Research Review: The role of diet in the treatment of attention-deficit/hyperactivity disorder: an appraisal of the evidence on efficacy and recommendations on the design of future studies

TY - JOUR

T1 - Research Review: The role of diet in the treatment of attention-deficit/hyperactivity disorder

T2 - an appraisal of the evidence on efficacy and recommendations on the design of future studies

AU - Stevenson, Jim

AU - Buitelaar, Jan

AU - Cortese, Samuele

AU - Ferrin, Maite

AU - Konofal, Eric

AU - Lecendreux, Michel

AU - Simonoff, Emily

AU - Wong, Ian C. K.

AU - Sonuga-Barke, Edmund

AU - European ADHD Guidelines Grp

PY - 2014/5

Y1 - 2014/5

N2 - BackgroundThe efficacy of three dietary treatments for ADHD has been repeatedly tested in randomized controlled trials (RCTs). These interventions are restricted elimination diets (RED), artificial food colour elimination (AFCE) and supplementation with free fatty acids (SFFA). There have been three systematic reviews and associated meta-analyses of the RCTs for each of these treatments.ScopeThe aim of this review is to critically appraise the studies on the dietary treatments of ADHD, to compare the various meta-analyses of their efficacy that have been published and to identify where the design of such RCTs could be improved and where further investigations are needed.FindingsThe meta-analyses differ in the inclusion and exclusion criteria applied to potentially eligible studies. The range of average effect sizes in standard deviation units is RED (0.29-1.2), AFCE (0.18-0.42) and SFFA (0.17-0.31). The methodology of many of the trials on which the meta-analyses are based is weak.ConclusionsNevertheless, there is evidence from well-conducted studies for a small effect of SFFA. Restricted elimination diets may be beneficial, but large-scale studies are needed on unselected children, using blind assessment and including assessment of long-term outcome. Artificial food colour elimination is a potentially valuable treatment but its effect size remains uncertain, as does the type of child for whom it is likely to be efficacious. There are additional dietary supplements that have been used with children with ADHD. A systematic search identified 11 RCTs that investigated the effects of these food supplements. Despite positive results for some individual trials, more studies are required before conclusions can be reached on the value in reducing ADHD symptoms of any of these additional supplements.

AB - BackgroundThe efficacy of three dietary treatments for ADHD has been repeatedly tested in randomized controlled trials (RCTs). These interventions are restricted elimination diets (RED), artificial food colour elimination (AFCE) and supplementation with free fatty acids (SFFA). There have been three systematic reviews and associated meta-analyses of the RCTs for each of these treatments.ScopeThe aim of this review is to critically appraise the studies on the dietary treatments of ADHD, to compare the various meta-analyses of their efficacy that have been published and to identify where the design of such RCTs could be improved and where further investigations are needed.FindingsThe meta-analyses differ in the inclusion and exclusion criteria applied to potentially eligible studies. The range of average effect sizes in standard deviation units is RED (0.29-1.2), AFCE (0.18-0.42) and SFFA (0.17-0.31). The methodology of many of the trials on which the meta-analyses are based is weak.ConclusionsNevertheless, there is evidence from well-conducted studies for a small effect of SFFA. Restricted elimination diets may be beneficial, but large-scale studies are needed on unselected children, using blind assessment and including assessment of long-term outcome. Artificial food colour elimination is a potentially valuable treatment but its effect size remains uncertain, as does the type of child for whom it is likely to be efficacious. There are additional dietary supplements that have been used with children with ADHD. A systematic search identified 11 RCTs that investigated the effects of these food supplements. Despite positive results for some individual trials, more studies are required before conclusions can be reached on the value in reducing ADHD symptoms of any of these additional supplements.

KW - fatty acid

KW - food supplements

KW - ADHD

KW - elimination diet

KW - food colours

KW - meta-analysis

KW - DEFICIT-HYPERACTIVITY DISORDER

KW - RANDOMIZED-CONTROLLED-TRIAL

KW - PLACEBO-CONTROLLED TRIAL

KW - RESTRICTED ELIMINATION DIET

KW - POLYUNSATURATED FATTY-ACIDS

KW - ARTIFICIAL FOOD COLORS

KW - DOUBLE-BLIND

KW - HYPERKINETIC DISORDER

KW - PILOT TRIAL

KW - CHILDREN

U2 - 10.1111/jcpp.12215

DO - 10.1111/jcpp.12215

M3 - Literature review

SN - 0021-9630

VL - 55

SP - 416

EP - 427

JO - Journal of Child Psychology and Psychiatry

JF - Journal of Child Psychology and Psychiatry

IS - 5

M1 - N/A

ER -