Developmental Brain-Behaviour Laboratory, Department of Psychology, University of Southampton, UK.
Am J Psychiatry. 2013 Mar;170(3):275-89. doi: 10.1176/appi.ajp.2012.12070991.
Nonpharmacological treatments are available for attention deficit hyperactivity disorder (ADHD), although their efficacy remains uncertain. The authors undertook meta-analyses of the efficacy of dietary (restricted elimination diets, artificial food color exclusions, and free fatty acid supplementation) and psychological (cognitive training, neurofeedback, and behavioral interventions) ADHD treatments.
Using a common systematic search and a rigorous coding and data extraction strategy across domains, the authors searched electronic databases to identify published randomized controlled trials that involved individuals who were diagnosed with ADHD (or who met a validated cutoff on a recognized rating scale) and that included an ADHD outcome.
Fifty-four of the 2,904 nonduplicate screened records were included in the analyses. Two different analyses were performed. When the outcome measure was based on ADHD assessments by raters closest to the therapeutic setting, all dietary (standardized mean differences=0.21-0.48) and psychological (standardized mean differences=0.40-0.64) treatments produced statistically significant effects. However, when the best probably blinded assessment was employed, effects remained significant for free fatty acid supplementation (standardized mean difference=0.16) and artificial food color exclusion (standardized mean difference=0.42) but were substantially attenuated to nonsignificant levels for other treatments.
Free fatty acid supplementation produced small but significant reductions in ADHD symptoms even with probably blinded assessments, although the clinical significance of these effects remains to be determined. Artificial food color exclusion produced larger effects but often in individuals selected for food sensitivities. Better evidence for efficacy from blinded assessments is required for behavioral interventions, neurofeedback, cognitive training, and restricted elimination diets before they can be supported as treatments for core ADHD symptoms.
尽管非药物治疗可用于治疗注意缺陷多动障碍（ADHD），但其疗效仍不确定。作者对饮食（限制消除饮食、人工食品色素排除和游离脂肪酸补充）和心理（认知训练、神经反馈和行为干预）ADHD 治疗的疗效进行了荟萃分析。
使用通用的系统搜索和严格的编码和数据提取策略，作者搜索电子数据库以识别发表的随机对照试验，这些试验涉及被诊断为 ADHD（或在经过验证的评分量表上达到了公认的临界值）的个体，并包含 ADHD 结果。
在 2904 份非重复筛选记录中，有 54 份被纳入分析。进行了两种不同的分析。当基于最接近治疗环境的评估者对 ADHD 的评估作为结果测量时，所有饮食（标准化均数差=0.21-0.48）和心理（标准化均数差=0.40-0.64）治疗均产生了统计学上显著的效果。然而，当采用最佳可能的盲法评估时，游离脂肪酸补充（标准化均数差=0.16）和人工食品色素排除（标准化均数差=0.42）的效果仍然显著，但其他治疗的效果显著减弱至无统计学意义水平。
即使采用可能的盲法评估，游离脂肪酸补充也能显著减少 ADHD 症状，尽管这些效果的临床意义仍有待确定。人工食品色素排除产生了更大的效果，但通常在对食物敏感的个体中。在支持行为干预、神经反馈、认知训练和限制消除饮食作为核心 ADHD 症状的治疗方法之前，需要更好的盲法评估疗效证据。
