Neuroimaging of diet and medication in the treatment of ADHD

饮食和药物治疗多动症的神经影像学

• 批准号: 8442418
• 负责人: STEVEN R. PLISZKA
• 金额: $ 22.72万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCIENCE CENTER
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-01-03 至 2014-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8442418
• 关键词: Affect; Aftercare; Age; Amygdaloid structure; Anterior; Attention; Attention deficit hyperactivity disorder; Behavior; Behavioral; Belief; Biological Markers; Blinded; Brain; Child; Clinical Trials; Complex; Conflict (Psychology); Control Groups; Counseling; Data; Development; Diet; Dietary Intervention; Double-Blind Method; Enrollment; Family; Food; Functional Magnetic Resonance Imaging; Functional disorder; Goals; Grant; Household; Image; Imaging Techniques; Insula of Reil; Lateral; Magnetism; Medial; Methylphenidate; Metric; Modeling; Moods; Nutritional; Outcome; Parents; Participant; Perception; Pharmaceutical Preparations; Phase; Placebos; Plant Roots; Prefrontal Cortex; Psychological Impact; Randomized; Relative (related person); Reporting; Rest; Rewards; Running; Societies; Structure; Symptoms; Taste Perception; Testing; Ventral Striatum; Work; active method; base; blind; diet compliance; dietary restriction; double-blind placebo controlled trial; food restriction; intraparietal sulcus; neuroimaging; nutrition; public health relevance; relating to nervous system; response; statistics; trial comparing; week trial

DESCRIPTION (provided by applicant): Dietary interventions for Attention Deficit Hyperactivity Disorder (ADHD) have been both controversial and popular. Recently, a "few foods" restriction diet was found to be efficacious relative to nutritional counseling in the treatment of ADHD. If these results were to be replicated, then a paradigmatic change in the management of ADHD would be in order. How does one perform a double blind study of a complex dietary treatment? How do dietary interventions compare to stimulant treatment and how might diet affect change at a neural level? In Phase I (2 years) of this R21/33 development grant, we plan to develop a Ruse Diet (RuD) that can be comparable to the Restriction diet (ReD) in impact on the child and family psychologically and which is similar in taste such that a blinded comparison is possible. We will then run a pilot double blind placebo controlled trial with 20 medication free children age 8 to 12 with ADHD. Our hypotheses are that the diet will be acceptable to families and the ReD will be superior to RuD in reducing parent ratings of ADHD behavior. Participants will have fMRI studies at baseline and at the end of the trial. For task fMRI, we will develop and determine the impact of the ReD vs. RuD diet on the regional activation levels and effective connectivity of the "attention" networks while participants perform an anticipation-response conflict task. Effective connectivity analysis will be performed using dynamic causal modeling (DCM). We hypothesize that ReD vs. RuD will be increase activation levels within the ADHD network and in particular change strength of connectivity between the Intraparietal sulcus (IPS), the dorsolateral prefrontal cortex (DLPFC) and the ACC during the anticipation- response conflict task (connectivity changes will be reflected in both task and resting state data). Next, we will pilot a task in which the participants will also passively view pictures of foods that are either on or off the ReD, with pictures of household objects as controls. Such a task is well known to activate a "reward" network of regions (ventral striatum, amygdala, anterior insula, and medial and lateral orbitofrontal cortex (OFC) that has been hypothesize to be involved in ADHD. In Phase II, (3 years), we will seek to determine the relative and combined efficacy of a restriction diet and methylphenidate in the treatment of ADHD, the acceptability/compliance of the diet to families and the child's perception of diet. We plan to randomize 40 children with ADHD (age 8-12) to a 2 (Placebo, methylphenidate) X 2 (ReD vs. RuD) for a five week period, obtaining task-fMRI based on our Phase I work. We will examine the efficacy of the ReD vs medication and determine if there any additive effects of ReD and medication vs. each treatment alone. We obtain fMRI using both the conflict and food imaging tasks both pre and post treatment. We seek to determine if the diet impacts functional connectivity (via DCM as above) in both the attention and reward networks and if such changes predict behavioral outcome.

描述（由申请人提供）：注意力缺陷多动障碍（ADHD）的饮食干预既有争议又流行。最近，在ADHD治疗中，与营养咨询相比，发现“几种食物”限制饮食是有效的。如果要复制这些结果，那么ADHD管理的范式更改将是按顺序进行的。如何对复杂的饮食治疗进行双盲研究？饮食干预措施与兴奋剂治疗相比如何，饮食在神经水平上如何影响变化？在此R21/33的第一阶段（2年）中，我们计划开发一种诡计的饮食（RUD），可以与限制饮食（红色）在对儿童和家庭的心理影响上相提并论，并且在口味上相似，因此可以进行盲目的比较。然后，我们将与 20岁儿童8至12岁的多动症儿童。我们的假设是，饮食将被家庭接受，红色在降低ADHD行为的父母评分方面优于RUD。参与者将在基线和试验结束时进行fMRI研究。对于fMRI的任务，我们将开发并确定红色与RUD饮食对区域激活水平的影响以及参与者执行的“注意”网络的有效连通性 预期响应冲突任务。有效的连通性分析将使用动态因果建模（DCM）进行。我们假设红色与RUD将提高ADHD网络内的激活水平，特别是改变了内部沟（IPS），背外侧前额叶皮层（DLPFC）和ACC之间连通性的强度（在预期响应响应任务 - 连通性的变化都会在任务和重新安排的状态数据中反映）。接下来，我们将驾驶一项任务，其中参与者还将被动地查看红色或红色的食物的图片，并以家用物体为控件的图片。众所周知，此类任务是激活区域（腹侧纹状体，杏仁核，前岛岛，内侧和外侧轨道额皮层（OFC）的“奖励”网络，已经假设在ADHD中参与ADHD。我们的饮食和孩子的感知。食物成像任务既有治疗前后，我们都试图确定饮食在注意力和奖励网络中是否会影响功能连通性（通过上述DCM），以及这种变化是否可以预测行为结果。