic and environmental factors.

Methods

References for this review were identified through a systematic search in PubMed by using special keywords for all years until January 2022.

Results

Several genes have been reported to associate with ADHD: DRD1, DRD2, DRD4, DAT1, TPH2, HTR1A, HTR1B, SLC6A4, HTR2A, DBH, NET1, ADRA2A, ADRA2C, CHRNA4, CHRNA7, GAD1, GRM1, GRM5, GRM7, GRM8, TARBP1, ADGRL3, FGF1, MAOA, BDNF, SNAP25, STX1A, ATXN7, and SORCS2. Some of these genes have evidence both from human beings and animal models, while others have evidence in either humans or animal models only. Notably, most of these animal models are knockout and do not generate the genetic alteration of the patients. Besides, some of the gene polymorphisms reported differ according to the ethnic groups. The majority of the available animal models are related to the dopaminergic pathway. Epigenetic changes including SUMOylation, methylation, and acetylation have been reported in genes related to the dopaminergic pathway.

Conclusion

The dopaminergic pathway remains to be crucial in the pathogenesis of ADHD. It can be affected by environmental factors and other pathways. Nevertheless, it is still unclear how environmental factors relate to all neurotransmitter pathways; thus, more studies are needed. Although several genes have been related to ADHD, there are few animal model studies on the majority of the genes, and they do not generate the genetic alteration of the patients. More animal models and epigenetic studies are required.

The Need for Consumer-Focused Household Food Waste Reduction Policies Using Dietary Patterns and Socioeconomic Status as Predictors: A Study on Wheat Bread Waste in Shiraz, Iran

Current household food waste (HFW) reduction plans usually focus on raising consumer awareness, which is essential but insufficient because HFW is predominantly attributed to unconscious behavioral factors that vary across consumer groups. Therefore, identifying such factors is crucial for predicting HFW levels and establishing effective plans. This study explored the role of dietary patterns (DP) and socioeconomic status (SES) as predictors of HBW using linear and non-linear regression models. Questionnaire interviews were performed in 419 households in Shiraz during 2019. A multilayer sampling procedure including stratification, clustering, and systematic sampling was used. Three main DPs, i.e., unhealthy, Mediterranean, and traditional, were identified using a food frequency questionnaire. Results indicated that a one-unit rise in the household’s unhealthy DP score was associated with an average increase in HBW of 0.40%. Similarly, a one-unit increase in the unhealthy DP score and the SES score increased the relative likelihood of bread waste occurrence by 25.6% and 14.5%, respectively. The comparison of findings revealed inconsistencies in HFW data, and therefore the necessity of studying HFW links to factors such as diet and SES. Further investigations that explore HFW associations with household characteristics and behavioral factors will help establish contextual and effective consumer-focused plans.

Replacement of refined sugar by natural sweeteners: focus on potential health benefits

Refined sugar is a processed product containing 99% sucrose, which is obtained from sugarcane (70%) or sugar beet (30%). In modern societies, sugar continues to play a significant role in the diet, recognised not only for its flavour and special sweetening properties but also for its role in food preservation. On the other hand, a high consumption of refined sugar is associated with non-communicable diseases and many health issues such as a high risk of dental caries, overweight and neurodevelopmental disorders in children. Alternatives like unrefined sugars have generated a lot of interest as a healthy substitute due to their nutraceutical properties. This paper is aimed to review the beneficial effects of sugar derived from natural sources and highlight health problems that could be caused by refined processed sugar. Refined sugar is frequently used in variety of items including processed foods, soft drinks or ice creams although it is considered unhealthy due to its high salt and sugar content as well as added fats and artificial coloring. Natural sugars are preferred because they have a high nutritional value and a high concentration of healthy compounds, which offset the negative effects of refined sugar. Therefore, removing refined sugar or at least reducing its consumption should be promoted as a healthier option in food choices.

Impulsiveness in children with attention-deficit/hyperactivity disorder after an 8-week intervention with the Mediterranean diet and/or omega-3 fatty acids: A randomised clinical trial

INTRODUCTION

The Barratt Impulsiveness Scale (BIS) is a self-administered instrument designed to assess the personality/behavioural construct of impulsiveness. Impulsiveness has been associated with several psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD). This study assesses the progression of impulsive behaviour in children with ADHD after an 8-week dietary intervention with the Mediterranean diet and/or omega-3 fatty acid supplementation, by using a version of the 11-item BIS adapted for children (BIS-11c).

METHODS

This cross-sectional study includes 60 children with ADHD from the region of Madrid, Spain. Participants were divided into 4 groups, with one control group (G1) and 3 intervention groups (Mediterranean diet [G2]; omega-3 supplementation [G3]; and Mediterranean diet plus omega-3 supplementation [G4]). A personalised Mediterranean diet was designed for members of groups 2 and 4. The BIS-11c was administered to determine the level of impulsiveness, and the KIDMED test was used to assess adherence to the Mediterranean diet.

RESULTS

The supplementation group showed a fairly significant decrease in the total BIS-11c (P=.049). Total cognitive score slightly decreased in the diet and supplementation groups. Only the control group showed a considerable decrease in the total motor score. Total nonplanning scores were lower in all groups after the intervention. Baseline and final BIS-11c scores were positively correlated with treatments (r>0.9).

CONCLUSION

An intake of 550mg EPA fatty acid and 225mg DHA fatty acid per day for 8 weeks is associated with less marked impulsive behaviour in children with ADHD. A Mediterranean diet may improve BIS scores, although our results are not conclusive in this population.

