Elimination diets for ADHD: beyond the media hype

March 5, 2015 by  
Filed under Commentary, Tips

I am often asked by parents about whether their child’s diet could be causing their ADHD or worsening it. My answer is that yes, there is some controlled research demonstrating that foods or additives can produce the symptoms of ADHD or exacerbate them, but let’s not jump to an elimination diet.

One of the most well-known studies on diet and ADHD was conducted by Dr. Lidy Pelsser and her colleagues, and was published in Lancet in 2011. That study – and an earlier study by Feingold – are the ones that seem to have attracted a lot of parental interest in the topic.

Dr. Pelsser and her colleagues randomly assigned 100 children aged 4-8 years who were diagnosed with ADHD to either a 5 -weeks restricted elimination diet or to a control group who were simply given instructions for a healthy diet. In the ADHD restricted diet group, 41 of 50 children finished the first phase. In that group of 41 children, 32, or 78%, responded favorably by having fewer symptoms. Overall, 32 of 50, or 64%, had decreased ADHD symptoms while on the diet. Associated symptoms such as oppositional behavior and tantrums also decreased. Most parents hear that over 60% improved on the diet and think, “Wow, that sounds great!” But not so fast, because the methodology was seriously confounded by relying on the reports of parents who were not blind to the child’s experimental condition, which can introduce a bias or placebo effect into their reports of improvement.
Children who showed a significant improvement in their ADHD symptoms while on the restricted elimination diet were then assigned to one of two food-challenge groups based on their individual immunoglobulins (IgG) blood tests. Significantly, two-thirds of the children displayed a relapse in their symptoms when challenge foods were re-introduced to their diet.

More recently, Joel T. Nigg, PhD and  Kathleen Holton, PhD, MPH reviewed the literature on research on foods and additives. Their full article is well worth attempting to read if you are considering undertaking an elimination diet for your child, as they point out that adequately controlled experiments generally do not provide evidence of dramatic effects in symptom reduction for the majority of children with ADHD:

The best estimate on the small literature is about a 25% rate of at least some symptom improvement. For some children, perhaps a minority of 10% of children with ADHD, response can include a full remission of symptoms equivalent to a successful medication trial. In short, the literature suggests that an elimination diet should be considered a possible treatment for ADHD, but one that will work partially or fully, and only in a potentially small subset of children.

Of course, every parent hopes their child will be in that subset who do respond to diet changes, but if you are not sure whether foods or additives are causing or exacerbating your child’s ADHD-like symptoms, speak with your pediatrician about whether an elimination diet might be in order as a 5-week trial or test. Maintaining a restricted diet is difficult, time-consuming, costly, and unlikely to work if you do not have pretty much total control over what your child eats both outside of the home and in your home. It is also important to ensure that the elimination diet does not deprive the child of important nutrients, so don’t just start removing everything from your child’s diet. Reading Drs. Nigg and Holton’s detailed review of studies may help you understand what to consider and what to ask your child’s physician.

N.H. special education school faces abuse allegations

October 26, 2014 by  
Filed under Advocacy, Commentary

James Vaznis reports:

Two families filed a federal lawsuit Wednesday against a highly regarded residential and day school for special education students in New Hampshire, alleging that several staff members verbally or physically abused their children.

In one instance, a classroom aide at the school run by the Crotched Mountain Foundation, in Greenfield, N.H., is accused of taking a picture of a naked 7-year-old boy on a toilet and posting it temporarily on the Internet while another aide laughed about the picture with colleagues, according to the civil lawsuit filed in the federal courthouse in Concord, N.H.

Read more on Boston Globe.

The allegations are horrifying, but as I read the news story, I found myself also wondering about what the U.S. Education Department (USED) might do over what appears to be allegations of violating the child’s privacy by uploading a picture of him naked to the Internet. Will they say that the picture is not an “education record,” and therefore it’s not a FERPA issue? I suspect they might.

Will the USED Office of Civil Rights open an investigation and possibly deny federal funds to the school for violations of students’ civil rights? They could, I think, but I somehow doubt that they will.

In any event, such abuse, if the allegations are true, does need to be prosecuted criminally. And schools need to be sued civilly to ensure they properly screen, train, and monitor aides.

Why Can’t Teenagers Go to Sleep Earlier? And Why Don’t Schools Accommodate That?

