Vitamins and minerals intake benefits children with ADHD and emotional dysregulation

"Supplementing with all known vitamins and essential minerals, at doses between Recommended Daily Allowance and Upper Tolerable Limit, may improve mood and concentration in children with ADHD and emotional dysregulation," said lead author Jeanette Johnstone, PhD, Assistant Professor, Department of Child and Adolescent Psychiatry, Oregon Health & Science University and Helfgott Research Institute, National University of Natural Medicine.

"These findings, replicating results of a previous randomized trial of micronutrients in children with ADHD conducted in New Zealand, confirm that supplementation with a broad range of nutrients may benefit some children. These findings may offer guidance to doctors and families seeking integrative treatments for their children with ADHD and related emotional dysregulation," Dr. Johnstone noted.

The triple-blinded study enrolled 135 medication-free children and their parents at three sites (Portland, Oregon; Columbus, Ohio; Alberta, Canada) and randomized participants to either micronutrient or placebo capsules for eight weeks. Three-quarters of the participants were adherent to the study protocol. The intervention was well-tolerated, with no significant differences in adverse events between the micronutrient and placebo groups, or safety concerns based on blood and urine tests. Parents, children and clinicians were blinded to treatment allocation and were not able to guess assignment better than chance.

In addition to behavioral and emotional benefits, children taking micronutrients grew 6mm more in height than those taking placebo after adjusting for baseline height. "The growth finding, also a replication from the previous child micronutrient study, is particularly encouraging, as height suppression is a concern with first-line ADHD medication," Dr. Johnstone added.

In contrast to clinician ratings, parents, who were also blinded to their child's treatment allocation, reported significantly improved behavior that was equal in both the micronutrient and placebo groups, with no significant between-group differences, highlighting the importance of blinded clinician ratings.

"No treatment is 100% effective for all with ADHD," commented L. Eugene Arnold, MD, Professor Emeritus of Psychiatry & Behavioral Health at Ohio State University and one of the senior co-authors. "For example, about 2/3 respond to the first stimulant drug tried, which is an established first-line ADHD treatment despite emotional, appetite, and growth side effects. So, it's encouraging that a good half of the children responded to this relatively safe treatment."

"Future studies will focus on the micronutrients' mechanisms of action and subgroup responses to understand for whom and why this intervention works. Mechanistic hypotheses to be tested include changes in the gut microbiome and its metabolome, reductions in inflammatory markers (e.g. cytokines), replenishment of minerals, and optimization of neurotransmission. In order to increase parent sensitivity to child behavior changes, we plan to utilize real-time data reporting methods such as 'ecological momentary assessment' using a phone or other device to capture behaviors when they occur," added Dr. Johnstone.

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10.1016/j.jaac.2021.07.005