Table of Contents October, 2008 Home 1) NEW Laura's October      Message 2) NEW October:      Pollens, Autism & ADHD 3)  NEW  Your       Questions Answered            4) NEW  Comments from     You 5) NEW Recipe of the     Month 6) References for You and     Your Doctor 7) Diagnosing ADD, ADHD     &  Related Disorders 8) Other Recommended     Books 9) Other Helpful Links 10) Dream Journeys CD Email Laura Laura's Latest Book 12 Effective Ways to Help Your ADD/ADHD Child

NEWS for YOU!

October, 2008

Pollens, Autism, and
ADHD

Is your child better in the winter?  Does your child have a general meltdown during pollen seasons in the spring and fall?  Weed pollens, especially ragweed, are high this time of year in many areas of the United States.  Two articles by Marvin Boris, M.D. published in the Journal of Nutritional & Environmental Medicine suggest that pollen can indeed be one cause of deterioration of neurobehavioral function in children with autism and ADHD.

 In the first study the researchers recruited 29 children with Autistic Spectrum Disorders (ASD) and 18 children with ADHD.  Their parents completed the Allergic Symptom Screen and for 2 weeks in the winter prior to pollen season.  They also completed checklists of behavior.  Next, the parents completed the same forms weekly from March 1 to October 31.  Pollen counts were recorded by the researchers on a daily basis.

Here are their results:  during natural pollen exposure, 15 of 29 (52%) children with ASD and 10 of 18 (56%) children with ADHD demonstrated marked neuro--behavior regression—their behavior got worse.  But there was no correlation with the child’s allergic status as measured by IgE, skin tests and RAST.  Interestingly, sales of Ritalin increase during spring and fall pollen seasons and decrease in July.

In a second study the same researchers studied the same children again.  During the winter, the parents of the ASD and ADHD children completed the Allergy Symptoms Screen and behavior checklists 4 times.    Blood was drawn from both groups and IgE (a measure of allergy) and RAST tests for oak tree pollen, timothy grass and ragweed were carried out.  Skin prick tests for the same pollens were also done.

Next the children recieved a nasal challenge of either the pollen mixture of timothy grass, oak trees and ragweed or a placebo.  Then the next week each child received the alternate challenge of either pollens or placebo.  The study was double-blinded—neither the children, their parents or the nurse who administered the spray knew which child was receiving the active treatment or the placebo.  The parents also completed the allergy and behavior questionnaires 4 times: 1) 2 weeks before the study began 2) at the baseline 3) after the first challenge 4) after the second challenge.

Here are the results:  55% of the children with ASD regressed while 67% of the children with ADHD regressed when challenged with the pollen mixture.  In the children allergic symptoms were not responsible for the change in scores.  Both allergic and non-allergic children responded adversely to the pollen challenge!

Sure enough, the children whose parents reported an increase in neurobehavioral symptoms in the spring and fall also were the ones who responded to the pollen challenges.

The researchers concluded, “This study implies that pollen exposure can significantly alter behavioral symptoms in ASD and ADHD children.”

Could pollen affect your child’s behavior?  (To find out what pollens are high where you live, both Claritin and Zyrtec provide websites where you can enter your zip code and receive a pollen count report.)  There is no evidence to date that allergy medicines improve behavior in children with ASD or ADHD. 

September, 2008

Diet Quality and School Performance

      Feeding your child’s brain is extremely important whether or not your child has ADD, ADHD or not!  There is a fascinating new study presented in the Journal of School Health (April 2008, Vol. 78, No. 4) by 3 Canadian scientists that examines the influence of diet quality on the academic performance of children.

      In 2003 over 5000 fifth grade children in Nova Scotia participated in this study.  With instruction, they completed the Harvard Youth/Adolescent Food Frequency Questionnaire (YAQ) and their heights and weights were recorded. (In a food frequency questionnaire you indicate on average how much and how often you consume different foods.) The YAQ allows calculation of a student’s intake of foods from recommended food groups and well as energy and nutrient intakes.  From this data, the researchers calculated the Diet Quality Index—International.  Scores ranged from 0 to 100 where higher scores indicated better diet quality.  For example, increased consumption of fruits and vegetables increased the score.

Students also completed an assessment of academic performance—the Elementary Literacy Assessment administered by the Nova Scotia Department of Education.  Basically, the test involved reading a number of passages and answering questions about the material the students had read.  Passing both the reading and writing assessment was considered a good performance.  Poor academic achievement was the failing of either or both reading and writing assessments.

Then both of these scores—the dietary assessment and the reading and writing tests—were analyzed.  The overall diet scores ranged from 26 to 86 with an average score of 62.4.  Not surprisingly, students reporting increased diet quality—increased fruit and vegetable intake, adequate iron, and lower intake of fat—were significantly less likely to fail the school performance tests.  Dietary adequacy and variety were identified as specific aspects of diet quality important for academic success.

Academic performance influences so many things in a child’s life—future academic attainment, income, health and quality of life for your child.  It not only affects your child’s future but that of future generations!  To attain high academic achievement your child must eat a nutrient-rich diet.  This includes:

7-9 servings of fruits and vegetables

whole grains

canola oil and other sources of omega-3 fatty acids

oily, coldwater fish

lean meats and poultry, eggs, beans

low fat milk and dairy products

unprocessed nuts and seeds (especially walnuts)

Foods to avoid or eat in very small quantities include:

            saturated, partially hydrogenated, and trans fats

            sugar and corn syrup

            artificial colors and flavors

            If you want your child to look sharp, feel sharp and act sharp you must feed his body and brain with the right foods in the right amounts!

July-August 2008

ADHD, Zinc and Artificial Colors

Last month your ADD/ADHD Online Newsletter featured several studies that reported lower levels of zinc in children with ADHD than in healthy children.  A couple of studies reported that zinc supplementation of children with ADHD improved behavior significantly more than placebo supplements in children with ADHD.  (Just page down to view that issue of the Newsletter.)