Diet cost plays a key role in determining the risk of pediatric attention deficit hyperactivity disorder: Findings from a case-control study

The aim of our study was to assess the association between diet cost and attention deficit hyperactivity disorder (ADHD) in children. This study was a case-control study conducted in Isfahan, Iran. Based on the Diagnostic and Statistical Manual of Mental Disorders-V criteria, a total of 200 children aged 4-12 years with ADHD and 300 age- and sex-matched children without ADHD, respectively, participated in case and control groups. A validated food frequency questionnaire that contained 168 food items was used to assess the dietary intake. The cost of food items was obtained from licensed markets. The food price was corrected for edible portion sizes as well as food weight changes due to cooking process. Our results indicated that diet cost per 1000 kcal was significantly lower in the case group compared with the control group (60,843.48 ± 6987.83 vs. 67,828.33 ± 8989.48 Rials, p < .01). In the crude model, a significantly lower risk of ADHD was observed in the higher quartiles of diet cost per 1000 kcal (odds ratio (OR) = 0.06; 95% confidence interval (CI) = 0.03, 0.13; p < .001). This finding remained significant, even after adjustment for potential confounders such as age, gender, body mass index (BMI), socioeconomic status (SES), and intakes of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and saturated fatty acids (SFA). Therefore, it seems that the risk of ADHD is inversely associated with diet cost in children. Further studies, particularly longitudinal ones, are warranted.

Dikkat Eksikliği ve Hiperaktivite Bozukluğunda Yağ Asitlerinin Rolü

Attention deficit hyperactivity disorder (ADHD) is a childhood-onset disorder that affects 5% to 12% of children worldwide. Etiological factors, including nutrition, are involved in this disease, which is characterized by inattention, impulsivity, and hyperactivity symptoms. Fats, which form an important part of the daily diet, can have effects on ADHD and its symptoms. In the literature, it is stated that omega-3 fatty acids are low in children with ADHD, and supplementation studies may be effective in improving symptoms. In addition, high omega-6/omega-3 fatty acids ratio in the diet and diets rich in saturated and trans fatty acids are associated with ADHD. In this review, the relationship between ADHD and dietary fatty acids will be evaluated.

Hedgehog Signal Defect Leading to Familial Exudative Vitreoretinopathy-Like Disease and Gastrointestinal Malformation

Objectives:

The aim of the study was to present a new genetic association presenting with gastrointestinal tract malformations (GTMs) and familial exudative vitreoretinopathy (FEVR)-like disease and review the genetics of Hedgehog signaling.

Materials and Methods:

Three neonates were diagnosed with FEVR-like retinal vascular disease upon routine ophthalmological examination during hospitalization in the neonatal surgical intensive care unit for GTMs. Genetic analysis of the neonates was performed.

Results:

Gestational age of the neonates was 39, 38, and 39 weeks and birth weights were 3,500, 3,600, and 3,300 grams, respectively. All six eyes of the three infants were treated by laser photocoagulation. Recurrence was not seen in any of the eyes. Genetical analysis of all the neonates diagnosed with FEVR-like disease revealed defects in the Hedgehog pathway.

Conclusion:

FEVR is a genetically well-defined retinal vascular disease. The current study is the first to show an association between FEVR-like retinal vascular disease and GTMs. This study demonstrates the importance of the Hedgehog pathway in retinal vascular and gut development.

Comparison of Vitamin D, Neurofeedback, and Neurofeedback Combined with Vitamin D Supplementation in Children with Attention-Deficit/Hyperactivity Disorder

Background: Nowadays, some treatments such as neurofeedback and Vitamin D Supplementation are of great importance in the treatment of attention-deficit/hyperactivity disorder (ADHD). To determine the efficacy of the combined treatment, the present trial was conducted to investigate the effectiveness of each one of them with combined neurofeedback and vitamin D supplementation in the reduction of ADHD symptom in children suffering from this disorder. Methods: In this study from March 2020 to June 2020, we enrolled a total of 120 patients (6-15 years old) who were referred to the Mehr psychiatric hospital (affiliated to Lorestan University of Medical Sciences). Patients were then randomly categorized into three experimental groups and one control group. The first, the second, and the third experimental groups consumed vitamin D pearl, neurofeedback combined with vitamin D, and neurofeedback for 12 weeks, respectively. The control group was given no treatment. Vitamin D serum level was evaluated at baseline, 4, 8, and 12 weeks in all participants. For data collection, the Parent Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV) was applied. The obtained information was analyzed using repeated measure variance analysis. Results: The mean scores were significantly different across the groups. Repeated measure variance analysis showed that the mean score was lower in the combined group in comparison with the other three groups (P<0.05). Conclusion: Combined treatment could be considered as more effective compared to separate treatments. In addition, in this study, by applying the combined intervention, the duration of treatment decreased significantly.

Connections between Children's Eating Habits, Mental Health, and Parental Stress

Background

Obesity and eating disorders are increasing in occidental countries and can undermine physical and psychological health. Therefore, preventing the insurgency of unhealthy eating habits in childhood is fundamental. Parents can play an important role in assisting pediatricians, psychiatrists, and clinical psychologists in the diagnosis of eating disorders because they have an active role in observing and assessing the quality of their children's eating habits.

