Is there a future for restricted elimination diets in ADHD clinical practice?

Rommelse, Nanda; Buitelaar, Jan K.

doi:10.1007/s00787-013-0394-x

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…44% of the participants showed significant improvement in a second part of the study during methylphenidate therapy. This is remarkably lower than described elsewhere (70%-90%) (55,65).…”

Section: Discussioncontrasting

confidence: 62%

“…A possible, not further investigated, explanation for this could be a rather common intolerance of inhaled food allergens (notably cooked legumes) which may have emanated from the table neighbours' dishes at baseline, but not while the proband consumed his usual diet in the introductory test phase These effects might be modulated by the parasympathic system or/and involving emotion dysreguating domains (56)(57)(58)(59). Contributing interactive or external study-related psycho-social factors and a more supportive attention from household partners might also explain this effect (55). Pelsser et al (60), however, found no "significant association between family structure and ADHD symptoms".…”

Section: Discussionmentioning

confidence: 99%

“…The blinded video-rating ensures an unbiased assessment of the raters. But it can still be criticized [see for example Rommelse & Buitelaar (55)] that the blinded rating is based on the nonblinded estimates of the parents. A classroom setting, as it was used in another study to compare the efficacy of different stimulant drugs in children with ADHD can actually be seen as the gold standard, providing "a controlled study environment" (66).…”

Section: Dölp Et Almentioning

confidence: 99%

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Oligoantigenic Diet Improves Children’s ADHD Rating Scale Scores Reliably in Added Video-Rating

et al. 2020

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Objectives: The influence of food intake on behavioural disorders was already described in the early 20th century. Elimination of individually allergenic food items from individual diets ["oligoantigenic diet" (OD)] showed promise to improve attention-deficit/ hyperactivity disorder (ADHD) symptoms. However, only few of the positive results were evaluated by blinded symptom rating. Therefore the present study's purpose was to evaluate the reliability of a non-blinded rating of the ADHD Rating Scale IV (ARS) for the assessment of OD effects in comparison to a blinded rating of the ARS based on pseudonymized video recordings. Methods: Ten children (8m/2f) aged 8 to 14 with ADHD according to ICD-10 participated in an uncontrolled, open-label dietary intervention study. Food items, commonly related to intolerances, were eliminated for four weeks. Participants with > 40% improvement in the ARS between T1 (before the diet) and T2 (after the diet) were defined as responders. Nutrients with individual relevance to ADHD symptoms were identified in a following reintroduction phase (T3-T4) lasting 8-16 weeks. The ARS was completed by a nonblinded child and adolescent psychiatrist (T0-T4). Sessions were recorded on video, pseudonymized, and evaluated by three blinded raters. Complete data were captured for eight children. The inter-rater reliability between the non-blinded therapist and every blinded rater was determined by the intra-class correlation coefficient (ICC). Correlations according to Pearson and Spearman between the non-blinded and blinded rating were calculated for each rater. Results: Two blinded raters and the non-blinded rater considered 5 of 8 (62.5%) children as responders, whereas one blinded rater disagreed as to the success of one case thus considering only 4 of 8 children as responders to the diet. Inter-rater reliability was assessed after each rater having scored 33 videos: The intra-class coefficients were >.9 for all raters (rater 1: ICC=.997, rater 2: ICC=.996, rater 3: ICC=.996) and the Spearman rho between the raters were high (n=33; rater 1: rho =.989, p<.0001, rater 2: rho=.987, p<.0001, rater 3: rho=.984, p<.0001), respectively.

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“…44% of the participants showed significant improvement in a second part of the study during methylphenidate therapy. This is remarkably lower than described elsewhere (70%-90%) (55,65).…”

Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Dölp Et Almentioning

confidence: 99%

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Oligoantigenic Diet Improves Children’s ADHD Rating Scale Scores Reliably in Added Video-Rating

et al. 2020

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“…Second, the study includes observations of the children's' behaviour by a reporter who is truly blind as to dietary treatment. Third, to control for nonspecific treatment effects, head‐to‐head studies of RED and treatment alternatives including control diets and/or treatment‐as‐usual need to be conducted (Rommelse & Buitelaar, ).…”

Section: Discussionmentioning

confidence: 99%

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

Stevenson¹,

Buitelaar

Cortese

et al. 2014

Child Psychology Psychiatry

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Nevertheless, 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.

