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 The inconclusive nature of the results of many studies related to this question has led many to dismiss the connection between ADHD and food additives.  But recently the issue is being looked at again by the medical community.  In 2008 Pediatrics professor Andrew Kemp of the University of Sydney called for the removal of food additives as standard treatment for kids with ADHD.   He explains that of the 22 studies performed between 1975 and 1994 sixteen found that dietary modifications had a positive impact on children with ADHD.  He claims that eliminating food additives is a relatively harmless intervention and in light of the large number of kids on drugs for hyperactivity it would be wise to institute it as standard procedure for treatment for ADHD.  He cites a recent study that shows an increased hyperactivity in children without ADHD who were fed foods high in food colorings and sodium benzoate to support his claim.  In February of 2008 the editors of the American Academy of Pediatrics publication AAP Grand Rounds cited the same study as Kemp and stated “the overall findings of the study are clear and require that even we skeptics, who have long doubted parental claims of the effects of various foods on the behavior of their children, admit we might have been wrong.”

 The European Union has agreed to place warning labels on foods containing six artificial colors that appeared in the The Lancet study which are: Yellow no. 5 Tartrazine, yellow no. 10 quinoline yellow ( not approved in the U.S.), Yellow no. 6 sunset yellow, red no. 3 carmoisine ( not approved in the U.S)., Red no. 7 ponceau 4R ( not approved in the U.S.), and red no. 40 allura red.  Sodium Bezoate is a food preservative that can be found in fruit juices, carbonated beverages, and pickles. 

 While the U.S. is lagging behind the European Union in terms of enacting laws requiring warning labels,Marylandis poised to become the first state to do so.  Two bills have been introduced into theMarylandStatelegislature and are awaiting confirmation.  Hopefully by 2012 the following warning will appear on foods containing certain food dyes:

“The color additives in this food may cause hyperactivity and behavior problems in some children.”

 References

Boyles, Salynn “Experts Revisit Food Additives and ADHD” WebMD.com. 24 Jan, 2011. www.webmd.com/add-adhd/news/20080522/experts-revisit-food-additives-adhd

 Gardner, Amanda. “9 Food Additives That may Affect ADHD” msn.com. 24 Jan. 2011. health.msn.com/health-topics/adhd/articlepage.aspx?cp-documentid=100268324

Shapley, Dan. “State May Ban Food Additives Linked to ADHD”

The Daily Green.com. 24 Jan 2011. www.thedailygreen.com/healthy-eating/eat-safe/food-colorings-47020907

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A good first step is to find out if your child with ADD is allergic or sensitive to any foods. While you can use blood tests and skin testing to determine this, you can also use an elimination diet to pinpoint trouble spots in the diet. There are a number of ways to do an elimination diet. One simple one is to begin by eliminating all foods with additives, dairy products, fruit juice, artificial sweeteners, processed meat, wheat, chocolate, and sugar. For two weeks, your child’s diet should consist of vegetables, fruit, and meat. After two weeks, try adding back one food at a time. If there is a reaction that you notice in terms of behavior, rashes, runny nose, it may indicate a problem with this food. Stop the food immediately, wait a couple of days, and add another food.

Once you find out what not to eat, you can look at what to eat. Researchers have found that diets high in protein are excellent for children with ADD. A general rule is to serve 70 percent protein and 30 percent carbohydrates for breakfast. Stick to about 50 percent protein and 50 percent carbohydrates for the other meals.

Omega-3 fatty acids are dietary essentials for everyone, but are especially important for children with ADD, as they are critical in brain function and development. Dr. Alexandra J. Richardson, in an article in Psychiatry says, “Increasing evidence suggests that a relative lack of omega-3 may -contribute to many psychiatric and neuro-developmental disorders.” Eating more flaxseed, sardines, and walnuts can help increase Omega-3 in the diet. You might also want to consider supplements of Omega-3.

Other tips for using an ADHD diet include things that are good advice for anyone’s diet. Drinking lots of water is important, as water acts as a purifier in the body. Additionally, eating lots of vegetables and fruit provides necessary vitamins and minerals.

