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

Abstract

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. K E Y W O R D Sattention-deficit hyperactivity disorder, oxidative stress, pine bark extract | INTRODUCTIONAttention-deficit hyperactivity disorder (ADHD) is one of the most prevalent neurobiological disorders in the world and presents a complex, highly inheritable etiology (Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014). The global prevalence of ADHD in school-age children is 5.3%-7.1%, which varies according to different diagnostic tools, diagnostic criteria, and case samples (Thomas, Sanders, Doust, Beller, & Glasziou, 2015). On the other hand, Huang et al. used a National Health Insurance database and found that the prevalence of ADHD among Taiwanese school children was 7%-12% and was more common among boys (14.9%) than girls (4.5%) (Huang, Chu, Cheng, & Weng, 2014). This difference is partially because boys have explicit behaviors, which are more easily exhibited in early stages. Conversely, girls often show inattention, anxiety, and depression. It was reported that in around 60% of children with ADHD, the problems of inattention and hyperactivity continue to occur in adulthood (Barkley,

Safety and efficacy of antioxidant therapy in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis

“…The results of the risk of bias assessment are presented in Fig 3 . Among the 48 included studies, 29 studies provided specific methods for random allocation [ 31 – 34 , 36 – 39 , 41 , 45 – 63 , 78 ], and were therefore rated as having a low risk of bias in random allocation. Most of these studies employed computer random sequence allocation.…”

Attention Deficit Hyperactivity Disorder (ADHD) and Polyphenols: A Systematic Review

“…A significant reduction was also observed in the hyperactivity-impulsivity parameter after PBE supplementation compared to the baseline (p = 0.029) and compared to the placebo (p = 0.024). Moreover, the evaluation of inattention and impulsivity through the Conners Continuous Performance Test 3rd edition (CPT-III) revealed that the T-score of commissions was significantly reduced compared to the baseline after 4 weeks of PBE supplementation (p = 0.048) [25].…”

“…The only opposite finding was detected by Tenenbaum and colleagues, who noticed no significant effects in the PBE group compared to the placebo. Finally, concerning the use of resveratrol as an add-on to methylphenidate, Rafeiy-Torghabeh et al showed significant results by revealing a decrease in the total scores and the inattention and hyperactivity subscores [24][25][26][27][28]; Table 2. ↓ after 8 weeks (17.60 to 4) Time-treatment interaction p = 0.036 Note: ↓ indicates a reduction; ↑ indicates an increase.…”

Theobromine improves hyperactivity, inattention, and working memory via modulation of dopaminergic neural function in the frontal cortex of spontaneously hypertensive rats

“…17,[21][22][23][24][25] Compounds derived from natural sources have shown potential in ameliorating central nervous system disorders, including ADHD. 26,27 Theobromine (TB), a primary methylxanthine found in cacao beans and prevalent in cacao products like cocoa and dark chocolate, is one such compound. 28 Our previous research indicated that long-term TB supplementation enhances motor learning and working memory by increasing BDNF levels in the PFC of rodents 29,30 Additionally, chronic consumption of dark chocolate, rich in TB, has been reported to improve frontal lobe function in healthy adoles-cents.…”