TY - JOUR
T1 - Short-term effects of an elimination diet and healthy diet in children with attention-deficit/hyperactivity disorder
T2 - a randomized-controlled trial
AU - Huberts-Bosch, Annick
AU - Bierens, Margreet
AU - Ly, Verena
AU - van der Velde, Jessica
AU - de Boer, Heleen
AU - van Beek, Gerry
AU - Appelman, Danielle
AU - Visser, Sacha
AU - Bos, Lisa H.P.
AU - Reijmers, Lisa
AU - van der Meer, Jolanda
AU - Kamphuis, Niki
AU - Draaisma, Jos M.T.
AU - Donders, Rogier
AU - van de Loo-Neus, Gigi H.H.
AU - Hoekstra, Pieter J.
AU - Bottelier, Marco
AU - Arias-Vasquez, Alejandro
AU - Klip, Helen
AU - Buitelaar, Jan K.
AU - van den Berg, Saskia W.
AU - Rommelse, Nanda N.
N1 - Publisher Copyright:
© 2023, The Author(s).
PY - 2024/8
Y1 - 2024/8
N2 - An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5–12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED—but not HD—participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably ‘easier to treat’ than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 (https://www.onderzoekmetmensen.nl/en/trial/25997).
AB - An Elimination Diet (ED) may be effective in reducing symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD), but has never been compared to an active control condition [i.e., Healthy Diet (HD)]. In a two-armed RCT, a total of N = 165 children (5–12 years) with ADHD were randomized by means of minimization (1:1) to either an ED (N = 84) or HD (N = 81) within two Dutch child and adolescent psychiatry centers. The design included a non-randomized comparator arm including N = 58 children being treated with Care as Usual (CAU). Treatment allocation was unblinded. The primary outcome was a 5-point ordinal measure of respondership based on a combination of parent and teacher ratings on ADHD and emotion regulation, determined after 5 weeks of treatment. Ordinal regression analyses were done on an intention-to-treat basis. Fewer ED (35%) than HD (51%) participants showed a partial to full response, despite overall good-to-excellent treatment adherence (> 88%) and comparable high parental prior believes. A younger age and higher problem severity predicted a better respondership. CAU-preferring participants responded more often favorably (56%) compared to ED—but not HD—participants. Small-to-medium improvements in physical health (blood pressure, heart rate, and somatic complaints) were found in response to ED/HD versus decrements in response to CAU (74% received psychostimulants). The lack of superiority of the ED versus HD suggests that for the majority of children, dietary treatment response is not rooted in food-allergies/-sensitivities. The comparable results for treatment with HD and CAU are remarkable given that CAU participants were probably ‘easier to treat’ than HD (and ED) participants with proportionally fewer with a (suboptimal/non-response to) prior treatment with medication (4% versus 20%). Further assessment of long-term effects is needed to evaluate the potential place of dietary treatment within clinical guidelines. The trial is closed and registered in the Dutch trial registry, number NL5324 (https://www.onderzoekmetmensen.nl/en/trial/25997).
KW - ADHD
KW - Child psychiatry
KW - Dietary treatment
KW - Emotion regulation
UR - http://www.scopus.com/inward/record.url?scp=85164482580&partnerID=8YFLogxK
U2 - 10.1007/s00787-023-02256-y
DO - 10.1007/s00787-023-02256-y
M3 - Article
C2 - 37430148
AN - SCOPUS:85164482580
SN - 1018-8827
VL - 33
SP - 1503
EP - 1516
JO - European Child and Adolescent Psychiatry
JF - European Child and Adolescent Psychiatry
IS - 8
ER -