To end with another substance to avoid, many doctors agree that it is best to avoid food additives. Children with ADHD often are very sensitive, and these chemical substances may contribute to distractibility and activity.

Mom’s Take:

Until I kept a food diary and wrote down what my daughter with ADD was actually eating, I didn’t realize how little protein she was getting. She disliked many foods, and she was filling up on a lot of carbohydrates. Since she doesn’t like meat or cheese very much, we decided to use a protein supplement. I make her a milk shake with protein powder every morning. She drinks that along with her scrambled eggs. I’ve noticed an improvement in her ability to get ready and get out to the bus in the morning.

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But if you don’t feel like printing out a three page article and dragging it to your doctor’s office we’ve come up with our own shorter version of 10 questions for you to print out and take with you to that all important second visit the doctor (the one where you actually come prepared):

1.   What causes ADHD?
2.   How is it diagnosed?
3.  What exactly is the difference between a high-energy kid and a child with ADHD?
4.   Does my child need to be treated with medication? How exactly does the medication work? What are side effects of the medication? Will he need this medication long term?
5.   Are there alternative methods of treatment?
6.   How can I explain to my son that he has ADHD?
7.   Does ADHD run in families? Should I have my other children evaluated? What about myself and my spouse?
8.   Will my child outgrow his or her ADHD?
9.   Is ADHD different in girls from boys?
10. What accommodations does his school need to make for him?

Mom’s Take:

When my child was first diagnosed with ADHD the conversation I found most enlightening was the one I had with my doctor about how to discuss the issue of ADHD with my son. I had no idea how to present the issue of ADHD to my son. I was worried about making him feel different from his friends. My doctor was a fantastic resource. He knew my son well enough to understand what my son would “get” and he told me the best way to present it to him when the time was right. Every kid is unique, but if you are concerned about how to present the issue of ADHD to your child your doctor might have some very helpful advice.

References

Baruchin, Aliyah “What to ask about ADHD” The New York Times. March 13, 2008

“10 Questions to Ask Your Doctor” Webmd.com. June 15, 2009

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Experts in Attention Deficit Hyperactivity Disorder do know that ADHD tends to run in families, so there is a genetic factor involved in the disorder. Close family members of people with ADHD have a much higher chance of developing ADHD, and some of the associated disorders including depression, learning disabilities, and anxiety. Siblings and identical twins, especially, have a high chance of sharing a sibling’s ADHD. Researchers continue to explore specific genes and how they might make a person more susceptible to ADHD.  Generally, researchers believe that the genes that control some chemicals in the brain are different in children with Attention Deficit Hyperactivity Disorder.

In some people, ADHD results from head trauma and brain injury. This may be because the neurotransmitters are damaged in a similar way that they are damaged by a defective gene. Being exposed to some prenatal assaults, such as drugs and cigarette smoke, as well as premature delivery, can increase the incidence of ADHD. Some environmental toxins may also contribute to developing ADHD. These toxins include exposure to lead and PCBs. These toxins may interfere with the development of the brain, and this may predispose a person to ADHD.

Some disorders, including epilepsy and craniosynostosis, are comorbid (exist along with) ADHD. Other comorbid disorders are learning disabilities and conduct disorder.

Some researchers believe that food and nutrition may play a role in developing ADHD. Some researchers believe that food additives may make ADHD symptoms worse. Others believe that a lack of certain fats, including omega-3, may be linked to ADHD.

So there are many factors that may cause ADHD or make ADHD symptoms worse. Researchers actually know more about what  ARE NOT ADHD  causes. ADHD is not caused by laziness, poor parenting, too much sugar, watching too much tv, or bad schools.

