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Centre for Evidence-
Based Medicine

Children with hyperactivity: Restricted diet controls reduces behavioural problems in some

Clinical Bottom Line

An oligoantigenic diet improves behaviour scores by more than 25% in 1 in 5 children with attention deficit disorder and / or conduct disorder.

Citation

Schmidt MH, Mocks P, Lay B, Eisert HG, Fojkar R, Fritz Sigmund D, Marcus A, Musaeus B.
Does oligoantigenic diet influence hyperactive/conduct-disordered children--a controlled trial.
Eur Child Adolesc Psychiatry 1997;6:88-95

Clinical Question

In children with hyperactivity, does any form of dietary modification improve behaviour?

Search Terms

Cochrane Library for "diet" or "food" or "allergy" with "hyperactivity" or "attention deficit"

The Study

  1. Children admitted to a psychiatric ward for hyperactivity or problem behaviour. 60% of sample had severe attention deficit hyperactivity disorder or severe conduct disorder or both.
  2. Randomised, crossover trial
  3. In treatment phase, subjects fed an "oligoantigenic diet" consisting of lamb, turkey, rice, potatoes, cabbage, carrots, apple and banana. In control phase, ate foods assumed to be antigenic (e.g. cereals) and to which food additives had been added.
  4. All foods cooked by same dietician; subjects unable to distinguish the diets; teachers and observers not allowed on ward during meals.
  5. Behavioural outcomes measured in ward, classroom and test situations.
  6. Successful outcome was defined as 25% better response on at least two situations.

The Evidence

Outcome Time to Outcome RRR ARR 95% CI NNT 95% CI
Lack of response During treatment week 21% 20% 7% to 33% 5 3 to 14

Comments

  1. Diet only likely to be successful in motivated families.
  2. Supervision needed in the medium term to prevent possibility of malnutrition.

Appraised By

Andrew Vickers, February 1999