Document Detail

Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments.
MedLine Citation:
PMID:  23360949     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: Nonpharmacological treatments are available for attention deficit hyperactivity disorder (ADHD), although their efficacy remains uncertain. The authors undertook meta-analyses of the efficacy of dietary (restricted elimination diets, artificial food color exclusions, and free fatty acid supplementation) and psychological (cognitive training, neurofeedback, and behavioral interventions) ADHD treatments.
METHOD: Using a common systematic search and a rigorous coding and data extraction strategy across domains, the authors searched electronic databases to identify published randomized controlled trials that involved individuals who were diagnosed with ADHD (or who met a validated cutoff on a recognized rating scale) and that included an ADHD outcome.
RESULTS: Fifty-four of the 2,904 nonduplicate screened records were included in the analyses. Two different analyses were performed. When the outcome measure was based on ADHD assessments by raters closest to the therapeutic setting, all dietary (standardized mean differences=0.21-0.48) and psychological (standardized mean differences=0.40-0.64) treatments produced statistically significant effects. However, when the best probably blinded assessment was employed, effects remained significant for free fatty acid supplementation (standardized mean difference=0.16) and artificial food color exclusion (standardized mean difference=0.42) but were substantially attenuated to nonsignificant levels for other treatments.
CONCLUSIONS: Free fatty acid supplementation produced small but significant reductions in ADHD symptoms even with probably blinded assessments, although the clinical significance of these effects remains to be determined. Artificial food color exclusion produced larger effects but often in individuals selected for food sensitivities. Better evidence for efficacy from blinded assessments is required for behavioral interventions, neurofeedback, cognitive training, and restricted elimination diets before they can be supported as treatments for core ADHD symptoms.
Edmund J S Sonuga-Barke; Daniel Brandeis; Samuele Cortese; David Daley; Maite Ferrin; Martin Holtmann; Jim Stevenson; Marina Danckaerts; Saskia van der Oord; Manfred Döpfner; Ralf W Dittmann; Emily Simonoff; Alessandro Zuddas; Tobias Banaschewski; Jan Buitelaar; David Coghill; Chris Hollis; Eric Konofal; Michel Lecendreux; Ian C K Wong; Joseph Sergeant;
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  The American journal of psychiatry     Volume:  170     ISSN:  1535-7228     ISO Abbreviation:  Am J Psychiatry     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-03-01     Completed Date:  2013-04-15     Revised Date:  2014-11-14    
Medline Journal Info:
Nlm Unique ID:  0370512     Medline TA:  Am J Psychiatry     Country:  United States    
Other Details:
Languages:  eng     Pagination:  275-89     Citation Subset:  AIM; IM    
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MeSH Terms
Attention Deficit Disorder with Hyperactivity / diagnosis,  psychology,  therapy*
Behavior Therapy
Central Nervous System Stimulants / therapeutic use*
Child, Preschool
Cognition Disorders / diagnosis,  psychology,  therapy
Cognitive Therapy
Combined Modality Therapy
Diet Therapy*
Fatty Acids, Nonesterified / administration & dosage
Food Coloring Agents / administration & dosage,  adverse effects
Food Hypersensitivity / complications,  therapy
Randomized Controlled Trials as Topic
Reg. No./Substance:
0/Central Nervous System Stimulants; 0/Fatty Acids, Nonesterified; 0/Food Coloring Agents
Comment In:
Am J Psychiatry. 2013 Jul;170(7):800-2   [PMID:  23820834 ]
Am J Psychiatry. 2013 Jul;170(7):799-800   [PMID:  23820843 ]
Am J Psychiatry. 2013 Jul;170(7):799   [PMID:  23820833 ]
Am J Psychiatry. 2013 Mar;170(3):241-4   [PMID:  23450282 ]
Evid Based Ment Health. 2013 Aug;16(3):77   [PMID:  23704705 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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