ADHD and Your Child

Q: I have been led to believe that sensitivities to wheat, dairy and sugar can present as ADHD symptoms, and that doctors typically do not rule out food sensitivities before diagnosing ADHD. Should food sensitivities be ruled out before making an ADHD diagnosis?

A: Current research does not support the definitive statement that sensitivities to food or additives are linked to any of the three subtypes of attention deficit disorder—predominately inattentive, predominately hyperactive and impulsive, and a combination of the two. However, every child is different and many factors are intertwined when it comes to behavioral issues. In fact, a few studies have shown that elimination diets such as the Feingold approach have helped a small percentage of children improve their behavioral patterns. In this regard, any evaluation would need to rule out dietary factors as a potential cause for your child’s behavioral issues before a diagnosis of ADHD is considered.

The diet dilemma

In regards to diet, food sensitivities or poor nutritional choices could certainly add to behavioral or physical issues. For example, a child who is hungry, in distress from an intolerance to milk or milk products, or experiencing an energy drain from a diet loaded with simple carbohydrates (cakes, cookies, soda and the like) would be more likely to act out, have trouble concentrating or remain calm. That said, I often ask a parent to keep a diary of all the foods, drinks and snacks their child has had, as well as their behavioral patterns (impulsive, does not listen, forgetful, excessive talking, fidgety, etc.) for at least two weeks prior to their visit. Then, if a pattern is observed, further evaluation by a registered dietitian and/or pediatric gastroenterologist may provide important information as to the cause and effect of dietary ingredients on their behavioral health.

The evaluation process

Establishing a diagnosis of ADHD is not a simple process. It involves the observations of parents, siblings and teachers, as well as any other person (babysitter, relative, etc.) who spends time with your child in different situations (school, work, play, social activities). Additionally, evaluations by physicians, teachers, psychologists and/or child psychiatrists, and school counselors are included in the team approach for the diagnostic work-up of ADHD. Specific information they consider includes but is not limited to:

• Psychological testing
• Parent and child interviews
• Parent questionnaires
• Neurologic and developmental screening
• Child behavior rating scales as assessed by parents and teachers
• Testing for learning disabilities (dyslexia, others)
• Intelligence testing

But that’s not all. It is also important to search for other health (hypothyroidism, allergies, nutritional deficiencies, others), sensory (hearing, speech, vision, etc.) or behavioral (anxiety, depression, bipolar) concerns that may be contributing to the issues at hand. Needless to say, many other causes must be eliminated, or at least considered as additional health concerns, before arriving at a diagnosis of ADHD.

For further information, visit Children and Adults with Attention Deficit/Hyperactivity Disorder (www.chadd.org) as well as the American Academy of Pediatrics (www.aap.org) and the American Dietetic Association (www.eatright.org)

More Advice From Dr. Rob:

• Treating ADHD Without Medication
• A Natural Approach to Gaining Better Focus
• Can Hypnosis Relieve Depression?
• Do the Kittens Have to Go?

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)