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DIET AND ADHD REVISITED
by David Rabiner, Ph.D., Licensed Psychologist
Copyright (C) 1999
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 childrenwith ADHD. The consensus within the mental health 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
that use 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 children's' 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 screened specifically to include those who are suspected of
having food sensitivities, half or more seem to respond well 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. In addition, even for children who are helped by dietary
changes, llittle is known about any long-term benefits associated with this
treatment approach. 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.
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.
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