Data mining the ScanBrit study of a gluten- and casein-free dietary intervention for children with autism spectrum disorders: behavioural and psychometric measures of dietary response.

We previously reported results based on the examination of a gluten- and casein-free diet as an intervention for children diagnosed with an autism spectrum disorder as part of the ScanBrit collaboration. Analysis based on grouped results indicated several significant differences between dietary and non-dietary participants across various core and peripheral areas of functioning. Results also indicated some disparity in individual responses to dietary modification potentially indicative of responder and non-responder differences. Further examination of the behavioural and psychometric data garnered from participants was undertaken, with a view to determining potential factors pertinent to response to dietary intervention. Participants with clinically significant scores indicative of inattention and hyperactivity behaviours and who had a significant positive changes to said scores were defined as responders to the dietary intervention. Analyses indicated several factors to be potentially pertinent to a positive response to dietary intervention in terms of symptom presentation. Chronological age was found to be the strongest predictor of response, where those participants aged between 7 and 9 years seemed to derive most benefit from dietary intervention. Further analysis based on the criteria for original study inclusion on the presence of the urine compound, trans-indolyl-3-acryloylglycine may also merit further investigation. These preliminary observations on potential best responder characteristics to a gluten- and casein-free diet for children with autism require independent replication.

Food additives and hyperkinesis: a controlled double-blind experiment.

A double-blind crossover trial involving a control diet and a diet eliminating artificial flavors, colors, and natural salicylates as recommended by Feingold was conducted on 15 hyperkinetic children. Teachers and parents observed the children for one month prior to treatment, using standardized rating scales. Both parents and teachers reported fewer hyperkinetic symptoms on the K-P diet as compared to the pretreatment baseline. The teachers noted a highly significant reduction of symptoms on the K-P diet as compared to the control diet but the parents did not. The control diet ratings did not differ from the baseline period ratings for either parents or teachers. It is concluded that the K-P diet may reduce hyperkinetic symptoms, though this result is put forth with caution in view of several features inherent in the present study which need further evaluation, including objective measures of change, manipulation of the independent variable, and reducing the independent variable to more specific components.

Diet and hyperactivity: is there a relationship.

In 1973 Dr Ben Feingold, a California alergist, proposed that salicylates, artificial flavors, and artificial food colors are a cause of hyperactivity. Dr Feingold recommended a diet free of these substances as both treatment and prevention of the condition. He has published two popular books on the subject, Why Your Child Is Hyperactive (1974) and The Feingold Cookbook for Hyperactive Children (1979). Many parents have adopted the diet for their hyperactive children, and some have reported a noticeable improvement in their child's behavior when the diet was followed. In recent years a number of experiments have been carried out to evaluate the relationship between hyperactivity, salicylates, artificial flavors. The data indicate that the symptoms of the vast majority of cases of children labeled "hyperactive" are not related to additives in their diet.

Hyperkinesis and food additives: testing the Feingold hypothesis.

Teacher ratings, objective classroom and laboratory observational data, attention-concentration, and other psychological measures obtained on 36 school-age, hyperactive boys under experimental and control diet conditions yielded no support for the Feingold hypothesis. Parental ratings revealed positive behavioral changes for the experimental diet; however, they seemed primarily attributable to one diet sequence. Parents' behavioral ratings on ten hyperactive, preschool boys indicated a positive response to the experimental diet; again, laboratory observations showed no diet effect.

Relative effects of drugs and diet on hyperactive behaviors: an experimental study.

In a test of Feingold's hypothesis that food additives trigger the hyperactive response, 26 hyperactive children were randomly assigned to treatment conditions whereby they were given active or placebo medications in combination with challenge cookies with artificial food colors or control cookies without the additives. The children were crossed over into each of the four treatment conditions and experimental procedures were employed, including double-blind assessments through the completion of behavior checklists, by teachers and parents. Stimulant medications were clearly more effective than diet in reducing hyperactive behavior. The parent ratings indicate strong drug effects and inconclusive diet effects. Drug effects are marked in teacher ratings as well. However, when the children were receiving placebos, their hyperactive behaviors in the classroom were greater when eating cookies with artificial colors than when eating cookies without artificial colors. According to the ratings, approximately seven children were no longer hyperactive. There is evidence to suggest that the behavior of three to eight children was diet-responsive, depending on the criteria used. There is evidence, particularly in teacher ratings, in support of Feingold's hypothesis if it is modified. Further research is required to specify which subtypes of hyperactive children respond to a diet free of artificial food colors.

Medication for hyperkinetic children.

