October is ADHD awareness month. If you have a child with ADHD you may have heard all sorts of things about the role of diet in ADHD and it can be really difficult to separate the fact from the fiction. In this post I present some facts, bust some myths and give you five things you need to know about ADHD and diet.
One: Distractibility and faddy eating are real problems
ADHD is a condition that is characterised by “distractibility.” This means that your child will be very easily distracted from activities and that includes eating and drinking. The aim is to get your child to a place when they can eat meals at the table with the family and eventually even eat out at a restaurant. This can be a huge mission for some children and getting to this point can take years. If you have other children particularly if they also have ADHD then you may have to take a very gradual approach to achieving this goal. Every case is different but the key is not to create a battle-ground over food. Rewards are positive and need to be sensible and unrelated to food. Sanctions often don’t work especially if your child has genuine anxieties around food, which can make them extremely faddy as well as distractible. This is important because 30% of children with ADHD have a co-existing anxiety disorder, which should be treated by a psychiatrist and psychologist working together with your Dietitian. Whatever you do never withhold food as a sanction. Simply hoping that they will eat once they are hungry enough is not an effective strategy and will just raise tensions and leave your child with inadequate nutrition.
You are almost certainly going to need some specialist advice and support but you can make a start by arranging meal times with at least one calm and supportive adult and your ADHD child. Observe your child carefully and see what conditions help them to be most calm, then alter the environment accordingly. This is going to look totally different from one child to the next. If things are really tough see if your child can eat one meal a week at the table with one supportive adult and work from there. Do not compare your family with other families. You are facing real and specific challenges and you are going to be on a long journey. This is quite understandable and neither you nor the child is to blame
Two: There’s a lot of hype around sugar
Despite the hype, if you pardon the pun, there is no robust research evidence to show that sugar causes hyperactivity in the general population or in children with ADHD. The research actually shows that parents who were told their child had been given sugar believed that they saw more behavioural problems whether or not their child had actually been given sugar. This indicates that it might be such an accepted myth that we actually see things that are not really there.
However we know that most children have more sugar than is good for their health. We also know that over-eating and gaining too much weight can be a problem in ADHD and consuming too much sugar is a big contributor to excess calories. Children should have no more than 6 tsp added or free sugar daily. Download the food smart app and check out how much your child is having.
You will probably find it’s way above this figure. Cutting back will reduce your child’s risk over their lifetime of dental decay, obesity, heart disease, diabetes, cancer and stroke.
Three: Growth must be monitored and supported
If you have chosen to use the drug methylphenidate (Ritalin) as part of your child’s ADHD treatment plan then you may find that they don’t quite have the appetite for food that they used to have. This is a very common side effect but it can be quite easily managed with a bit of planning. Help your child to eat small amounts regularly and make sure that they have a good meal before they take their medication and a good meal in the evening after it has worn off. During the rest of the day make sure they are well supplied with small healthy snacks so that they can keep their blood sugars and brain chemicals stable even if they don’t feel like sitting down to a full meal. Your Dietitian will be able to make suggestions tailored to your child’s needs and likes.
Four: Sensitivity to additives varies
Some artificial food colourings such as tartrazine (E102) and preservatives such as sodium benzoate have been linked with hyperactivity. However the research does not show that these additives cause ADHD or that all children with ADHD should avoid them. So if you think your child does react start to keep a food diary and check food labels to see if you can make any links. There are several additives that can cause problems so if you think this might be an issue for your child, consult your Dietitian
Five: Supplements are not routinely required
There is evidence to show that some children with ADHD have lower blood levels of iron, zinc and magnesium than other children. However this does not mean that these low levels are a cause of ADHD or that they exacerbate ADHD. In any case these low levels are not present for all children with ADHD. There is no evidence to support supplementing your child’s diet with these minerals. However it is important to make sure that their diet contains good sources. A healthy balanced diet including meat, fish, eggs, dairy products, pulse vegetables, nuts (take care with young children who may choke) and seeds is all that is needed. If your child is following a vegetarian or vegan diet do get some advice from your Dietitian.
Some children with ADHD also have low blood levels of omega 3 fatty acids. Again we don’t really know why this is and there is no evidence to suggest that all children with ADHD should take supplements. However omega 3 fats are important for all of us so it’s a good idea to make sure your child has a good intake. ALA or (alpha-linolenic acid) is a type of omega 3 fat found in vegetable oils, seeds such as chia seeds and linseed (flaxseed), nuts such as walnuts, pecans and hazelnuts and green leafy vegetables. It cannot be made in the body and must be obtained from the diet. There is less evidence that ALA is protective in relation to our health than there is for the omega 3 fats found in oily fish. These “fishy” omega 3’s are called EPA (eicosapentanoic acid ) and DHA (docosahexanoic acid.) Although our bodies can make EPA and DHA from ALA, the conversion rate is slow and only small amounts of EPA and DHA are made. It is therefore recommended that we include sources of EPA and DHA in other words oily fish, in the diet. In practical terms this means including fish like salmon, fresh tuna, mackerel and sardines. Don’t be put off by scare stories about dangerous contaminants in oily fish. Just stick to 2 portions a week. Lots of kids are a bit resistant to eating these fish but there are lots of great recipes around designed to appeal to children. The BBC Good Food website has a page dedicated to child-friendly fish recipes.
ADHD presents along a spectrum and some cases need specialist multidisciplinary support around food. Others just need a clear and practical plan from a Dietitian. If you would like to find a suitable treatment package to help your child with ADHD eat better then please do make an enquiry. I can carry out an assessment, help you make a plan and support you to access the help you need from other healthcare professionals as required.