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Greetings:
The article below appeared in a recent issue of ADHD RESEARCH
UPDATE. The subject of this article is the scientific evidence
for the effectiveness of dietary interventions for children with
ADHD. As you will see in the article, a number of studies
have indicated that this can be a useful intervention approach
for some children with ADHD, although many questions remain.
I've also included a brief summary of an interesting conference
I attended recently on the public health aspects of ADHD that
was sponsored by the Centers for Disease Control (CDC) in
Atlanta.
If you are interested in more extensive coverage of new research
on ADHD, and how new findings can be applied to help children
with this condition, please consider becoming a regular subscriber
to ADHD RESEARCH UPDATE. I have included information about
subscribing at the end of the article in case you are interested.
Feel free to forward this message to others you know who may
be interested in the information below.
Sincerely,
David Rabiner, PhD
Licensed Psychologist
Duke University
==================================================================
* DIET AND ADHD REVISITED
What is the evidence to support the effectiveness of dietary
interventions for treating ADHD? This has been a source of
ongoing controversy. Advocates of dietary interventions report
that this can be a helpful approach for many children with ADHD.
The consensus within the medical community, however, has
been much less supportive. This has ranged from the belief that
dietary changes are not helpful at all, to this intervention
approach may help a small minority of ADHD children.
This issue is addressed in a paper by Dr. Eugene Arnold that
appeared in the Journal of Attention Disorders (Arnold, L.E. (1999) Treatment alternatives for ADHD. Journal of Attention Disorders,
3, 48). In this extensive paper, Dr. Arnold reviews a host of
alternative treatment approaches in regards to their current
scientific status. (Note: I reviewed a presentation he gave on
this work at the recent NIH Consensus Conference on ADHD in Volume
14 of ADHD RESEARCH UPDATE). Here, however, I want to focus on
his detailed review of dietary interventions.
Dr. Arnold notes that since 1982, at least 8 controlled studies
of the link between dietary factors and ADHD symptoms in children
have been conducted using adequate scientific methodologies.
These studies have all demonstrated either significant
improvement in children's behavior compared to a placebo condition
when certain foods are removed from a child's diet, or, the
significant deterioration in childrens' behavior when the
offending substances are introduced. According to Dr. Arnold, a
typical diet associated with improvement in ADHD symptoms might
exclude everything except the following: lamb, chicken, potatoes,
rice, bananas, apples, cucumbers, celery, carrots, parsnip,
cabbage, cauliflower, broccoli, salt, pepper, vitamins, and
calcium.
The conclusion reached by Dr. Arnold is that the efficacy of
dietary interventions for some children with ADHD has been
convincingly demonstrated. The main scientific task at this point,
he feels, is to determine what percentage of children with ADHD
this approach is helpful for. Apparently, when children with
ADHD are specifically screened to include those who are suspected
of having food sensitivities, half or more seem to respond well
to dietary interventions under controlled conditions. Thus, for a
child with ADHD and demonstrated food sensitivities, dietary
interventions may have a reasonably good chance of being helpful.
What proportion of the general population of children with ADHD
this represents is unknown, however. For instance, if only a
relatively small proportion of children with ADHD actually have
special sensitivities to certain foods, than dietary interventions
would not be unlikely to be of much benefit to the large majority
of children with ADHD. In addition, even for children who are
helped by dietary changes, little is known about any long-term
benefits associated with this treatment approach. Finally, the
magnitude of the benefits produced by dietary interventions -
even for children who may be helped by it - need to be carefully
compared to the benefits typically produced by other treatments
such as stimulant medication and behavioral interventions. For
many children, careful treatment with stimulant medication and/or
behavioral treatments can reduce their symptoms to a degree that
they are no longer distinguishable from children without ADHD.
How often dietary interventions typically produce gains of this
magnitude is unclear.
There would not seem to be any significant risks associated with
this approach. Some have questioned whether such restrictive diets
provide children with sufficient nutrient intake while others
suggest that eliminating junk food improves essential nutrient
intake. Some professionals have also voiced concerns about the
conflict that may arise from placing children on such a restricted
diet. Then again, this would not seem to necessarily have to be
any worse or more common than the conflicts that can emerge over
taking medication. In both cases, addressing these challenges in
a thoughtful manner would be required.
Overall, Dr. Arnold suggests the greatest risk may be the delay
of more effective treatment if the child is a non-responder. Like
any treatment approach - including medication - you would need to carefully monitor how the treatment is effecting your child in
multiple domains (i.e. behavior, academics, social relations)
and to make changes and adjustments - including abandoning the
approach - if it does not seem to be providing adequate results
after a fair trial. Getting regular and systematic feedback from
your child's teacher in these areas is essential for gauging the
effectiveness of any treatment approach being utilized - and
for knowing when modifications and adjustments are needed.
I find this work to be quite interesting. If you are a parent
who wants to consider this approach for your child, it would
be important to try and find someone who really knows what they
are doing in this regard. For example, I know that advising
parents on how to implement this approach would certainly
not be something that I was qualified to do. I'll keep my eyes
open for more work in this interesting area and will include it
in the newsletter as I come across it.
RECENT CONFERENCE ON THE PUBLIC HEALTH ASPECTS OF ADHD
SPONSORED BY THE CENTERS FOR DISEASE CONTROL (CDC)
Last week I attended a conference in Atlanta sponsored by
the Centers for Disease Control on ADHD from a public health
perspective. It was quite encouraging to learn that the CDC
has started to view ADHD as a significant public health problem,
and is likely to get involved in funding research and possibly
other programs to address the public health impact of ADHD.
There was lots of material covered in the conference - most of
the principal investigators from the NIMH Multi-site intervention
study were there are made presentations. Some of the recurring
themes were:
* We know very little about the actual cost and impact of undiagnosed
and/or improperly treated ADHD on children, families, schools,
and society.
* The biggest risk to the long-term outcomes of children with ADHD is
the development of co-morbid conditions - especially conduct
disorder.
* The failure to evaluate and address co-morbid conditions is one
of the biggest gaps in the treatment that many children with
ADHD receive in the community.
* Although stimulant medication and behavior treatment have been
shown to be effective treatments in the short-run, there is still
no data on the long term impact (i.e. more than 1-2 years) of
these treatments. Such studies are badly needed.
* ADHD is underidentified in general, although there are likely to
be areas where it is overdiagnosed and overtreated.
* Treatment that children with ADHD typically receive in community
settings is not monitored not nearly as carefully as it should be.
There will undoubtedly be some interesting work that comes out
of the CDC conference and I will try to include this in
future mailings as I become aware of it.
*****************************************************************
IF YOU ARE INTERESTED IN MORE EXTENSIVE INFORMATION
ABOUT NEW RESEARCH ON ADHD, PLEASE CONSIDER SUBSCRIBING
TO ADHD RESEARCH UPDATE. SEE DETAILS BELOW.
Dear Parent or Health Care Professional:
I hope the information above was of interest to you.
If you have a child with ADHD, learning about the
latest research findings will help you make better
informed decisions about the best ways to promote your
child's healthy development.
If you work with children who have ADHD, subscribing to
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All types of studies are reviewed, including studies on new
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Best wishes,
David Rabiner, PhD
Licensed Psychologist
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