ADHD
What is ADHD?
ADHD is the most common coexisting diagnosis in children with autism.
An estimated 20-50% of children with ADHD meet ASD criteria, while an estimated 30-80% of children with ASD meet ADHD criteria [5]
Children with ADHD meet one if not all of the following symptoms: [1]
Inattention
Impulsivity
ADHD has 3 different presentations: [1]
Predominantly Inattentive: Most symptoms meet criteria of inattention, though no hyperactivity-impulsivity for at least 6 months
Predominantly Hyperactive-Impulsive: Most symptoms meet criteria for hyperactive-impulsivity, but not inattention for at least 6 months
Combined Presentation: Symptoms for both criteria of inattention and hyperactivity were present for at least 6 months
To see the full DSM-5 Criteria for ADHD, click here.
ADHD often lasts into adulthood. To diagnose ADHD in adults and adolescents age 17 years or older, only 5 symptoms are needed instead of the 6 needed for younger children. Symptoms might look different at older ages. For example, in adults, hyperactivity may appear as extreme restlessness or wearing others out with their activity.
Nearly two-thirds (64%) of children with ADHD also have another mental, emotional, or behavioral disorder, such as conduct disorder, anxiety, depression, autism, and Tourette syndrome. [2]
Children with ADHD may have alterations in the immune system or increased oxidative stress, both which can lead to ADHD symptoms. Antioxidants may be appropriate to aid in oxidative stress. [3]
Dietary patterns such as decreased intake of fruits, vegetables, and fatty fish, and increased intake in sugar, candy, and fast food may increase risk of ADHD. [4]
Signs & Symptoms
Per the CDC, a child with ADHD might: [1]
Daydream a lot
Forget or lose things often
Squirm or fidget
Talk too much
Make careless mistakes or take unnecessary risks
Have a hard time resisting temptation
Have trouble taking turns
Have difficulty getting along with others
Next Steps
Diet
Increase foods rich in antioxidants such as berries, leafy greens, and dark chocolates. Antioxidant supplements include glutathione, vitamin E, and CoQ10, among others. Increasing antioxidants in the diet may be therapeutic in children with ADHD. [14]
Consume protein at each meal to support neurotransmitters and balance blood sugars.
Eating foods high in omega-3 fatty acids like fish and shellfish can be helpful for brain health and focus
Place special emphasis on foods containing B vitamins, such as folate and vitamin B12. Minerals such as zinc, iron, and magnesium may be indicated.
Consider eliminating artificial food dyes
Look into possible food reactions that could be causing hyperactivity or inattention
A Mediterranean Diet may decrease risk of ADHD, which includes a diet rich in vegetables, fruits, nuts, beans, and whole grains in combination with poultry, eggs, and fatty fish. [4]
Supplements
Magnesium may be therapeutic in reducing hyperactivity.
Consider methylated B vitamins, such as folate and vitamin B12. Minerals such as zinc, iron, and magnesium may be indicated. You may also consider a multivitamin and omega-3 fatty acids.
Neurotransmitter supports such as GABA, L-Theanine, or L-Tyrosine
Gastrointestinal issues such as yeast overgrowth and dysbiosis can cause brain fog or inattention. Consider foods and supplements that can support the gut such as fermented foods, probiotics, fiber, and prebiotics.
Lifestyle
Strive for 60 minutes of physical activity each day
Routines
Routines can be especially helpful for those with ADHD. Routines can be helpful for eating, sleeping, or just day-to-day tasks. Consider having dietary changes and/or supplements built into a routine that your child can expect.
Low Toxin Lifestyle
There are many things we cannot change (our genetics, for example) - but many things in our environment can be in our control! Children with autism may have a decreased ability to detox from their environment, therefore limiting toxin exposure can be extremely beneficial (for your whole family!)
You can check out the Toxic Load note for more on this!
PLEASE NOTE: Every child with ADHD is different and requires individualized care. Please consult your pediatrician and Registered Dietitian before modifying medications, supplements, or diet.
