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


METHODS
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.
Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, UK. ejb3@soton.ac.uk
Edmund J S
EJ
Sonuga-Barke
Daniel
D
Brandeis
Samuele
S
Cortese
David
D
Daley
Maite
M
Ferrin
Martin
M
Holtmann
Jim
J
Stevenson
Marina
M
Danckaerts
Saskia
S
van der Oord
Manfred
M
Döpfner
Ralf W
RW
Dittmann
Emily
E
Simonoff
Alessandro
A
Zuddas
Tobias
T
Banaschewski
Jan
J
Buitelaar
David
D
Coghill
Chris
C
Hollis
Eric
E
Konofal
Michel
M
Lecendreux
Ian C K
IC
Wong
Joseph
J
Sergeant
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001521:Behavior Therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D004035:Diet Therapy; D005230:Fatty Acids, Nonesterified / Q000008:administration & dosage; D005505:Food Coloring Agents / Q000008:administration & dosage / Q000009:adverse effects; D005512:Food Hypersensitivity / Q000150:complications / Q000628:therapy; D006801:Humans; D058765:Neurofeedback; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic
D000697:Central Nervous System Stimulants; D005230:Fatty Acids, Nonesterified; D005505:Food Coloring Agents