Attention deficit hyperactivity disorder in children and adolescents

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

ADHD is the one of the most common behavioural disorders in the UK. Parent training/education programmes have been recommended as a first-line treatment for moderate ADHD, although the evidence is not strong. For severe ADHD, evidence supports the recommendation of pharmacological treatment with methylphenidate, atomoxetine, and dexamfetamine. Very frequently, however, parents consider using nutritional supplements for controlling the core ADHD symptoms. This overview examines the effects of nutritional supplements in children and adolescents with ADHD.

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Focus of the review

This overview presents evidence on the effectiveness of nutritional supplements, such as omega-3 polyunsaturated fatty acid compounds (fish oils) and minerals (iron and zinc supplements) in reducing the symptoms of ADHD. The reason behind including omega-3 polyunsaturated fatty acid compounds is to begin to explore the growing amount of research that points to some effect of components of the polyunsaturated fatty acids (PUFA) group of substances on the symptoms of ADHD.

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Comments on evidence

We found two small RCTs of sufficient quality, which included 127 children in total, looking at omega-3 polyunsaturated fatty acid compounds. The evidence was not sufficient to conclude on the effectiveness of omega-3 polyunsaturated fatty acids compared with placebo in controlling the symptoms of ADHD. No RCTs were found on the effects of iron supplements. One small RCT was identified that looked at the effects of zinc supplements compared with placebo, but the evidence was insufficient to conclude on effectiveness. In general, trials were short-term; we found no trials that reported outcomes beyond 4 months. There is a need for further large high-quality trials in this field.

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Search and appraisal summary

The update literature search for this review was carried out from the date of the last search, August 2009, to June 2014. A search back-dated to 1966 was performed for the new options added to the scope at this update. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the review, please see the Methods section. After deduplication and removal of conference abstracts, 91 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 29 studies and the further review of 62 full publications. Of the 62 full articles evaluated, four additional systematic reviews were included at this update.

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Substantive changes at this update

Omega-3 polyunsaturated fatty acid compounds (fish oils) New option. Two systematic reviews added.[20][21] Categorised as 'unknown effectiveness'.

Iron supplements New option. One systematic review added.[30] Categorised as 'unknown effectiveness'.

Zinc supplements New option. One systematic review added,[33] including one RCT.[34] Categorised as 'unknown effectiveness'.

Abstract

INTRODUCTION: Prevalence estimates of attention deficit hyperactivity disorder (ADHD) vary according to the diagnostic criteria used and the population sampled. DSM-5 prevalence estimate among school children in the US is 5%, but other estimates vary from 2% to 16%. No objective test exists to confirm the diagnosis of ADHD, which remains a clinical diagnosis. Other conditions frequently co-exist with ADHD. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of nutritional supplements in children and adolescents with ADHD? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 2014 (BMJ Clinical Evidence overviews are updated periodically, please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 157 studies. After deduplication and removal of conference abstracts, 91 records were screened for inclusion in the review. Appraisal of titles and abstracts led to the exclusion of 29 studies and the further review of 62 full publications. Of the 62 full articles evaluated, four additional systematic reviews were included at this update. We performed a GRADE evaluation for two PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for three interventions, based on information relating to the effectiveness and safety of iron supplements, omega-3 polyunsaturated fatty acids, and zinc supplements.

Cite as

Keen D, Hadjikoumi I. Attention deficit hyperactivity disorder in children and adolescents. Systematic review 312. BMJ Clinical Evidence. . 2015 August. Accessed [date].

Latest citations

Practice advisory: The utility of EEG theta/beta power ratio in ADHD diagnosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. ( 10 January 2017 )

Polyunsaturated fatty acids (PUFAs) for children with specific learning disorders. ( 10 January 2017 )