In my search of the literature, I found a really interesting article by Neil Ward, Ph.D.: The Influence of the Chemical Additive Tartrazine on the Zinc Status of Hyperactive Children—a Double-blind Placebo-controlled Study” that was published in the Journal of Nutritional Medicine in 1990.  Tartrazine is an artificial color found abundantly in our food supply.  It’s also known as Yellow #5. Other artificial colors in our foods have a similar chemical structure to tartrazine. Here’s what the researchers did

They recruited 20 hyperactive male children who were assessed for zinc status compared with 20 healthy children.  Both groups ate a similar diet for 3 days:  it consisted of chicken, green vegetables and fruits with low consumption of carbohydrate and fats.  No commercial beverages or foods were allowed because they might contain artificial colors.

After an overnight fast, the researchers collected blood, saliva, scalp hair, fingernails and urine from the 20 ADHD children and 20 Controls.  Then the ADHD children were divided into 2 groups (10 each) and the Control children were also divided into two groups (10 each).  So there were now 4 groups.  One group of ADHD and one group of Controls consumed a drink known to contained tartrazine. The other 2 groups drank a beverage without colors.

Then blood serum was collected 30 minutes after drinking for all 40 subjects.  Urine samples were also collected for the next 24 hours.  Behavior was monitored by a pediatric neurologist who did not know which children were in which group.

When the researchers compared the baseline scores of the ADHD children to the Controls they found significantly lower levels of zinc especially in urine and washed hair.  Blood serum, 24 hour urine, and fingernails also were significantly lower.  There was no difference in saliva zinc.

Next, they looked at the zinc measures in the four groups who consumed the colored or the placebo drinks.  In the hyperactive children who drank the artificially colored beverage, zinc levels of blood serum and saliva decreased significantly.  However, urinary zinc measured over 24-hours significantly increased!  None of the zinc values of the 3 other groups changed. This suggests that the yellow dye may bind to zinc in the body and is then excreted in the urine!  This is definitely not desirable in hyperactive children who are already zinc depleted.

The results of the psychological observations revealed that only the hyperactive children given the yellow dye had changes in behavior or emotional states.

The researchers concluded, “…the effect of tartrazine (as opposed to the placebo) on inducing a deterioration in behavior and zinc status of the hyperactive children was very significant for such a limited dose.”

The message here is simple: Don’t allow your children to consume any artificial colors (or flavors or preservatives)! 

June, 2008
ADHD & Zinc

Zinc is a vital mineral that is a cofactor in many key metabolic pathways.  It also binds to the dopamine transporter and deactivates it.  The dopamine transporter has been the topic of much research in ADHD.  Zinc is also involved in essential fatty acid metabolism which has been found to be abnormal in several studies of ADHD children and adults.

Zinc deficiency is known to cause a hyperactive syndrome in rats.  When young monkeys were moderately deprived of zinc their performances on visual attention, short-term memory tasks were impaired.^{1, 2}

However, in 1990 McGee³ and co-workers in New Zealand studied hyperactivity and zinc levels in hair and serum in 11-year old children from the general population.  The results of this study indicated there was no relationship between inattentiveness, hyperactivity, and antisocial behavior and serum or hair zinc levels.

But in a 1996 study⁴, researchers in Israel and at Yale University reported that zinc concentrations in 43 children with ADHD were significantly lower than those of healthy children.

In another 1996 study⁵, Bekaroglu and co-workers in Turkey studied the relationship between serum fatty acids and zinc and ADHD.  Forty-eight children with ADHD were compared to 45 healthy children.  The average zinc level in the serum was significantly lower in the ADHD children than in the control group.  These zinc levels correlated with the free fatty acids in the ADHD group.

In 2004⁶ Iranian researchers gave zinc supplements (about 15 mg zinc as zinc sulfate) plus methylphenidate (Ritalin) or just methylphenidate to 44 children with ADHD for 6 weeks.  The patients who took methylphenidate with zinc outperformed the children who just received the drug as evaluated by both parents and teachers.

In the same year inTurkey⁷, researchers reported their study of zinc sulfate supplements for the treatment of ADHD.  They reported significant improvements in hyperactivity, impulsivity and socialization scores with a 40 mg supplement of zinc sulfate versus a placebo. 

In 2005⁸ Eugene Arnold, M.D., a well-respected ADHD researcher at Ohio State’s Medical School, reported that a group of 48 children carefully diagnosed with ADHD had low levels of serum zinc in their blood that did not seem to be related to their diets.  Arnold and his co-workers are currently conducting a large study of the effect of zinc supplement (zinc glycinate) versus placebo in children diagnosed with ADHD. An early report indicates that according to teacher evaluations of a group of ADHD children given zinc supplements, there have been significant improvements in behavior in those children receiving the zinc but not the placebo.

Where does this leave you?  The RDA for zinc in children ages 4-10 is 15 milligrams.  For boys, ages 11-14 the RDA is 15 milligrams and for girls 12 milligrams. Good food sources include eggs, liver, shellfish, wheat germ, beef, dark-meat turkey, nuts, and seeds.

If your child has a loss of appetite, slow growth, slow wound healing, altered taste perception, and/or white spots on his fingernails, he may have a marginal zinc deficiency.  Taking 10 mgs a day as part of a multi-mineral supplement for two months may improve his health and behavior.  Taking too much zinc is harmful because it decreases the absorption of other important minerals.  According to expert Leo Galland, M.D., an expert in nutritional medicine, the multi-mineral tablet containing 10 mg of zinc should also include 1 mg copper, 10 mg manganese, 75 mg of selenium, 200 mcg chromium, and 200 micrograms of molybdenum.  There are a number of different zinc preparations to choose from—zinc gluconate, zinc citrate, zinc glycinate are all well absorbed. 

1. Golub, M.S. 1994.  Modulation of behavioral performance of prepubertal monkeys by
moderate dietary zinc deprivation.  American Journal of Clinical Nutrition. Vol. 60,
pp.238-243.

