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The notion that there is a relationship between diet and children’s behavior and learning originates from the early 1970s from Dr Ben Feingold, who in 1975 wrote a best selling book, Why Your Child is Hyperactive (Feingold 1975). He claimed in the book that food additives and naturally occurring salicylates adversely affected behavior in up to 50 per cent of children, but produced no scientific evidence to support these claims. However, these assertions were immediately taken up by large numbers of parents as well as professionals. There have been numerous studies in the past 20 years on the effects of diet on hyperactivity and ADHD. A number of early studies, published in peer reviewed journals claimed to show the benefits of elimination diets in children with hyperactivity”.

Subsequent placebo-controlled studies have investigated the effects of multiple substances in children’s diet and have suggested, usually cautiously, that diet may contribute to behavior problems in some children (Rowe and Rowe 1994; Egger, Carter, Graham et al 1985; Carter, Urbanowitz, Hemsley et al 1993; Kaplan, McNichol, Conte et al 1989; Swanson and Kinsbourne 1980). Other studies have failed to demonstrate any beneficial effect of controlled diet on behavior (Williams and McGee 1989, Wender 1986; Levy, Dumbrell, Hobbes et al 1978). In recent years there have been several articles focusing on sugar as a possible cause of problem behaviors (Prinz, Roberts and Hartman 1980). Carefully controlled studies, however, have failed to demonstrate any significant effect on behavior (Bachorowski, Newman, Nichols et al 1990).

It has been argued that even where reports of an improvement in diet occur, this may be due to reasons other than the diet itself. The modification of the diet in a child is likely to be accompanied by changes in management which may bring about an improvement in behavior (Williams and McGee 1989).

It is only relatively recently that methodologically-sound studies have been published suggesting that there may be place for dietary manipulation in a small number of children with ADHD. These studies are not able to determine the percentage of children who may benefit, nor provide information which enables clinicians to reliably decide whether diet is relevant in an individual child.

At this stage it is not possible to state that dietary manipulation should be considered part of the routine management of ADHD. If a special diet is instituted, it should be under the careful supervision of a qualified dietitian, preferably with experience in this area.

Recommendation

While some studies have suggested that food and food additives influence some behaviors in some children, dietary manipulation is not recommended in the routine management of ADHD. If a special diet is instituted, it should be under the careful supervision of a qualified dietitian, preferably with experience in this area.

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