Nutritional or dietary interventions for children and adolescents with autism spectrum disorder or ADHD

This document was published more than 2 years ago. The nature of the evidence may have changed.

There are theories that different types of nutritional or dietary interventions, where specific food items are excluded from the diet or where nutritional supplements are added, may affect the symptoms of persons with Attention Deficit Hyperactivity Disorder (ADHD) or autism spectrum disorder. This applies, for example, to gluten-free and casein-free diet, ketogenic diet (a strict option of a low carbohydrate diet) or diet where sugar or various additives are excluded. Nutritional supplements may include fatty acids and vitamins.


Which systematic reviews investigates the effect of nutritional or dietary interventions for children and adolescents with autism spectrum disorder or ADHD?


Studies were identified by a literature search of four electronic databases. The full search strategies are available below. We have only included systematic reviews written in English or Swedish. Thesis’s, guidelines and umbrella reviews have been excluded. A total of 1 472 abstracts were reviewed, and of these, 163 articles were assessed in full. Abstracts as well as full text articles were assessed by one person. 33 systematic reviews were found relevant in relation to the question and are listed below.

Identified literature

  1. Kemper AR. Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents. In: Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents. Rockville (MD): AHRQ (US Agency for Healthcare Research and Quality); 2018.
  2. Catala-Lopez F, Hutton B, Nunez-Beltran A, Page MJ, Ridao M, Macias Saint-Gerons D, et al. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLoS One 2017;12:e0180355.
  3. Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 2013;170:275-89.
  4. Heilskov Rytter MJ, Andersen LB, Houmann T, Bilenberg N, Hvolby A, Molgaard C, et al. Diet in the treatment of ADHD in children - a systematic review of the literature. Nord J Psychiatry 2015;69:1-18.
  5. Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry 2012;51:86-97.e8.
  6. Bloch MH, Mulqueen J. Nutritional supplements for the treatment of ADHD. Child Adolesc Psychiatr Clin N Am 2014;23:883-97.
  7. Rucklidge JJ, Kaplan BJ. Broad-spectrum micronutrient formulas for the treatment of psychiatric symptoms: A systematic review. Expert Review of Neurotherapeutics 2013;13:49-73.
  8. Cortese S, Angriman M, Lecendreux M, Konofal E. Iron and attention deficit/hyperactivity disorder: What is the empirical evidence so far? A systematic review of the literature. Expert Rev Neurother 2012;12:1227-40.
  9. Ghanizadeh A, Berk M. Zinc for treating of children and adolescents with attention-deficit hyperactivity disorder: a systematic review of randomized controlled clinical trials. Eur J Clin Nutr 2013;67:122-4.
  10. Ghanizadeh A. A systematic review of magnesium therapy for treating ADHD. Archives of Iranian Medicine 2013;16:412-17.
  11. Cooper RE, Tye C, Kuntsi J, Vassos E, Asherson P. The effect of omega-3 polyunsaturated fatty acid supplementation on emotional dysregulation, oppositional behaviour and conduct problems in ADHD: A systematic review and meta-analysis. J Affect Disord 2016;190:474-82.
  12. Hawkey E, Nigg JT. Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials. Clin Psychol Rev 2014;34:496-505.
  13. Puri BK, Martins JG. Which polyunsaturated fatty acids are active in children with attention-deficit hyperactivity disorder receiving PUFA supplementation? A fatty acid validated meta-regression analysis of randomized controlled trials. Prostaglandins Leukot Essent Fatty Acids 2014;90:179-89.
  14. Agostoni C, Nobile M, Ciappolino V, Delvecchio G, Tesei A, Turolo S, et al. The role of omega-3 fatty acids in developmental psychopathology: A systematic review on early psychosis, autism, and ADHD. International Journal of Molecular Sciences 2017;18.