2.  Golub, M.S. 1996.  Activity and attention in zinc-deprived adolescent monkeys.  American Journal of Clinical Nutrition.  Vol.64, pp. 908-15.

3.  McGee, R.  et al.  1990.  Hyperactivity and Serum and Hair Zinc Levels in 11-Year-Old Children from the General Population.  Biological Psychiatry, Vol. 28.  pp. 165-168.

4.  Toren, P et al.  1996.  Zinc Deficiency in Attention-Deficit Hyperactivity Disorder.
Biological Psychiatry.  Vol.40, pp. 1308-10.

5.  Bekaroglu, M et al.  1996. Relationships between Serum Fatty Acids and Zinc, and Attention Deficit Hyperactivity Disorder: A research Note. Journal of Child Psychology and Psychiatry. Vo. 37, pp.225-227.

6.  Akhondzadeh, S. et al.  2004.  Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children:  A double blind and randomized trial.  BMC Psychiatry.  Vol. 4(9).

7.  Bilici, M.  2004.  Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder.  Progress in Neuro-Psychopharmacology & Biological Psychiatry.  Vol. 28, pp. 181-90.

8.  Arnold, L.E. 2005.  Serum Zinc Correlates with Parent- and Teacher-Rated Inattention in Children with Attention-Deficit/Hyperactivity Disorder.  Journal of Child and Adolescent Psychopharmacology.  Vol. 15(4), pp. 628-636.

May, 2008
Stimulants, ADHD, and Heart Problems

In recent years there has been concern about rare cardiovascular side effects of stimulant drugs.  In 2006 there was a meeting of the Drug Safety and Risk Management Advisory Committee of the Food & Drug Administration (FDA).  They reported that between 1999 and 2003 25 people (19 children) taking ADHD drugs died suddenly.  Also 43 people (26 children) experienced strokes, cardiac arrest and heart palpitations.

Next the FDA Pediatric Advisory Committee met later in 2006 and reported that data from 1992 to 2005 revealed 11 sudden deaths in children associated with methylphenidate (Ritalin) and 13 with amphetamines.  There were also 3 deaths in children taking atomoxetine (Strattera) between 2003 and 2005.  In February 2007, the FDA issued a press release titled, “FDA Directs ADHD Drug Manufacturers to Notify Patients About Cardiovascular Adverse Events and Psychiatric Adverse Events.”   The drug manufactures who make all the drugs for ADHD were required to develop Patient Medication Guidelines.

The Cardiology authors make the follow points:

1.  These drugs have been widely studied and their effectiveness has been confirmed.  More than 70% of children with ADHD respond.

2. The general side effects of these drugs are decreased appetite, insomnia, emotional lability (meltdowns), stomachaches, and headaches.

3.  Data from many studies indicate that these medications are safe for healthy children with ADHD.

4. On average the heart rate increases 1 to2 beats per minute.  Blood pressure increases by 3-4 mm Hg.  In the past these have been thought to be clinically insignificant.

5.  There is potential for severe adverse events in some children with certain forms of congenital heart disease or abnormal heart rhythms which could be a predisposition for sudden cardiac arrest.

6.  Combining stimulants with other medications such as Clonidine may increase cardiac risks.  In 1995 4 children died suddenly who had been taking these drugs.

            Now the American Heart Association has come up with the following recommendations.

1.      Medical evaluation of children for whom stimulants are being considered.  This would include a careful medical history of the child, his family medical history, and an electrocardiogram (ECG) read by a pediatric cardiologist or a physician trained in reading pediatric ECGs.  This test should be performed before medication and once after.  The physical exam should include an evaluation for abnormal heart murmurs, hypertension, and irregular or rapid heart beat.

2.      If a child is already taking stimulant meds, physicians should take a careful medical history, review the physical exam, and order an ECG if this was not done previously.

What does all this mean for you and your child?  If your child is on stimulant meds, discuss your concerns with your doctor.  You may want to insist that your child have an ECG just to be sure.  If you are considering whether or not to place your child on medications, ask your doctor to perform an ECG and careful physical exam.  Be sure to tell him/her about any family history of heart problems and certainly any in your child.  These include Rheumatic fever, seizures, history of fainting or dizziness, chest pain, shortness of breath with exercise, and high blood pressure.

To see what the FDA warning about each ADHD drug, just go to Google and type in “FDA medication guide” and the name of the drug you are interested in.

In the view of many nutritionally-oriented physicians helping a child with ADHD is like trying to solve a jigsaw puzzle.  Puzzle pieces might include low iron status, lead poisoning, poor diet, essential fatty acid deficiencies, magnesium deficiency, zinc deficiency, sensitivities to artificial colors, flavors and preservatives and foods, and so on.  Each child might have a different puzzle to be completed.  After all, does it make sense to treat a child with stimulant meds instead of identifying and treating one or more of these puzzle pieces?  Should a child who is actually sensitive to artificial colors and flavors be placed on strong medications or should  artificial colors and flavors be removed from his diet?

April 2008 Food Dyes & ADHD 

There is more than ample evidence in the medical literature that artificial colors, flavors and preservatives can provoke symptoms in many children with ADHD.  Yet most pediatricians, psychologists, psychiatrists and even nutritionists insist that there is no evidence to support this statement.

However, a breath of fresh air blew through the September 2007 issue of the American Academy of Pediatrics (AAP) Grand Rounds.  The author was Alison Schonwald, a Boston physician and an instructor of pediatrics at Harvard Medical School.  She reviewed in detail the research recently reported in an article, “Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomized, double-blinded, placebo-controlled trial.” This article had been published in the prestigious British medical journal, Lancet, in September.  The conclusion of the researchers was that the results of the study suggest that food additives and/or sodium benzoate (a preservative) increase hyperactive behavior in children. (For more information, just scroll down until you come to the November 2007 Newsletter devoted to that study.)