Methods

In our study, we collected data from a sample of children (n = 125) and their parents (n = 161) without symptoms related to eating disorders. Parents assessed the eating habits, behavior problems, and mental health of their children and parental stress. In addition, we measured body mass index, anxiety, and lifestyle in children. Data were analyzed with bivariate correlation and MIMIC models.

Results

Both mothers' and fathers' assessments of children's eating habits are reliable. Unhealthy eating habits are connected with children's behavioral problems and parental stress. We did not find significant differences in feeding styles and ways of assessing the quality of eating habits between mothers and fathers. Our study showed greater sensitivity of mothers toward the physical fitness of their children rather than fathers.

Conclusions

Mothers and fathers both proved to be good observers of their children's eating behavior, and they could cooperate with medical and psychological operators in preventing the risk of obesity.

Household Food Insecurity Is Associated with Symptoms of Emotional Dysregulation in Children with Attention Deficit Hyperactivity Disorder: The MADDY Study

The association of household food insecurity with symptoms of attention deficit hyperactivity disorder (ADHD) and emotional dysregulation in children was examined in this study. We utilized baseline data from 134 children aged 6–12 years who were enrolled in a clinical trial investigating multinutrient supplementation as a treatment for ADHD and emotional dysregulation. Household food security status was assessed using the 18-item US Household Food Security Survey Module. The symptoms of ADHD and emotional dysregulation disorders (oppositional defiant disorder (ODD) and disruptive mood dysregulation disorder (DMDD)) were assessed using the Child and Adolescent Symptom Inventory-5 and other comorbid emotional dysregulation symptoms were assessed using the Strengths and Difficulties Questionnaire (SDQ). Multiple linear regression determined associations between household food security status and symptoms of ADHD, ODD and DMDD, emotional symptoms and conduct problems. Household food insecurity was associated with more severe emotional symptoms (β = 2.30; 95% CI = 0.87–3.73; p = 0.002), conduct problems (β = 1.15; 95% CI = 0.01–2.30; p = 0.049) and total difficulties scores (β = 4.59; 95% CI = 1.82–7.37; p = 0.001) after adjusting for covariates (child’s sex, parent marital status, household income, parental anxiety and other parental psychopathology). In unadjusted analyses, household food insecurity was also associated with increased ODD (β = 0.58; 95% CI = 0.21–0.95; p = 0.003) and DMDD symptoms (β = 0.69; 95% CI = 0.20–1.19; p = 0.006), but these associations attenuated to non-significance after adjusting for all covariates. Household food insecurity was associated with more severe emotional dysregulation symptoms. Discussing and addressing food insecurity may be appropriate initial steps for youths with ADHD and emotional dysregulation.

Determinants of Common Mental Disorders (CMD) among adolescent girls aged 15-19 years in Indonesia: Analysis of the 2018 National Basic Health Survey Data

Common Mental Disorders (CMD) are distress conditions which manifest themselves with anxiety, somatic, and depressive symptoms. CMD are highly prevalent in Indonesia especially among adolescents. Adolescent girls have a higher risk to develop CMD than boys. This may be related to anaemia, potentially aggravated by early onset of menstruation. This study aimed to determine the association between haemoglobin concentration and other determinants of CMD among adolescent girls in Indonesia. Data of 1,052 adolescent girls aged 15-19 years old from the Indonesian Basic Health Survey 2018 were analysed. CMD was measured using the Self Reporting Questionnaire (SRQ-20). Principal Component Analysis of main determinants was applied and resulting principal components were investigated as risk factors for CMD. The prevalence of CMD among the study population was 16.5%. Anaemia and Age at Menarche (AAM) were not associated with CMD. Three principal components were significantly associated with higher CMD score: 1) higher parental education, better employment of the father, and living in an urban area (β: 0.16, 95%-CI: 0.02; 0.30); 2) higher consumption of salty foods, high-fat foods, and soft drinks (β: 0.23, 95%-CI: 0.05; 0.40); and 3) having asthma, smoking, and a higher haemoglobin concentration (β: 1.74, 95%-CI: 1.59; 1.89). The strongest clustered associates of CMD among adolescent girls in Indonesia were asthma, smoking status, and higher haemoglobin concentration, whereas anaemia and AAM were not associated. Causality of smoking and diet to CMD could not be disentangled in this cross-sectional study. Our findings imply that adolescent girls who have asthma and smoke, as well as those having parents with higher education and secured occupation, are more likely to have mental disorders.

Do Children with Attention-Deficit/Hyperactivity Disorder Follow a Different Dietary Pattern than That of Their Control Peers?

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in children and adolescents. A current area of interest is the association between ADHD and food consumption. The aim of this study was to determine the food consumption and dietary patterns of children with and without ADHD in relation to their age and ADHD presentation. The study involved 259 preschoolers aged 3 to 6 years old (57 with ADHD and 202 controls) and 475 elementary-school-age children, aged 10 to 12 years old (213 with ADHD and 262 controls) from Spain. ADHD was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders (5th edition) from Schedule for Affective Disorders and Schizophrenia for School-Age Children interviews. Eating data were collected using a food consumption frequency questionnaire, and principal component analysis was carried out to analyze dietary patterns. Western-like, sweet, and healthy patterns were identified. The ADHD group was negatively associated with the healthy pattern (p < 0.001) and positively associated with the Western-like diet (p = 0.004). Children with inattentive presentation showed lower adherence (12.2%) to a healthy pattern than that of the control group (39.9%) (p < 0.001). There is an association between ADHD and dietary habits; children with inattentive presentation may particularly be at risk of unhealthy eating habits.

