View Full Version : Medscape article on non med interventions


Dizfriz
02-04-13, 05:09 PM
Something interesting I ran across on Medscape.


http://www.medscape.com/viewarticle/778483 Jan 30, 2013

Some excerpts:

Conducted by the European ADHD Guidelines Group, a multidisciplinary and multinational group of ADHD experts, the meta-analysis showed that the positive effects on ADHD symptoms reported with cognitive training, neurofeedback, behavioral interventions, and exclusion of foods associated with hypersensitivity were lost when the analyses were restricted to blinded studies. The analysis included 7 studies that examined restricted elimination diets, 8 trials of artificial food color exclusions, 11 studies of free fatty acid supplementation, 6 trials of cognitive training, 8 neurofeedback studies, and 15 behavioral intervention trials.

The investigators found positive effects on ADHD symptoms for all interventions when raters were unblinded. However, under blinded conditions, statistically significant effects on ADHD symptoms were only found for omega-3/omega-6 fatty acids or elimination of artificial food colorings, although these effects were small and/or restricted to food-sensitive individuals. Lots of details not reported. While not ground shaking, it will be interesting to see what kind of reception this gets.

Abstract:

http://ajp.psychiatryonline.org/article.aspx?articleid=1566975


Dizfriz

Abi
02-04-13, 05:12 PM
:| <-- this is my "not surprised" face.

Thanks for sharing. :)

mildadhd
02-04-13, 06:11 PM
Something interesting I ran across on Medscape.


http://www.medscape.com/viewarticle/778483 Jan 30, 2013

Some excerpts:

Lots of details not reported. While not ground shaking, it will be interesting to see what kind of reception this gets.

Abstract:

http://ajp.psychiatryonline.org/article.aspx?articleid=1566975


Dizfriz

I would like hear your opinion how this research information from the OP,

The investigators found positive effects on ADHD symptoms for all interventions when raters were unblinded. However, under blinded conditions, statistically significant effects on ADHD symptoms were only found for omega-3/omega-6 fatty acids or elimination of artificial food colorings, although these effects were small and/or restricted to food-sensitive individuals.

would "miss" results like the information recently presented by Dr.Barkley,

(that was mentioned in a recent thread),

about a lack of glucose in the brain,

effecting the function of the prefrontal cortex?


(Side Note: I agree with Dr.Barkley when glucose in the brain is low it does effect the functioning of the Prefrontal Cortex and therefore ADD)



Something(s) seriously missing in this research testing.

Blind or unblind,

the issues with low glucose should be the same.


How could this be "missed" is the question?

And what else is being "missed"?






.

dvdnvwls
02-04-13, 06:36 PM
How could this be "missed" is the question?

It could easily be missed if it wasn't there. When results don't match assumptions, change your assumptions.

mildadhd
02-04-13, 06:40 PM
It could easily be missed if it wasn't there. When results don't match assumptions, change your assumptions.

Or another option is to change the test!

So you disagree with Dr.Barkley?

There is no assumption on my part.

I am sure Dr.Barkley is right about low blood sugar effecting the performance of the prefrontal cortex.




.

mildadhd
02-04-13, 08:07 PM
Quotes about blood sugar and ADD,

by ADD experts Dr.Mate and Dr.Barkley.



"The ADD child completely falls apart when his blood sugar is too low,

becomes hyper when it is too high,

showing how directly nutritional states affect the brain."

-Dr.Mate (1999)



"the fuel in the tank,

is sugar in the blood stream,

in the frontal lobe,

blood glucose in the frontal lobe,

is directly correlated with executive abilities."

-Dr.Barkley (2012)

Drewbacca
02-05-13, 12:35 AM
There is no mention of glucose, because the study didn't look at glucose. This study looked at Omega 3&6 fatty acids and it looked at food dyes. Glucose isn't a component of either of these. Discussion of glucose belongs in another thread, as it is not mentioned in the above posted article.

The study wasn't looking for a contribution from glucose, there are other studies which look at this factor.

It's fair game to acknowledge that a given variable was ignored and/or not accounted for in the study (if there is reason to believe that it somehow interacts with the variables being studies i.e. coloring and fatty-acids). If you know of any research looking at the interaction between glucose and coloring or fatty-acids (working as a catalyst)... then this would be an appropriate place to mention it.

Otherwise, there's no reason to discuss it (in this thread) beyond noting that it wasn't included in the research.

