Nutrition Therapy for Children With Attention Deficit Hyperactivity Disorder

NUTRITION THERAPY FOR
CHILDREN WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER
Carol M. Bareuther, RD

Click here to return to the Nutrition CPE page

Marne Stollenwerk: "I am never disappointed in the Wolf Rinke CEU curricula. It is easy reading and very organizaed. Always a pleasure."

Tracy Cukierski: "Mentioned all sides of the ADHD areas (nutrition, medication, herbals etc."

Jennifer Brent: "I liked the use of a plethora of research studies being reduced to the important, concise depth that I find in other programs."

Anita M Slacanin: "Program was organized and easy to follow. Charts were especially helpful."

Forgetful in daily activities. Fidgets and squirms. Butts into conversations. These are just a few of the symptoms of children with attention deficit hyperactivity disorder (ADHD). ADHD is one of the most common neurobehavioral disorders of childhood and can persist through adolescence and into adulthood. Currently the causes are unknown. Children, and adults, with ADHD have chronic levels of inattention, impulsivity, and/or hyperactivity such that daily functioning is compromised. Since there is no tangible test for ADHD, the diagnosis is made when symptoms of the disorder are present at levels higher than expected for a person's developmental stage and interfere with the person's ability to function in different settings (e.g., in school and at home). Someone with ADHD may struggle in important areas of life, such as peer and family relationships, and school or work performance. During the past decade, prescriptions for ADHD medications have increased dramatically across the United States. Fear of side effects with these medications has led parents to experiment with diet therapy-including elimination of additives, preservatives and natural salicylates; reduction of sugar intake; manipulation of dietary intake of fats; and megavitamin therapy and herbal supplements-to control ADHD symptoms. However, current research suggests that combining medical and behavioral therapies, while providing a well-balanced diet with sufficient energy for growth, is an especially effective approach to treating this disorder's comorbidities.
Chapter I lays the groundwork for understanding how diet interacts with ADHD by discussing the evolution of the definition of ADHD and providing information about prevalence, diagnosis and etiology in the context of brain physiology.
Chapter II reviews landmark and contemporary studies concerning diet and additives, preservatives and salicylates; sugar; essential fatty acids; vitamin and mineral supplements and herbals.
Chapter III examines the role of stimulant medications in the treatment of ADHD. Food-related side effects and food-drug interactions are discussed.
Chapter IV concludes with a discussion of how multiple modes of treatment are most successful for treatment of ADHD.
This learning program is a level 2 Continuing Professional Education (CPE) program approved for 12 continuing education units (CPEUs). That means that the reader has general knowledge of literature and professional practice in the area covered. The focus of the program is to enhance knowledge and application.
To get the most benefit from this program, we suggest you adhere to the following four steps:
Step 1: Review the objectives for the learning program.
Step 2: Study each chapter. As you read, think of patients from your own practice that fit the situation described.

Step 3: Assess what you have learned by completing the self-assessment instrument at the end of this learning program.
Step 4: Compare your answers to the answer key that has been provided. If you score at least 80 percent correct, you are ready to transfer your answers to the CPE REPORTING FORM. If you scored less than 80 percent correct, re-read this learning program until you score at least 80 percent correct.

After you have successfully completed this program, mail or fax the completed CPE REPORTING FORM to:
Wolf Rinke Associates, Inc.
P.O. Box 350
Clarksville, MD 21029
Fax: (410) 531-9282

Upon receipt of your successfully completed CPE REPORTING FORM, a certificate of completion will be sent to you.

Upon completion of this accredited, self-directed, continuing professional education program, you should be able to:
" Define attention deficit hyperactivity disorder (ADHD).
" Identify symptoms of inattention, hyperactivity and impulsivity.
" Recognize the structure in the brain that is affected in ADHD.
" Relate how prenatal insults, thyroid function, genetic factors and environmental causes play a potential role in the etiology of ADHD.
" Explain the underlying rationale for the Feingold diet.
" Assess data from several studies and recognize limitations in research linking additives, preservatives and natural salicylates to symptoms in ADHD.
" Explain the rationale behind considering dietary sugars as causes of ADHD symptoms.
" Recognize four major problems inherent in researching the link between sugar intake and behavior.
" Identify foods with considerable amounts of added sugars.
" Define chronic health problems caused by excess dietary sugar intake.
" Explain the rationale behind how essential fatty acids (EFAs) interact in the etiology and symptoms of ADHD.
" Relate how zinc interacts with EFA metabolism.
" Describe the concept of "smart fats" and how dietary manipulation of fat may aid ADHD symptoms.
" Identify foods that are a good source of omega-3 fatty acids.
" Recognize how nutrient deficiencies can affect brain development and learning.
" Relate megavitamin quantities of select vitamins and minerals.
" Recognize how environmental toxins can affect brain development, learning and ADHD symptoms.
" Recognize herbs tested for usefulness in treating ADHD and evaluate studies of herbs' effectiveness.
" Describe how stimulant drugs aid in control of ADHD symptoms.
" Caution clients about the side effects of common medications used to treat ADHD.
" Instruct clients regarding food-drug interactions for common medications used to treat ADHD.
" Apply dietary methods for overcoming potential growth suppression problems in children prescribed stimulant medications.
" Apply a multimodal treatment for ADHD.