Harmonized Phenotypes for Anxiety, Depression, and Attention-Deficit Hyperactivity Disorder (ADHD)

In multi-cohort consortia, the problem often arises that a phenotype is measured using different questionnaires. This study aimed to harmonize scores based on the Child Behaviour Check List (CBCL) and the Strength and Difficulties Questionnaire (SDQ) for anxiety/depression and ADHD. To link the scales, we used parent reports on 1330 children aged 10–11.5 years from the Raine study on both SDQ and CBCL. Harmonization was done based on Item Response Theory. We started from existing CBCL and SDQ scales related to anxiety/depression and ADHD (theoretical approach). Next, we conducted a data-driven approach using factor analysis to validate the theoretical approach. Both approaches yielded similar scales, validating the combination of existing scales. In addition, we studied the impact of harmonized (IRT-based) scores on the statistical power of the results in meta-analytic gene-finding studies. The results showed that the IRT-based harmonized scores increased the statistical power of the results compared to sum scores, even with an equal sample size. These findings can help future researchers to harmonize data from different samples and/or different questionnaires that measure anxiety, depression, and ADHD, in order to obtain the larger sample sizes, to compare research results across subpopulations or to increase generalizability, the validity or statistical power of research results. We recommend using our item parameters to estimate harmonized scores that represent commensurate phenotypes across cohorts, and we explained in detail how other researchers can use our results to harmonize data in their studies.

Childhood ADHD, Going Beyond the Brain: A Meta-Analysis on Peripheral Physiological Markers of the Heart and the Gut

Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder diagnosed in children. Questions regarding its increased diagnostic rates and pharmacological treatments in developing children have led to a more holistic review of the multi-system pathophysiology observed in ADHD. The dopaminergic neurotransmitter system, known for its influence on reward-motivated behaviors and motor control, and the frontostriatal systems, that mediate motor, cognition, and behavior, are associated with ADHD's development. However, studies have shown that these neural systems do not wholly account for ADHD's multilayered and heterogeneous symptom presentation. For instance, the literature suggests that emotional dysregulation, the inability to regulate one's emotional responses to provoking stimuli, is associated with increased risk for social impairment in ADHD. A broader examination of physiological systems in children with ADHD has found potential markers in the heart-brain and gut-brain axes that correspond with certain behaviors associated with emotional dysregulation in recent studies. Hence, the purpose of this meta-analysis is to aggregate ten applicable published case studies and analyze task-related heart rate reactivity (HRR; n = 5 studies) and gut microbiota (n = 5 studies) data in children with and without ADHD. Data from a total of 531 youth with ADHD and 603 youth without ADHD revealed significant small and medium effect sizes for higher Chao1 levels and Actinobacteria levels in the ADHD group, respectively, but no evidence of altered task-related HRR. Thus, further research into multi-system psychophysiological measures of emotional dysregulation and ADHD is warranted. The clinical, empirical, and educational implications of these findings are discussed.

SYSTEMATIC REVIEW REGISTRATION

https://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42021236819).

Food Perceptions in Adults with and without ADHD

INTRODUCTION

Adults with attention-deficit/hyperactivity disorder (ADHD) have unhealthy eating habits, associated with overweight/obesity. We explored whether they present with different food-related benefit/risk perceptions, compared to those without ADHD.

METHODS

One hundred five university students with (n = 36) and without (n = 69) ADHD, aged 22-30, participated in the study. They rated the level of frequency and likelihood of food consumption, as well as the perceived attractiveness, convenience, and risk of 32 healthy and unhealthy food items.

RESULTS

The findings revealed significantly lower healthy/unhealthy food frequency consumption ratios for the ADHD group compared with the non-ADHD one but no differences in the ratios of estimated likelihood of food consumption and perceptions (attractiveness, convenience, and risk).

CONCLUSION

The results of this study demonstrated a discrepancy between the eating behavior (more unhealthy eating patterns in adults with ADHD compared with controls) and their food-related perceptions (same perceptions regarding the benefit and risk of foods in both groups).

Gene-Environment Interactions in Attention-Deficit/Hyperactivity Disorder Symptom Dimensions: The Role of Unhealthy Food Habits

Background: Dietary habits were investigated as environmental risk factors for Attention-Deficit/Hyperactivity Disorder (ADHD). However, no previous studies explored the effects of dietary factors on modifying the role of genetic factors on ADHD. Methods: Based on a Swedish population-based twin study with 1518 twin pairs aged 20-47 years, we tested whether the importance of genetic and environmental effects on ADHD varied as a function of dietary habits. Self-reported dietary habits and ADHD symptoms were collected. Twin methods were used to test the degree to which high-sugar and unhealthy food intake moderated the genetic and environmental influences on ADHD symptoms. Results: In middle-aged adults, genetic influences on inattention symptoms were statistically significantly higher among individuals with higher levels of high-sugar (45%, 95%CI: 25-54%) and unhealthy food intake (51%, 95%CI: 31-60%), compared with those with lower levels of consumption of high-sugar (36%, 95%CI: 25-47%) and unhealthy foods (30%, 95%CI: 20-41%). Similar patterns were also found for the associations between hyperactivity/impulsivity and high-sugar/unhealthy food intake, even though the moderation effects were not statistically significant. Conclusion The present study suggests that genetic factors play a more prominent role in individual differences of ADHD symptoms in the presence of the high consumption of sugar and unhealthy foods. Future longitudinal studies with multiple assessments of ADHD and dietary habits are needed to replicate our findings.

