Nutrition for Youth Athletes with ADHD: What We Know and Practical Applications

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This article is on an important topic. However, most of the article focusses on medication use with ADHD. I suggest reducing these sections and expanding on the sections that focus on nutrition since it is submitted to a nutrition-specific journal.

Additional specific comments:

Line 34 what age do you consider youth athletes? Clarify this here.

Lines 37 and 38 are these costs per year? please clarify

Line 40 same comment

Line 131 correct to “more likely to have had a concussion”

Line 160 “ It is difficult to ascertain if having ADHD as an adult is due to the condition itself or a consequence of having it.” I am not sure this sentence makes sense.

Lines 172 to 175. This sentence can be rewritten to make it shorter.

Line 189 change “there” to “their”

Line 207: “ The researchers speculated that methylphenidate administration leads to inhibition of the central nervous system to cease exercise during warmer, ambient conditions, and thus allows a higher power output during those conditions”. I am not sure this sentence makes sense.

Line 330 “should be to consume” - some rewording is required here.

Line 332. How are insulin and leptin regulated? Are they increased or decreased?

Line 336 “have often have” - change to “often have”

Lines 358 to 359. This sentence needs to be rewritten for clarity.

Lines 366 to 367 here it would be good to expand on this section on omega-3 fatty acids. For example, there are many studies that indicate beneficial effects on the brain from intake of omega-3 fatty acids such as DHA and EPA. 

 Line 385. There are many other types of fatty fish aside from salmon that are high in omega-3 fatty acids. These could be mentioned here.

Line 389. This section could be expanded by explaining the possible mechanisms by which these micronutrient deficiencies are related to ADHD.

Line 414. Another good source of iron is red meat, such as beef and organ meats, such as liver. This could be mentioned here.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

The authors present an interesting review examining the current knowledge on the area of ADHD in young athletes and their nutritional status and implications for their health and wellbeing. Briefly, the authors highlight that given the percentage of the population diagnosed with ADHD, there is a demographic that behaves differently to those without ADHD. As such, those policies and approaches that are applied to the general public warrant review given that those with ADHD are potentially more susceptible to things like serious injury, and their recovery may be impacted by differences in their nutritional profile courtesy of factors such as medications. This review delves into the current stats and figures behind this area, and also focusses on nutritional approaches that may have beneficial effects if deployed in an appropriate manner. Given the number of individuals impacted upon by this, this area does warrant further research, and this review is timely in that regard.

In reviewing the article I did make note of a couple of things to bring to the authors’ attention. The following should be considered by the authors when preparing a suitable revision.  

 

1. For context, it might be useful if statistics were included that indicated the number of cases suspected to not be diagnosed. Currently the article states 10.47% of the US children have ADHD, but this may actually be significantly different based on a number of reasons. The authors are advised to expand on this in the introduction.
2. The review focuses for the most part on demographics from the United States, however, there may be stark differences when compared to other nations. The authors should consider including details on similarities and differences between the US demographic and others as part of the review.
3. There is a good degree of repetition between the Introduction (Section 1.0) and those which follow. The authors should review the level of detail afforded in the introduction, so as to reduce those instances of information that repeat themselves.
4. The authors have gathered many references under each heading, and in that regard the review is information rich. As a suggestion, there are opportunities within the review to include this information in a tabulated format such as to condense and disseminate the information in an alternative manner. For example, Sections 6 and 7 have information across a number of nutritional categories that could have information grouped such as to demonstrate the weight of evidence in their application in an ADHD/athletic context.
5. The authors should consider including information on the state-of-the-art in this area. While the review focuses much on those studies which have been carried out previously, it would be good to include some ‘future perspectives’ or similar in terms of what direction the field is going. Are there new medications/supplements currently in trial? Are there any on-going studies within US populations, or outside of such, which may inform future directions? What are the current greatest challenges to this area? The review would benefit greatly from having a section on this included to set it apart from others that have been published previously on similar topics.

 

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Comments and Suggestions for Authors

Thanks for responding to my comments