ADHD and diet
All child and adolescent psychiatrists have interviewed at least 1 parent who strongly asserted that this or that type of food caused their offspring to become more acutely symptomatic, while eating other types of foods improved symptoms. The therapeutic and pathogenic theoretical roles of foods in ADHD, however, have fallen into disfavor since the 1980s, and most clinicians have tended to take parental reports regarding dietary effects with a certain degree of skepticism.
The results of 2 recent analyses may validate such previously discredited parental reports to some extent. Bloch and Qawasmi17 found that omega-3 fatty acid supplementation, particularly with higher doses of eicosapentaenoic acid, was modestly effective for treating ADHD. Nigg and colleagues18 studied the role of diet and food colors and found that restriction diets reduced ADHD symptoms and that an estimated 8% of children who have ADHD may have symptoms related to synthetic food colors.
Practical tip: An emerging body of evidence has concluded that certain artificial dyes used in food seem to increase hyperactivity and their elimination from the diet of children may improve behavior and attention, although the effect sizes of these approaches are much lower than those of stimulants (Figure 2). These data are intriguing but do not yet support routine dietary assessments.
On the other hand, clinicians should not dismiss unsolicited parental reports of food effects as invalid; explore these reports further and consider recommending a diet that excludes the posited offending agent. Furthermore, since fatty acids have a benign adverse-effect profile, they could be used to supplement/augment usual medications or they could be recommended in cases in which families are averse to prescription drugs but not opposed to over-the-counter options.
Recently published articles on the cardiovascular safety of ADHD agents
ADHD and driving
Obtaining the first driving license generally causes exhilaration in teenagers and anxiety in parents. For ADHD patients, the newly acquired independence that driving brings can also carry additional risks, because there is evidence that ADHD may impair motor vehicle operation. Stimulant medication, however, appears to improve driving skills in persons with ADHD.
Biederman and colleagues19 conducted a randomized, double-blind, 6-week, placebo-controlled, parallel-design study to determine the effect of lisdexamfetamine (LDX) on driving performance in a validated driving simulation paradigm. Sixty-one 18- to 26-year-old outpatients of both sexes with ADHD were randomized to receive LDX or placebo after a baseline driving simulation. They completed a second driving simulation 6 weeks after beginning the drug or placebo. LDX treatment was associated with significantly faster reaction times and a lower rate of simulated driving collisions.
In another study, Cox and colleagues20 investigated whether methylphenidate(Drug information on methylphenidate) delivered through a long-acting transdermal system (MTS) would reduce collision rates of young adult drivers with ADHD. Seventeen young adults completed this open-label, crossover design study in which drivers were randomly assigned either to no medication for 3 months and then MTS for 3 months or to the reverse sequence. In-car video monitoring of routine driving occurred during these 6 months. Participants who were receiving MTS had fewer video-recorded collisions and other problematic driving events.
Practical tip: Distracted driving has become a public health concern, eliciting comments from federal officials such as Secretary of Transportation Ray LaHood, who has called it “an epidemic on America’s roadways.” Psychiatrists have not routinely addressed the issue of driving with their ADHD patients. Given the compelling evidence, however, families who are considering medication for their adolescent should be made aware of these data because they could offer improved reassurance that the risk to bene-fit ratio for symptomatic driving-age youths favors the use of ADHD medication.
Conclusions
The overwhelming number of articles published about ADHD every year necessitates that clinicians rely on aggregators to highlight the most significant articles in their quest to improve the quality and options of care offered to patients. This article outlines the latest research on topics of high importance to the field. Nothing can replace, however, a direct examination of the data, so readers are encouraged to review the original reports for those topics they have found most interesting.
