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 ompared 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.

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