Dr. Schonwald also wrote about another study that was published in the Journal of Developmental Behavior Pediatrics in 2004.  In this article the authors combined the results of15 trials that tested artificial colors.  The authors had stated, “There is accumulating evidence that neurobehavioral toxicity may characterize a variety of widely distributed chemicals.” 

Dr Schonwald concluded, “In real life, practitioners faced with hyperactive preschoolers have a reasonable option to offer parents.  For the child without a medical, emotional, or environmental etiology [cause] of ADHD behaviors, a trial of a preservative-free, food coloring-free diet is a reasonable intervention.”

Next the editor of the AAP Grand Rounds article concluded, “The overall findings of the [Lancet] study are clear and require that even we skeptics, who have long doubted parental claims of the effects of various foods on the behavior of their children, admit we might have been wrong.”

Finally, in the latest issue of the Nutrition Action Healthletter from the Center for Science in the public Interest, the executive director Michael Jacobson, Ph.D., wrote this month, “Food dyes are certainly not the only cause of ADHD.  But they could be the most easily controlled.”

Jacobson continued, “Dyes confer absolutely no health benefits.  Their primary purpose is to mask the absence of real fruit or other colorful ingredients.

“It’s high time that the government eliminated dyes from the food supply—starting with foods that are marketed to children.  That includes candies, candy-like cereals, gelatin desserts, and practically any package with a cartoon character on the front.”

What’s interesting about the article in the AAP Grand Rounds is that there are many other better articles.  Here is a list for you and your doctor:

Swanson, JM and Kinsbourne, M. 1980.  Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test.  Science Vol. 207, pp 1485-1487. 

 Salamy J et al.  1982.  Physiological Changes in Hyperactive Children Following the Ingestion of Food Additives.  International Journal of Neuroscience.  Vol 16, pp. 241-246.

 Egger. J. 1985. Controlled Trial of Oligoantigenic Treatment in Hyperkinetic Syndrome. Lancet, Vol. 1(8428) pp. 540-45.

 Carter, C. 1993.  Effects of a Few Food Diet in Attention Deficit Disorder. Archives of Diseases in Childhood 69, 1993, p. 564-568

 Boris, M. 1994 Foods and additives are common causes of attention deficit hyperactive disorder in children. Annals of Allergy Vol 72, pp. 462-468.

 Uhlig, T.  1997.  Topographical mapping of brain electrical activity in children with food-induced attention deficit hyperkinetic disorder.  European Journal of Pediatrics Vol. 156, pp. 557-561. 

 Bateman, B. 2004.  The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity general population sample of preschool children. Archives of Diseases of Childhood Vol. 89, pp. 506-511.

B. Kaplan. Dietary replacement in preschool-aged hyperactive boys. Pediatrics 1989, pp. 7-17.

K. Rowe. Synthetic food coloring and behavior: A dose response effect in a double blind, placebo-controlled, repeated measures study. Journal of Pediatrics Vol. 125, 1994 pp. 691-8.

March, 2008

ADHD & Iron

           Several interesting studies have been published recently about iron deficiency and ADHD.  Let’s review each one (If you find this boring, just skip to the next section!!):

1)     In 2001, Halterman and her coworkers studied the relationship between iron deficiency and cognitive achievement in 5398 school-aged children and adolescents aged 6 to 16.¹ They measured 3 indicators of iron deficiency including serum ferritin.  Scores on standardized tests were compared for children with and with iron deficiency.  Three percent were iron-deficient which represent 1.2 million school-aged children in the US.  According to the researchers, this has a huge potential for being a major public health crisis. The prevalence was highest amount adolescent girls (8.7%).  The researchers also demonstrated that lower math scores were associated with iron deficiency.  They recommend “Screening for iron deficiency without anemia may be warranted for children at risk.”  We’ll talk about risk factors later.

2)     In Israel in1997 Sever and coworkers reported a pilot study in which they recruited 14 boys with ADHD.² The severity of the behavior symptoms were determined by parents and teachers using the Conners Rating Scale.  You may have completed such a form for your child.  The researchers administered an iron supplement (Ferrocal) using 5 mg for each kilogram of body weight.  The study lasted a month.  They also took blood samples before and after supplementation.  There was a significant increase in serum ferritin and a significant decrease on the parents (but not the teachers) Conners Rating Scale Scores.  This was just a pilot study and there was no placebo group that was treated with a dummy supplement and the number of children in the study was low.  But the researchers concluded that the effect of iron supplements on the behavioral and cognitive symptoms in children with ADHD children merits further investigation.

3)     Another interesting report was published in 2004 of a study in France where the incidence of iron deficiency in children with ADHD was studied.³  They assessed iron status in 53 children with ADHD and 27 controls.  The average serum ferritin levels were significantly  lower in the children with ADHD (23±ng/mL) than the controls (44±22 ng/mL).  In fact serum ferritin levels were low (<30 ng/mL) in 84% of children with ADHD and 18% of controls.  Also low serum ferritin levels were correlated with more severe general measures of ADHD using the Conners’ Parent Rating Scale and also greater cognitive deficits.

4)      In 2003 researchers studied Restless Leg Syndrome in sleep and the iron status in children.⁴ These were not ADHD children but previous studies have shown that there is a high rate of Restless Leg Syndrome (RLS) in children with ADHD.  RLS in children (it also occurs in adults) is a sleep disorder characterized by growing pains, restless sleep, insomnia, daytime sleepiness.  Children have significant problems keeping their legs still especially in the evening and while they are trying to go to sleep.  They have this tremendous urge to move their legs for no reason and describe discomfort in the legs as “creepy” or “crawly”.  In this study researchers conducted sleep studies and also measured serum iron and serum ferritin levels.  Those patients, 20 boys and 19 girls with restless leg syndrome and serum ferritin levels of < 50 ug/L were prescribed supplements containing iron sulfate at 3 mg per kilogram of body weight.  The study lasted 3 months.  Here are the results.  Twenty eight children had low levels of serum ferritin and 25 children received the iron supplement.  Nineteen of the 25 children responded favorably and had significantly fewer restless legs syndrome symptoms and increases in serum ferritin after 3 months of treatment.  The researchers concluded that the frequency of Restless Leg Syndrome is frequently associated with low serum iron and also low serum ferritin levels, and in addition iron therapy is associated with clinical improvement in most of these patients!

