Attention-Deficit/Hyperactivity Disorder (ADHD) affects approximately 5-10% of all children and 4% of all adults worldwide. Since more than 50 years, psychostimulants are the first choice medication in treating ADHD in children, adolescents, and adults. There is strong evidence that stimulant medication relieves ADHD symptoms in about 70-80% of affected patients. However, stimulants have also some well known common side effects, such as reducing of appetite and sleeping problems. Furthermore, a lot of parents and patients do not want to use stimulant medication despite its known efficacy. Therefore, nonpharmacological treatments, such as behavioural and nutritional interventions, are important treatment options in ADHD that need to be tailored around the preferences of patients and their families. A further problem is that nutritional interventions in ADHD are usually overemphasized in the lay press. A critical appraisal of the evidence is therefore needed to inform patients and their families about the potential, but also about the limitations of nutritional interventions in ADHD.

Some clinical evidence suggests that nutritional interventions may have some beneficial preventive and therapeutic effects in children with ADHD. This even seems to start during pregnancy with the right nutrition of the mother. Dietary lifestyle such as the so-called Western diet can worsen ADHD symptoms while the Mediterranean diet seems to be beneficial. One potential pathway for these observed associations may be food intolerances. Malnutrition and consecutive supplementation could potentially lessen the severity of ADHD symptoms. Furthermore, nutritional counseling in conjunction with stimulant medication is also important as weight loss is such a common side effect of stimulant medication, possibly also associated with growth problems, in particular in young children with ADHD. One the other hand binge eating and obesity are other phenomena reported in ADHD populations. Potential mechanisms from food to behavior, studied in patients or (animal) models can help to understand the impact of nutrition on ADHD.

Nevertheless, nutritional interventions are often neglected in ADHD management plans despite increasing evidence of the interplay between diet, body weight, growth, reward, cognition and mental health. Future research should investigate the role of nutrition, microbiome and development to better inform us about the pathophysiology as well as for individualized treatment approaches in ADHD.

Potential topics
• Pregnancy
• Dietary lifestyle
• Food Intolerances
• Supplementation
• nutritional counseling in conjunction with stimulant medication
• binge eating
• obesity
• Basic research

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Frontiers in Psychiatry

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