Dietary patterns in middle childhood and behavior problems in adolescence

BACKGROUND/OBJECTIVES

Adherence to a "Western" style dietary pattern has been related to behavior problems in children in high-income countries; however, dietary patterns may differ in countries undergoing the nutrition transition. Associations of dietary patterns with behavior problems in a Latin American context have not been evaluated.

SUBJECTS/METHODS

Mothers of 385 children 5 to 12 y old completed a food frequency questionnaire (FFQ) on the children's usual intake at enrollment into a cohort study. Four dietary patterns were identified through principal component analysis of the FFQ: animal protein, snacking, cheaper protein, and traditional/starch. After a median 6 y follow-up, adolescents reported behavior problems via the Youth Self Report, a standardized questionnaire. We compared the continuous distributions of externalizing and internalizing behavior problems and their subscales across quartiles of adherence to the four dietary patterns using multivariable linear regression.

RESULTS

Boys in the highest quartile of adherence to the animal protein pattern in middle childhood had an adjusted 5.5 units lower (95% CI -9.5, -1.5) mean total externalizing problems score compared with boys in the lowest quartile (P trend = 0.008). Adherence to the animal protein pattern was also inversely related to the aggressive behavior externalizing subscale in a dose-response manner among boys (P trend = 0.009). There were no associations between adherence to other dietary patterns and externalizing problems in boys or girls. There were no associations with internalizing problems.

CONCLUSION

Adherence to an animal protein dietary pattern in middle childhood was associated with less externalizing behavior problems in adolescent boys.

Impulsiveness in children with attention-deficit/hyperactivity disorder after an 8-week intervention with the Mediterranean diet and/or omega-3 fatty acids: a randomised clinical trial

INTRODUCTION

The Barratt Impulsiveness Scale (BIS) is a self-administered instrument designed to assess the personality/behavioural construct of impulsiveness. Impulsiveness has been associated with several psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD). This study assesses the progression of impulsive behaviour in children with ADHD after an 8-week dietary intervention with the Mediterranean diet and/or omega-3 fatty acid supplementation, by using a version of the 11-item BIS adapted for children (BIS-11c).

METHODS

This cross-sectional study includes 60 children with ADHD from the region of Madrid, Spain. Participants were divided into 4 groups, with one control group and 3 intervention groups (Mediterranean diet; omega-3 supplementation; and Mediterranean diet plus omega-3 supplementation). A personalised Mediterranean diet was designed for members of groups 2 and 4. The BIS-11c was administered to determine the level of impulsiveness, and the KIDMED test was used to assess adherence to the Mediterranean diet.

RESULTS

The supplementation group showed a fairly significant decrease in the total BIS-11c (P = .049). Total cognitive score slightly decreased in the diet and supplementation groups. Only the control group showed a considerable decrease in the total motor score. Total nonplanning scores were lower in all groups after the intervention. Baseline and final BIS-11c scores were positively correlated with treatments (r > 0.9).

CONCLUSION

An intake of 550 mg EPA fatty acid and 225 mg DHA fatty acid per day for 8 weeks is associated with less marked impulsive behaviour in children with ADHD. A Mediterranean diet may improve BIS scores, although our results are not conclusive in this population.

Early-life environmental exposure determinants of child behavior in Europe: A longitudinal, population-based study

BACKGROUND

Environmental exposures in early life influence the development of behavioral outcomes in children, but research has not considered multiple exposures. We therefore aimed to investigate the impact of a broad spectrum of pre- and postnatal environmental exposures on child behavior.

METHODS AND FINDINGS

We used data from the HELIX (Human Early Life Exposome) project, which was based on six longitudinal population-based birth cohorts in Europe. At 6-11 years, children underwent a follow-up to characterize their exposures and assess behavioral problems. We measured 88 prenatal and 123 childhood environmental factors, including outdoor, indoor, chemical, lifestyle and social exposures. Parent-reported behavioral problems included (1) internalizing, (2) externalizing scores, using the child behavior checklist (CBCL), and (3) the Conner's Attention Deficit Hyperactivity Disorder (ADHD) index, all outcomes being discrete raw counts. We applied LASSO penalized negative binomial regression models to identify which exposures were associated with the outcomes, while adjusting for co-exposures. In the 1287 children (mean age 8.0 years), 7.3% had a neuropsychiatric medical diagnosis according to parent's reports. During pregnancy, smoking and car traffic showing the strongest associations (e.g. smoking with ADHD index, aMR:1.31 [1.09; 1.59]) among the 13 exposures selected by LASSO, for at least one of the outcomes. During childhood, longer sleep duration, healthy diet and higher family social capital were associated with reduced scores whereas higher exposure to lead, copper, indoor air pollution, unhealthy diet were associated with increased scores. Unexpected decreases in behavioral scores were found with polychlorinated biphenyls (PCBs) and organophosphate (OP) pesticides.

CONCLUSIONS

Our systematic exposome approach identified several environmental contaminants and healthy lifestyle habits that may influence behavioral problems in children. Modifying environmental exposures early in life may limit lifetime mental health risk.

Food preferences, food neophobia and chemosensation among adolescents with ADHD

AIM

It has been suggested that adolescents diagnosed with ADHD have an unhealthier diet compared to their peers without ADHD. The association between chemosensation (smell and taste) and dietary patterns remains unknown. The aim is to investigate unhealthy food preferences and food neophobic behaviour among adolescents diagnosed with ADHD. Additionally, it is to investigate the relationship between dietary patterns and chemosensory function.

