Am J Psychiatry：注意力缺陷多动症的非药物干预疗效

　　日前，《美国精神病学杂志》（Am J Psychiatry）上发表的一项系统性回顾和Meta分析指出，即使采用盲法评估 ，游离脂肪酸补充也可显著地减少注意力缺陷多动症（多动症）（ADHD）症状。人为食物颜色剔除可产生较大影响，但仅仅常见于对食物敏感的个体。在行为干预、神经反馈、认知训练以及限制性剔除饮食的疗效用作ADHD核心症状的治疗方法之前，还需要更有力的盲法评估证据来证明其疗效。

　　非药物治疗（膳食治疗和心理治疗）ADHD是可行的，但其疗效仍不确定。该研究旨在分析膳食治疗（限制性剔除饮食，人为食物颜色剔除，和游离脂肪酸补充）和心理（认知训练，神经反馈和行为干预）治疗ADHD的疗效。

　　研究人员采用通用的系统性检索和严格的编码、数据提取策略，搜索电子数据库来选定已发表的随机对照临床试验，这些试验涉及诊断为ADHD的个体（或者是使用公认评定量表已排除有效的个体）和具有ADHD临床转归的个体。

　　在2,904例非重复筛选的记录中，有54例纳入了分析。研究人员采用了两种不同的分析方法。当评估结果为基于最接近治疗环境的评估者所做的ADHD评估时，所有饮食（标准差= 0.21-0.48）和心理（标准差= 0.40-0.64）治疗均有效果并有统计学意义。然而，当采用盲法评估时，仅游离脂肪酸补充（标准差= 0.16）和人为食物颜色剔除（标准差= 0.42）的效果显著，而其他的治疗方法效果减弱至不显著。

Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments

Objective  

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.

Method  

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.

Results  

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.

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.