Mom’s Take:

This is reassuring. When my daughter was first diagnosed, I drove myself (and everyone around me) a little crazy trying to figure out why this had happened. What were her causes of ADHD? Where had these ADHD symptoms came from? I remembered that I had gotten an ear infection during the pregnancy and had taken antibiotics. Was that it? I thought about the awful preschool she was in for a couple of months. Could this be the reason? On and on…

Resources: Mayo Clinic, WebMD

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While this list is not exhaustive, here are some common myths about ADHD:

1. ADHD is not a medical problem
2. Bad parenting causes ADHD
3. ADHD is much more common in boys than girls
4. ADHD is over-diagnosed
5. People with ADHD are just lazy or developmentally delayed
6. An ADHD diagnosis can be confirmed if stimulant medication is effective
7. Children diagnosed with ADHD will outgrow the disorder
8. Children treated with ADHD medications will abuse drugs when they get older
9. Only children who are hyperactive have ADHD
10. ADHD medication cures ADHD

ADHD is not a medical problem.

ADHD is a legitimate medical diagnosis. The American Psychiatric Society labels Attention Deficit Hyperactivity Disorder (or Attention Deficit Disorder) a medical disorder, as does the US Department of Education and the National Institutes of Health.  A great deal of research has been conducted, and the conclusion is that ADHD results from problems with the neurotransmitters in the brain. This results in behavioral changes, including impulsivity, attention issues, and sometimes in hyperactivity.

Bad parenting causes ADHD

Children with Attention Deficit Hyperactivity Disorder have biological problems making it difficult to control impulses and behavior. Diligent parents may have tried to teach their children to behave, but the brain chemistry is always working against them. It is easy to label children with ADHD as “brats” or “undisciplined,” but the facts are that the changes in their brain are to blame—not the parents.

ADHD is much more common in boys than girls

Because of this myth, it is true that more boys are diagnosed with ADHD than are girls, but there is no evidence that girls are not just as susceptible to the disorder as are boys.

ADHD is over-diagnosed

About 3% to 7% of school-age children in the U.S. have an ADHD diagnosis. Because there is no one test that conclusively diagnoses ADHD, there may be cases of misdiagnosis, but some experts believe that it is more likely that the disorder is under-diagnosed. This is particularly true in the case of girls. Unfortunately, many children go untreated.

People with ADHD are just lazy or developmentally delayed

A person’s intellectual ability is totally unrelated to ADHD. While people who are developmentally delayed can have ADHD, many extremely intelligent people also have the disorder. Untreated ADHD can lead to problems with schoolwork, but, again, this is not because of intellectual abilities.

An ADHD diagnosis can be confirmed if stimulant medication is effective

Some people think that giving stimulant medications, such as Ritalin, can be used as a test to confirm an ADHD diagnosis. However, even children without the disorder can respond to these medications and exhibit behavior changes. A trial of medicine alone is not recommended as a way to diagnose ADHD.

Children diagnosed with ADHD will outgrow the disorder

The vast majority of people an ADHD diagnosis as children continue to have the disorder as teenagers and as adults. Unfortunately, most adults with ADHD do not get a diagnosis and, therefore, do not get treatment. These undiagnosed people are prone to anxiety, depression, and substance abuse.

The good news is that if a child is diagnosed early, he or she can learn coping mechanisms, get support, and find the right medication, if necessary, to develop into highly productive adults.

Children treated with ADHD medications will abuse drugs when they get older

Untreated ADHD is actually more likely to lead to substance abuse. If children get the support they need, in the form of behavior therapy, medication, and parental understanding, the risk of drug and alcohol abuse is reduced.

Only children who are hyperactive have ADHD

While many children with Attention Deficit Hyperactivity Disorder do exhibit hyperactivity, not all do. ADHD is now used to refer both the ADHD and ADD (Attention Deficit Disorder). Some children fall into a category of hyperactivity and impulsivity; some children only exhibit the inattention part of the disorder; and still others exhibit both

ADHD medications cure ADHD

ADHD medications don’t cure the ADHD, but they can be very effective at treating some of the symptoms of the disorder.

While psycho-stimulant medication can help many children with ADHD to be less hyperactive and more focused, medication should be just part of the treatment plan. Other parts of the plan may include psychotherapy and behavior modification therapy.

