Johnstone JM et al. Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. J Am Acad Child Adolesc Psychiatry. 2022 May;61(5):647-61.

Attention deficit hyperactivity disorder (ADHD) affects 5-7% of children and often continues into adulthood. ADHD increases the risk of negative outcomes including poor educational achievements, incarceration, substance abuse and long-term psychiatric conditions. Emotional dysregulation, including irritability and anger, is a significant aspect of ADHD that contributes to impairment. Pharmacologic treatments such as stimulant medications are often used, and are effective; however, they can have concerning side effects and potential long-term health impacts, including growth suppression in children. Non-pharmacological treatments may provide an alternative or additional benefit when used alongside these medications.

Previous studies on single nutrients such as zinc and magnesium have shown mixed results. Broad-spectrum multinutrient supplementation has demonstrated benefits in both open-label and blinded studies for ADHD and co-occurring mood issues.

The MADDY Study

The Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths (MADDY) study is an eight week, fully blinded, randomised controlled trial that investigated the effects of a multinutritional supplement in 135 children diagnosed with ADHD. The children were between six and twelve years of age, and were unmedicated during the trial, though 39% of the children had taken stimulant medication previously. The children were given a high dose multinutrient supplement containing vitamins, minerals and antioxidants, or placebo daily.

Key Findings

Patients in the supplement group were three times more likely to have a beneficial response to treatment than participants in the placebo group. In the multinutrient group, 54% had a significant improvement based on physician-rated Clinical Global Impression-Improvement (CGI-I) scores, versus 18% in the placebo group (p<0.001). Both groups showed significant symptom improvement according to the parent-rated CGI-I scores, with the multinutrient group showing a greater trend to improvement though this did not quite reach statistical significance (p=0.07). The authors speculated that this may be due to parents failing to notice small daily improvements, which may be apparent to an outside observer who sees the child less often. In addition to these behavioural improvements, participants in the multinutrient group grew on average six millimetres in height more than the placebo group (p=0.002). This suggests that multinutrient supplementation may partially alleviate the negative effects of stimulant medication on children’s growth.

No serious adverse events were reported. Micronutrients were well tolerated and compliance was high.

The Bottom Line

Multinutrient supplementation showed global benefits over placebo by clinician rating in children with ADHD, with additional benefits for their physical growth. This study provides evidence that nutritional support can be a safe and effective alternative or adjunct treatment for children with ADHD.