METHODS

We enrolled 36 adolescents with and without ADHD to complete a food item and a food neophobia questionnaire and to undergo chemosensory testing.

RESULTS

Adolescents with ADHD performed significantly worse on both chemosensory tests compared to the non-ADHD group. No difference in food preferences nor food neophobia was found between the two groups.

CONCLUSION

Adolescents with ADHD have a lower score on chemosensory tests compared to their peers, suggesting impaired chemosensory function. No differences in dietary preferences nor food neophobia were seen between the two groups.

Advertising Influences Food Choices of University Students With ADHD

Objective: Previous research in adults with ADHD showed high rates of obesity and unhealthy food choices. There is evidence that contextual cues, for example, advertisements, influence food choices. This study assessed the sensitivity of university students with ADHD to advertised food. Method: University students (N = 457) with and without ADHD participated in a cafeteria field experiment. Food choices were examined in periods of advertising either healthy or unhealthy sandwiches. Results: Students with ADHD (a) chose less healthy food items, (b) were more influenced by advertising, (c) showed the same overall healthy food choices as controls when exposed to healthy advertising. Conclusion: Students with ADHD chose unhealthier foods at the cafeteria but were also more influenced by advertising. Healthy food advertisements raised their healthy food choices. As this population has strong association with unhealthy dietary patterns, it is important to investigate the influence of food cues on their eating habits.

The Adaptive GameSquad Xbox-Based Physical Activity and Health Coaching Intervention for Youth With Neurodevelopmental and Psychiatric Diagnoses: Pilot Feasibility Study

Background

The prevalence of neurodevelopmental and psychiatric diagnoses (NPDs) in youth is increasing, and unhealthy physical activity (PA), diet, screen time, and sleep habits contribute to the chronic disease disparities and behavioral challenges this population experiences.

Objective

This pilot study aims to adapt a proven exergaming and telehealth PA coaching intervention for typically developing youth with overweight or obesity; expand it to address diet, screen, and sleep behaviors; and then test its feasibility and acceptability, including PA engagement, among youth with NPDs.

Methods

Participants (N=23; mean age 15.1 years, SD 1.5; 17 males, 9 people of color) recruited in person from clinic and special education settings were randomized to the Adaptive GameSquad (AGS) intervention or wait-list control. The 10-week adapted intervention included 3 exergaming sessions per week and 6 real-time telehealth coaching sessions. The primary outcomes included feasibility (adherence to planned sessions), engagement (uptake and acceptability as reported on process questionnaires), and PA level (combined light, moderate, and vigorous as measured by accelerometer). Descriptive statistics summarized feasibility and engagement data, whereas paired, two-tailed t tests assessed group differences in pre-post PA.

Results

Of the 6 coaching sessions, AGS participants (n=11; mean age 15.3 years, SD 1.2; 7 males, 4 people of color) completed an average of 5 (83%), averaging 81.2 minutes per week of exergaming. Of 9 participants who completed the exit questionnaire, 6 (67%) reported intention to continue, and 8 (89%) reported feeling that the coaching sessions were helpful. PA and sleep appeared to increase during the course of the intervention over baseline, video game use appeared to decrease, and pre-post intervention PA per day significantly decreased for the control (−58.8 min; P=.04) but not for the intervention group (−5.3 min; P=.77), despite potential seasonality effects. However, beta testers and some intervention participants indicated a need for reduced complexity of technology and more choice in exergames.

Conclusions

AGS shows promise in delivering a health behavior intervention remotely to youth with NPDs, but a full-scale efficacy trial with a larger sample size is needed to confirm this finding. On the basis of feedback from beta testers and intervention participants, the next steps should include reduced technology burden and increased exergame choice before efficacy testing.

Trial Registration

ClinicalTrials.gov NCT03665415; https://clinicaltrials.gov/ct2/show/NCT03665415.

Understanding the Link Between Allergy and Neurodevelopmental Disorders: A Current Review of Factors and Mechanisms

Both allergic diseases and neurodevelopmental disorders are non-communicable diseases (NCDs) that not only impact on the quality of life and but also result in substantial economic burden. Immune dysregulation and inflammation are typical hallmarks in both allergic and neurodevelopmental disorders, suggesting converging pathophysiology. Epidemiological studies provided convincing evidence for the link between allergy and neurodevelopmental diseases such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). Possible factors influencing the development of these disorders include maternal depression and anxiety, gestational diabetes mellitus, maternal allergic status, diet, exposure to environmental pollutants, microbiome dysbiosis, and sleep disturbances that occur early in life. Moreover, apart from inflammation, epigenetics, gene expression, and mitochondrial dysfunction have emerged as possible underlying mechanisms in the pathogenesis of these conditions. The exploration and understanding of these shared factors and possible mechanisms may enable us to elucidate the link in the comorbidity.

