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1.
Use of Non-Pharmacological Supplementations in Children and Adolescents with Attention Deficit/Hyperactivity Disorder: A Critical Review.
Rosi, E, Grazioli, S, Villa, FM, Mauri, M, Gazzola, E, Pozzi, M, Molteni, M, Nobile, M
Nutrients. 2020;(6)
Abstract
Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents, with environmental and biological causal influences. Pharmacological medication is the first choice in ADHD treatment; recently, many studies have concentrated on dietary supplementation approaches to address nutritional deficiencies, to which part of non-responses to medications have been imputed. This review aims to evaluate the efficacy of non-pharmacological supplementations in children or adolescents with ADHD. We reviewed 42 randomized controlled trials comprised of the following supplementation categories: polyunsaturated fatty acids (PUFAs), peptides and amino acids derivatives, single micronutrients, micronutrients mix, plant extracts and herbal supplementations, and probiotics. The reviewed studies applied heterogeneous methodologies, thus making it arduous to depict a systematic overview. No clear effect on single cognitive, affective, or behavioral domain was found for any supplementation category. Studies on PUFAs and micronutrients found symptomatology improvements. Peptides and amino acids derivatives, plant extracts, herbal supplementation, and probiotics represent innovative research fields and preliminary results may be promising. In conclusion, such findings, if confirmed through future research, should represent evidence for the efficacy of dietary supplementation as a support to standard pharmacological and psychological therapies in children and adolescents with ADHD.
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2.
The role of marine omega-3 in human neurodevelopment, including Autism Spectrum Disorders and Attention-Deficit/Hyperactivity Disorder - a review.
Martins, BP, Bandarra, NM, Figueiredo-Braga, M
Critical reviews in food science and nutrition. 2020;(9):1431-1446
Abstract
Autism Spectrum Disorders (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are two increasingly prevalent neurodevelopmental disorders. This rise may be associated with a higher dietary intake of n-6 polyunsaturated fatty acids (PUFAs) and lower of n-3 PUFAs. Docosahexaenoic acid (DHA), a key nutritional n-3 PUFA, is crucial for an optimal offspring's neurodevelopment through the last trimester of pregnancy. Recently, lower DHA levels have been reported in children with ASD and ADHD. The present review summarizes the main research achievements concerning the effect of DHA in children neurodevelopment, in order to elicit its role in the prevention and mitigation of ASD and ADHD. As main finding, a low DHA supply seems to negatively affect childhood neurodevelopment in specific conditions and increase the risk and the severity of ASD or ADHD. Higher DHA status at birth was associated with better childhood neurodevelopmental, but controversial results found in prenatal supplementation raised the hypothesis that the benefits of DHA may be influenced by other factors as socio-economic background and life-style. In conclusion, an optimal DHA provision through maternal diet or breastfeed may promote some neuronal protection in specific offspring's populations, suggesting that DHA may act as a modifiable risk factor for ASD and ADHD.
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3.
TYROSINEMIA TYPE III: A CASE REPORT OF SIBLINGS AND LITERATURE REVIEW.
Barroso, F, Correia, J, Bandeira, A, Carmona, C, Vilarinho, L, Almeida, M, Rocha, JC, Martins, E
Revista paulista de pediatria : orgao oficial da Sociedade de Pediatria de Sao Paulo. 2020;:e2018158
Abstract
OBJECTIVE Tyrosinemia type III (HT III) is the rarest form of tyrosinemia, and the full clinical spectrum of this disorder is still unknown. The neurological involvement varies, including intellectual impairment and attention deficit disorder with hyperactivity (ADHD). We report the case of two siblings diagnosed with HT III at different ages. CASE DESCRIPTION The index case was diagnosed by newborn screening for endocrine and metabolic disorders, starting a low-protein diet immediately, with a consistent decrease in tyrosine levels. By the age of three, the child displayed a hyperactive behavior, starting treatment for ADHD two years later. At seven years of age, he shows a slight improvement in terms of behavior and attention span and has a cognitive performance slightly lower than his peers, despite maintaining acceptable tyrosine levels. His sister, who had a history of ADHD since age five, was diagnosed with HT III after family screening at the age of eight. Despite initiating a dietetic treatment, her behavior did not improve, and she has a mild intellectual impairment. COMMENTS This is the first case report describing siblings with HT III who underwent nutritional treatment with a low-protein diet in different phases of life, with a better neurological and behavioral evaluation in the patient who started treatment earlier.