Mom’s Take:

I guess it makes sense that the myth that hurts the most is number 2, that bad parenting is at fault. I even believed that myself in the beginning. I’d be at the playground with my daughter, and the other mothers were sitting and chatting while their kids played together. I never got to sit down because of the constant barrage of trouble my daughter was causing. She took someone’s toy, she pulled another’s hair, she ran out of the fenced area around the playground and into the street, she screamed for no apparent reason—I could go on. And I saw the way the other mothers looked at me. I felt that I was inadequate to handle my own child and that they knew it. That, of course, was before we got help, but I still hate to think of those days.

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1. Kitchen timer: a timer is  an important tool to have if you are about to embark on a project.  The Invisible Clock is a more sophisticated version of the timer.  This can be worn on your belt and vibrate. It can be set to go off at various intervals (if you want it to go off at a few different points during a meeting for example).
2.  Daily Planner:  A daily planner is essential to record what you intend to carry out on a given day.  It allows you to jot down phone numbers, appointments, meetings and any other important pieces of information you might need to remember.
3.  ADD Planner: If you are still having a hard time getting things done you might need some planning software. The software will generate reminders for you for those all-important meetings, and it will break down overwhelming tasks like “paying taxes”  into more feasible ones like  “find documents, collect receipts, fill out forms.. .”
4.  Keyless locks: If you tend  lose your keys often, install locks that substitute numerical codes for keys.  The cost is around $300.
5. Keyfinder: Not just for keys! You can attach the electronic fob to anything you tend to lose – the TV remote, your glasses, the telephone – and wallah! An Everything Finder.
6.  Intelligent watch: A water resistant watch that set alarms for 15-30 minute intervals with vibrating alarms.  Some of these models are programmable and can store hundreds of phone numbers and appointments.

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If your house is anything like mine a good night’s  sleep is  often elusive.  It’s not just my energetic son, who somehow never seems to tire, that could use a few more hours sleep a night.  It’s also his exhausted parents who get even less sleep than he does.  His bedtime battles, nighttime awakenings, and morning sleep-ins are enough to make any parent want to throw in the towel.  But we are clearly not alone.  Research has shown that 20% of children with ADHD have trouble falling asleep.  That is three times the rate of children without ADHD.  But that is not the most bothersome statistic.  According to a study from England involving 100 parents of children with ADHD, 57% receive less than six hours of sleep and 27% get less than five hours.  More than half of those said children get up more than four times during the night and 42% of them wake up before 6:00 AM.  Lack of sleep is clearly an international phenomenon when it comes to kids with ADHD and their parents.  It’s no mystery that sleep is so evasive to our children.  Many of the same regions of the brain that control attention also regulate sleep.    So how do we help our children get the shut-eye that we all so desperately crave?  As a desperately exhausted parent I have done my research and I am proud to say that I have made some substantial changes to my son’s bedtime routines that have made a big impact on our nighttime schedule.  Here are some things that I have learned:

1.  Your child’s day should be full of exercise which helps the body make the transition between phases of sleep and places physical stress on the body which will ultimately increase the amount of time the body will spend in the deep sleep phase.
2. Try to avoid sugary snacks before bedtime.  A pre-bedtime snack should consist of warm milk and some saltines, or perhaps some turkey  which contains the natural sleep-inducing chemical tryptophan.
3.  It’s important to point out that most sleeping pills have not been adequately tested for their safety and effectiveness in children.  This is true of both over the counter drugs like melatonin as well as prescription drugs.  Medications should only be used after careful consultation with your pediatrician.
4.  Bedtime routines allow fearful children to feel secure and signal the brain to slow down.  Read a bedtime story or allow an older child to read in bed.  Give younger children and blanket or a doll to cuddle with.
5. There are relaxation techniques that you can do to help your child fall asleep.  You can give her a foot rub by making a fist with your hand, having her lie on her back and rubbing her foot gently up and down.  Deep breathing exercises are great relaxation techniques.  Have your child picture an elevator going up and down as he inhales and exhales.
6.  6.The hour prior to bedtime should be devoted to relaxing things like reading and listening to music as opposed to playing video games or even pillow fights.
7.  The bedroom should be completely dark.  All visual distractions should be eliminated.  If your child is fearful of  the dark a dim nightlight should be used.
8.  Background music or white noise is sometimes helpful in quieting down the mind and drifting one off to sleep…

