Many people look toward alternative or even non-conventional approaches to treating symptoms of attention deficit/hyperactivity disorder (ADHD). Although medication (when appropriate) combined with behavioral modification can have a major impact in improving symptoms, often parents of children with ADHD experience some feelings of resistance in regards to medication.
Medication is never the first treatment intervention, but is introduced into the treatment plan after other interventions have been implemented yet not affected enough change. Any treatment approach for ADHD should be multifaceted and may include medication (when appropriate) combined with education for the child and parent about ADHD, behavior modifications and management techniques, and educational management.
In addition, parents often consider dietary changes for their child in hopes that these adjustments will reduce problematic behaviors. Sometimes there are concerns that a child is not getting enough proper nutrients in his or her daily diet. Other times there may be concerns that certain substances in the child’s diet are causing impairments characteristic of ADHD in children.
The Feingold Diet
Benjamin Feingold, MD (1899 – 1982) was a pediatrician and allergist who proposed that much of the hyperactivity and learning problems seen in school-aged children was triggered by synthetic additives in a child’s diet, as well as by substances called salicylates which are naturally present in many fruits and vegetables.
While serving as Chief Emeritus of the Department of Allergy at the Kaiser Permanente Foundation Hospital and Medical Group in San Francisco, Dr. Feingold devised a diet free of food containing natural salicylates and all artificial food colors and flavors. He called his diet the “Kaiser Permanente diet” or “K-P diet.” Later he also added the elimination of the preservatives, butylated hydroxytoluene (BHT) and butylated hydroxyanisole (BHA), which he claimed also triggered hyperactive behavior. Eventually, his diet was renamed the "Feingold Diet."
In 1975, Feingold published a best-selling book for parents, Why Your Child is Hyperactive (Random House). In the book Dr. Feingold linked diet and behavior and promoted the belief that many children develop ADHD as a reaction to food additives. He theorized that hyperactivity could be prevented by adopting a diet free of food additives.
While the prospect of dietary treatment for hyperactivity was very appealing, Dr. Feingold’s proposition that ADHD could be caused by one’s diet has received much criticism. Many of his claims were based on anecdotal accounts rather than on conclusive scientific evidence.
The Feingold Diet Plan for ADHD
The Feingold Diet for ADHD is based on Dr. Feingold’s premise that hypersensitivity or intolerance to certain types of foods and food additives can trigger or exacerbate ADHD-like behaviors. Stage One of the diet plan involves eliminating artificial food colors, artificial flavors, three preservatives (BHA, BHT, TBHQ), and certain salicylates from a child’s diet and assessing symptom improvement. If improvements on target symptoms are noted, the diet is continued as part of a child’s treatment.
After observing a favorable response to Stage One, salicylates may be reintroduced and tested for tolerance. Common salicylate-containing foods include citrus fruits, peanuts, beans, peas. This Stage Two of the Feingold Diet allows parents to gradually expand their child’s food choices by reintroducing salicylate-containing foods, one at a time, back into their child’s diet. Symptoms are evaluated with each addition in order to assess whether any of the problematic behaviors return. Through this trial and error process parents can rule out or identify sensitivity to additives and salicylates.
Is the Feingold Diet an Effective Treatment Approach for ADHD?
According to the American Academy of Pediatrics, elimination diets such as the Feingold Diet are more likely to affect behavioral improvement in children who have inhaled and food allergies, a family history of migraines, and food reactivity. Younger children seem to be the most responsive. Research has shown a link between sensitizing foods (including whole foods like milk, nuts, wheat, fish, and soy in addition to additives) and some health and behavior problems in a small percentage of children with ADHD. In addition, the behavioral modification techniques that parents use to effectively restrict a child's diet are generally the same as interventions that help modify behavior in children with ADHD — possibly also resulting in the effectiveness of this approach.
Good nutrition is important for all children. A healthy, well-balanced diet with few processed foods -- while not a specific treatment for ADHD -- is certainly a sensible health measure. Elimination diets can consume parental time, money, and effort for intensive management. Of greater concern, however, is that such diets may distract or delay from engaging in treatments for ADHD with documented efficacy.
If you are concerned that your child may have a food or additive sensitivity, work with a physician or certified dietitian to develop and implement a healthy, safe diet plan with clear, countable targets identified to assess symptom change. Elimination diets should not be continued permanently if there is no improvement within two weeks. If there is benefit, foods can begin to be added back in to test for sensitivity.
If your child is on a special diet, make sure it is not replacing a more effective treatment for ADHD symptoms.
6 Things You Need to Know If Your Child Has ADHD
L. Eugene Arnold, MEd, MD; Elizabeth Hurt, PhD; Nicholas Lofthouse, PhD; “Attention-Deficit/Hyperactivity Disorder: Dietary and Nutritional Treatments” – Child and Adolescent Psychiatric Clinics of North America. Volume 22, Issue 3 , Pages 381-402, July 2013.
LJ Stevens; T Kuczek; JR Burgess; E Hurt; LE Arnold, Dietary Sensitivities and ADHD Symptoms: Thirty-Five Years of Research. Clin Pediatr (Phila);2011 Apr;50(4):279-93. doi: 10.1177/0009922810384728. Epub 2010 Dec 2.
Feingold Association of America, “Behavior, Learning and Math: The Dietary Connection” – Edited by: Shula Edelkind 2007.
American Academy of Pediatrics, ADHD: What Every Parent Need to Know – 2011.