title: Clinically Significant Symptom Reduction in Children with Attention-Deficit/Hyperactivity Disorder Treated with Micronutrients: An Open-Label Reversal Design Study.
abstract: OBJECTIVE
  The purpose of this study was to investigate the clinical effect and safety of a broad spectrum, 36 ingredient micronutrient (vitamins and minerals) in treating children with attention-deficit/hyperactivity disorder (ADHD).
  
  
  METHODS
  This open-label, on-off-on-off (reversal design) study followed 14 participants (8-12 years of age) with ADHD, diagnosed using standardized instruments, for 6 months with no dropouts. Following baseline assessment, including hematology and biochemistry screening, participants began an 8 week treatment phase with micronutrients titrated up to maximum dose (15 capsules/day). Treatment was withdrawn for 4 weeks, reinstated for a further 8 weeks, and then withdrawn for 4 weeks. Primary outcomes included the Conners' Parent Rating Scale, the Clinical Global Impressions Scale (CGI), and the Strengths and Difficulties Questionnaire - Parent version (SDQ). Secondary outcomes were mood and global functioning.
  
  
  RESULTS
  Modified Brinley plots revealed a reduction in ADHD symptoms, improved mood, and improved overall functioning during intervention phases, and deterioration in ADHD symptoms, mood, and overall functioning during the withdrawal phases. Reliable change analyses, Cohen's d and percent superiority effect sizes, 95% confidence intervals and t tests confirmed clinically and statistically significant change between the intervention and withdrawal phases, with large effect sizes observed pre- to post-exposure of micronutrients (d = 1.2-2.2) on ADHD symptoms during intervention phases. Seventy-one percent of participants showed at least a 30% decrease in ADHD symptoms by the end of the second treatment phase, and 79% were identified as "much improved" or "very much improved" at the end of the second phase (5 months) based on the clinician-rated CGI when considering functioning generally. The SDQ showed that these benefits occurred across other areas of functioning including emotional symptoms, conduct problems, and prosocial behaviours. The children's self-reports confirmed the improvements. Excellent adherence to treatment occurred throughout, side effects were mild and transitory, and no safety issues were identified through blood analyses.
  
  
  CONCLUSIONS
  This study demonstrates the clinical benefit, feasibility, and safety of broad-spectrum micronutrients in the treatment of childhood ADHD. Replications utilizing double-blind placebo-controlled studies are warranted. Trial is registered with the Australia and New Zealand Clinical Trial Registry: ACTRN12612000645853.
authors.affiliation: 1 Department of Psychology, University of Canterbury , Christchurch, New Zealand .
authors.forename: Heather A
authors.initials: HA
authors.lastname: Gordon
authors.affiliation: 1 Department of Psychology, University of Canterbury , Christchurch, New Zealand .
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Rucklidge
authors.affiliation: 1 Department of Psychology, University of Canterbury , Christchurch, New Zealand .
authors.forename: Neville M
authors.initials: NM
authors.lastname: Blampied
authors.affiliation: 2 Departments of Neurology and Psychiatry, Oregon Health & Science University , Portland, Oregon.
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Johnstone
mesh_terms: D000339:Affect / Q000187:drug effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000494:pharmacology / Q000627:therapeutic use*; D009483:Neuropsychological Tests / Q000706:statistics & numerical data; D010290:Parents
chemical_list: D018977:Micronutrients