Complementary effects of pine bark extract supplementation on inattention, impulsivity, and antioxidative status in children with attention-deficit hyperactivity disorder: A double-blinded randomized placebo-controlled cross-over study

The purpose of this study was to investigate the complementary effects of polyphenolic compounds from pine bark extract (PE) as a strong antioxidative substrate on the symptoms of inattention and impulsivity in children with attention-deficit hyperactivity disorder (ADHD). This was a randomized, double-blind, crossover, placebo-controlled study that included two experimental units (4 weeks with PE supplementation and 4 weeks with placebo supplementation) separated by a 2-week washout period. ADHD participants were supplemented with 25 mg or 50 mg PE. We recruited 20 participants (17 boys and 3 girls) with a mean age of 10.0 ± 2.1 years. PE supplementation caused a significant reduction in the inattention and hyperactivity-impulsivity items of SNAP-IV. During the period of PE supplementation, the item of commissions in the Continuous Performance Test III (CPT III) significantly decreased, which was used to evaluate the symptoms of inattention and impulsivity. In addition, the erythrocytic reduced glutathione/oxidized glutathione ratio significantly increased, and the plasma TBARs level significantly decreased after 4 weeks of PE supplementation. However, there was no significant correlation between CPT III (commission) and antioxidative status indictors. PE supplementation may have potential effects of ameliorating inattention and impulsivity, and elevating the antioxidative status in children with ADHD.

Dietary pattern trajectories across adolescence and early adulthood and their associations with childhood and parental factors

BACKGROUND

Although adolescent dietary patterns tend to be of poor quality, it is unclear whether dietary patterns established in adolescence persist into adulthood.

OBJECTIVES

We examined trajectories across adolescence and early adulthood for 2 major dietary patterns and their associations with childhood and parental factors.

METHODS

Using data from the Western Australian Pregnancy Cohort (Raine Study), intakes of 38 food groups were estimated at ages 14, 17, 20 and 22 y in 1414 participants using evaluated FFQs. Using factor analysis, 2 major dietary patterns (healthy and Western) were consistently identified across follow-ups. Sex-specific group-based modeling assessed the variation in individual dietary pattern z scores to identify group trajectories for each pattern between ages 14 and 22 y and to assess their associations with childhood and parental factors.

RESULTS

Two major trajectory groups were identified for each pattern. Between ages 14 and 22 y, a majority of the cohort (70% males, 73% females) formed a trajectory group with consistently low z scores for the healthy dietary pattern. The remainder had trajectories showing either declining (27% females) or reasonably consistent healthy dietary pattern z scores (30% males). For the Western dietary pattern, the majority formed trajectories with reasonably consistent average scores (79% males, 81% females) or low scores that declined over time. However, 21% of males had a trajectory of steady, marked increases in Western dietary pattern scores over time. A lower maternal education and higher BMI (in kg/m2) were positively associated with consistently lower scores of the healthy dietary pattern. Lower family income, family functioning score, maternal age, and being in a single-parent family were positively related to higher scores of the Western dietary pattern.

CONCLUSIONS

Poor dietary patterns established in adolescence are likely to track into early adulthood, particularly in males. This study highlights the transition between adolescence and early adulthood as a critical period and the populations that could benefit from dietary interventions.

Unique Trans-fatty Acid Profile in Children With Attention Deficit Hyperactivity Disorder

Background: Attention deficit hyperactivity disorder (ADHD) is the most common developmental disorder in children. Studies suggest an association between fatty acids composition and ADHD pathogenesis. We aimed to investigate whether children diagnosed with ADHD present unique fatty acid profiles in red blood cells (RBC), as compared to children without ADHD. Method: We examined 60 children aged 6-14 years, out of which 32 were diagnosed with ADHD, and 28 were not. Blood was collected from all children to quantify an array of 26 fatty acids from RBC membranes. Fatty acid methyl esters were generated by acid transesterification and analyzed by gas chromatography. Results: We found that children with ADHD presented unique fatty acid profiles on RBC membranes with significantly higher levels of most of the trans-fatty acids (Total trans-fatty acids 0.64 ± 0.21 vs. 0.49 ± 0.18 p = 0.003) and lower levels of docosahexaenoic acid (DHA), as compared to controls (4.06 ± 0.79 vs. 4.68 ± 1.37 p = 0.040). Additionally, total trans-fatty acids were higher in children with extremely severe clinical ADHD condition score, as compared to milder ADHD scores and to control children (0.72 ± 0.18, 0.64 ± 0.20, 0.61 ± 0.22, 0.49 ± 0.18, p = 0.010, accordingly). Conclusion: Children with ADHD have higher levels of trans-fatty acids in RBCs, compared to children without ADHD. This study points to a possible link between trans-fatty acids and ADHD. Understanding these findings and the clinical meaning will potentially contribute to a more targeted dietary intervention.

The Relationship Between Sugar-Sweetened Beverages, Takeaway Dietary Pattern, and Psychological and Behavioral Problems Among Children and Adolescents in China

