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Can we predict treatment response in children with ADHD to a vitamin-mineral supplement? An investigation into pre-treatment nutrient serum levels, MTHFR status, clinical correlates and demographic variables.

Abstract

BACKGROUND

Intent-to-treat analyses from a randomized controlled trial showed significant between-group differences favouring micronutrient treatment on the Clinical Global Impression-Improvement, but no group differences on clinician, parent and teacher ratings of overall ADHD symptoms. There was an advantage of micronutrients over placebo in improving overall function, emotional regulation, aggression, and reducing impairment as well as improving inattention based on clinician but not parent observation. No group differences were observed on hyperactive-impulsive symptoms. We investigated predictors of response defined by pre-treatment variables.

METHOD

We conducted analyses of data from a clinical trial of children (7-12 years) with ADHD, whereby participants were randomized to receive micronutrients or placebo for 10 weeks followed by a 10 week open-label (OL) phase. We included only children who had been exposed to micronutrients for a full 10 week period and demonstrated satisfactory adherence, either in RCT phase (n = 40) or OL phase (those who received placebo during RCT phase; n = 31). Seven outcomes were examined: change in ADHD symptoms (clinician/parent), ADHD responder, overall responder, change in mood, change in functioning, and change in aggression. Demographic, developmental variables, current clinical and physical characteristics, MTHFR genotype at two common variants, and pre-treatment serum/plasma levels (vitamin D, B12, folate, zinc, copper, iron, ferritin, potassium, calcium, magnesium, and homocysteine) were all considered as putative predictors.

RESULTS

Substantial nutrient deficiencies pre-treatment were observed only for vitamin D (13%) and copper (15%), otherwise most children entered the trial with nutrient levels falling within expected ranges. Regression analyses showed varying predictors across outcomes with no one predictor being consistently identified across different variables. Lower pre-treatment folate and B12 levels, being female, greater severity of symptoms and co-occurring disorders pre-treatment, more pregnancy complications and fewer birth problems were identified as possible predictors of greater improvement for some but not all outcome measures although predictive values were weak. Lower IQ and higher BMI predicted greater improvement in aggression.

CONCLUSIONS

This study replicates Rucklidge et al. (2014b) showing the limited value of using serum nutrient levels to predict treatment response although we cannot rule out that other non-assayed nutrient levels may be more valuable. Additionally, no specific demographic or clinical characteristics, including MTHFR genetic status, were identified that would preclude children with ADHD from trying this treatment approach.

Authors+Show Affiliations

Department of Psychology, University of Canterbury, Christchurch, New Zealand. Electronic address: julia.rucklidge@canterbury.ac.nz.Canterbury District Health Board, Christchurch, New Zealand.Department of Psychology, University of Canterbury, Christchurch, New Zealand.Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand.Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30217770