Chapter I: What is Attention Deficit Hyperactivity Disorder? 1
A. DEFINITION AND PREVALENCE 1
B. DIAGNOSIS 3
C. ETIOLOGY 9
1. Prenatal Insults 10
2. Hypothyroid Function 10
3. Genetic Factors 12
4. Environmental Causes 13
Chapter II: Diet and ADHD 15
A. ADDITIVES, PRESERVATIVES AND SALICYLATES: THE FEINGOLD DIET 15
B. SUGAR 29
1. Sugar Intake and ADHD 29
2. Sugar and Health. 35
C. ESSENTIAL FATTY ACIDS 38
1. Brain Development 38
2. EFA Deficiency and ADHD 40
3. Smart Fats 44
D. VITAMIN-MINERAL THERAPY 48
1. Nutrition and Learning 49
2. Supplementation Studies 50
a. Multivitamin-mineral supplements 51
b. B-vitamins 52
c. Magnesium 55
d. Zinc 56
e. Other nutrients 57
3. Environmental Toxins 59
4. Nutrient Recommendations 62
E. HERBAL THERAPY 66
Chapter III: Diet and Drug Interactions 69
A. DRUG TREATMENT IN ADHD 69
B. DIET AND DRUG SIDE EFFECTS 74
C. NUTRITIONAL CONCERNS WITH DRUG THERAPY 75
Chapter IV: Multimodal Treatment for ADHD 81
APPENDIX A: Food Guide Pyramid 87
APPENDIX B: Human Brain 91
REFERENCES 93
FOR YOUR CONTINUING LEARNING 111
RESOURCES 113
LIST OF ABBREVIATIONS 117
GLOSSARY 119
SELF-ASSESSMENT QUESTIONS 121
ANSWER KEY 132
EXPLANATION TO QUESTIONS 133
ABOUT THE AUTHOR 137
ABOUT WOLF RINKE ASSOCIATES, INC 138

Carol M. Bareuther is a registered dietitian and member of the American Dietetic Association. A New Jersey native, she holds a bachelor of science degree in dietetics from Marshall University, Huntington, WV, and completed a dietetic internship at the University of Kentucky Medical Center, Lexington, KY. She completed post-graduate training in nutrition at the University of Kentucky and Drexel University in Philadelphia, PA.
Bareuther started her career as a pediatric-obstetric dietitian at the University of Kentucky Medical Center. Subsequently, she worked as a clinical dietitian at the Hospital University of Pennsylvania, Philadelphia, PA; therapeutic dietitian at the Roy L. Schneider Community Hospital, St. Thomas, U.S. Virgin Islands; and clinic nutritionist for the Virgin Islands Special Supplementary Nutrition Program for Women, Infants and Children (WIC). She is currently employed part-time as a public health nutritionist by the Virgin Islands' Department of Health's Bureau of Nutrition & Physical Activity. In 1995, she authored an American Dietetic Association-approved self-directed, accredited learning program, Nutrition for Infants and Young Children, published by Wolf Rinke Associates, Inc., followed by Nutrition for Pregnancy and Lactation in 1998, and Nutrition for Attention Deficit Hyperactivity Disorder in 2003.
Bareuther works part-time as a freelance writer, and has contributed food and nutrition articles to national publications such as Cooking Light, Vegetarian Gourmet, Deli Business, Produce Business, Food Distribution Magazine, Veggie Life, HeartCorps, Cruising World, Best Recipes, Vegetarian Journal, Fancy Food, Chefs, Caribbean Travel & Life, Latitudes South, Bally Total Fitness and Pillsbury's Fast and Healthy Magazine. From 1995 to 1999, Bareuther was the syndicated columnist for Copley News Services' Kitchen Kids, and from 2000 to 2001 the Caribbean Cuisine guide for About.com.
An author as well as a journalist, Bareuther has published two books, Virgin Islands Cooking and Sports Fishing in the Virgin Islands. She has co-authored Slim-To-Shore with Jan Robinson and Native Recipes, produced by the University of the Virgin Islands Cooperative Extension Service.
Since 1996 she has co-hosted "Nutrition In Good Taste," a weekday radio nutrition program on WVWI AM 1000, which airs throughout the eastern Caribbean. Since 2000, Bareuther has co-hosted "Shape Up Virgin Islands" a monthly half-hour PBS TV program that seeks to show culturally relevant ways to prepare healthful foods and incorporate physical activity.
Bareuther is the mother of two children and, in her spare time, enjoys cooking with her children, swimming, hiking and reading.