Background and Aim: The association of sugar-sweetened beverage (SSB) consumption and takeaway dietary pattern with psychological problems in Chinese children and adolescents has not been concretely reported. Our study aimed to investigate the association between SSB consumption, takeaway dietary pattern, and psychological and behavioral problems (PBPs). Methods: Cluster sampling method has been adopted from April to May 2019 to conduct a questionnaire survey among 30,188 children and adolescents in grades 1 to 12 from 14 schools in six streets in Bao'an District of Shenzhen. This cross-sectional study investigated the association of consumption of SSBs and takeaway patterns with PBPs, and PBPs were measured by the Strengths and Difficulties Questionnaire (SDQ) in primary, junior, and senior high school students. Results: A total of 33,801 primary, junior, and senior high school students (mean age = 12.44, SD = 3.47) ranging from 6 to 18 years old were recruited in this study using a health survey of children and adolescents in junior and senior high schools (grades 1-12), and 30,188 students with no missing data were finally analyzed (questionnaires with missing value >5% were excluded). The top three SSBs in the intake frequency were milk beverage drinks (not milk), vegetable protein drinks, and fruit and vegetable juice drinks. Adjusted for demographic factors, the higher the frequency of students consuming SSBs who have significantly higher PBPs, the higher the frequency of students with takeaway dietary patterns who also have significantly higher PBPs. More frequent intake of SSBs [odds ratio (OR) = 2.23, 95%CI = 2.0-2.47, p < 0.01] and higher takeaway dietary patterns (OR = 2.34, 95%CI = 1.81-3.03, p < 0.01) were associated with higher SDQ total difficulties scores. When low and medium consumption of SSB was compared, children and adolescents who have high SSB intake were more associated with total difficulties score (OR = 3.10, 95%CI = 2.67-3.59, p < 0.01), and when low and medium takeaway dietary patterns were compared, children and adolescents who have high takeaway dietary patterns were more associated with total difficulties score. The joint associations of SSBs and takeaway pattern with SDQ were stronger than the associations individually. Conclusions: Students consuming higher SSBs and having takeaway dietary pattern are associated with increased levels of PBPs individually and interactively. These results may have implications for mental health prevention in adolescents.

The association between ADHD and physical health: a co-twin control study

Attention-deficit/hyperactivity disorder (ADHD) has been associated with increased risk for physical comorbidity. This study used a twin cohort to investigate the association between physical diseases and phenotypic variations of ADHD. A twin cohort enriched for ADHD and other neurodevelopmental conditions were analysed. The Attention Problems subscale of the Child Behavior Checklist/Adult Behavior Checklist (CBCL/ABCL-AP) was used to measure the participants’ severity of ADHD symptoms. Physical health issues were obtained with a validated questionnaire and were tested in relation to ADHD symptom severity in a co-twin control model. Neurological problems were significantly associated with a diagnosis of ADHD. A conditional model for the analysis of within-twin pair effects revealed an inverse association between digestive problems and the severity of ADHD symptoms, after adjusting for co-existing autism spectrum disorder and ADHD medications. Our findings suggest that individuals with ADHD are susceptible to neurological problems, why a thorough neurological check-up is indicated in clinical practice for this population. In addition, health conditions of digestive system could be considered as a non-shared environmental factor for behavioral phenotypes in ADHD. It supports the possible role of gut-brain axis in the underpinnings of ADHD symptoms, at least for a subgroup of individuals with certain genetic predisposition.

Optimizing Diet Of Children With Mental Disorders

When monitoring principles of nutrition for children with mental health problems who study in specialized institutions of the Russian Federation or live in boarding schools, it has been revealed that there is no special adapted diet for them. According to the World Health Organization (WHO), unbalanced diets along with lifestyle habits are the main risk factors for chronic diseases, which can develop together with disorders in intellectual and cognitive abilities. Our objective was to study reference data for identifying and summarizing the nutritional characteristics typical for children requiring special medical care. The review has presented data of foreign and national authors, as well as data obtained with the “Arktika” Research Scientific Center of the Far Eastern Branch of the Russian Academy of Sciences, on the elemental status observed in children with autism spectrum disorders, and the nutritional characteristics of the diet kept by residents of Magadan Region under conditions of the Far North. Based on the data, we have made some recommendations for optimizing diet for children with mental disorders.

DNA methylation associated with persistent ADHD suggests TARBP1 as novel candidate

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by age-inappropriate symptoms of inattention and/or hyperactivity and impulsivity. ADHD is highly prevalent in childhood and often persists into adulthood. Both genetic variants and environmental factors play a role in the onset and persistence of ADHD, and epigenetic changes, such as DNA methylation are considered as a link for their interplay. To investigate this, we studied DNA methylation in 37 candidate genes by performing targeted bisulfite sequencing of DNA isolated from whole blood of N = 88 individuals diagnosed with adult ADHD and N = 91 unaffected individuals (mean age 34.2 years). Differentially methylated sites were assessed by generalized linear models testing ADHD status and ADHD symptoms, accounting for a methylation-based smoking score, age, sex, and blood cell count. DNA methylation of single sites within DRD4 and KLDR1 was associated with adult ADHD status, and multiple DNA methylation sites within TARBP1 were associated with ADHD symptoms in adulthood and childhood. Awaiting replication, findings of this pilot study point to TARBP1 as a new candidate gene for ADHD symptoms. Our work also stresses the need for research to further examine the effects of environmental factors, such as nicotine exposure, on epigenetic modifications associated with psychiatric traits.

The Brain-Gut-Microbiome Axis in Psychiatry

Beginning with the concept of the brain-gut axis, the importance of the interaction between the brain and the gastrointestinal tract has been extended to the microbiome with increasing clinical applications. With the recent development of various techniques for microbiome analysis, the number of relevant preclinical and clinical studies on animals and human subjects has rapidly increased. Various psychotic symptoms affect the intestinal microbiome through the hypothalamus-pituitary-adrenal gland axis. Conversely, the intestinal microbiome regulates the gastrointestinal tract environment and affects psychological factors by means of the microorganisms or their metabolites, either acting directly on the brain or through the synthesis of various neurotransmitters. This review discusses the clinical applicability of the brain-gut-microbiome axis and directions for improving psychological symptoms based on the studies published to date.

The Association of Lifestyle Factors and ADHD in Children

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.