That said,

I'd like to remind all participating members to maintain a respectful tone with one another.

Forum Guideline (http://www.addforums.com/forums/showthread.php?t=15843)reminder:
*Please remember that ADD Forums is a place for support. All members should feel comfortable at ADD Forums!

*Please be respectful to one another. People come from all different backgrounds and many have different ideas and views on different issues.

*Treat your fellow members with courtesy (especially if you disagree with them).

and of course, stay on the topic at hand.

Tyler Durden
02-05-13, 12:44 AM
Abstract link didn't work, cannot get access to other without creating an account oh joy.

So what are you saying Dizfriz, only medication is the solution?

All this shows is the lack of understanding of the un derlying complexities involved.

People read far too much into this kind of research, adding up 1+1 and getting 16

Drewbacca
02-05-13, 12:46 AM
Tyler, what/who are you referring to?

Tyler Durden
02-05-13, 12:57 AM
Was this just an examination of the difference in results between blind and unblinded tests? The influence of preconception on bias? Hardly breaking new ground, but that is probably all it is likely good for, what is the intention of the OP?

meadd823
02-05-13, 01:22 AM
ADHD Studies Shed Little Light on Efficacy of Nonpharma Tx (http://www.medscape.com/viewarticle/778483)

Dr. Sonuga-Barke reports that he has been involved in the development, implementation, and trialing of the New Forest Parenting Programme for preschool children with ADHD and has received royalties from sales of a New Forest Parent Training self-help manual; he has served as a speaker, adviser, or consultant for AstraZeneca, Flynn Pharma, Shire, and UCB Pharma; he has received conference support from Shire; and he has received research support from Janssen-Cilag, Shire, and Qbtech. The disclosures of the other authors can be found in the original study.

I have an account with medscape already so I read that study .

The major problem with accessing the original study is as stated above I would have to PAY for an account.

While I do not accuse any one of purposeful prejudice I am always interested in from what point of view they approach any "meta-analysis" - There were meta-listing of researchers from all over the UK.

Drewbacca
02-05-13, 01:28 AM
Based on the OP, it looks like there were two results:

The first, as you point out, is that there is a bias (in this particular study, I don't think that necessarily voids any other, similar, studies... I look forward to seeing it challenged/reproduced). I agree that it's not really new ground.

The second, which is meaningful states that the factors mentioned above DO play a role in ADHD symptoms (albeit, only in individuals with sensitivity). I don't really think you can look at one conclusion without the other.

My question is this, how were individuals with sensitivity defined/tested? I hope that the researchers didn't classify their subjects after the fact? Dizfriz? (I don't have access to the article either).

meadd823
02-05-13, 01:29 AM
As a moderator who has no personal poodle in the puddle please keep in mind this area is for actual scientific discussions in a more formal format so topic adherence and the expectation for scientific support documentation for claims will be some what stricter in this section.

Member cooperation in this regard is appreciated

mildadhd
02-05-13, 01:51 AM
There is no mention of glucose, because the study didn't look at glucose. This study looked at Omega 3&6 fatty acids and it looked at food dyes. Glucose isn't a component of either of these. Discussion of glucose belongs in another thread, as it is not mentioned in the above posted article.

The study wasn't looking for a contribution from glucose, there are other studies which look at this factor.

It's fair game to acknowledge that a given variable was ignored and/or not accounted for in the study (if there is reason to believe that it somehow interacts with the variables being studies i.e. coloring and fatty-acids). If you know of any research looking at the interaction between glucose and coloring or fatty-acids (working as a catalyst)... then this would be an appropriate place to mention it.

Otherwise, there's no reason to discuss it (in this thread) beyond noting that it wasn't included in the research.

That said,

I'd like to remind all participating members to maintain a respectful tone with one another.

Forum Guideline (http://www.addforums.com/forums/showthread.php?t=15843)reminder:


and of course, stay on the topic at hand.


The second link mentions restricted elimination diets as well as, artifical food color exclusions and fatty acids supplementation.

In the study abstract.

The authors undertook meta-analyses of the efficacy of dietary (restricted elimination diets, artificial food color exclusions, and free fatty acid supplementation)

Then says that only elimination of artifical coloring food and addition fatty acids only helped some people.(in blind study)

So what foods are they eliminating in the elimination diet, in the research?






.

mildadhd
02-05-13, 02:07 AM
Abstract Conclusion in the second link:

Conclusions 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.


The problem seems to me to be a problem of assessment.

