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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