Journal of Attention Disorders
A Preliminary Investigation of ADHD Symptoms in Persons With Celiac Disease
http://jad.sagepub.com
Helmut Niederhofer / Klaus Pittschieler
Regional Hospital of Bolzano, Italy
Objective: Several studies report a possible association of celiac disease (CD) with psychiatric and psychological disturbances, such as ADHD. Method: The authors assess 132 participants from 3 to 57 years of age (M = 19.3 years) affected by CD for the possibility of an associated ADHD-like symptomatology, using the Conner Scale Hypescheme, a behavioral scale similar to the Conners Rating Scales, before their gluten-free diet was started and 6 months later. Results: The overall score improves significantly as well as most of the ADHD-like symptomatology specific features (Bonferroni-corrected, paired-sample t tests). Conclusion: The data indicate that ADHD-like symptomatology is markedly overrepresented among untreated CD patients and that a gluten-free diet may improve symptoms significantly within a short period of time. The results of this study also suggest that CD should be included in the list of diseases associated with ADHD-like symptomatology. (J. of Att. Dis. 2006; 10(2) 200-204) .
Clinical Implications
Our results indicate that ADHD-like symptomatology is markedly overrepresented among untreated CD outpatients, and a gluten-free diet improves these symptoms
significantly (before diet overall average Hypescheme score of 22, after diet overall average Hypescheme score of 16). Confusing data are seen in the literature, as Pynnonen, Isomets, Aalberg, Verkasab, and Savilahti (2002) found that CD is not more frequently present among psychiatric patients than in the general population. Instead, Kozlowska (1991) observed a significantly higher incidence of psychiatric disorders in treated CD patients, but he did not check untreated ones. For that reason, all ADHD-like symptomatology patients should be tested for CD with serum screening tests such as EMA or tTGA, as CD could be one of the causes of these neuropsychiatric symptoms. We are convinced that untreated CD may predispose to important mental and behavioral disorders.
Our results suggest that ADHD-like symptomatology should be included in the list of symptoms of CD, which has a prevalence rate of 4% (Not et al., 1998). ADHDlike symptomatology is a frequently diagnosed disease. Barbaresi et al. (2002) report an incidence of 10% as well as a prevalence of stimulant treatment of 86.5% for definite ADHD and 50% for probable and questionable ADHD, which indicates that stimulant treatment is also administered even if diagnosis is not proven. We found a CD prevalence rate of also 4% (121 of 300,000 inhabitants in South Tyrol). Assuming that the ADHD prevalence corresponds to that reported by Barbaresi et al. (2002), we suppose that 0.4% (12 patients) suffer from definite CD and definite ADHD, and 2% (60 patients) suffer from definite CD and probable or ques tionable ADHD, which are treated with stimulants.
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