A new study assessing the effectiveness of a restricted elimination diet on the behavior of children with attention deficit hyperactivity disorder was published in the February 2011 edition of Lancet. The study was conducted in the Netherlands and Belgium. They enrolled 100 children (4 – 8 years) and randomly assigned them to either a group that received this special diet or to a control group that was just given instructions for a healthy diet. They were to follow the assigned protocol for 5 weeks. They were assessed before and after using using several ADHD rating scales. The assessment indicated that 64% of those using the elimination diet had a significant improvement in symptoms. I commented in May 2010 on a similar study conducted in the UK.
So what does this mean? It probably means that the children who improved using the diet had a food allergy which produced symptoms similar to ADHD. Thus, the diagnosis of ADHD may have been incorrect given these findings.
There are many other questions that were not answered. For instance, the children’s parents knew which treatment they were receiving. Could this have influenced their ratings? Remember, they were recruited by advertising which may have attracted parents who wanted their children off medication and who may have believed that diet might be a significant factor. We also know that increased positive attention by a parent can reduce ADHD symptoms. I discuss this in depth in Total Focus. Could increased attention have played a role in the improvement? The study lasted for 5 weeks. Can the results be maintained over a long period of time? If the offending foods were reintroduced, would the symptoms return?
Another study published in the December 2010 issue of Clinical Pediatrics conducted a systematic and comprehensive review of all the literature related to diet and ADHD and concluded that there are a select group children who present with ADHD symptoms who show improvement as a result of a change in their diet. The Feingold Diet Program has been around for 35 years. While it has its share of advocates, all of the professional societies issuing treatment guidelines have concluded that there is insufficient evidence to prove its efficacy as a primary treatment for ADHD. Please go to the Feingold Diet website to learn more. Then go to the Quakwatch as well as the Clinical Pediatricsarticle for another point of view. If you are inclined to try a diet approach, PLEASE CHECK WITH YOUR CHILD’S PHYSICIAN, before proceeding.
While diet appears to be helpful for some children (the size of this group is in question), another intervention that has proven to be successful when used with or without medication and most likely would enhance any benefits derived from a dietary approach is behavioral treatment. This is often either overlooked or only partially implemented due to constrictions of time and resources. This results in parents, teachers, and providers seeking what seems to be the convenient solution. However, in the latest review of the results of the “gold standard” MTA study, children who’s family received behavioral interventions had the best long-term outcome. According to a principal investigator in that study after conducting a review of the Total Focus program, “it incorporates a wealth of extremely helpful information and programming, derived largely from evidence-based practice presented in an extremely user-friendly format for the families of children with attention-deficit/hyperactivity disorder (ADHD).” Parents who are looking for an alternative from medication as well as for significant, long lasting improvement may be surprised at the results they achieve by investing just a few hours per week working with their son or daughter implementing the researched based interventions in Total Focus. Visit this link for a free trial.
A recent research study to be published in the August 2010 issue of Child Psychiatry and Human Development found that low blood levels for zinc and iron are associated with symptoms of attention deficit hyperactivity disorder based on scores on the Conner’s Parent Rating Scale through the low levels were not associated with higher scores on the Conner’s Teacher Rating Scale.
There were 118 with ADHD (ages 7-14 years). While Conduct Problems and Anxiety were associated with lower zinc levels, increased Hyperactivity scores were related to both lower zinc and iron levels. It is known that these two minerals as involved with dopamine metabolism, one of the two neurotransmitters related to ADHD.
Parents may want to ask their child’s physician to check these levels and recommend supplements if they are found to be out of the normal range. Parents should be cautioned however, to not rush to some the supplement products on the market containing zinc and/or iron. Unless a child’s level is low for either of these two minerals, there is no evidence that boosting normal levels would be beneficial and could be harmful.
It is known that a healthy diet and regular exercise is good for brain development for all children and certainly beneficial for children with attention deficit hyperactivity disorder. With the exception of fish oil with Omega 3 antioxidants, no other supplements containing mega doses of vitamins, minerals or other “natural” substances have been proven through rigorous scientific research to be beneficial for kids with ADHD.
Parents concerned about their child’s ADHD symptoms should rely on treatment recommended by professional organizations which are (1) behavioral interventions, (2) school interventions and (3) stimulant medication for severe symptoms that do not respond to the first two approaches.
Many parents find it difficult to find an effective, affordable and user friendly option for behavioral interventions. Total Focus is a comprehensive behavioral program using evidence-based techniques to improve behavior, learning, self-esteem and social skills. Parents and children work together as a team to bring about real lasting change involving activities that are fun and require less than an hour per day. Total Focus costs less than one visit to a mental health professional.
I fully understand the concerns of parents regarding medication for ADHD. My wife and I struggled with this when my son was 5. He had a great response to stimulant medication and remained on medication until he was 14. He suffered no observable side effects. He is a 6’4” guy who completed college with honors and has been employed for 5 years in the film industry and currently is an editor for a top rated cable network show. We were at our wits end and what we called “the small vitamin” was a miracle drug. At home we also used psychosocial interventions from time to time during his formative years.
During my years as a child psychologist, I have been able to help many children with mild to moderate symptoms of ADHD do well at home and school without medication using psychological interventions. However, children with more severe symptoms benefit greatly from medication. Current guidelines now state that behavioral interventions should be tried first for mild to moderate symptoms and also should be used for more severe manifestations along with medications which may reduce the dose needed to control symptoms and may reduce the length of time required to remain on medication.
Many of you have been talking about the effects of diet and food additives on kids with ADHD, so I wanted to weigh in on this topic.
In a well-known UK study last year, the effects of artificial food color and additives (AFCA) on kids found that food additives make hyperactive behaviors more pronounced in children as young as 3 and up to middle childhood, around 9 years of age. The study found that a significant though small group of children exhibited hyperactivity as a result of drinking a specially concocted drink containing food colors and preservatives.
What this means is that some children react to substances found in many processed foods that may increase hyperactivity and inattention–to the extent of causing problems at school. In the study, 18% of the children were adversely affected by the drink.
So it appears that up to 18% of the child population may exhibit hyperactivity symptoms as the result of consistent exposure to food additives. The question is: Do these kids have ADHD, or something else?
In order to be diagnosed, the child must meet the criteria for the disorder plus not have any other conditions that might cause the symptoms. One could make that point that these kids have an allergy to these substances and should not be diagnosed as having ADHD. (There are other substances, such as lead, that can also cause these symptoms.)
If you suspect an allergy, it should be treated by an elimination diet. A well known program for this purpose is the Feingold Diet. I have always told parents who ask to go ahead and try this approach as it is not harmful at all. (One note of caution: It’s very time-consuming and has not yielded significant results when used with children who already havebeen diagnosed with ADHD.)