Managing ADHD: Goodbye Additives, Hello Routine

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Managing ADHD: Goodbye Additives, Hello Routine

When Matthew Grover was five years old, his parents took him to see a psychiatrist. His teachers had complained about his behavior at school, where he was extremely rambunctious, acted out, and often seemed to be in his own world.

After three years of talk therapy, Matthew was finally given a diagnosis: Attention Deficit Hyperactivity Disorder (ADHD).

Like many children with ADHD—a developmental disorder characterized by inattention, hyperactivity, and impulsivity—Matthew was prescribed stimulants, the most widely accepted treatment for ADHD. But as the age of diagnosis and treatment gets closer to the preschool years, many researchers, parents, and physicians, are concerned. In addition to misuse and over prescription, stimulants have the potential to stunt growth in this young population. Parents are looking for an alternative to medication. But is there one?

The problem with answering this question has to do with the fact that the exact cause of ADHD is unknown.

Though genetics play a large role, the impact of environmental factors has remained inconclusive. Removing suspect nutritional offenders—like sugar and other carbohydrates—has been a popular, but largely unproven, way to try to abate ADHD symptoms. However, a recent study conducted by Britain’s Food Standards Agency and published in the medical journal, The Lancet, found that it is not sugary foods, but the common food colorings and preservatives that are often added to them, that were responsible for hyperactivity in a sample of three-year-olds and eight and nine-year-olds.

The researchers gave one set of children a drink containing a preservative, sodium benzoate, and common food colorings (typical examples of similar drinks are sodas or juice “drinks” that are not 100 percent juice). Another set of kids received a drink that looked and tasted the same, but did not have artificial ingredients. Hyperactivity was recorded by teachers and parents. The trial was double-blind, meaning neither researchers nor parents knew which concoction the kids were given.

The study found that kids who received the artificial ingredients had higher mean levels of hyperactivity than those who received the placebo. The results support prior research on this topic and begs the question: why are these additives allowed in food in the first place?

But the picture, acknowledged by the authors in their report, is much more complex than just additives.

“Removal of these additives is not a panacea for ADHD. We recognize that hyperactivity is a behavior influenced by a wide range of experiential and biological factors.”

One of the biological factors is genetics, which is thought to be a major factor in the development of ADHD. Although the study implicated, quite convincingly, that additives contribute to hyperactivity, it also showed that not all children respond to additives in the same way.

A histamine genetic polymorphism (polymorphisms are differences in DNA sequences that give rise to different forms of a gene) may lead to differential sensitivity to artificial colors. Just as some people are more sensitive to alcohol or caffeine, some children may be more sensitive (i.e. allergic) to the additives in foods because they have a different genetic make-up than their peers. The central histamine receptors, which are thought to play this mediating role, can affect learning, hyperactivity, and promote the release of dopamine, another neurotransmitter.

A father of three admitted recently to how “wild” his children get after eating hotdogs or sandwich meats with preservatives—more so than they do after having juice or homemade cake.  

Because there are likely many factors contributing to ADHD, the British Food Agency did not ban the substances. They did, however, advise parents to eliminate or reduce additive-rich foods from their child’s diet when possible. (And, the United Kingdom is quite strict generally, so foods with additives and preservatives are labeled as such.)

Different Approaches

Perhaps the best way to see if your child is additive-sensitive is to restrict additives and preservatives from your child’s diet and monitor how your child responds. A well-researched approach to treat ADHD children is behavioral therapy. It has generally been used as an augment to pharmaceutical treatment, not as a main form of treatment. However, a recent study of preschoolers indicates that it could be used for more than that.

The study, conducted at LeHigh University, focuses on a range of behavioral-only therapies for preschooler children diagnosed with severe ADHD. The results of the study found that aggression and other problem behaviors decreased by almost 30 percent when rules and routines were stressed.

Parents and teachers were also taught to praise kids for good behavior and for following those rules and routines, rather than punish for acting out.

This reinforces the message on the National Institute of Mental Health’s Web site that notes ADHD children need help organizing their day and activities and respond to positive reinforcement of good behavior.

Some simple tips they recommend are following a set schedule everyday by setting aside an allotted time for every activity; organizing needed items like clothing, school work and playthings; and using notebook organizers to keep track of school assignments. 

Though dietary and behavioral interventions may work for some—and are definitely worth pursuing—some children may also need medication. Matthew, who is now twenty-four, feels that his behavior as a child was something he “couldn’t control.”  Although he has never tried to alter his diet, he did try structured learning. It helped, but not as much as his medication. After years of trial and error, he seems to have found a drug that helps him at work and at home. When he doesn’t take it, he is unable to pay attention, obnoxious, and bounces around the house. I asked him if he thought he would be on medication for the foreseeable future.

“If I want to keep my girlfriend, definitely.”