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4.
The Role of the Gut-Brain Axis in Attention-Deficit/Hyperactivity Disorder.
Dam, SA, Mostert, JC, Szopinska-Tokov, JW, Bloemendaal, M, Amato, M, Arias-Vasquez, A
Gastroenterology clinics of North America. 2019;(3):407-431
Abstract
Genetic and environmental factors play a role in the cause and development of attention-deficit/hyperactivity disorder (ADHD). Recent studies have suggested an important role of the gut-brain axis (GBA) and intestinal microbiota in modulating the risk of ADHD. Here, the authors provide a brief overview of the clinical and biological picture of ADHD and how the GBA could be involved in its cause. They discuss key biological mechanisms involved in the GBA and how these may increase the risk of developing ADHD. Understanding these mechanisms may help to characterize novel treatment options via identification of disease biomarkers.
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5.
Epigenetics and ADHD: Toward an Integrative Approach of the Disorder Pathogenesis.
Hamza, M, Halayem, S, Bourgou, S, Daoud, M, Charfi, F, Belhadj, A
Journal of attention disorders. 2019;(7):655-664
Abstract
OBJECTIVE Epigenetic hypothesis is one of the research pathways used to explain the complex etiology of neurodevelopmental disorders. This review highlights the findings of recent studies in the field of epigenetics in ADHD. METHODS An electronic literature search using Medline. RESULTS In the Gene × Environment interaction model, several clinical, genetic and molecular arguments support the epigenetic hypothesis in ADHD etiology. Environmental ADHD risk factors including toxic, nutritional factors and stressful life events lead to changes in DNA methylation and in histone modification levels. One critical CpG site located in the promoter of the DRD4 gene exhibited a specific pattern in ADHD children. A methylome wide exploration of DNA showed decreased methylation in vasoactive intestinal peptide receptor 2 gene, which was not replicated by further research. CONCLUSION Current data require consolidation and could lead to the identification of biomarkers and the introduction of new modalities of treatment.
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6.
The Relationship between Food Insecurity and Symptoms of Attention-Deficit Hyperactivity Disorder in Children: A Summary of the Literature.
Lu, S, Perez, L, Leslein, A, Hatsu, I
Nutrients. 2019;(3)
Abstract
Food insecurity is a major public health concern characterized by an individual or household lacking access to adequate food to support a healthy lifestyle. Food insecurity has been associated with predisposing or exacerbating mental health symptoms in children. However, the evidence is scarce with regards to Attention-Deficit Hyperactivity Disorder (ADHD) symptoms in children. The purpose of this review is to summarize and identify gaps in the existing literature, as well as to explore associations between food insecurity and symptoms of childhood ADHD. Literature for this review was pulled from Ovid MEDLINE and PubMed library databases, with a focus on food insecurity, food insufficiency, hunger, and ADHD symptoms such as inattention, hyperactivity, and impulsivity in children. The limited evidence to date shows a predictive and inverse relationship between childhood experience of food insecurity and symptoms of ADHD, with lasting impacts into adulthood. Evidence exists to hypothesize that childhood food insecurity is associated with predisposing or exacerbating ADHD symptoms in children, yet the literature needed to confirm this relationship is scarce and utilizes inconsistent methodology. Future research is needed to further characterize this complex relationship and inspire community or public health interventions addressing food insecurity in children with ADHD. Additionally, it may be clinically useful to routinely screen for food insecurity when assessing pediatric ADHD symptoms.
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7.
A Review: Associations Between Attention-deficit/hyperactivity Disorder, Physical Activity, Medication Use, Eating Behaviors and Obesity in Children and Adolescents.
Quesada, D, Ahmed, NU, Fennie, KP, Gollub, EL, Ibrahimou, B
Archives of psychiatric nursing. 2018;(3):495-504
Abstract
UNLABELLED In the past few years we have become increasingly aware of strong associations between obesity and ADHD. Both conditions are major public health issues, affecting children, adolescents and adults alike. OBJECTIVE This review seeks to (1) examine prior research on the association between ADHD and obesity in children and adolescents; (2) discuss mechanisms and consequent behavioral attributes to gain understanding of the path association between ADHD and obesity, (3) review studies examining the role of physical activity, medication, eating behavior and gender on the relationship between ADHD and obesity in children and adolescents. METHOD PubMed, CINAHL and PsycINFO databases were used to search for studies whose subjects were children and adolescents, ages 0-17 years and whose publication years were from 2000 to 2016. After screening 31 studies were included in the review. RESULTS The literature suggests that there is a significant association between ADHD and obesity. Further, the inattentive and impulsive behaviors that characterize ADHD could contribute to dis-regulated eating behaviors and a lack of motivation to engage in physical activity. In addition, it is proposed that medication, gender and physical activity play a role in mediating and moderating the relationship between ADHD and obesity.
