Elimination diets for ADHD: beyond the media hype

March 5, 2015 by  
Filed under Commentary, Tips

I am often asked by parents about whether their child’s diet could be causing their ADHD or worsening it. My answer is that yes, there is some controlled research demonstrating that foods or additives can produce the symptoms of ADHD or exacerbate them, but let’s not jump to an elimination diet.

One of the most well-known studies on diet and ADHD was conducted by Dr. Lidy Pelsser and her colleagues, and was published in Lancet in 2011. That study – and an earlier study by Feingold – are the ones that seem to have attracted a lot of parental interest in the topic.

Dr. Pelsser and her colleagues randomly assigned 100 children aged 4-8 years who were diagnosed with ADHD to either a 5 -weeks restricted elimination diet or to a control group who were simply given instructions for a healthy diet. In the ADHD restricted diet group, 41 of 50 children finished the first phase. In that group of 41 children, 32, or 78%, responded favorably by having fewer symptoms. Overall, 32 of 50, or 64%, had decreased ADHD symptoms while on the diet. Associated symptoms such as oppositional behavior and tantrums also decreased. Most parents hear that over 60% improved on the diet and think, “Wow, that sounds great!” But not so fast, because the methodology was seriously confounded by relying on the reports of parents who were not blind to the child’s experimental condition, which can introduce a bias or placebo effect into their reports of improvement.
Children who showed a significant improvement in their ADHD symptoms while on the restricted elimination diet were then assigned to one of two food-challenge groups based on their individual immunoglobulins (IgG) blood tests. Significantly, two-thirds of the children displayed a relapse in their symptoms when challenge foods were re-introduced to their diet.

More recently, Joel T. Nigg, PhD and  Kathleen Holton, PhD, MPH reviewed the literature on research on foods and additives. Their full article is well worth attempting to read if you are considering undertaking an elimination diet for your child, as they point out that adequately controlled experiments generally do not provide evidence of dramatic effects in symptom reduction for the majority of children with ADHD:

The best estimate on the small literature is about a 25% rate of at least some symptom improvement. For some children, perhaps a minority of 10% of children with ADHD, response can include a full remission of symptoms equivalent to a successful medication trial. In short, the literature suggests that an elimination diet should be considered a possible treatment for ADHD, but one that will work partially or fully, and only in a potentially small subset of children.

Of course, every parent hopes their child will be in that subset who do respond to diet changes, but if you are not sure whether foods or additives are causing or exacerbating your child’s ADHD-like symptoms, speak with your pediatrician about whether an elimination diet might be in order as a 5-week trial or test. Maintaining a restricted diet is difficult, time-consuming, costly, and unlikely to work if you do not have pretty much total control over what your child eats both outside of the home and in your home. It is also important to ensure that the elimination diet does not deprive the child of important nutrients, so don’t just start removing everything from your child’s diet. Reading Drs. Nigg and Holton’s detailed review of studies may help you understand what to consider and what to ask your child’s physician.

About 7% of Kids Worldwide Have ADHD: Study

March 3, 2015 by  
Filed under Research

Dennis Thompson reports:

About 7 percent of children worldwide have attention-deficit/hyperactivity disorder (ADHD), new research concludes.

This estimate — which differs significantly from other recent appraisals — is based on data from 175 prior studies conducted over nearly four decades.

The approximation could help public health officials determine whether ADHD is overdiagnosed or underdiagnosed in their nation, state or community, said lead author Rae Thomas, of Bond University in Australia.

Read more on HealthDay.

Comorbidity in Tourette Syndrome: lifetime prevalence and risks

March 3, 2015 by  
Filed under Featured, Research

Finally we have a study that provides us with some analysis of comorbidity in Tourette Syndrome (TS)  based on a large sample size.

The Tourette Syndrome Association International Consortium for Genetics has published a report that looked at lifetime prevalence, clinical associations, ages of highest risk, and etiology of psychiatric comorbidity in 1,374 individuals with TS who were compared to 1,142 TS-unaffected family members.

Some of the key findings include:

  • The lifetime prevalence of any psychiatric comorbidity among individuals with TS was 85.7%;
  • 57.7% of individuals with TS had 2 or more psychiatric disorders.
  • 72.1% of individuals with TS met DSM-IV-TR diagnostic criteria for OCD or ADHD.
  • Other disorders, including mood, anxiety, and disruptive behavior, each occurred in approximately 30% of the participants.
  • The age of greatest risk for the onset of most comorbid psychiatric disorders was between 4 and 10 years, with the exception of eating and substance use disorders, which began in adolescence.
  • TS was associated with increased risk of anxiety and decreased risk of substance use disorders  independent from comorbid OCD and ADHD; however, high rates of mood disorders among participants with TS (29.8%) may be accounted for by comorbid OCD.
  • Parental history of ADHD was associated with a higher burden of non-OCD, non-ADHD comorbid psychiatric disorders.
  • Genetic correlations between TS and mood, anxiety, and disruptive behavior disorders may be accounted for by ADHD and, for mood disorders, by OCD.

Looking at their findings, there’s really nothing surprising in the rates of comorbidity nor the possibility that some comorbidity may be better accounted for by the presence of ADHD or OCD than by TS itself.