5)      Another study undertaken in Chicago in 2006 drew different conclusions about the incidence of iron deficiency in children diagnosed with ADHD.  The average serum ferritin was not different from that of the control children who did not have ADHD.  Forth-four percent of the total population had serum ferritin levels below 30 ng/m.  Those with the lowest levels of ferritin did not have` a greater frequency of severity of ADHD symptoms.

6)      In a 2007 article Konofal and his associates from France published a paper describing a study that linked Restless Leg Syndrome (for more information, scroll way down until you find the newsletters for Sleep Problems and ADHD), ADHD and low serum ferritin levels.  The researchers concluded that children who had a family history of Restless Leg Syndrome appeared to be at risk for severe ADHD symptoms.  Iron deficiency may contribute to the severity of symptoms.  We suggest that clinicians consider assessing children with ADHD for RLS, a family history of RLS, and iron deficiency.”

7)      In another 2007 article researchers from Turkey reported an association between low serum ferritin and RLS in patients with ADHD.  They evaluated 87 ADHD subjects ages 6 to 16.  They assessed the severity of ADHD symptoms and serum ferritin levels.  RLS was found in a third of the patients.  The rate of iron deficiency was higher in the ADHD children with RSL than in the ADHD children without RLS.  The researchers concluded, “Iron deficiency, which is associated with both ADHD and RLS, seems to be an important modifying factor in the relationship between these two conditions.”

8)     In another 2007 article, two researchers from Turkey reported that serum ferritin levels were related to symptoms ratings in ADHD.  There were 151 children with ADHD. In the ADHD group, the lower the serum ferritin levels the higher the ADHD symptoms as rated by both teachers and parents.

9)    In a 2008 study from the same group of scientists, they assessed 52 children with ADHD.  They found that 7 children had iron deficiency and that lower ferritin levels were associated with higher hyperactivity scores in parental ratings. 

10)   In an article published this year Konofal and associates from France reported the effects of iron supplementation on ADHD in children.  Although this was a small study with only 23 children with ADHD, those who received an iron supplement had a progressive decrease in ADHD scores over 12 weeks. They reported, “Iron therapy was well tolerated and effectiveness is comparable to stimulants.”

You and Your Child

So how does this apply to you and your child?  To determine if your child might have a marginal iron deficiency, begin by answering the following questions:

1. Is your child pale?
2. Is your child tired?
3. Is your child inattentive?
4. Is your child irritable?
5. Is your child performing poorly in school?
6. Is your child a large milk consumer?  (Milk contains little iron, and the calcium in it inhibits the absorption of iron from other foods.)
7. Is your child a poor consumer of red meats?
8. Is your child a picky eater?
9. Does your child have Restless Leg Syndrome?

If you answered yes to any of these questions, ask your doctor to test your child for a marginal iron deficiency using a serum ferritin test. Even if your child does not have any of these symptoms, it still may be worthwhile to check this out.  Even if your child does not have iron-deficiency anemia, low iron stores can affect his behavior and school performance.

If the tests show that your child is deficient in iron, your doctor will encourage you to give your child more iron-rich foods. (If this is impossible, he may prescribe an iron supplement.)  Here are some foods high in iron:

            Beef pot roast, 3 ounces, 2.0 milligrams (mgs) of iron

            Turkey, dark meat, 3 ounces, 2.0 mgs

            Tuna, 3 ounces, 1.9 mgs

            Green peas, 1/2 cup, 1.8 mgs

            Hamburger, lean, 3 ounces, 1.8 mgs

            Chicken drumstick, 1 average, 1.0 mgs

            Egg, 1 large, 0.9 mgs of iron

            Banana, 1 medium, 0.9 mgs of iron

Potato baked, 1 medium, 0.7 mgs of iron

Peanut butter, 2 tablespoons, 0.6 mgs of iron

Whole wheat bread, 1 slice, 0.5 mgs of iron 

The Recommended Dietary Allowance (RDA) for children aged one to 10 is 10 mgs of iron.  For older children, the iron RDA is 12 mgs for boys and 15 mgs for girls.

Do not give your child iron supplements unless blood tests show he is iron-deficient and your doctor prescribes them.  Too much iron in the system can interfere with absorption of other important minerals including zinc and manganese.  Keep all iron supplements out of the reach of young children to prevent iron poisoning, which can be life-threatening.

References

1)     Halterman, JS.  2001 Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. Vol. 107 (6), 2001, pages 1381-1386)

2)     Sever, Y. 1997.  Iron treatment in children with attention deficit hyperactivity disorder. A preliminary report.  Neuropyschobiology. Vol. 35(4), pages 178-80.

3)     Konofal, E. 2004 Iron deficiency in children with Attention-Deficit/Hyperactivity Disorder. Archives of Pediatric and Adolescent Medicine.  Vol. 158, pages 1113-1115.

4)     Simakajomboon, N. 2003.  Periodic limb movements in sleep and iron status in children.  Sleep. Vol. 26(6), pages 735-8. 

5)  Millichap, JG.  2006 Serum ferritin in children with attention-deficit hyperactivity disorder.  Pediatric Neurology. Vol. 34(3), pages 200-3.

6). Konofal, E. 2007.  Impact of restless legs syndrome and iron deficiency on attention-deficit/hyperactivity disorder in children.  Sleep Medicine.  Vol. 8, pages 711-715.

7) Oner, P. 2007.  Association between low serum ferritin and restless legs syndrome in patients with Atte tnion Deficit Hyperactivity Disorder. Tohoku Japan Exp. Med. Vol. 213, pages 269-76.

8) Oner, P. 2007.  Relationship of ferritin to symptom ratings children with Attention Deficit Hyperactivity Disorder: Effect of comorbidity.  Child Psychiatry and Human Development.  Online.

