Attention deficit hyperactivity disorder (ADHD) affects 3% or more of school-going children and is more common in boys than in girls.
With 3 out of every 10 school children having to cope with a disorder that prevents them from fully realising their potential, it is essential that parents arm themselves with knowledge about ADHD and how to adopt a holistic approach.
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Diet can also play an important role in normalising your child’s life.
The role of diet in ADHD
A number of special diets and diet therapies have been suggested for children with ADHD. The modern approach to the dietary treatment of ADHD consists of the following:
1) Balanced diet
All members of the family should eat a balanced diet and stick to regular meals. Good wholesome food and an emphasis on whole, unprocessed cereals, wholewheat bread, pasta, brown rice, legumes (dry beans, peas and lentils), low-fat milk and dairy products, large helpings of raw, fresh fruit and vegetables, and moderate intakes of lean meat, chicken, fish and eggs will supply plenty of carbohydrate to meet energy needs, dietary fibre, and protective vitamins, minerals and trace elements, and a moderate fat intake.
The emphasis in the ADHD diet should be on unprocessed or minimally processed foods as will be explained below under the heading of 'Avoiding food additives'.
2) Low-GI diet
Some children will respond well to a diet based on foods with a low glycaemic index (GI), as such a diet will ensure that blood sugar and insulin levels are kept constant, thus preventing pronounced dips and peaks in these values which can make children fractious and irritable.
If in doubt, consult a clinical dietician to help you work out a diet that provides your child with the nutrients he needs and that will keep his blood sugar levels on an even keel.
3) Supplements
Children with ADHD and their parents often require additional nutrients (calcium, magnesium, potassium, zinc, selenium, B vitamins, beta-carotene, vitamins E and C, and essential fatty acids such as omega-6 and omega-3) to help them cope with the additional stress their bodies and nervous systems are exposed to.
Use a complete vitamin and mineral supplement that contains omega-6 (evening primrose oil) and omega-3 (salmon oil), and invest in foods that are enriched with omega fatty acids (such as omega-3 enriched eggs, milk and bread, which are available at most reputable supermarkets).
4) Avoiding food additives
As mentioned in 1) above, diets for children with ADHD should be as unprocessed as possible. This not only ensures that the children eat a diet with a high nutrient density, but also that they avoid exposure to the wide range of artificial colourants, flavourants and preservatives that are used in practically every processed food in the modern world.
Recent research published by the University of Southampton (McCann et al, 2007) has shown that artificial colourants and preservatives had a significant negative effect on the behaviour of 3-year-old and 8-9-year-old children.
The authors concluded that, "Artificial colours or a sodium benzoate preservative (or both) in the diet result in increased hyperactivity in 3-year-old and 8/9-year-old children in the general population."
This is the first well-designed scientific study to provide proof that preservatives like sodium benzoate and artificial colourants can even make children without ADHD develop hyperactivity.
If non-hyperactive children reacted to these additives, then one can imagine how children with ADHD who are sensitive to colourants and preservatives will react when they eat modern processed foods.
Although it is difficult, you may find that by carefully selecting foods and drinks that do not contain artificial colourants, flavourants and preservatives, your ADHD child will benefit greatly.
Read food labels and don't buy foods that contain the following additives:
a) Colourants, such as Sunset yellow (E110), Quinoline yellow (E104), Carmoisine (E122),
Allura red (E129), Tartrazine (E102) and Ponceau (E124)
b) Preservatives, such as sodium benzoate.
5) Elimination diets
Elimination diets should only be used under the supervision of a clinical dietician to prevent your child from developing nutrient deficiencies and for the purpose of determining if your child’s condition deteriorates when he eats foods containing certain colouring agents, flavourings and/or preservatives.
If your child has been on a supervised elimination diet and you have been able to identify a specific additive and/or sugar as a trigger of hyperactive behaviour, then the relevant foods should be avoided.
6) Sugar
Regarded for many years as the prime food trigger of hyperactivity, sugar has to a great extent been exonerated by well-controlled clinical studies. It is often the additives in foods with a high sugar content (e.g. colourants in cold drinks) that cause the reaction and not sugar per se.
There are also indications that high-carbohydrate diets, which include some table sugar, are beneficial to ADHD children. Carbohydrates are a good source of energy that meet the increased needs of ADHD children and high-carbohydrate diets help to increase levels of serotonin, a brain chemical believed to play a crucial role in ADHD.
7) Eating habits
ADHD children often develop aversions to or cravings for certain foods. They also tend to have a great need for liquids and may drink litres of water every day.
The most important thing to remember is that meals should never, ever be turned into a battle field. If your ADHD child won’t eat peas and insists on having five slices of bread with every meal and drinks water all day long, don’t make an issue out of this.
Accept that there will be certain foods that your child will not eat and only if the child avoids a vital food component such as milk, do you need to make contingency plans (provide another source of calcium such as yoghurt or cheese, or use a calcium supplement to ensure that the child gets the calcium he requires for rapid growth of bones and teeth).
8) The role of medication
There is probably no more emotive subject in the treatment of ADHD than the use of medications such as Ritalin. Volumes have been written about its dangers and ill effects.
The decision to use, or not use, Ritalin for the treatment of a child with ADHD should be left to an expert (a child psychiatrist). It is important that the child psychiatrist monitors your child’s growth when he is taking Ritalin, as the drug can depress the appetite and cause growth retardation.
If such growth failure occurs, consult the child psychiatrist who may suggest reducing the dose, discontinuing treatment, or substituting with another medication.
9) The role of exercise
Exercise is one of the most therapeutic things you, your ADHD child, and the rest of the family can do.
Regular exercise uses up some of the excess ADHD energy your child is bubbling over with, improves muscle and eye coordination, keeps the body healthy, prevents depression, and helps the child to relax.
Parents also benefit enormously from regular exercise which promotes relaxation, combats depression, and increases vitality, thus making you more fit to handle the physical, mental and emotional demands of your child. Let the whole family join a gym or a Walk/Run for Life club.
Text copyright: Dr I.V. van Heerden, D.Sc.
3 December 2007
Reference:
(McCann D et al (2007). Food additives & hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet, 370(9598): 1560-7)
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