Referencce:
Hirschtritt ME, Lee PC, Pauls DL, Dion Y, Grados MA, Illmann C, King RA, Sandor P, McMahon WM, Lyon GJ, Cath DC, Kurlan R, Robertson MM, Osiecki L, Scharf JM, Mathews CA; for the Tourette Syndrome Association International Consortium for Genetics. Lifetime Prevalence, Age of Risk, and Genetic Relationships of Comorbid Psychiatric Disorders in Tourette Syndrome. JAMA Psychiatry. 2015 Feb 11. doi: 10.1001/jamapsychiatry.2014.2650. [Epub ahead of print]

ADHD may raise the odds of premature death

March 3, 2015 by  
Filed under Featured, Research

I realize this post will likely distress or upset some readers, but sticking our heads in the sand about risks our loved ones or students may face won’t help. So as alarming as the research results may be, if it gets us off the dime in protecting our families or getting them help, it’s important to discuss.

Health24 reports:

People with attention-deficit hyperactivity disorder (ADHD) are more than twice as likely to die prematurely as those without the common disorder, a new study finds.

The risk is small, but it’s a clear indication that the disorder is a serious problem, the researchers said.

Risk significantly higher for women

In a study of more than 2 million people, Danish researchers found that accidents were the most common cause of premature death among people with ADHD. And the risk was significantly higher for women and those diagnosed in adulthood, the researchers added.

Read more on Health24.

Having read the full study, it’s important to note that although there is an increased risk, because ADHD is diagnosed more strictly in Denmark, the researchers appropriately note that the sample of ADHD patients may not be a representative sample of what we’d find here in the U.S. or elsewhere. Similarly, because ADHD tends to be underdiagnosed in females, the females with ADHD are likely to represent those with more severe cases. As to those first diagnosed as adults, well, again, they are more likely to be more severe/persistent cases. So their findings of increased risk may be somewhat overestimating the risk for a sample that might include milder or more moderate cases of ADHD.

As the researchers report, the primary factor appears to be the increased risk of accidents with more serious injuries, something I’ve been pointing out for over 15 years.  What the Danish study didn’t look at, however, was whether treatment would reduce or normalize the risks.

But what about ADHD and suicide risk? In an unrelated study, Drs. Lan, Bai, and their colleagues in Taiwan recently reported that the presence of ADHD was independently associated with an increased risk of suicide in adolescents and young adults over and above the increased risk due to comorbid Bipolar Disorder. This study, too, did not look at whether treatment would change the outcomes or findings.

So what we have is a growing body of evidence that ADHD is associated with increased risk of both suicide and premature death due to accidents.

Yet when I go into schools or look at plans for students with ADHD, I generally do not see extra safety precautions. Isn’t about time we got schools to implement more safety protections for students with ADHD?

 

 

 

If Facebook Use Causes Envy, Depression Could Follow

March 2, 2015 by  
Filed under Research

Browsing Facebook has become a daily activity for hundreds of millions of people. Because so many people engage with the website daily, researchers are interested in how emotionally involved Facebook users can be with the social networking site and how regular use can affect their mental health. Now, researchers at the University of Missouri have found that Facebook use can lead to symptoms of depression if the social networking site triggers feelings of envy among its users. Margaret Duffy, a professor and chair of strategic communication at the MU School of Journalism, says that how Facebook users use the site makes a difference in how they respond to it.

“Facebook can be a fun and healthy activity if users take advantage of the site to stay connected with family and old friends and to share interesting and important aspects of their lives,” Duffy said. “However, if Facebook is used to see how well an acquaintance is doing financially or how happy an old friend is in his relationship—things that cause envy among users—use of the site can lead to feelings of depression.”

For their study, Duffy and Edson Tandoc, a former doctoral student at MU and now an assistant professor at Nanyang Technological University in Singapore, surveyed young Facebook users and found that some of those who engage in “surveillance use” of Facebook also experience symptoms of depression while those who use the site simply to stay connected do not suffer negative effects. Surveillance use of Facebook occurs when users browse the website to see how their friends are doing compared with their own lives. The researchers found that Facebook postings about things such as expensive vacations, new houses or cars, or happy relationships can evoke feelings of envy among surveillance users. They say that these feelings of envy can then lead to Facebook users experiencing symptoms of depression.

“We found that if Facebook users experience envy of the activities and lifestyles of their friends on Facebook, they are much more likely to report feelings of depression,” Duffy said. “Facebook can be a very positive resource for many people, but if it is used as a way to size up one’s own accomplishments against others, it can have a negative effect. It is important for Facebook users to be aware of these risks so they can avoid this kind of behavior when using Facebook.”

“Social media literacy is important,” Tandoc said. “Based on our study, as well as on what others have previously found, using Facebook can exert positive effects on well-being. But when it triggers envy among users, that’s a different story. Users should be self-aware that positive self-presentation is an important motivation in using social media, so it is to be expected that many users would only post positive things about themselves. This self-awareness, hopefully, can lessen feelings of envy.”

Patrick Ferrucci, a former doctoral student at the MU School of Journalism and currently an assistant professor at Bradley University, also co-authored the study. This study, based on a survey of more than 700 college students, was published in Computers in Human Behavior.

SOURCE: University of Missouri

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