Lynne Lamberg  explains that puberty is associated with delays in nocturnal melatonin secretion, resulting in teens staying up approximately two hours later than pre-pubertal children. But since teens still need as much sleep as prepubertal children, they suffer a sleep deficit if school starts early.

We’ve known this for decades, but even now, most school districts continue to start (too) early.  Think of how you function if you do not get enough sleep. Is it any surprise that teens who are sleep-deprived will be more likely to have behavioral and emotional problems or have more difficulty focusing, learning, and producing? Why, oh why, don’t schools just start later?

Lamberg recaps some of the available research in her article on Psychiatric Times:

When school starts later, academic performance and other health indicators improve, said Kyla Wahlstrom, Ph.D., director of the University of Minnesota’s Center for Applied Research and Educational Improvement (CAREI).

Wahlstrom led CAREI’s three-year study of about 9,500 students in grades 6 to 12 in eight public schools in Wyoming, Minnesota, and Colorado following start-time delays. In schools that started at 8:35 a.m., her group found, about 60 percent of students slept eight hours or longer on school nights. In schools that began at 7:30 a.m., only 34 percent of students got that much sleep.

Grades rose in first-period classes in the core subjects of English, math, science, and social studies. State and national standardized achievement test scores also rose, the CAREI team reported earlier this year. “We found a proportional benefit for a proportional delay in start time,” Wahlstrom said. The research was funded by the Centers for Disease Control and Prevention (CDC).

Worries that students will stay up later when schools delay start times are unfounded, Wahlstrom said. Students maintain their previous bedtimes and get more sleep.

An earlier CDC study, using data from the 2007 Youth Risk Behavior Survey, found students who slept less than eight hours a night on average were more likely than those who slept longer to report that they drink, smoke cigarettes, use marijuana, are sexually active, and had at least one physical fight in the preceding year.

Yet after all the research and all the decades, most schools continue to start school too early.

This past year, I’ve seen parents become more active advocates for their children’s privacy and data security. Those are serious issues,  but most parents still are not actively involved in advocating for later school start for teens. If we really want to improve educational outcomes and decrease behavioral and emotional problems – in school and out of it – we need to stop starting school for the convenience of the districts and working parents, and start school at an hour that works for the students.

Teen arrested for making threats on Facebook

July 28, 2014 by  
Filed under Commentary

Deborah Wrigley recently reported that a 13-year-old girl from Splendora, Texas faces felony prosecution for making a “terroristic threat” on Facebook. What was the threat? “I am going to kill everyone in Splendora on July 13th.”

Why did she make that threat? Did she mean it or was she just trying to get a reaction? It’s not known, but it seems to have started as a cyber-bullying incident:

Read more on ABC13, and then ask yourself whether you know what your child is posting on Facebook.

Certainly, we can ask if the child should have been charged with a felony or just referred to a psychiatrist or psychologist – or if she just needed educating about appropriate conduct on the Internet. But this incident could result in her being sent away and her life ruined.

In the wake of Columbine and other tragedies, there are those who will undoubtedly think law enforcement was correct to take this as a serious threat and to prosecute it as such. But is this another instance of over-reaction and our failure to understand kids and teens and to help them instead of punishing them? In any event, parents need to walk a fine line between respecting their children’s privacy and supervising them enough so that they don’t run into serious problems like this one. In this case, could the parents have even known? It seems that the teen used a fake name to set up the Facebook account.

Suicide of 9-Year-Old Isn’t School’s Fault

March 10, 2014 by  
Filed under Advocacy, Commentary

Jack Bouboushian reports on Courthouse News:

A Texas school district is not liable for a bullied fourth grader’s tragic suicide in the school nurse’s bathroom, the 5th Circuit ruled.

Montana Lance was just 9 years old when he hanged himself with his belt in a bathroom of the school nurse’s office in 2010.

The child had just returned to Stewarts Creek Elementary School after an eight-day stint at an alternative school where he went for pulling a penknife on Stewarts Creek classmates who had threatened him.

Read more on Courthouse News.

How is that we have zero tolerance cases that result in children being suspended for pointing their fingers like guns, but when it comes to students being harassed or bullied, schools that seemingly do not do enough to stop and prevent bullying are not liable?

If children can be held responsible for their conduct, when will we hold the schools fully responsible and accountable for their inaction or lack of safeguards?

Next Page »