9. Oner, P. 2008.  Relation of ferritin levels with symptom ratings and cognitive performance in children with attention deficit-hyperactivity disorder.  Pediatrics International.  Vol. 50, pages 40-45.

9) Konofal, E. 2008. Effects of iron supplementation on attention deficit hyperactivity disorder in children.  Pediatric Neurology. Vol. 38(1), pages 20-6.

February, 2008

Breakfast & Your Child's Behavior

Breakfast consumption has declined steadily for the last twenty-five years.  Of children aged eight and nine, 79 percent eat breakfast regularly, while only 58 percent of twelve- to thirteen-year olds eat breakfast regularly. (1)

The results of a 1998 study by Harvard researchers showed that the children who ate breakfast regularly demonstrated significantly higher reading and math scores, significantly lower reports of depression and anxiety, lower levels of hyperactivity, better school attendance, less tardiness, improved attention spans, fewer behavior problems, and fewer visits to the school nurse.(2) 

Other studies showed that children who skipped breakfast had greater inattention problems and poorer scores on tests of cognitive tasks involving memory.(3)  In other words, children who are hungry have more problems paying attention, behaving, and learning.

For your ADHD child, the kind of breakfast you choose can make a big difference.  According to a 1987 study by C. Keith Conners, one of the most-respected ADHD researchers in the US, a refined, carbohydrate-rich breakfast appears to have harmful effects.(4,5)  They studied 39 hyperactive children and compared them with 44 controls who had no psychiatric problems.  Each child was randomly assigned to 1 of 3 breakfasts: high carbohydrate (2 slices of buttered white toast), high protein (2 scrambled eggs) or no breakfast at all.  When the high carbohydrate group also consumed an orange drink sweetened with sugar, they performed poorly on special tests.  Hyperactive children given the high-protein meals did a lot better than hyperactive children eating the high-carbohydrate meal or no breakfast at all.

Breakfast should contribute about one-third of the day’s calories and nutrients.  Sidney Baker, M.D., in his fascinating book The Circadian Prescription, recommends a breakfast high in protein and very low in simple carbohydrates (sugars) to help the brain function optimally.(6)  Dr. Baker has been helping children with ADD/ADHD for over 25 years.  He has found that the children most likely to benefit from a high protein breakfast are those with the following profile: 

-He currently doesn’t eat breakfast

-She eats sweetened cereal, fruit juices, jams and jellies, soda, sweet
  rolls, bagels, or white bread for breakfast

-He craves carbohydrates at other meals and between meals

-"She sometimes or often appears drunk—sad, happy, silly, mean, or
                        spacey drunk.”

Here are some easy, high protein breakfast suggestions.  Don’t overdo on the fruits! 

-Eggs, whole grain toast, small glass of orange juice

-Homemade sausage, whole grain cereals topped with seasonal fresh  fruits

-Leftover cold meat, poultry or fish, whole grain roll, fresh fruits

-Grilled hamburger, steak or pork chop, a whole-grain bun, cantaloupe slice

-Plain yogurt with strawberries, sliced peaches, blueberries

-Cottage cheese, whole grain toast, fruit

-Grilled cheese sandwich made from real cheese on whole grain
             bread, small fruit cup

-A high protein shake (click on “Recipe of the Month” at the right). 
            Don’t use commercial instant breakfasts because they are loaded
            with sweeteners, dyes and artificial flavors.

Finally, if stimulant meds are killing your child’s appetite for breakfast, ask your doctor if you can give the pill after or with breakfast.

So, if you want your child to pay attention, behave, learn, and feel his/her best, start the day with a good breakfast!  To start your day well, enjoy the same breakfast!!

1.  Miller GD.  Breakfast Benefits Children in the US and Abroad, Journal of the American College of Nutrition.  Vol. 17(1) pp. 4-6, 1998. 

2.  Murphy JM et al.  The Relationship of School Breakfast to Psychosocial and Academic Functioning. Archives of Pediatric and Adolescent Medicine Vol. 152 1998 pp. 899-907. 

3.   Wesnes, K.A. 2003.  Breakfast reduces declines in attention and memory over the morning in schoolchildren.  Appetite. Vol. 41, pp. 329-331.

 4.  Conners, CK.  1989.  Feeding the Brain:  How Foods Affect Children. Plenum Press: New York. 

5.  Conners, CK. 1982-3.  Nutritional effects on behavior of children.  Journal of Psychiatry.  Vol. 17(2) pp. 193-201. 

6.  Baker SM. The Circadian Prescription. Putnam: New York 2000.

January, 2008

Knowledge Is Power!

Here is a list of places where you can learn more.  Don’t be overwhelmed by all the material.  Just take it a step at a time.  Rome wasn’t built in a day and neither will you find all the answers to your child’s problems in a day! 

Diagnosis

            If you’re wondering whether your child has ADD, ADHD, ODD, Conduct Disorder, and/or depression, please click here Diagnosing ADD, ADHD & Related Disorders. This will also tell you about what should be included in an evaluation for these disorders.  Diagnosis of ADD, ADHD or related disorders should not be made in a quick 10 to 15 minute appointment with your doctor! 

How to Find a Psychologist or Psychiatrist to Assist You:

1.      Ask your doctor for a recommndation.

2.      Ask your school for an evaluation by school personnel (this should be free) or ask them for names of professionals in the community.

3.      Ask your friends and other parents of children with behavior problems.

4.      If you have a university near you, call the psychology department and ask if they have any special services for ADD/ADHD children.  If your child has learning disabilities check with the education department.

5.      Call your local mental health association and ask who they would recommend.  If money is a problem, they should be able to refer you to clinicians who charge on the basis of your ability to pay.

