Diet for ADHD, Autism, and Sensory Disorders

I am often asked what kind of diet a may be helpful for children with Attention Deficit Disorder (ADD) or Autistic Spectrum Disorders (ASD; also sometimes referred to as Pervasive Development Disorders, PDD). Parents and care-givers of these special kids are desperately seeking anything that may help them better cope with their environment and be successful in life. I get this. I really do. I have a son who has severe Attention Deficit Hyperactivity Disorder (ADHD), sensory processing disorder, and a host of other diagnosed “disorders” with many of the challenges of kids on the spectrum. Interestingly, many professionals who work with this population consider ADD and ADHD to be on the autistic spectrum. I tend to believe this is true. I know that the nutrition therapies that work for ADD and ADHD also tend to work for autism (including Asperger’s) and those with sensory integration disorders (also called sensory processing disorder or SPD).  But I also know that there is no one-size-fits-all diet for any of these diagnoses.

No One Right Diet

There are parents, organizations, and even entire movements that swear by a particular diet as THE diet to treat ADHD or ASD, and are so passionate about it because of their personal experience that they insist every kid with these challenges be put on the same diet.  While I will whole-heartedly agree that diet/nutrition can have a huge impact on many of these kids, I think it is important to not assume they will all respond to the same diet. My own son responded significantly to dietary changes, but as a professional who has worked with numerous kids with mood, attention, and behavior challenges, I can attest that the diet that is helpful for my son may or may not be helpful for someone else. The reason is rather simple. These diagnoses are based on symptoms and do not address what causes the symptoms. While the symptoms may be similar, the root cause is not always the same. Consider all of the things that may cause a stomach ache, for example. If it’s caused by a milk allergy then removing milk from the diet should solve the problem. However, if it was caused by food poisoning, an ulcer, or an sensitivity to chicken then removing milk from the diet won’t resolve the symptoms of the stomach ache. The same is true for behavior, mood and sensory symptoms. They are not caused (or triggered) by the same things in everyone who has them, therefore a single diet will not help everyone. Individual assessments are necessary to determine what is most helpful in each case.

Food Sensitivities

  One popular recommendation for kids with ADHD or ASD is a gluten-free/ casein-free diet (GF/CF diet).  This can indeed be very helpful for some kids… but for other’s it makes no difference at all.  For reasons that are unclear, food sensitivities are prevalent in this population, but not all these kids are sensitive to gluten and/or casein. Some are affected by one but not the other, and some are not affected by either but have other food sensitivities that can send the spinning. Milk and gluten (or sometimes it’s just wheat) are 2 of the most common food sensitivities in the general population, so it is no surprise that in a population prone to food sensitivities we see a relatively high incidence of sensitivities to these. However, one should not assume that gluten or casein are problematic and I am always cautious about removing more types of foods than necessary – especially in population of kids that often have limited foods they are willing to eat to start.Other popular diets (such as the Feingold diet or DAN diet) “work” for many because they cast a wide net. In other words, if you eliminate a wide enough variety of foods from the diet there is a good possibility that you targeted at least one or two that are problematic. In my professional experience I have found that even kids who respond well to a GF/CF aren’t actually sensitive to either. For example, a child may be sensitive to cheese but OK with other dairy products. Likewise, I’ve seen cases where it was actually the yeast in the bread and not the gluten that caused problems. I’ve also worked with kids who have no sensitivity with anything to do with wheat, gluten, or dairy, but who respond beautifully when other food sensitivities are identified. I’ve also been able to successfully reintroduce some foods into diets of children who have been on very restrictive diets that “work” without seeing any adverse effects. The goal is to maximize nutrition and minimize harm in the least disruptive way possible. There are enough other battles on any given day, so minimizing those that involve food is a worthy goal.

Tests

  So how do you know what foods to eliminate? Find a nutrition professional who specializes in food sensitivities, is willing to really work with you to develop a diet that works for your individual child, and does not just administer an expensive food sensitivity test then send you out the door with a print out of the results to figure things out on your own. Sometimes I am able to spot pattern in patients’ diets that allow me to identify food sensitivities without the need for laboratory tests; but for some patients I find food sensitivity testing to be a very useful assessment tool. Once we have an accurate assessment, I can then work with the individual (and their parent) to design an customized diet complete with strategies for introducing changes (which, in this population often has to be done gradually and progressively due to difficulties with transitions).  However, it is important to be aware that not all food sensitivity tests are equal or useful.

Food allergies are severe immune reactions that are often tested by skin scratch tests. These are typically performed by Allergists and Immunologists, and will identify the more severe reactions. Food sensitivities are also immune reactions, but are typically not strong enough of a reaction to be detected by skin scratch tests.

Blood tests that look for antibody (immunoglobulin) reactions (IgG, IgE, IgA, etc.) are often favored by general practitioners and alternative healthcare providers (Naturopaths, etc.), but are often expensive and are very limited in their usefulness. Because these antibody blood tests are highly dependent on the patient’s current diet, they are only about 60% accurate. For instance, if a person has been avoiding gluten, this type of test will be negative for a gluten sensitivity even if the person has a severe sensitivity to it because it is not in their system at the time of the testing. Similarly, if a person has a mild sensitivity to a certain food but has been eating a lot of it prior to the test, the antibody blood test will indicate the person is highly sensitive to it. Thus, immunoglobulin blood tests for food sensitivities often have a significant number of false negative and false positive results. I’m not convinced these test are worth spending your money on.

A third type of test is called a mediator release test (MRT). When there is an immune response, chemicals such as histamines, cytokines and prostaglandins (and a hundred or so others) are released from cells into the surrounding fluids. The MRT measures the size of blood cells and the volume of surrounding fluids before and after a test substance is added to the sample. If the cell shrinks and the surrounding fluid increases significantly this suggests an immune response. The results of the MRT test are then verified with an elimination diet. This is done with the aid of specially trained dietitians who guide patients through the process utilizing a customized elimination diet based on the individual’s MRT results. I have found this to be a very useful tool to help identify sensitivities to foods, food additives and chemicals commonly found in foods and medications. This is the test I use in my practice when appropriate.

Sensory Issues

It is also worth mentioning that this special population of kids often have sensory issues that need to be considered in regards to diet and food choices. Some have aversions to certain types of food textures; some have an affinity for specific food textures; and many have a combination of both. An example might be a child who avoids “slimy” foods but is attracted to crunchy foods. Temperature of food can also be an issue for these kids; many will only eat food at room temperature, and others seek out hot or cold foods. These types of sensory issues all need to be considered when customizing a diet for these special kids.

Summary

1. There is no one-size-fits all diet for autism, Asperger’s, ADD, ADHD or Sensory Processing Disorder
2. Not all food sensitivity test are the same, and some are not worth the expense.
3. Skin scratch tests are useful for detecting allergies, but often miss food sensitivities
4. Blood tests that measure antibodies or immunoglobulins (IgG, IgE, IgA, etc.) are prone to false negative and false positive results so are unreliable and of limited use
5. Mediator Release Tests can be useful in identifying food and chemical (additives, etc.) sensitivities.
6. Chose a nutrition specialist who has training and experience for your child’s specific needs. Not all dietitians and nutritionists are equipped to work with your child’s specific needs.