  15. Derbyshire E. Do Omega-3/6 Fatty Acids Have a Therapeutic Role in Children and Young People with ADHD? Journal of Lipids 2017;2017.
  16. Gillies D, Sinn JKH, Lad SS, Leach MJ, Ross MJ. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database of Systematic Reviews 2012;2012:CD007986.
  17. Königs A, Kiliaan AJ. Critical appraisal of omega-3 fatty acids in attention-deficit/hyperactivity disorder treatment. Neuropsychiatric Disease and Treatment 2016;12:1869-1882.
  18. Ortega RM, Rodríguez-Rodríguez E, López-Sobaler AM. Effects of omega 3 fatty acids supplementation in behavior and non-neurodegenerative neuropsychiatric disorders. British Journal of Nutrition 2012;107:S261-S270.
  19. Brondino N, Fusar-Poli L, Rocchetti M, Provenzani U, Barale F, Politi P. Complementary and Alternative Therapies for Autism Spectrum Disorder. Evidence-based Complementary and Alternative Medicine 2015;2015:258589.
  20. Frye RE, Rossignol D, Casanova MF, Brown GL, Martin V, Edelson S, et al. A review of traditional and novel treatments for seizures in autism spectrum disorder: findings from a systematic review and expert panel. Front Public Health 2013;1:31.
  21. Williamson E, Sathe NA, Andrews JC, Krishnaswami S, McPheeters ML, Fonnesbeck C, et al. AHRQ Comparative Effectiveness Reviews. In: Medical Therapies for Children With Autism Spectrum Disorder-An Update. Rockville (MD): Agency for Healthcare Research and Quality (US); 2017.
  22. Sathe N, Andrews JC, McPheeters ML, Warren ZE. Nutritional and Dietary Interventions for Autism Spectrum Disorder: A Systematic Review. Pediatrics 2017;139.
  23. Elder JH, Kreider CM, Schaefer NM, de Laosa MB. A review of gluten- and casein-free diets for treatment of autism: 2005-2015. Nutr Diet Suppl 2015;7:87-101.
  24. Hurwitz S. The gluten-free, casein-free diet and autism: limited return on family investment. Journal of Early Intervention 2013;35:3-19.
  25. Mari-Bauset S, Zazpe I, Mari-Sanchis A, Llopis-Gonzalez A, Morales-Suarez-Varela M. Evidence of the gluten-free and casein-free diet in autism spectrum disorders: a systematic review. J Child Neurol 2014;29:1718-27.
  26. Piwowarczyk A, Horvath A, Lukasik J, Pisula E, Szajewska H. Gluten- and casein-free diet and autism spectrum disorders in children: a systematic review. Eur J Nutr 2018;57:433-40.
  27. Buie T. The relationship of autism and gluten. Clin Ther 2013;35:578-83.
  28. Castro K, Faccioli LS, Baronio D, Gottfried C, Perry IS, Dos Santos Riesgo R. Effect of a ketogenic diet on autism spectrum disorder: A systematic review. Research in Autism Spectrum Disorders 2015;20:31-8.
  29. Gogou M, Kolios G. The effect of dietary supplements on clinical aspects of autism spectrum disorder: A systematic review of the literature. Brain Dev 2017;39:656-64.
  30. Alanazi AS. The role of nutraceuticals in the management of autism. Saudi Pharm J 2013;21:233-43.
  31. Li YJ, Ou JJ, Li YM, Xiang DX. Dietary supplement for core symptoms of autism spectrum disorder: Where are we now and where should we go? Frontiers in Psychiatry 2017;8.
  32. Cheng YS, Tseng PT, Chen YW, Stubbs B, Yang WC, Chen TY, et al. Supplementation of omega 3 fatty acids may improve hyperactivity, lethargy, and stereotypy in children with autism spectrum disorders: A meta-analysis of randomized controlled trials. Neuropsychiatric Disease and Treatment 2017;13:2531-43.
  33. Mazahery H, Stonehouse W, Delshad M, Kruger MC, Conlon CA, Beck KL, et al. Relationship between long chain n-3 polyunsaturated fatty acids and autism spectrum disorder: Systematic review and meta-analysis of case-control and randomised controlled trials. Nutrients 2017;9.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 9/12/2018
Report no: ut201826