PowerPoint Presentation · 2019-08-14 · •Some evidence of benefits for tic disorders/ Tourette’s syndrome ... .ac.nz/childwellbeing @UCChildwellbeing @UCCWRI Supplementation

12/06/2019

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UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI

The use of diet and nutrition in supporting children with developmental disorders-

what does the research say?

Dr Mairin Taylor

Clinical psychologist

Lecturer, School of Health Sciences, University of Canterbury


Acknowledgements and Safety• Professor Julia Rucklidge- Mental health and

nutrition research group/ Child Wellbeing Research Institute, University of Canterbury

• Dr. Kelly Carrasco, Dr. Chi-ching Chung and Shoko Nagatomo, Okinawa Institute of Science and Technology

• Review paper1

• Provisos- seek qualified medical advice


Neurodevelopmental disorders review

• Often diagnosed in childhood

• Impairment in multiple domains: learning, social functioning, emotion regulation, communication

• Most common: Attention-deficit/ hyperactivity disorder (ADHD) diagnosed in 1 in 20 children²

• Autism spectrum disorder: diagnosed in 1 in 59 children³

• Also: communication disorders, intellectual disabilities, motor disorders & specific learning disorders


What is the purpose of reviewing the research?

• Existing treatments include medication and behavioural therapies

• Many families are using dietary methods (up to 50% of children with ADHD4 & up to 74% of kids with ASD are given CAM5)

• Missing information on effectiveness (a lot of misinformation & methods are time consuming and costly) and unclear information on safety

• Review exclusion diets then the use of supplements

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Gluten free/ casein free diets (GFCF)

• Arose out of observed changes in ASD behaviour after adoption of diet

• Association between ADHD sxs in those suffering from Celiacs disease

• Not much research on GFCF diet and ADHD- not enough to be persuasive

• More extensive research with individuals with ASD: co-occurence of GI

issues in ASD from gluten and dairy

• 9 RCT studies- mixed results, methodological issues: effects are

inconclusive


Other exclusion diets

• Ketogenic diet: high fat, low carb. attention in epilepsy; parent-reported improvements in ASD (sociability and cognition) but small studies. Not enough research evidence

• Food additive exclusion: Feingold (1975); food colouring/ preservatives & ADHD. Includes natural (salicylates) & artificial

• Numerous studies, small effects for >25% of those with ADHD6

• General sensitivity, not specific to ADHD

• Sugar exclusion: arose out of observation of incr hyperactivity in kids after ingesting sugar.

• Meta-analyses 16 double-blind RCT studies did not demonstrate significant cognitive or behavioural measures and sugar in kids in general

• Studies comparing kids with/ without ADHD did not demonstrate a significant effect from sugar intake


Oligoantigenic/ Few Food diets (FFDs)

• Increased food sensitivities/ allergies in ADHD

• Diets restrictive- no wheat, dairy, certain meats, carbs, fruits & veges. Then gradually introduced

• Many MH practitioners not able to provide guidance

• Methodological issues in studies (not blind, parent report)

• for a minority of children, may be significant behavioural and/or cognitive effects

• Some evidence of benefits for tic disorders/ Tourette’s syndrome


SupplementationPUFAs (omega fatty acids)

• Lower blood serum levels in ppl with ADHD

• Poor absorption/ incr metabolism?

• Evidence of role in neurological processes

• RCT studies- persuasive for ADHD (if dose and ratio

correct). A significant effect (~0.2) for minority

• Uncertain effect for ASD- more research needed

• No evidence for SLD

Probiotics• Evidence that microbiome-gut-brain axis involved in

ASD and ADHD

• Promising effects in small number of studies on ADHD

• Mixed but promising results in ASD

• More stringent, replicated studies needed before recommended

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Supplementation cont…

Single- supplements:

• ADHD- deficiencies in iron, magnesium and zinc

• ASD- deficiencies in Vit D, B vitamins, magnesium, amino acids

• Evidence of Vitamin D and core ASD symptoms

• Evidence of B6 & Magnesium combination effectiveness for ASD

• Single supplement outcomes variable for ADHD- complex interactions between vitamins & minerals

• Broad spectrum micronutrients (BSM) may be effective due to: 1) poor gut health; 2) inflammation; 3) genetic variation leading to differences in metabolism or availability of nutrients (or all 3)


Broad spectrum micronutrients

• Few RCT studies but improvements in:

SleepReceptive languageBehavioural difficultiesNonverbal intellectual functioningCommunicationDaily life skills

• Effective results from studies with long time-frame (e.g. 12 months) and highdoses

• Early studies- controversial: very small doses or mega (toxic) doses

• Two RCT double-blind studies7,8, improvements for children and adults with ADHD:

Core ADHD symptoms (incl. inattention)Emotion regulationAggression

• But, unknown affects of BSM and stimulant medications

• Effective results from studies with long time-frame (e.g. 12 months) and high doses

ASD ADHD


Summary

Food exclusions

• Largely inconclusive results for ADHD and ASD

• But for a highly sensitive minority, may have significant effects (e.g. Few foods diet)

• In consultation with dietician & GP

Supplementation

• BSM general preferable (except Omegas, Vit D & probiotics)

• High doses, long term

• Difference between RDA and UL (upper level)


References1. Taylor, M. R., Chuang, C., Carrasco, K. D., Nagatomo, S., & Rucklidge, J. J. (2018). Dietary and Micronutrient Treatments for Children with

Neurodevelopment Disorders. Current Developmental Disorders Reports. https://doi.org/10.1007/s40474-018-0150-5

2. Scahill, L., & Schwab-Stone, M. (2000). Epidemiology of ADHD in school-age children. Child and Adolescent Psychiatric Clinics of North America, 9(3), 541–555, vii.

3. Baio, J., Wiggins, L., Christensen, D. L., Maenner, M. J., Daniels, J., Warren, Z., … Dowling, N. F. (2018). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. Morbidity and Mortality Weekly Report. Surveillance Summaries , 67(6), 1–23.

4. Chan, E., Rappaport, L. A., & Kemper, K. J. (2003). Complementary and alternative therapies in childhood attention and hyperactivity problems. Journal of Developmental and Behavioral Pediatrics: JDBP, 24(1), 4–8.

5. Hanson, E., Kalish, L. A., Bunce, E., Curtis, C., McDaniel, S., Ware, J., & Petry, J. (2007). Use of complementary and alternative medicine among children diagnosed with autism spectrum disorder. Journal of Autism and Developmental Disorders, 37(4), 628–636.

6. Nigg, J. T., & Holton, K. (2014). Restriction and elimination diets in ADHD treatment. Child and Adolescent Psychiatric Clinics of North America, 23(4), 937–953.

7. Rucklidge, J. J., Eggleston, M. J. F., Johnstone, J. M., Darling, K., & Frampton, C. M. (2017). 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, and Allied Disciplines. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12817/full

8. Rucklidge, J. J., Frampton, C. M., Gorman, B., & Boggis, A. (2014). Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. The British Journal of Psychiatry: The Journal of Mental Science, 204, 306–315.

https://doi.org/10.1007/s40474-018-0150-5

http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12817/full

Documents

PowerPoint Presentation · 2019-08-14 · •Some evidence of benefits for tic disorders/ Tourette’s syndrome ... .ac.nz/childwellbeing @UCChildwellbeing @UCCWRI Supplementation