Does oligoantigenic diet influence hyperactive/conduct-disordered children ? a controlled trial

Abstract

A crossover 'placebo'-controlled, double-blind design was used to examine the effectiveness of an oligoantigenic diet in 49 children with hyperactive/disruptive behavior disorder. Effects of diet were compared with those yielded by stimulant medication (methylphenidate). The study was conducted in an inpatient unit at the Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, Mannheim. Change in behavior was measured in standardized situations by trained raters, including behavior assessment when testing with CPT and PAT, during a free play situation, and at school. Twelve children (24%) showed significant behavioral improvement in two behavior ratings during diet relative to control diet conditions. Methylphenidate used in 36 children yielded more responders (44%) than diet. The amount of positive changes in behavior in those who received both treatments was about the same. Although only effective in a minority of children, dietary treatment cannot be neglected as a possible access to treating hyperactive/disruptive children and merits further investigation.

Meta-Analysis of Attention-Deficit/Hyperactivity Disorder or Attention-Deficit/Hyperactivity Disorder Symptoms, Restriction Diet, and Synthetic Food Color Additives

“…We identified six restriction diet studies that used either a placebo-controlled diet challenge or a crossover design, 26,33,35–38 which in aggregate examined 195 children for improvement in hyperactive symptoms. These studies yielded a summed response rate of 41.5% (95% CI = 22%–64%), again with substantial heterogeneity (Q = 29.7; p < .001).…”

“…In the six above-mentioned studies, 26,33,35–38 we examined the average size of the change in symptoms, because the definition of the term “responder” varied arbitrarily across studies. Pooling all sources of outcome information (parents, teachers, and observers) within studies, the aggregate effect was g = 0.58 (SE = 0.25 [95% CI = 0.10–1.1]; p = .019).…”

“…For the five homogeneous studies, 26,35–38 there was no publication bias using the trim-and-fill estimator 39 with no missing studies imputed. The fail-safe analysis indicated that it would have required four studies (nearly as many as were published) with a negative effect of −0.25 to reduce the summary effect to a trivial g = 0.05.…”

Restriction and Elimination Diets in ADHD Treatment

“…They identified 6 restriction diet studies that used either a placebo-controlled diet challenge or a crossover design, 29,39,43–45 which in aggregate examined 195 children for improvement in hyperactive symptoms. However, one study 39 had questionable blinding of participants and was also a statistical outlier that fully accounted for heterogeneity of effects.…”

“…Schmidt and colleagues 45 created a reasonable attempt at a double-blind, placebo-controlled oligoantigenic diet for 49 children. The outcome was judged based on ratings in a standardized setting by trained raters blinded to intervention condition.…”