Rucklidge JJ, et al. - This study was performed to investigate whether vitamin-mineral treatment improved aggression and emotional regulation in children with ADHD. In this sample of children with ADHD, micronutrients improved overall function, reduced impairment, and improved inattention, emotional regulation, and aggression, but not hyperactive/impulsive symptoms. The low rate of adverse effects and the benefits reported across multiple areas of functioning indicated micronutrients could be a favourable option for some children, especially those with both ADHD and emotional dysregulation, although direct benefit for core ADHD symptoms was modest, with mixed findings across raters.

• The authors performed this first fully blinded randomized controlled trial of medication-free children (n = 93) with ADHD (7–12 years).
• They assigned children to either micronutrients (n = 47) or placebo (n = 46) in a 1:1 ratio, for 10 weeks.
• For this study, all children received standardized ADHD assessments.
• They collected data from clinicians, parents, participants, and teachers across a range of measures assessing ADHD symptoms, general functioning and impairment, mood, aggression and emotional regulation.

• The authors demonstrated significant between-group differences favouring micronutrient treatment on the Clinical Global Impression-Improvement (ES = 0.46) in this intent-to-treat analyses, with 47% of those on micronutrients identified as ‘much’ to ‘very much’ improved vs. 28% on placebo.
• They identified no group differences on clinician, parent and teacher ratings of overall ADHD symptoms (ES ranged 0.03–0.17).
• However, 32% of those on micronutrients vs. 9% of those on placebo demonstrated a clinically meaningful improvement on inattentive (OR = 4.9; 95% CI: 1.5–16.3), but no group differences on improvement in hyperactive-impulsive symptoms (OR = 1.0; 95% CI: 0.4–2.5), according to clinicians.
• Those on micronutrients indicated greater improvements in emotional regulation, aggression, and general functioning compared to placebo (ES ranged 0.35–0.66), based on clinician, parent and teacher report.
• There were two dropouts per group.
• They identified no group differences in adverse events and in serious adverse events.
• In this study, blinding was found to be successful with guessing no better than chance.