NICE ADHD addendum

Abstract

T here continues to be considerable interest in the effect of diet on ADHD symptoms and it was not surprising that new evidence was found when the guidelines update team reviewed the effectiveness of 'few-food' diets and the impact this may have on current recommendations.² The guidelines update team asked two questions. They first looked at the clinical and cost effectiveness of elimination/restriction diets in children and young people with ADHD, and they looked at the clinical and cost effectiveness of polyunsaturated fatty acid supplementation.For the first question, a systematic search of the literature identified only two articles that met the criteria and were included. There were no studies that met criteria for inclusion in answering the economic question of cost effectiveness of 'few food' diets. This evidence did favour the 'few food' diet, although the data were generally of low quality with major limitations. [3][4] The NICE guidelines process for reviewing evidence is rigorous and we have not questioned the validity of their findings. We have, however, done a further literature review to look for any new evidence that may have been published since the addendum was written. The same search criteria as used by NICE was completed and only RCTs and systematic reviews and literature published in the English language were included. Medline was used and the search was limited to studies from 2015 only. No further relevant studies were identified that could add to the evidence already included by NICE.With this in mind the current recommendation is to ask about foods or drinks that appear to influence hyperactive behaviour during clinical assessment of ADHD in children and young people, and if there is a clear link to ask parents to keep a food diary. If the diary supports evidence of a link, refer to a dietitian and ensure that parents are aware of the limited evidence about long-term effectiveness and potential harms to starting a 'few food' diet without specialist advice.New evidence was found for supplementation with polyunsaturated fatty acids. The second question asked what the clinical and cost effectiveness was for offering such supplements to young people with ADHD.² A systematic search of the literature identified 15 articles that met criteria for inclusion in looking at the clinical effects. [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] No articles were included in answering the economic question. The evidence was of variable quality, and none showed any clinically relevant improvement in ADHD symptoms in the short, medium or long term. A further literature search was completed, as above, to look for any new evidence since the addendum was written. Three further relevant studies, 23-25 including one systematic review and meta-analysis, 23 were identified, which could not add to the evidence already included by NICE.The advice remains as previously stated in the NICE guidelines, that polyunsaturated fatty acid supplements should not be recommended for children and young peop...