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Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments

Sonuga-Barke, Edmund J.S ; Brandeis, Daniel ; Cortese, Samuele ; Daley, David ; Ferrin, Maite ; Holtmann, Martin ; Stevenson, Jim ; Danckaerts, Marina ; van der Oord, Saskia ; Döpfner, Manfred ; Dittmann, Ralf W ; Simonoff, Emily ; Zuddas, Alessandro ; Banaschewski, Tobias ; Buitelaar, Jan ; Coghill, David ; Hollis, Chris ; Konofal, Eric ; Lecendreux, Michel ; Wong, Ian C.K ; Sergeant, Joseph

The American journal of psychiatry, 2013-03, Vol.170 (3), p.275-289 [Periódico revisado por pares]

Arlington, VA: American Psychiatric Association

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Título:
Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments
Autor: Sonuga-Barke, Edmund J.S ; Brandeis, Daniel ; Cortese, Samuele ; Daley, David ; Ferrin, Maite ; Holtmann, Martin ; Stevenson, Jim ; Danckaerts, Marina ; van der Oord, Saskia ; Döpfner, Manfred ; Dittmann, Ralf W ; Simonoff, Emily ; Zuddas, Alessandro ; Banaschewski, Tobias ; Buitelaar, Jan ; Coghill, David ; Hollis, Chris ; Konofal, Eric ; Lecendreux, Michel ; Wong, Ian C.K ; Sergeant, Joseph
Assuntos: Adolescent ; Attention Deficit Disorder with Hyperactivity - diagnosis ; Attention Deficit Disorder with Hyperactivity - psychology ; Attention Deficit Disorder with Hyperactivity - therapy ; Attention deficit disorders. Hyperactivity ; Attention deficit hyperactivity disorder ; Behavior Therapy ; Biological and medical sciences ; Central Nervous System Stimulants - therapeutic use ; Child ; Child clinical studies ; Child, Preschool ; Clinical trials ; Cognition Disorders - diagnosis ; Cognition Disorders - psychology ; Cognition Disorders - therapy ; Cognitive Therapy ; Combined Modality Therapy ; Diet ; Diet Therapy ; Fatty Acids, Nonesterified - administration & dosage ; Food Coloring Agents - administration & dosage ; Food Coloring Agents - adverse effects ; Food Hypersensitivity - complications ; Food Hypersensitivity - therapy ; Humans ; Hyperactivity ; Medical sciences ; Neurofeedback ; Pharmacology ; Psychology ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Psychotherapy ; Randomized Controlled Trials as Topic ; Systematic review
É parte de: The American journal of psychiatry, 2013-03, Vol.170 (3), p.275-289
Notas: ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-1
ObjectType-Review-4
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ObjectType-Undefined-3
ObjectType-Literature Review-3
Descrição: A meta-analytic review of six types of nonpharmacological interventions, including dietary and psychological treatments, for children with ADHD found positive effects on ADHD symptoms for all types when raters were aware of treatment allocation (unblinded conditions). However, when raters were blinded, statistically significant effects on ADHD symptoms were found only for supplementation with omega-3/omega-6 free fatty acids or elimination of artificial food colorings, effects that were small or restricted to food-sensitive individuals. ObjectiveNonpharmacological 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.MethodUsing 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.ResultsFifty-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.ConclusionsFree 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.
Editor: Arlington, VA: American Psychiatric Association
Idioma: Inglês

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Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments

Arlington, VA: American Psychiatric Association

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