powerpoint presentation · 2019-08-14 · •some evidence of benefits for tic disorders/...
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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
UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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
UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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
UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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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UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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
UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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
UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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
UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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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UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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)
UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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
UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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)
UC Child Well-being Research Institute | www.canterbury.ac.nz/childwellbeing @UCChildwellbeing @UCCWRI
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.