Attention Deficit Disorder

Does Food Change Behavior?
Charles R. Attwood, M.D., F.A.A.P.

rian, age 6, didn't show one moment of shyness when he and his mother entered my examining room. In fact, after 5 minutes he had already turned on the water at the lavatory, inspected the pictures on the wall, knocking several off their hooks, and had inspected the entire contents of the waste basket in the corner. His mother handed me a note from his first grade teacher. Brain, it said, distracted the whole class, couldn't stay in his seat, and behaved in a manner much like I was witnessing at that moment.

With another school year underway, many parents, like Brian's, have already been contacted by school authorities about learning difficulties their children have encountered in the classroom, or of behavior problems at school. They wonder, is it serious or is it just a phase. You may know such families, and you may want to help. Then you remember reading about a condition, which has appeared frequently in the news media in recent years known as Attention Deficit Disorder (ADD). It's a poorly understood affliction characterized by an abnormally short attention span and often, but not always, hyperactivity, when it's then called Attention Deficit Hyperactivity Disorder (ADHD). I now see more of these children in my office each day than I saw in a whole month 15 years ago. Fortunately, it can be successfully managed in most cases, but first a definite diagnosis must be made.

Where does a parent begin? Should it be ignored or should parents seek special testing and treatment? Pediatrician Mike Melancon of Lafayette, Louisiana, who specializes in the diagnosis and treatment of ADD, asked parents at a recent seminar, "Does everyone have ADD? Does anyone have it?" He admits that he still doesn't know for sure. But in my experience, it's a real entity, classically starting very early in childhood, even during infancy, and may continue throughout the teens and even into adulthood. Parents of these children often recall a very active infant and preschooler. The Parent-Teacher Questionnaire below is a sensible first step in diagnosing this disorder.

My brief test can be carried out at home by a parent and by a teacher who has observed the child regularly in a classroom. This adaptation of material first published by Dr. Keith Conners is a modification of a more comprehensive psychological test, with questions pertaining to ADD and ADHD grouped and easily arranged for a parent and a teacher to score. It's only a guideline; the child's doctor will have to make the final diagnosis.

The parent and teacher should not see the other's score before making an evaluation. Two separate test pages may be used.

Parent-Teacher Questionnaire

Each gives a score of:
0 = not at all, 1 = just a little, 2 = Pretty much, and 3 = Very much.

1. Excitable, impulsive ( ) 1. Excitable, impulsive ( )
2. Difficulty in learning ( ) 2. Difficulty in learning ( )
3. Restless, squirmy ( ) 3. Restless, squirmy ( )
4. Restless, on the go ( ) 4. Restless, on the go ( )
5. Doesn't finish things ( ) 5. Doesn't finish things ( )
6. Childish, immature ( ) 6. Childish, immature ( )
7. Short attention span ( ) 7. Short attention span ( )
8. Easily frustrated ( ) 8. Easily frustrated ( )
9. Quick mood changes ( ) 9. Disturbs other children ( )
10. Denies mistakes ( ) 10. Demands quick attention ( )
Total ( ) Total ( )
Combined total ( )

Add up the total score of the parent's questionnaire.
Add up the total score of the teacher's questionnaire.
Now add the two scores together for a Combined total.


(Scores of 15 by the parent alone or 15 by the teacher alone should be considered a possibility. Take these scores to your doctor for his opinion.)

So what causes this perplexing condition, and why are we seeing so much more of it than ever before? One of the major controversies concerning ADD today is whether or not food additives, food colorings, preservatives, sugar (sucrose), or aspartame) either cause it or make is more pronounced. A double-blind controlled study conducted by the Department of Pediatrics at Vanderbilt University, and reported in the New England Journal of Medicine (Feb. 1994), found no evidence that either sugar or aspartame affected children's behavior or cognitive function, even though the study group had been described by the parents as being sensitive to sugar.

Another 1994 study at the University of Melbourne, in Australia, reported in the Royal Journal of Pediatrics, found a strong association between hyperactivity and a synthetic food coloring (tartrazine). This double blind study also reported increasing hyperactivity throughout six increasing dose levels of the dye. On the other hand, other clinical studies have shown no relationship between ADD and sugar, food colorings, or any other food additive. Chronic lead poisoning and the fetal alcohol syndrome have been suggested as a possible cause of this disorder. However, in the great majority of my cases, this etiology has been ruled out. Whatever the cause, in my experience, the condition is more or less permanent, extending well into adulthood.

An interesting improvement of irritability and other negative mood states, including tobacco withdrawal and premenstrual syndrome, by a diet high in complex carbohydrates has been reported consistently in the medical literature. This has been related to increased serum ratios of tryptophane to other large neutral animo acids over that seen in diets high in protein. (35) (33) The possibility that inattention and hyperactivity in either children and adults may be caused or worsened by a high animal protein intake -- a characteristic of the typical American diet -- has not been adequately studied.

ADD, carefully diagnosed by professionals, seems to have the unique characteristic of sudden and dramatic improvement when treated by certain stimulant drugs, such as Ritalin, Dexadrine, and Clyert. If a medical professional wishes to treat this condition with any of these medications, the questionnaire above may be used to follow the progress of treatment, and for making adjustments in dosage. Sometimes the effect of Ritalin is incredible. I've very often seen children go from failing grades to the dean's list within a month. Ongoing counseling by a therapist familiar with the disorder seems to enhance any effects from medication. And finally, I've concluded during recent years that my patients who are on a plant-based diet rarely have severe ADD. Those who do, seem to respond more easily to treatment, whether it be Ritalin or counseling or both. I strongly feel that all four facets of treatment are important, but the dietary approach should precede the others. So once again, my Four Stages To An Ideal Diet (December issue) is a sensible first step.

(35) Christensen L; Redig C. Effect of meal composition on mood. Behav Neurosci 1993 Apr;107(2):346-53
(33) Christensen L. Effects of eating behavior on mood: a review of the literature. Int J Eat Disorder 1993 Sep;14(2):171-83

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