Importance of elimination diet is not ruled out.

The quote from the OP posted by Dizfriz below is not the full conclusion.(according to the abstract conclusion in the second link above)


The analysis included 7 studies that examined restricted elimination diets, 8 trials of artificial food color exclusions, 11 studies of free fatty acid supplementation, 6 trials of cognitive training, 8 neurofeedback studies, and 15 behavioral intervention trials.

The investigators found positive effects on ADHD symptoms for all interventions when raters were unblinded. However, under blinded conditions, statistically significant effects on ADHD symptoms were only found for omega-3/omega-6 fatty acids or elimination of artificial food colorings, although these effects were small and/or restricted to food-sensitive individuals.


Why did you post this information Dizfriz?


.

meadd823
02-05-13, 02:10 AM
If there is any questions, concerns, or comments regarding moderator notes and / or actions please feel free to PM me so we do not derail the thread.

Thank you

namazu
02-05-13, 05:45 AM
I was able to pull up the original article, and also chase down some references relevant to elimination diets. PM me for details.

Here were its long-form conclusions:
Free fatty acid supplementation and artificial food color exclusions appear to have beneficial effects on ADHD symptoms, although the effect of the former are small and those of the latter may be limited to ADHD patients with food sensitivities. Evidence for the value of behavioral interventions is limited to unblinded ratings made by individuals likely to have an investment in treatment success. While the most proximal assessment data on neurofeedback, cognitive training, and restrictive elimination diets were potentially more positive, evidence of efficacy from blinded assessments is required before they are likely to be supported as ADHD treatments. The challenge
for the future is to improve the efficacy of nonpharmacological interventions on the basis of a growing understanding of ADHD pathophysiology and to better integrate these interventions with pharmacological approaches. Properly powered, randomized controlled trials with blinded, ecologically valid outcome measures are urgently needed, especially in the psychological treatment domain. Future trials should focus across a broader range of child-, parent-, and family-related functional outcomes. It is important that implementation of adequately blinded designs in future studies does not compromise the quality of the treatment being evaluated.


So what foods are they eliminating in the elimination diet, in the research?
They varied a lot. Some gave a standardized "few foods diet" (usually a couple carbs like rice and potatoes, plain chicken, and some green vegetables) to all of the kids, then introduced foods into the diet to see what the kids reacted to. Others used more customized diets based on pre-identified sensitivities.

Related to glucose... At least one of the elimination diets was explicitly "low in simple sugars", while another mentioned that in kids who were suspected to be sensitive to sugar, it was eliminated/reduced. However, this kind of diet would really be looking at the opposite effect of what Drs. Mate and Barkley were discussing, because this diet would reduce sugar intake even further. That said, I'm not exactly sure how perfect the correlation is between blood glucose and glucose availability in the prefrontal cortex. (I'm sure they're related, but not sure how well, because there are probably some regulatory processes in-between.)

Dizfriz
02-05-13, 08:33 AM
Abstract Conclusion in the second link:
Why did you post this information Dizfriz?
.

I thought it interesting.

Dizfriz

mildadhd
02-06-13, 11:59 AM
I was able to pull up the original article, and also chase down some references relevant to elimination diets. PM me for details.

Here were its long-form conclusions:
Free fatty acid supplementation and artificial food color exclusions appear to have beneficial effects on ADHD symptoms, although the effect of the former are small and those of the latter may be limited to ADHD patients with food sensitivities. Evidence for the value of behavioral interventions is limited to unblinded ratings made by individuals likely to have an investment in treatment success. While the most proximal assessment data on neurofeedback, cognitive training, and restrictive elimination diets were potentially more positive, evidence of efficacy from blinded assessments is required before they are likely to be supported as ADHD treatments. The challenge
for the future is to improve the efficacy of nonpharmacological interventions on the basis of a growing understanding of ADHD pathophysiology and to better integrate these interventions with pharmacological approaches. Properly powered, randomized controlled trials with blinded, ecologically valid outcome measures are urgently needed, especially in the psychological treatment domain. Future trials should focus across a broader range of child-, parent-, and family-related functional outcomes. It is important that implementation of adequately blinded designs in future studies does not compromise the quality of the treatment being evaluated.


They varied a lot. Some gave a standardized "few foods diet" (usually a couple carbs like rice and potatoes, plain chicken, and some green vegetables) to all of the kids, then introduced foods into the diet to see what the kids reacted to. Others used more customized diets based on pre-identified sensitivities.