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“…There is also an urgent need in society to develop alternative treatment modalities for ADHD [8], beyond psychostimulant medication. As stated by Stevenson et al [11], many families would prefer a nonpharmacological intervention if an effective one were available, given frequent concerns associated with medication use, with regard to the risk of altering children's personality by medicating them, but also with regard to adverse effects on sleep, appetite and growth and uncertainties about possible longterm adverse effects on the brain and cardiovascular system.…”

mentioning

confidence: 99%

Attention-deficit/hyperactivity disorder: seeking the right balance between over- and undertreatment

Hoekstra

Dietrich

2014

Eur Child Adolesc Psychiatry

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This issue of European Child and Adolescent Psychiatry contains an article that addresses functional impairments associated with subthreshold attention-deficit/hyperactivity disorder (ADHD) [2]. In a Korean nationwide community sample of 921 children, aged 8-11 years, the authors report that children with subthreshold ADHD were found to experience significant functional impairments, i.e., poorer behavioral and emotional control and worse academic performance compared to control children. Subthreshold ADHD was defined by the presence of at least three but no more than five inattentive or hyperactive/impulsive symptoms. However, whereas the diagnostic threshold (C6/9) for the DSM-IV symptoms represents a clear-cut operationalization for a diagnosis of ADHD, this disregards the fact that for the affected individuals and their parents the relevance of each symptom is likely to be different; for the diagnostic assessment as defined by the DSM-IV the symptoms are merely being counted, without taking the severity of each symptom into account. Furthermore, the subjective and objective impairment due to ADHD symptoms can in theory be greater in a child who fulfills only five symptoms in comparison to a child with six or more symptoms. These considerations illustrate how difficult it is to meaningfully operationalize thresholds for a spectrum disorder such as ADHD.It is certainly an interesting approach to illustrate impairments in a subthreshold version of a disorder that has received so much coverage by media, politicians, and government due to concerns about overdiagnosis and overtreatment with medication, in particular psychostimulants. The article of Hong et al. [2] in this issue illustrates that there is not a simple clear-cut boundary between ADHD and 'normality', which we should be well-aware of, when considering concerns of possible overdiagnosis.What is true, is that over the past decade, there has been a rapid and tremendous increase in the diagnosis of ADHD and in the use of medication treatments for ADHD within many European countries, in particular methylphenidate. This increase in the use of medication may be explained by several factors. First, better recognition and diagnosing of ADHD, in particular among girls. Second, the observation that children with ADHD receive the medication at a younger age than before. Third, it is now commonplace to receive the medication for many years, often during adolescent years and more and more into adulthood [4]. It is unclear, however, whether also children are being diagnosed and/or medicated in spite of falling below the diagnostic threshold set by DSM-IV (C6/9 criteria for either inattention or hyperactivity/impulsivity, or both) or failing to meet other aspects of the DSM-IV algorithm.A second issue is that the increased and longer use of methylphenidate contrasts with the lack of long-term data on effectiveness. In fact, for example, the official Dutch multidisciplinary guidelines explicitly state that there is currently only evidence for the long-term effectivenes...

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Is there a future for restricted elimination diets in ADHD clinical practice?

Cited by 5 publications

References 21 publications

Oligoantigenic Diet Improves Children’s ADHD Rating Scale Scores Reliably in Added Video-Rating

Oligoantigenic Diet Improves Children’s ADHD Rating Scale Scores Reliably in Added Video-Rating

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

Attention-deficit/hyperactivity disorder: seeking the right balance between over- and undertreatment

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