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8.
Vitamin D's Molecular Action Mechanism in Attention-Deficit/ Hyperactivity Disorder: A Review of Evidence.
Saedisomeolia, A, Samadi, M, Gholami, F, Seyedi, M, Effatpanah, M, Hashemi, R, Abdolahi, M, Honarvar, NM
CNS & neurological disorders drug targets. 2018;(4):280-290
Abstract
BACKGROUND & OBJECTIVE Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous disorder characterized by hyperactivity, impulsivity and inattention. Children with ADHD have challenges with learning, behavior and psychosocial adjustments, sometimes retained into adulthood. The exact etiology of ADHD is unknown, and the pathophysiology of this disease is complex. Several hypotheses have been raised regarding ADHD pathogenesis, including serotonergic and catecholaminergic signalling pathway dysfunction, neurotropic-related factors, oxidative stress, or neuroinflammation. Vitamin D has an important protective effect against inflammation, oxidative stress and certain neurotrophic factors and neurotransmitter, as well as facilitating dopaminergic and serotonergic functions. Vitamin D levels in children with ADHD are lower than in healthy children, and thus may be involved in the pathogenesis of ADHD. These observations, therefore, confirm the neuroprotective role of vitamin D through multiple molecular mechanisms and can be considered as a promising target in understanding ADHD pathology. CONCLUSION In this context, the present study reviews the molecular pathways of vitamin D in ADHD patients.
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9.
Supplementation with polyunsaturated fatty acids (PUFAs) in the management of attention deficit hyperactivity disorder (ADHD).
Banaschewski, T, Belsham, B, Bloch, MH, Ferrin, M, Johnson, M, Kustow, J, Robinson, S, Zuddas, A
Nutrition and health. 2018;(4):279-284
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Abstract
While pharmacotherapy and psychosocial interventions are recommended as the primary frontline treatment for attention deficit hyperactivity disorder (ADHD), alternative approaches to managing ADHD are becoming increasingly popular among patients and their families. Supplementation with polyunsaturated fatty acids (PUFAs) is an example of this. PUFA supplementation is not recommended by guidelines for managing ADHD; however, patients may still decide to use it. To provide direction to healthcare professionals (HCPs) managing ADHD, eight international experts in the field of adult and child ADHD came together for the Continuum Education Board: Omega Supplements in ADHD meeting. This commentary summarises the panel's consensus that current evidence suggests PUFA supplementation has a small beneficial effect on behaviour in children with ADHD, and that further high-quality research is needed to clearly evaluate and define its role in the management of ADHD of children, adolescents and adults. The panel concluded that in cases where patients use PUFA supplementation, HCPs should be comfortable explaining the potential gains that they may have and their possible side effects. The panel also concluded HCPs should not reinforce the idea that PUFA supplementation should replace treatment approaches with a more robust evidence base for managing ADHD.
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10.
Manganese and Developmental Neurotoxicity.
Lucchini, R, Placidi, D, Cagna, G, Fedrighi, C, Oppini, M, Peli, M, Zoni, S
Advances in neurobiology. 2017;:13-34
Abstract
Manganese (Mn) is an essential metal that plays a fundamental role for brain development and functioning. Environmental exposure to Mn may lead to accumulation in the basal ganglia and development of Parkinson-like disorders. The most recent research is focusing on early-life overexposure to Mn and the potential vulnerability of younger individuals to Mn toxicity also in regard to cognitive and executive functions through the involvement of the frontal cortex.Neurodevelopmental disturbances are increasing in the society, and understanding the potential role of environmental determinants is a key for prevention. Therefore, assessing the environmental sources of Mn exposure and the mechanisms of developmental neurotoxicity and defining appropriate biomarkers of exposure and early functional alterations represent key issues to improve and address preventive strategies. These themes will be reviewed in this chapter.