Related to glucose... At least one of the elimination diets was explicitly "low in simple sugars", while another mentioned that in kids who were suspected to be sensitive to sugar, it was eliminated/reduced. However, this kind of diet would really be looking at the opposite effect of what Drs. Mate and Barkley were discussing, because this diet would reduce sugar intake even further. That said, I'm not exactly sure how perfect the correlation is between blood glucose and glucose availability in the prefrontal cortex. (I'm sure they're related, but not sure how well, because there are probably some regulatory processes in-between.)


Thanks Namazu,

Sounds like the testers where testing the value of the tests,

more that coming to any solid conclusions in regards to ADD.

I have a close relative with type one diabetes,

and the person has some similar signs as a person with ADD.

When blood sugar is to high or to low.(not exactly the same, but similar)

(they have a more extreme response when outside the normal blood sugar range)


I wonder if testing/measuring blood sugar levels in people with ADD would be a good idea?

I understand the levels should not exceed the normal range,

but we would be able to explore what we feel like at both ends of the spectrum.

Both high and low.

I might explore measuring my blood sugar sometime.

thanks for the help in explaining the research position.

Amtram
02-08-13, 06:24 PM
The reason that the difference between blinded and unblinded results is important, Peripheral, is that unblinded tests are biased. The subject and/or the examiner already knows whether they are getting a placebo or the real thing, and their responses are going to reflect that they know this.

So what this meant is that when subjects or examiners knew they were getting a treatment that was supposed to do something, they reported that the treatment worked. When they didn't know whether they were getting the treatment or placebo, they didn't report that the treatment worked any more than they reported that the placebo worked.

Lunacie
02-08-13, 06:45 PM
After reading the abstract, it seems to me that these experts

were looking to see which fields of research would suggest further study.

They concluded that adding Omega 3 supplements and eliminating artificial

food colors shows the most promise in non med interventions for ADHD.


They didn't rule out the possibility of benefit from behaviorial interventions,

neuorfeedback, cognitive training, and restricted elimination diets,

but those need more research before they can be considered

as beneficial treatments.

mildadhd
02-08-13, 07:12 PM
The reason that the difference between blinded and unblinded results is important, Peripheral, is that unblinded tests are biased. The subject and/or the examiner already knows whether they are getting a placebo or the real thing, and their responses are going to reflect that they know this.

So what this meant is that when subjects or examiners knew they were getting a treatment that was supposed to do something, they reported that the treatment worked. When they didn't know whether they were getting the treatment or placebo, they didn't report that the treatment worked any more than they reported that the placebo worked.

I am not discussing blind verse unblind.

I am discussing the blind and unblind ,test, as a whole unit.

If glucose levels are directly correlated with the function of the prefrontal cortex (effecting emotional ,executive, self regulation functioning)

and these tests both blind and unblind,

don't show these results.

Then maybe the problem is with the tests?

Like Lunacie said ,

They didn't rule out the possibility of benefit from behaviorial interventions,

neuorfeedback, cognitive training, and restricted elimination diets,

but those need more research before they can be considered

as beneficial treatments.


The testing methods/research needs improvement.

Before any conclusions can be made,

even with the research results of Essential Oil and Elimination of Artificals Coloring.(they could be much higher)




Side Note:
I am wondering what my personal results would be after closely moderating my glucose levels over a period of time during normal daily routines?

Need to ask my doctor how to measure my blood sugar levels, consistently.

It would be cool if I could get a watch or something that did it for me?

Lunacie
02-08-13, 07:29 PM
I am not discussing blind verse unblind.

I am discussing the blind and unblind ,test, as a whole unit.

If glucose levels are directly correlated with the function of the prefrontal cortex (effecting emotional ,executive, self regulation functioning)

and these tests both blind and unblind,

don't show these results.

Then maybe the problem is with the tests?

Like Lunacie said ,



The testing methods/research needs improvement.

Before any conclusions can be made,

even with the research results of Essential Oil and Elimination of Artificals Coloring.(they could be much higher)




Side Note:
I am wondering what my personal results would be after closely moderating my glucose levels over a period of time during normal daily routines?

Need to ask my doctor how to measure my blood sugar levels, consistently.

It would be cool if I could get a watch or something that did it for me?

I began a new thread to address the issue of blood glucose levels and

how that affects the expression of ADHD symptoms.

http://www.addforums.com/forums/showthread.php?t=139796