“The Diet Factor in Attention-Deficit/Hyperactivity Disorder,” the much-cited study released by the journal Pediatrics this week, did not make much of a case for using dietary change to treat Attention-Deficit/Hyperactivity Disorder (ADHD). But it did make an interesting case for using food control to treat parents’ angst about their kids’ ADHD.
The study’s authors, J. Gordon Millichap, a neurologist, and Michelle M. Yee, a nurse-practitioner, who both specialize in ADHD at Children’s Memorial Hospital in Chicago, carried out a critical review of all the research literature dating back to 1976 listed by PubMed, the U.S. National Library of Medicine’s database of articles from scientific journals, relating to the use of diet and dietary supplements in treating ADHD. They found that fish oil, in the right doses and combinations (still to be determined), might help with the cognitive and behavioral impairments associated with the disorder (though it’s still unproven.) They found that it’s helpful to remove additives and preservatives from the diet of the kids (“a small subgroup”) who are sensitive to them. Ditto for allergens for children who have food allergies.
They found iron supplements and zinc to be interesting ideas. Sugar and aspartame? More or less benign.
Most promisingly, Millichap and Yee reported an association between ADHD and children who ate a Western diet high in saturated fat, refined sugars and sodium, and lacking omega-3 fatty acids, fiber and folate. They did not say why this association occurred, however, except to acknowledge that the direction of causality between bad food and bad behavior (or bad concentration, or self-regulation or any of the other problems associated with ADHD) could go either way.
“The relationship between a Western dietary pattern and ADHD may be mediated by other factors, such as poor family functioning and emotional distress, leading to a craving for fat-rich snack foods,” they wrote. In other words, the stress of having ADHD or being in a family riddled with ADHD, could lead to overindulgence in unhealthy foods.
The only clear result from this exploration of the role of diet in ADHD was uncertainty, except when it came to parent behavior. Regarding that, the authors noted that, no matter what they reported, parents were going to do what they wanted to do. Take the longtime one-size-fits-all villain, sugar: “In practice, the link between sugar and hyperactive behavior is so universal in the opinion of parents of children with ADHD that no controlled study or physician counsel is likely to change this perception,” they wrote.
As we all know, cutting sugar can’t hurt. And, ironically, the authors suggested, for non-dietary reasons, it might even help. That’s because of the Hawthorne Effect — a well-known research phenomenon whereby children (or adults) experience improvement in an area precisely because that area has been singled out for observation. “The specific type of therapy or discipline may be less important than the attention provided by the treatment,” they explained.
The relationship between parents’ feelings and expectations and their perceptions of their children’s ADHD has been proven before. In the National Institute of Mental Health’s Collaborative Multisite Multimodal Treatment Study of Children with ADHD, or MTA study, the largest study of comparative ADHD treatments conducted to date, parents reported being most satisfied with their children’s progress when their kids were treated with behavioral therapy without medication — despite the fact that behavioral therapy alone was nowhere nearly as effective as medication plus therapy (or medication alone) in reducing core ADHD symptoms. Therapy improved the parent-child interaction, which made everyone feel (and no doubt, behave) better. I would venture to say that not giving medication may have made parents feel a whole lot better about themselves, which, coupled with the special training they received, may have made them parent more competently, too — and thus see better results in their kids.
A major problem with testing dietary remedies for ADHD is that factoring out the placebo effect is extremely difficult: you can’t fake giving a kid a certain food, the way you can give a sugar pill instead of Ritalin. But maybe, for kids whose symptoms are very mild and not particularly impairing, this doesn’t matter. If dietary change produces positive alterations in the behavior, cognition and, in particular, self-judgment of parents, it may be a boon for children with ADHD as well.