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ADHD in children

and impacts of nutrition

Objectives

1.

2.

3.

Students will be able to list 2 foods/products that are thought to worsen ADHD symptoms, 100% of the time.

Students will be able to name at least 1 nutritional supplement that may be beneficial for ADHD symptom reduction, 100% of the time.

Students will be able to name at least 1 diet associated with reducing ADHD symptoms, 100% of the time.

Overview of ADHD

Overview

A complex developmental impairment presenting with persistent inattentiveness, hyperactivity, and impulsivity severe enough that it interferes with functioning in more than one setting.

ADHD is not a behavior disorder

What neuroscience, brain imaging & clinical research show:

ADHD is not a mental illness

Fact Check

ADHD is a developmental impairment of the self-management system within the brain.

Children and adults can both be diagnosed.

ADHD is not a specific learning disability

Primarily hyperactive-impulse type

Almost 11% of children in the US are diagnosed and impacted by some or many of these symptoms

Symptoms

Primarily inattentive type (commonly called ADD)

  • Self-focused behavior
  • Trouble waiting turn
  • Emotional turmoil
  • Fidgeting
  • Problems playing quietly
  • Trouble finishing tasks
  • Lack of focus
  • Forgetfulness

Primarily combined type- can show symptoms of inattentiveness and hyperactivity

Treatment

Treatment

Parents are faced with a decision to choose the best path for their child to succeed.

  • Medication? Stimulant or non-stimulant?
  • Should we try something natural first? What would that even be?

Stimulants

Non-Stimulants

Rx

Methylphenidate

Amphetamine

*Stimulates specific cells in the brain to make more norepinephrine & dopamine.

Atomoxetine

Clonidine

Guanfacine

*Increase norepinephrine and dopamine in the prefrontal cortex.

75% of children with ADHD recieve some form of treatment.

Pharmacological treatments help reduce symptoms, but may often present unwanted side effects or prove unsatisfactory long-term.

Pharma

31% medication & behavior therapy

30% medication only

14% behavior therapy only

Side Effects

fatigue

stomach pain

decreased appetite

nausea

decreased appetite

stomach pain

sleep disturbances

headaches

worsens tics

Dietary Changes

Suggest

Food

Remove

3 interventions to remove elements from the diet that may cause symptoms to worsen:

Remove

  • Avoiding artificial food colorants & other additives

  • Limiting sugar

  • Few Foods Diet

Increase

Increasing the following dietary nutrients where ADHD children may have a deficiency caused by low intake or higher requirement:

Increase

  • Omega 3 LC PUFA

  • Broad-spectrum micronutrients

  • Exercise!

Worksheet

Research

Research

Systematic Review of Literature

Grey: Removed

Black: Added

Small: less studies

Large: more studies

Systematic Review of Literature

Rucklidge et al. (2018)

93 children ages 7-12

The first fully blinded RCT to investigate efficacy and safety of micronutrient supplementation in children with ADHD.

  • 32% of children on micronutrients decreased inattentive symptoms.

  • Clinican assessment for overall improvement in mood regulation noted a 41% improvement.

  • Significant improvements in vitamin D, B12, and folate levels.

  • Vitamin-mineral improved overall function, aggression, inattention, emotional regulation, and reduced impairment.

  • Parents reported ADHD symptoms were still present, but their child was calmer, more able to reason with, and happier.

Broad-spectrum micronutrients

Findings were mixed among the raters for modest improvements for ADHD symptoms, but with a low rates for adverse side effects, it is a hopeful option to continue studying.

Findings

Omega-3 Long-Chain Polyunsaturated Fatty Acids Intake in Children with Attention Deficit and Hyperactivity Disorder

(2019)

help with absorption of vitamins.

Many studies focus on one type of omega 3 so more research like this is needed using real food sources and variety.

Intake of seafood, particularly fish, is reduced in children with ADHD.

  • Omega-3 LC PUFA (EPA +DHA) are essential for proper brain development.
  • Increasing amounts of of seafood and fish intake showed an increase in attention/decrease in aggrivation.