Citation

Rucklidge, Julia J., et al. "Can We Predict Treatment Response in Children With ADHD to a Vitamin-mineral Supplement? an Investigation Into Pre-treatment Nutrient Serum Levels, MTHFR Status, Clinical Correlates and Demographic Variables." Progress in Neuro-psychopharmacology & Biological Psychiatry, vol. 89, 2019, pp. 181-192.
Rucklidge JJ, Eggleston MJF, Darling KA, et al. Can we predict treatment response in children with ADHD to a vitamin-mineral supplement? An investigation into pre-treatment nutrient serum levels, MTHFR status, clinical correlates and demographic variables. Prog Neuropsychopharmacol Biol Psychiatry. 2019;89:181-192.
Rucklidge, J. J., Eggleston, M. J. F., Darling, K. A., Stevens, A. J., Kennedy, M. A., & Frampton, C. M. (2019). Can we predict treatment response in children with ADHD to a vitamin-mineral supplement? An investigation into pre-treatment nutrient serum levels, MTHFR status, clinical correlates and demographic variables. Progress in Neuro-psychopharmacology & Biological Psychiatry, 89, pp. 181-192. doi:10.1016/j.pnpbp.2018.09.007.
Rucklidge JJ, et al. Can We Predict Treatment Response in Children With ADHD to a Vitamin-mineral Supplement? an Investigation Into Pre-treatment Nutrient Serum Levels, MTHFR Status, Clinical Correlates and Demographic Variables. Prog Neuropsychopharmacol Biol Psychiatry. 2019 03 8;89:181-192. PubMed PMID: 30217770.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can we predict treatment response in children with ADHD to a vitamin-mineral supplement? An investigation into pre-treatment nutrient serum levels, MTHFR status, clinical correlates and demographic variables. AU - Rucklidge,Julia J, AU - Eggleston,Matthew J F, AU - Darling,Kathryn A, AU - Stevens,Aaron J, AU - Kennedy,Martin A, AU - Frampton,Christopher M, Y1 - 2018/09/12/ PY - 2018/06/07/received PY - 2018/09/10/revised PY - 2018/09/10/accepted PY - 2018/9/16/pubmed PY - 2019/3/26/medline PY - 2018/9/16/entrez KW - ADHD KW - Children KW - Micronutrients KW - Minerals KW - Predictors KW - Treatment KW - Vitamins SP - 181 EP - 192 JF - Progress in neuro-psychopharmacology & biological psychiatry JO - Prog. Neuropsychopharmacol. Biol. Psychiatry VL - 89 N2 - BACKGROUND: Intent-to-treat analyses from a randomized controlled trial showed significant between-group differences favouring micronutrient treatment on the Clinical Global Impression-Improvement, but no group differences on clinician, parent and teacher ratings of overall ADHD symptoms. There was an advantage of micronutrients over placebo in improving overall function, emotional regulation, aggression, and reducing impairment as well as improving inattention based on clinician but not parent observation. No group differences were observed on hyperactive-impulsive symptoms. We investigated predictors of response defined by pre-treatment variables. METHOD: We conducted analyses of data from a clinical trial of children (7-12 years) with ADHD, whereby participants were randomized to receive micronutrients or placebo for 10 weeks followed by a 10 week open-label (OL) phase. We included only children who had been exposed to micronutrients for a full 10 week period and demonstrated satisfactory adherence, either in RCT phase (n = 40) or OL phase (those who received placebo during RCT phase; n = 31). Seven outcomes were examined: change in ADHD symptoms (clinician/parent), ADHD responder, overall responder, change in mood, change in functioning, and change in aggression. Demographic, developmental variables, current clinical and physical characteristics, MTHFR genotype at two common variants, and pre-treatment serum/plasma levels (vitamin D, B12, folate, zinc, copper, iron, ferritin, potassium, calcium, magnesium, and homocysteine) were all considered as putative predictors. RESULTS: Substantial nutrient deficiencies pre-treatment were observed only for vitamin D (13%) and copper (15%), otherwise most children entered the trial with nutrient levels falling within expected ranges. Regression analyses showed varying predictors across outcomes with no one predictor being consistently identified across different variables. Lower pre-treatment folate and B12 levels, being female, greater severity of symptoms and co-occurring disorders pre-treatment, more pregnancy complications and fewer birth problems were identified as possible predictors of greater improvement for some but not all outcome measures although predictive values were weak. Lower IQ and higher BMI predicted greater improvement in aggression. CONCLUSIONS: This study replicates Rucklidge et al. (2014b) showing the limited value of using serum nutrient levels to predict treatment response although we cannot rule out that other non-assayed nutrient levels may be more valuable. Additionally, no specific demographic or clinical characteristics, including MTHFR genetic status, were identified that would preclude children with ADHD from trying this treatment approach. SN - 1878-4216 UR - https://www.unboundmedicine.com/medline/citation/30217770/Can_we_predict_treatment_response_in_children_with_ADHD_to_a_vitamin_mineral_supplement_An_investigation_into_pre_treatment_nutrient_serum_levels_MTHFR_status_clinical_correlates_and_demographic_variables_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0278-5846(18)30407-X DB - PRIME DP - Unbound Medicine ER -