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Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments

Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments
Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments
Objective: honpharmacological 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
1535-7228
275-289
Sonuga-Barke, Edmund J.S.
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Brandeis, D.
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Cortese, S.
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Daley, David
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Ferrin, M.
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Holtmann, M.
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Stevenson, J.
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Danckaerts, M.
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van der Oord, S.
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Doepfner, M.
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Dittman, R.
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Simonoff, E.
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Zuddas, A.
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Banaschewski, T.
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Buitelaar, J.
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Coghill, D.
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Hollis, C.
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Konofal, E.
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Lecendreux, M.
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Wong, I.
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Sergeant, J.
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European ADHD Guidelines Group
Sonuga-Barke, Edmund J.S.
bc80bf95-6cf9-4c76-a09d-eaaf0b717635
Brandeis, D.
b3f7c424-d307-476e-aac8-edff6ca08921
Cortese, S.
41e2e5d1-0b3d-40b5-b1db-2aacbdf69bbe
Daley, David
651d0b29-8790-4a13-aa18-ad9a499d34e8
Ferrin, M.
7d647a18-b4cb-4616-9192-fc88e794a886
Holtmann, M.
44c88726-6e97-4b7e-b0e5-b2e7780e31c2
Stevenson, J.
0c85d29b-d294-43cb-ab8d-75e4737478e1
Danckaerts, M.
f1067bea-510c-4206-a24d-ecaee0d57d6f
van der Oord, S.
c6f89aff-e14e-419d-9e32-98f91656956f
Doepfner, M.
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Dittman, R.
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Simonoff, E.
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Zuddas, A.
487c598f-2f61-4f20-bef7-dcdbbdfb4633
Banaschewski, T.
ca2651e5-143a-4171-b6d0-3e3853b684d8
Buitelaar, J.
fa22aba5-1307-4627-9ae8-e564013a5af8
Coghill, D.
a4b982d1-4788-41aa-90c5-b4a7f7dffad7
Hollis, C.
dc8c2836-32b3-4f5a-a53a-aeeef1ae0334
Konofal, E.
3ab52364-5424-45ff-bd71-a7925b4d3afc
Lecendreux, M.
59877699-5351-4d9a-8937-2546a49ea7b2
Wong, I.
655a30a1-ca15-43ed-bd74-90f086c42679
Sergeant, J.
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Sonuga-Barke, Edmund J.S., Brandeis, D., Cortese, S., Daley, David, Ferrin, M., Holtmann, M., Stevenson, J., Danckaerts, M., van der Oord, S., Doepfner, M., Dittman, R., Simonoff, E., Zuddas, A., Banaschewski, T., Buitelaar, J., Coghill, D., Hollis, C., Konofal, E., Lecendreux, M., Wong, I. and Sergeant, J. , European ADHD Guidelines Group (2013) Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170 (3), 275-289. (doi:10.1176/appi.ajp.2012.12070991).

Record type: Article

Abstract

Objective: honpharmacological 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

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Published date: 1 March 2013
Organisations: Clinical Neuroscience

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Local EPrints ID: 347884
URI: https://eprints.soton.ac.uk/id/eprint/347884
ISSN: 1535-7228
PURE UUID: fd80c04d-8368-42bf-ad61-344af91b73b5

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Date deposited: 01 Feb 2013 14:21
Last modified: 16 Sep 2019 18:38

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Contributors

Author: Edmund J.S. Sonuga-Barke
Author: D. Brandeis
Author: S. Cortese
Author: David Daley
Author: M. Ferrin
Author: M. Holtmann
Author: J. Stevenson
Author: M. Danckaerts
Author: S. van der Oord
Author: M. Doepfner
Author: R. Dittman
Author: E. Simonoff
Author: A. Zuddas
Author: T. Banaschewski
Author: J. Buitelaar
Author: D. Coghill
Author: C. Hollis
Author: E. Konofal
Author: M. Lecendreux
Author: I. Wong
Author: J. Sergeant

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