The hyperkinetic syndrome is a symptom complex of hyperactivity, short attention span, distractibility, impulsivity, learning difficulties, other behaviour problems and 'equivocal' neurological signs. However, none of these terms has ever been objectively defined and at present diagnosis is largely a matter of clinical judgement. In the management of the disorder, drugs do have a place but the decision to use medication is a complex procedure diagnostically and therapeutically calling for the highest in clinical skill and medical supervision. The most useful medication at present is the stimulant group of drugs, particularly dextroamphetamine and methylphenidate. Antipsychotic drugs are sometimes useful but carry the risk of depressing higher CNS functions such as attention and cognition. Other drugs which have been shown to be of value include tricyclic antidepressants (although their effect is less predictable and less striking than that of the stimulants) and pemoline.

Nutrition, brain function and behavior.

Current food intake has been shown to directly affect neurotransmission, with resultant modification of behavior. The role of vitamin co-factors in brain function is discussed, with emphasis on changes in mood and neurological function with deficiency. The use of megadoses of vitamins for the treatment of psychiatric diseases has little scientific support at this time. Current research also does not substantiate the Feingold thesis of improvement in childhood hyperkinesis when an additive-free diet is consumed. The effects of medications used to moderate mood are related to changes in nutrient intake that in turn alters weight status. In addition, the effect of certain nutrients modifying the dose response to mood altering drugs has been discussed. Finally evidence for mood state directly affecting the capacity of the body to utilize nutrients is presented.

Effect of Feingold's K-P diet on a residential mentally handicapped population.

Independent investigations of Feingold's K-P diet have not produced consistent results. Even the most carefully designed experiments by Connors et al. resulted in an internal inconsistency; namely, the results differed, depending on the order in which the control and K-P diets were used. This study involved a double-blind, crossover design with random assignment to treatment and control groups. Subjects were drawn from a residential mentally handicapped population. There was no significant difference between Feingold's K-P diet and the control diet regarding the specific dependent variables of general activity, attention span, and excitability.

Nutrient intakes of children on the hyperkinesis diet.

The nutrient intakes of fifty-four hyperactive children during a baseline period and while following the hyperkinesis diet were calculated. During both periods, mean dietary intakes compared favorably with the Recommended Dietary Allowances. A comparison of three-day food records showed that, relative to baseline values, nutrient intakes did not change significantly while the children followed the hyperkinesis diet. The majority of the children reported intakes sufficient to meet the recommended allowances during both the baseline and diet periods.

Dietary characteristics of hyperactive and control boys.

The purpose of this study was to examine the relationship between dietary habits and behavioral problems in hyperactive boys and to determine how successful parents are in maintaining their children on sugar-free diets. The mothers of 32 hyperactive boys aged 7 to 12 years and 26 matched controls completed 3-day diet records and food frequency interviews. The hyperactive boys were also evaluated in a playroom for impulsivity, compliance, attention, motor activity, memory, and learning. No differences were found in any of the measures of dietary content between the hyperactive and control groups. The only significant differences between those two groups were a lower socioeconomic status and a greater number of parents attempting sugar-restricted diets in the hyperactive group. Boys on sugar-restricted diets had only one significant dietary difference from those not restricted. Correlations between the information obtained in food frequency interviews and in 3-day diet histories were not significant (r = .06 to .33) for the hyperactive group, but the food frequency interviews were significant for the control group (r = .41 to .47). Four behavioral variables showed significant partial correlations with reported sugar intake. Overall, the results demonstrated that the diets of a group of hyperactive boys were similar to those of a control group. There appeared to be little difference between the diets of the families that attempted to restrict sugar and those that did not.

Diet and hyperkinesis--an update.

Ten years ago, Dr. Feingold proposed that hyperactivity and learning disabilities in children are commonly caused by the ingestion of food additives and claimed that elimination of foods with additives from the diet resulted in major improvements in three-quarters of hyperactive children. In the last five years, controlled double-blind studies have been conducted by many investigators to test this hypothesis. The results, which are mainly negative, are summarized. The authors conclude that 2% (contrasted with Feingold's claims of 75%) of hyperactive children respond adversely to dye additives. Even the 2% are questionable. There is no need for high-priority research or for changes in public policy regarding the use and labeling of foods containing additives. Hyperkinesis has multiple etiologies, which require other types of biological and psychological research.

A study of the efficacy of the Feingold diet on hyperkinetic children. Some favorable personal observations.

A study was conducted with 59 children, ages 6 to 14 years, heterogeneously grouped together under the diagnosis of the hyperkinetic, minimal brain dysfunction syndrome. Of 32 who were able to tolerate the Feingold salicylate-low and additive-free diet, 11 were markedly improved. A placebo effect could not definitely be ruled out, but the startling changes seen in patients who had been followed for years with other forms of therapy suggest strongly that this improvement was genuine.

Effect of diet treatment on enuresis in children with migraine or hyperkinetic behavior.