Omega-3s

1. Evaluated pattern consumption of main dietary sources of food containing omega-3s in children with and without ADHD.

2. Estimated daily intake of omega-3 (EPA + DHA).

3. Evaluated influences of age, sex, and BMI upon omega-3 LC PUFA consumption.

Recommendations to increase fish and seafood consumption is strongly advised.

Current Recommendations

  • 0 to 12 months: 0.5 g/day
  • 1 to 3 years: 0.7 g/day
  • 4 to 8 years: 0.9 g/day
  • 9 to 13 years (boys): 1.2 g/day
  • 9 to 13 years (girls): 1.0 g/day
  • 14 to 18 years (boys): 1.6 g/day
  • 14 to 18 years (girls): 1.1 g/day

Few Foods Diet

Elimination-style diet, followed by re-introduction in aims to treat ADHD in children. 5 week study in 3 general practice settings. (2020)

(eg.rice, quinoa, turkey, some vegetables, pears, water.)

57 children started FFD. 34 remained on the diet at the end.

Few Foods Diet

After 6 months, 14 of 34 children were continuing the diet.

21 of 27 children successfully ceased taking ADHD medication.

The authors suggest that coaching may be helpful for families implementing this plan

It is not currently likely that the US health care system will allow a broad implementation approach to diagnosing or treatment for ADHD, yet it is very likely that we will see parents searching for natural and diet alternatives for treatment.

Future

Research

Actinobacteria

Bifidobacterium

Coriobacteriaceae

Human gut microbiome changes during a 10 week Randomised Control Trial for micronutrient supplementation in children with attention deficit hyperactivity disorder

Stevens et al., 2019

Future Considerations

Collinsella

Bifidobacterium is being mentioned in many studies on neuropsychiatric disorders.

References

Resources

1. ADHD Throughout the Years (2020, September 3). In Center of Disease Control and Prevention. Retrieved October 15, 2020.

2. Williams, P. (2019, November 24). ADHD in Children: Symptoms, Evaluations & Treatments. In ADDitude. Retrieved October 15, 2020.

3. Rytter, M., Anderson, L., Houmann, T., Bilenberg, N., Hvolby, A., Molgaard, C., ... Lauritzen, L. (2015). Diet in the treatment of ADHD in children- A systematic review of the literature. Nord J Psychiatry, 69(1).

4. Rucklidge, J. J., Taylor, M. R., & Johnstone, J. M. (2018, September). Do Diet and Nutrition Affect ADHD? Facts and Clinical Considerations. Psychiatric Times.

5. Fuentes-Albero, M., Martinez-Martinez, M. I., & Cauli, O. (2019, May 23). Omega-3 Long- Chain Polyunsaturated Fatty Acids Intake in Children with Attention Deficit and Hyperactivity Disorder. Brain Sciences, 9(5).

6. Rucklidge, J. J., Eggelston, M. J. F., Johnstone, J. M., Darling, K., & Frampton, C. M. (2018). Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo-controlled trial. Journal of Child Psychology and Psychiatry, 59(3), 232-246.

7. Stevens, A. J., Purcell, R. V., Darling, K. A., Eggleston, M. J., Kennedy, M. A., & Rucklidge, J. J. (2019). Human gut microbiome changes during a 10 week Randomised Control Trial for micronutrient supplementation in children with attention deficit hyperactivity disorder. Scientific Reports, 9.

8. Newmark, S. (2020, April 28). Eggs, Dairy, Nuts, and Soy: Testing for Food Sensitivities with an ADHD Elimination Diet. In ADDitude.

9. Pelsser, L., Frankena, K., Toorman, J., & Pereira, R. R. (2020). Retrospective outcome monitoring of ADHD and nutrition (ROMAN): The effectiveness of the Few-Foods Diet in general practice. Front Psychiatry, 11(96).

10. Cording, J. (2020, July). Do Kids Need Omega 3 Fats. In eatright. Academy of Nutrition and Dietetics. Retrieved October 20, 2020, from https://www.eatright.org/food/vitamins-and- supplements/types-of-vitamins-and-nutrients/do-kids-need-omega-3-fats

Questions?

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