How to Find a Doctor to Help You with Nutritional Aspects of ADD/ADHD

            Google:  Academy of Environmental Health
                         http://www.aaemonline.org/

Google:  Human Ecology Action League
            http://members.aol.com/HEALNatnl/index.html#consultant 

Informative Websites
                Leo Galland, M.D.
                       Foundation for Integrated Medicine
                       http://www.mdheal.org/

Nutritional Help for the ADD/ADHD Child
            http://www.mdheal.org/attention.htm

Sidney Baker, M.D.Medigenesis
                         http://www.medigenesis.com/ 

Searching the Medical Literature

       Perhaps a friend has said to you, “Artificial colors and flavors really bother my child,” but your doctor says, “The idea that food affects behavior is nonsense.”  What should you do?

          It’s easy to search the medical literature for studies that support or reject this premise.  Just enter “PubMed” into Google.  Then once in PubMed just enter “food colors and ADHD”—without the quote marks.  The author and title of 4 articles will come up.  If you want to know more about the Boris study just click on it and the Abstract will come up.  The Abstract is a short summary of the study.  If you want to see the whole article, just ask your librarian to order it free for you on Inter Library Loan.  It’s easy and you will more empowered! 

My Favorite Newsletters

Nutrition Action Health Letter
         by the Center for Science in the Public Interest
ADDitude
Pure Facts
         by the Feingold Association           

Books You’ll Really Like

The books below can be ordered from your favorite online
bookstore or by asking your bookstore to order a book for you.  Or you look for a book at your local library.  If they don’t have what you’re looking for, you can ask them to order it for you to borrow free on Inter Library Loan.  For online orders choose one of the following:

Barnes & Noble: www.barnesandnoble.com

Amazon.com: www.amazon.com

BordersBookstores:
                http://beta.bordersstores.com/online/store/La
                nding?type=1&nav=5185&kids=false

My favorite cookbooks 

The Revised Food Guide Pyramid from Harvard

If you’re wondering what constitutes a healthy diet, you’ll like this website. 

http://www.intelihealth.com/IH/ihtIH/WSIHW000/325/28910/329091.html?d=dmtContent

December, 2007

Celebrating Happy Holidays

If holidays are a zoo at your house, how can you make them happier?  First, what you feed your child during the holidays may greatly influence his behavior!   If you have found like many, many other parents that your child is “turned on” by various foods and food additives, here are suggestions for upcoming happy holidays.  There are three ways to handle holidays and parties.  The first way is to just “blow the diet” and let your child eat what he wants with the explicit understanding that this is just temporary.  The disadvantage of this approach is that your child may be out of control and ruin the holiday for everyone.

The second way is to limit the amounts of forbidden foods.  Talk with your child before the holiday and settle on how much of each food or candy he can have—perhaps one small piece of cake or three pieces of candy.  Emphasize the foods he enjoys and can safely eat.

The third way is to stick to the diet but provide alternative treats.  Talk with your child about the coming holiday or party and explain that he won’t be able to eat some things that he has eaten in the past.  List the foods he can have, especially the ones he likes best.  If he understands the situation, you have a good chance of getting his cooperation.  When invited to friends’ houses or relatives for the holidays, offer to bring a dish your child likes and can eat.  Perhaps the hostess will understand your problem and provide some alternative foods for your child that everyone will enjoy. You’ll have to choose which of these three approaches works best for your family.

One step that's easy to carry out is to make sure any snack your child eats includes an excellent source of protein--nuts, cheese, deviled eggs, slice of cold meat, yogurt, etc.  For example, a child who's extra bouncy after drinking 100% apple juice by be able to tolerate it better if a handful of nuts are eaten at the same time.

For Christmas, here are some suggestions of ways to cope.  Christmas stockings can be stuffed with an orange, small cars, card games, a yo-yo, a small stuffed animal, crayons, special pencils and pens (if the fumes are tolerated), and so on.  If candy is a must, then try a couple of white candies sweetened with sorbitol.  Keep in mind that too many can result in diarrhea!  Skip the candy cane as it’s full of corn syrup and red dye.

For Christmas parties serve cookies sweetened with concentrated fruit juices or with sweet fruits like raisins, dried cherries or dates.  I’m not big on using artificial sweeteners, but your child may tolerate some treats made with Splenda, the newest artificial sweetener.  Put out bowls of unprocessed nuts.  If you like roasted nuts better, just toss them with a little canola oil and toast them on a cookie sheet in the oven until they are slightly brown. Lightly salt them.  Serve a platter of fresh veggies or colorful fruits with dips.  The drinks can be simple—unsweetened 100 percent fruit juice over ice served with holiday cups and napkins. Many children with ADD/ADHD do a lot better with a low juice intake or by always eating some protein food with the 100% juice.

At our house we always have the same dinner on Christmas that we have at Thanksgiving.  Here is this year’s Christmas feast!

            Roast turkey with bread stuffing

            Cranberry Sauce

            Mashed potatoes with homemade gravy

            Frozen peas

            Wheat rolls

            Apple Pie and Pumpkin Pie

*Choose a fresh turkey that is not self-basting.  Stuff it with bread stuffing using whole-wheat or cracked wheat bread.  If your child is sensitive to wheat, try a rice stuffing instead. 

*Thicken gravy with cornstarch, tapioca or potato starch. 

*Commercial cranberry jelly is full of corn syrup but making your own is a snap.  (See Recipe of the Month). 

*Mash either sweet potatoes with Rice Dream milk or soymilk.  Don’t use instant mashed potatoes, packaged stuffings, or prepared gravies as they are usually full of additives, artificial colors, preservatives, milk, or other problem foods. 

*Choose whole-grain rolls

*You can make great apple pie without any sugar or artificial sweeteners.  Just choose Red Delicious Apples or other sweet apples and forget the sugar.  Pumpkin Pie can be made using concentrated fruit juices, stevia, or artificial sweeteners like saccharin or Splenda.  For more ideas consult my book, 12 Effective Ways to Help Your ADD/ADHD Child.