Twenty-one children with migraine and/or hyperkinetic behavior disorder which was successfully treated with an oligoantigenic (few-foods) diet also suffered from nocturnal and/or diurnal enuresis. On diet, the enuresis stopped in 12 of these children and improved in an additional four. Identification of provoking foods was by sequential reintroduction of the foods that were avoided on the oligoantigenic diet. In eight of the 12 children who recovered on the oligoantigenic diet and in the four who improved, reintroduction of one or more foods provoked a reproducible relapse of the enuresis. Nine children were subjected to a placebo-controlled, double-blind reintroduction of provoking foods. Six children relapsed during testing with incriminated foods; none reacted to placebo. Enuresis in food-induced migraine and/or behavior disorder seems to respond, in some patients, to avoidance of provoking foods.

Effect of dietary protein content on behavior in dogs.

OBJECTIVE: To determine the effect that feeding diets containing a low (17%), medium (25%), or high (32%) protein content would have on behavior in dogs. DESIGN: Prospective, controlled study. ANIMALS: 12 dogs with dominance aggression, 12 dogs with hyperactivity, 12 dogs with territorial aggression, and 14 control dogs without behavioral problems. PROCEDURE: Dogs were fed each of the diets for a 2-week period, and owners were instructed to score their dogs' behavior on a daily basis. RESULTS: Behavior of the dogs with dominance aggression, dogs with hyperactivity, and control dogs was unchanged by the dietary manipulations. Territorial aggression was significantly reduced when dogs were fed the low- or medium-protein diet, compared with territorial aggression when fed the high-protein diet. Post hoc analysis indicated that this effect was attributable to a marked reduction in aggression in a subset of the group (n = 7) in which territorial aggression was a result of fear. CLINICAL IMPLICATIONS: Results of this study suggest that a reduction in dietary protein content is not generally useful in the treatment of behavior problems in dogs, but may be appropriate in dogs with territorial aggression that is a result of fear.

The management of hyperkinetic children: a trial of dietary therapy.

The standard techniques in the management of hyperkinetic children are not uniformly successful. Recently, there has been considerable interest in dietary therapy. The diet, low in artificial colours, and flavours and in naturally occurring salicylates has been adapted for use in New Zealand. Ten hyperkinetic children have been treated with the diet, five of whom improved dramatically and are now off all other therapy. Their response to accidental and deliberate challenge supports the hypothesis that the dietary regime described has been responsible for their improvement.

Nutrition and behavior: complex interdisciplinary research.

Nutrition and behavior research presents a particularly challenging field of study for scientists. An overview is provided of research on nutrition and behavior of adequately nourished populations in industrialized countries. Discussions and findings from research presented include: refined carbohydrate consumption, maladaptive behavior, behavior disorders and learning; a history of the 'Feingold diet' and the basis for its controversy; an examination of recent critiques of research on artificial food dyes and hyperkinesis; indications for dietary intervention of hyperactive preschoolers; the role of iron in behavior disorders; effects of sub-clinical vitamin deficiencies on behavior; trace element analysis studies and violent behavior; and, suggested guidelines for further research into this complex and challenging field. Studies cited are from Canada, France, the United Kingdom, and the United States.

Symptom alleviation in the hyperactive child by dietary modification: a report of two cases.

Case reports are presented of two hyperactive preschool boys, one with severe cognitive and one with emotional problems, treated as a last resort with the Kaiser-Permanente elimination diet. Outcomes suggest further study of the effectiveness of the diet in alleviating symptoms of hyperactivity, especially in the preschool child who is unresponsive to medication and whose hyperactivity may be compounded by other developmental and emotional problems.

Pills or skills for hyperactive children.

The controversial nature of drug treatment of hyperactivity, the incidence and sequelae of hyperactivity, and problems of differential diagnosis of hyperactivity versus aggression were discussed. The effects of psychostimulant medication and behavior therapy on hyperactive children were reviewed with regard to effects on their social and academic behavior. Both treatments have resulted in clear short-term changes in social behavior but neither long-term academic nor long-term social effects have been shown with either treatment. Short-term effects on academic behavior have resulted from behavioral interventions but not from psychostimulants. However, the interventions have been too brief to allow one to draw unequivocal conclusions about the clinical efficacy of behavioral treatments. Although there have been long-term evaluations of psychostimulant therapy, there have not been any evaluations of long-term behavioral treatment programs for hyperactive children. Given the salutary short-term effects of behavior therapy with hyperactive children, extended clinical trials of behavior therapy need to be conducted. Finally, specific directions are suggested for future research.

A plea for comprehensive treatment for the hyperkinetic child.

Having a multimodality approach to the hyperkinetic child may make the difference between success or failure in the management of the child. Frequently, one or two modes of intervention alone will not be sufficient. Although several modes of intervention have been described, the helping professional must exercise his own creativity in order to assist specific children.