Is Self-Medication With Drugs and Alcohol in Anxious Individuals Common ? Self-Medication of Anxiety Disorders With Alcohol and Drugs : Results From a Nationally Representative Sample

Content Provider	Semantic Scholar
Author	Lmj, Pelsser
Copyright Year	2009
Abstract	Background: Dietary studies using restricted food (elimination diet) have shown some evidence of efficacy in the treatment of attention deficit/hyperactivity disorder (ADHD) in selected subgroups (eg, those with food sensitivity or atopic disorder). While a previous small open trial has previously shown significant symptom reductions in unselected children with ADHD, controlled trials of benefits of dietary interventions are lacking. Objective: To assess the efficacy of a restricted elimination diet in reducing symptoms in an unselected group of children with DSM-IV ADHD. Design: Randomized controlled trial. Interventions: 5 weeks of a restricted foods elimination diet or a wait-list control condition. Participants: 27 children (aged 3 to 8 years) with DSM-IV ADHD, combined or hyperactive/impulsive type. Methods: Subjects were assigned randomly to either an intervention group (15) or a waiting-list control group (12). After a 2-week baseline period during which subjects continued their usual diet and parents completed food diary measures, children assigned to the restricted diet ate only rice, turkey, lamb, vegetables, fruits, margarine, vegetable oil, tea, pear juice, and water. Subjects were assessed at baseline and at week 9 using parent and teacher ratings on the Conners Scale and the ADHD Rating Scale (ARS). Results: The intention-to-treat analysis showed that the proportion of subjects in the intervention group rated as clinical responders (a decrease in the baseline score for both the Conners and ARS 50%) was significantly larger than that in the control group (parent, 73% vs 0%; teacher, 70% vs 0%). There were very large effect sizes for active treatment on both the abbreviated Conners (parent d =2.8; teacher d =2.4) and the ARS (parent d =2.1; teacher d =2.5) Eighty percent of the sample had comorbid oppositional defiant disorder at baseline. Dietary restriction also produced a large effect size (d =1.1) on comorbid oppositional defiant disorder (ODD) symptoms measured by a parent-report structured interview. At week 9, there were fewer subjects in the intervention group who met criteria for ODD than in the control group (27% vs 83%). Conclusions: A strictly supervised elimination diet may be effective in treating children with ADHD. Further research on the extent to which dietary factors are important in the etiology and management of the disorder is needed. Reviewer's Comments: Neither parents nor teachers were blind to group status since they were required to supervise the child's diet throughout the day. This may have resulted in inflated effect sizes due to expectancy bias. Replication should require independent, blind evaluations of outcome, together with more objective measurements of motor behavior and executive functioning. Despite the intensive nature of the diet and supervisory requirements, only one subject in the intervention group dropped out due to burden. It is unclear whether observed benefits are maintained long term and if compliance with a restricted diet is possible for extended periods.
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Language	English
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Content Type	Text
Resource Type	Article