Sleep is food for your brain!  Another major component  of sanely celebrating the holidays is to make sure everyone, especially your ADHD child, gets enough sleep.  I know, this is really difficult to do when you’re visiting relatives or you have guests to your home.  But it’s really important.  Several studies have shown that many children with ADHD often have specific sleep disorders that adversely affect daytime behavior.  Your child may have trouble getting to sleep, staying asleep or waking up in the morning.  Of course, part of this can be due to stimulant medication taken earlier in the day.  But studies of children who have ADHD who don’t take any medication have shown that they too have more sleep problems than children with normal behavior. (For more information about sleep and ADD/ADHD, just scroll down until you find past newsletter articles about sleep.)  Also, be sure to get enough sleep yourself so that you can cope better with any problems that arise!

May you and your family enjoy happy holidays!

November 2007

Nasty Food Additives

            In September an article entitled “Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomized, double-blinded, placebo-controlled trial” was published in Lancet, a leading medical journal in England.  The investigators were members of the School of Psychology and School of Medicine at the University of Southampton in the UK.

            The researchers recruited 153 3-year-olds and 144 8 to 9-year-olds from the general population.  For 3-year-olds the primary outcome measure, Global Hyperactivity Aggregate (GHA,) comprised the sum of parent rating scales, teacher rating scales and classroom observation code.  For the 8 to 9-year-olds the same measures were used but also included a computer test of attention.

            First, all the subjects followed an additive-free diet for 1 week.  Next both age groups were given either a mixed fruit juice or a fruit juice plus artificial colors and the preservative, sodium benzoate.  The children and parents were unable to differentiate the fruit juice and the fruit juice plus colors and sodium benzoate as they looked and tasted the same. The colors they tested were ones that have been approved for use in the UK but not necessarily the United States.  However, the colors that are allowed in Britain and the ones allowed in the United State are very chemically similar.

            During the next six weeks, either the mixed fruit juice or the mixed fruit juice plus colors was given for a whole week.  The children and parents didn’t know when they were getting the placebo or the real thing.  Evaluation measures were repeated each week.  The researchers reported statistically significant increases in GHA scores when the children were consuming the additive mix.

            Here’s what the team of researchers concluded:  “These findings show that adverse effects are not just see in children with extreme hyperactivity (ie, ADHD), but can also be seen in the general population and across the range of severities of hyperactivity.  Our results are consistent with those from previous studies and extend the findings to show significant effects in the general population.”

            These same artificial colors and flavors have also been shown to cause severe changes in behavior in many children with ADHD.  These reports have been published in first rate journals in Science, Lancet, Pediatrics, Journal of Pediatrics, Annals of Allergy, and Archives of Disease in Children.

            Where does this leave you, the tired, harassed parent?  This study and a similar one from Australia suggest that a trial of a diet free of artificial colors and flavors for a week or two is well worth your effort for both your children with ADHD and those without! You’ll have to read all labels carefully.  At the end of this time on a Saturday or Sunday (not before church!), you can give your children a glass of water or 100% fruit juice to which you’ve added a couple of drops of each color found in McCormick’s or French’s Artificial Colors in the little bottles in the spice section of your grocery store.  If they don’t respond to the first glass, give them a second one.  Do your children react adversely either behavior-wise or with physical complaints?  This easy test will tell you whether or not your children are sensitive to these additives.

            For more information, see Why Can’t My Child Behave by Jane Hersey published by Pear Tree Express or my book, 12 Effective Ways to Help Your ADD/ADHD Child published by Penguin Putnam.  Also, scroll way down to find the May 2005 newsletter that also addresses artificial colors and flavors.

October 2007

The Sugar Controversy Part 2

To help determine whether or not your child consumes a large amount of sugar and may be affected by sugar, answer yes or no to the following questions:

1.  Does your child consume one or more glasses of soft drinks each day?

2.  Does your child drink fruit punch rather than 100% unsweetened fruit juice?

3.  Does your child eat a lot of cookies, candy, and sugary desserts?

4.  Does your child start the day with a highly sugared cereal, donuts, or pancakes?

5.  Does your child crave sugar? 

6.  Has your child ever stolen candy or money to buy candy?

7.  Do your child’s behavior problems worsen around holidays?

8.  Has your child suffered repeated ear infections and taken many rounds of antibiotics?

If you answered “yes” to one or more of these questions, your child may be a “sugarholic.” It’s easy with today’s fast food and convenience foods to take in a lot of sugar each day.  For example, a can of pop has 9 teaspoons of sugar—that’s like drinking liquid candy!  Fruit punches contain 12 teaspoons in 12 ounces—that’s a quarter of a cup!  A chocolate shake has 9 teaspoons.  A cup of Fruit Loops, Cocoa Krispies, Trix, or Apple Jacks contains 3 ½ teaspoons of sugar plus the sugar your child adds at the table.

The Sugar Pig-out Test

But how do you really know for sure if your child’s behavior is related to his sugar intake?  After all, not all ADHD children react to sugar. How can you convince yourself and your child?  Here’s how:  For 2-3 weeks gradually reduce the sugar in your child’s diet.  Your child will be a happier camper if the whole family joins him in this test.  A gradual reduction is preferable to a sudden withdrawal because some children feel and act  worse if sugar intake is abruptly stopped.  For example, instead of a sugary breakfast, serve high protein breakfasts.  Breakfast could include eggs, homemade sausage, a grilled steak or hamburger, cold meat from the night before, unsweetened yogurt with some fruit added, cottage cheese, chili, etc.  Stay away from all the sugary breakfast foods.  The increased protein and the reduced sugar will help your child pay better attention and complete his work at school.  After 2-3 weeks ask yourself these questions:

●  Is my child’s performance in school improved? 

●  Is his behavior around the house better? 

●  How is his inattention? 

●  Is he less impulsive? 

●  If he’s normally overactive, is his activity level better? 

●  Does he feel and look better generally? 

●  Is his general mood better?

After 2-3 weeks you’re ready to try the “Sugar Pig-Out Test.”  This is adapted from Dr. Sidney Baker’s book, The Circadian Prescription (you would find this book very interesting and helpful).   Both kids and adults like this diet—the child likes the idea of