Author:
Huberts-Bosch Annick,Bierens Margreet,Ly Verena,van der Velde Jessica,de Boer Heleen,van Beek Gerry,Appelman Danielle,Visser Sacha,Bos Lisa H. P.,Reijmers Lisa,van der Meer Jolanda,Kamphuis Niki,Draaisma Jos M. T.,Donders Rogier,van de Loo-Neus Gigi H. H.,Hoekstra Pieter J.,Bottelier Marco,Arias-Vasquez Alejandro,Klip Helen,Buitelaar Jan K.,van den Berg Saskia W.,Rommelse Nanda N.
Abstract
AbstractAn 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).
Funder
Horizon 2020 Framework Programme
ZonMw
Innovatiefonds Zorgverzekeraars
Publisher
Springer Science and Business Media LLC
Subject
Psychiatry and Mental health,Developmental and Educational Psychology,General Medicine,Pediatrics, Perinatology and Child Health
Cited by
3 articles.
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