Mom’s Take:

Bedtime doesn’t have mean battle time in your home anymore. If done right it could actually turn into one of your favorite times of the day.  It just has to be eased into and planned well.  Things need to start quieting down an hour prior to bedtime.  That’s when televisions and computers screens need to be shut down for the night.  You might encounter resistance to that idea at first, but it’s well worth the battle.  Bedtime has become so much easier since we have instituted some of the above ideas.  My son has started  falling asleep faster and he’s even managed to sleep through the night.  Now if only I could learn how to do the same…

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 Studies have shown that both children and adults with ADHD have exhibited inconsistent working memories.  Working memory is the ability to hold onto information long enough to be able to accomplish a certain goal.  A recent study published in the journal Child Neuropsychology compared 25 children with ADHD to 24 of their peers without ADHD.  The children were given computer based arithmetic problems and asked to solve them without the use of a pencil and paper.  Then they were asked if a given sum was correct or not.  While the answers of the children with ADHD were just as accurate as the ones without ADHD, the response times were not as consistent.  Many of the children with ADHD took longer to respond.  According to Dr. Julie Schweitzer, associate professor of the M.I.N.D. Institute  and Department of Psychiatry and Behavioral Sciences, University of California-Davis (the author of this study),  this study shows why “working memory may be fine at one moment and poor at another, just as one day a child with ADHD seems to be able to learn and focus in class and on another day seems distracted and not pay attention.”

 The study simply confirms what many parents and ADHD sufferers have experienced daily.  Struggling with your child to study for a test, or complete a homework assignment can be incredibly frustrating.  Fighting to hold down a job of your own can be depressing and often self defeating.   But there is help.  There are games for children and high tech tools for both kids and adults that can dramatically improve working memory and concentration skills for the ADHD population.

1. I read about this game in an article by Dr, Robert Myers, a child psychologist.  He suggested you collect a pile of assorted coins and a cardboard sheet to cover them.  Next choose a sequence of five coins (2 dimes, 2 pennies, 1 nickel, for example) and set them up.  Ask your child to study the sequence and then cover them up with the cardboard.  Ask your child to use the coins in the pile to make the same pattern that he just saw.  Time him with a stop watch. When he is done remove the cardboard to see if he is correct.  If not, have him keep trying until he gets it right.  You can increase the difficulty of the sequences as you go along and watch your child’s memory and concentration improve.
2. The computer offers a wide variety of memory games for kids.  The website Lumosity.com offers adolescents and adults a good brain workout.
3. If you are looking for a high tech approach Play Attention http://www.playattention.com/ is a fantastic option.  Play Attention uses a helmet that reads your brain signals to indicate if you are focusing.  If you are not properly focusing, the game shuts off.  This teaches a child what it means to focus.  Ultimately the games trains your brain to concentrate better and helps to improve your memory skills. When you go to the website click on “ADHD” and listen to “Brody’s story”.  Brody’s mother describes Play Attention very well and she is someone with whom we can all relate.  Play Attention is meant for both children and adults as well.
4. Cogmed Memory Training is another excellent option that has attained proven results.  It is a program that is down-loaded onto your home computer where your child plays video games that work to improve his memory.  The games grow increasingly more difficult as his memory improves and at the end of each week a trainer calls to speak to the parents, answer questions, and encourage the child.  The training lasts five weeks.  It has been shown to improve 75%-80% of the kids treated and MRIs that have been performed have shown changes in the pre-frontal and parietal regions of the brains of the children who underwent the program.  After six months and one year 80% of these children maintained their improved status.  Clearly this program works.  Cogmed is a program that is geared for people of all  ages. The costs range from $1500 to $2000.

Mom’s Take:

One of our favorite memory games is Simon.  Simon is like Monopoly and Life – it’s one of those games that will always be around.  I still remember playing it when I was a child.  Only now if you don’t own it, you can play it for free on your home computer.  Just go to http://www.netrover.com/~crose/memory/memory2.htm and start sharpening your own memory.  Challenge your child  to a few rounds.  Some games just never grow old.

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