ADHD in the Research
Sensory Processing & ADHD
Both children diagnosed with ASD and ADHD had elevated sensory processing patterns. Children with ASD showed the highest rate of oral processing differences, followed by ADHD, and then children who were typically developing. [6]
Children who are more sensory sensitive are at higher risk for consistent pickiness as they age [9]
ADHD Diet
Low adherence to a diet rich in fruit, vegetables, pasta, and rice and low consumption of fatty fish was associated with ADHD diagnosis [4]
Higher frequency of skipping breakfast and eating at fast-food restaurants were associated with ADHD diagnosis [4]
High consumption of sugar, candy, cola beverages, and non-cola soft drinks were also associated with a higher prevalence of ADHD diagnosis. [4,12]
Exercise
The existing preliminary evidence suggests that exercise can improve cognitive performance observed in ADHD and children without ADHD. [7]
Glyphosate
While more research needs to be done, the current research suggests that pesticide exposure, even at levels that do not cause acute toxicity, may be among the multifactorial causes of ADHD and ASD. [8]
Antioxidants & Polyphenols
Children with ADHD may have increased oxidative stress and immune dysfunction, warranting removal of sensitive foods, focusing on the microbiome, and increasing antioxidants in the diet. [3]
Dietary polyphenols, for example, have antioxidant capacities as well as immunoregulatory effects and, therefore, appear appropriate in ADHD therapy. [3]
Conflicting Research
Some studies suggest that there is no clear evidence that supports dietary interventions for the treatment of ADHD. Though there is evidence that children with ADHD are less likely to engage in healthy lifestyle behaviors than non-ADHD youth. [10-11,13]
Remember that all children with ADHD or autism are uniquely different, so every nutrition approach discussed will not benefit every individual. Consider trialing one change at a time to identify nutrition interventions that benefit your child the most.
References
[1] Attention-Deficit / Hyperactivity Disorder (ADHD). Centers for Disease Control and Prevention Website. Accessed 16 Sept 2020. https://www.cdc.gov/ncbddd/adhd/index.html
[2] National Prevalence of ADHD and Treatment. Centers for Disease Control and Prevention Website. Accessed 16 Sept 2020. https://www.cdc.gov/ncbddd/adhd/features/national-prevalence-adhd-and-treatment.html
[3] Verlaet AAJ, Maasakkers CM, Hermans N, Savelkoul HFJ. Rationale for Dietary Antioxidant Treatment of ADHD. Nutrients. 2018;10(4):405. Published 2018 Mar 24. doi:10.3390/nu10040405
[4] Ríos-Hernández A, Alda JA, Farran-Codina A, Ferreira-García E, Izquierdo-Pulido M. The Mediterranean Diet and ADHD in Children and Adolescents. Pediatrics. 2017;139(2):e20162027. doi:10.1542/peds.2016-2027
[5] Leitner Y. The co-occurrence of autism and attention deficit hyperactivity disorder in children - what do we know?. Front Hum Neurosci. 2014;8:268. Published 2014 Apr 29. doi:10.3389/fnhum.2014.00268
[6] Little LM, Dean E, Tomchek S, Dunn W. Sensory Processing Patterns in Autism, Attention Deficit Hyperactivity Disorder, and Typical Development. Phys Occup Ther Pediatr. 2018;38(3):243-254. doi:10.1080/01942638.2017.1390809
[7] Christiansen L, Beck MM, Bilenberg N, Wienecke J, Astrup A, Lundbye-Jensen J. Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations. J Clin Med. 2019;8(6):841. Published 2019 Jun 12. doi:10.3390/jcm8060841
[8] Roberts JR, Dawley EH, Reigart JR. Children's low-level pesticide exposure and associations with autism and ADHD: a review. Pediatr Res. 2019;85(2):234-241. doi:10.1038/s41390-018-0200-z
[9] Steinsbekk S, Bonneville-Roussy A, Fildes A, Llewellyn CH, Wichstrøm L. Child and parent predictors of picky eating from preschool to school age. Int J Behav Nutr Phys Act. 2017;14(1):87
[10] Cagigal C, Silva T, Jesus M, Silva C. Does Diet Affect the Symptoms of ADHD?. Curr Pharm Biotechnol. 2019;20(2):130-136. doi:10.2174/1389201019666180925140733
[11] Pelsser LM, Frankena K, Toorman J, Rodrigues Pereira R. Diet and ADHD, Reviewing the Evidence: A Systematic Review of Meta-Analyses of Double-Blind Placebo-Controlled Trials Evaluating the Efficacy of Diet Interventions on the Behavior of Children with ADHD. PLoS One. 2017;12(1):e0169277. Published 2017 Jan 25. doi:10.1371/journal.pone.0169277
[12] Yu CJ, Du JC, Chiou HC, et al. Sugar-Sweetened Beverage Consumption Is Adversely Associated with Childhood Attention Deficit/Hyperactivity Disorder. Int J Environ Res Public Health. 2016;13(7):678. Published 2016 Jul 4. doi:10.3390/ijerph13070678
[13] Del-Ponte B, Anselmi L, Assunção MCF, et al. Sugar consumption and attention-deficit/hyperactivity disorder (ADHD): A birth cohort study. J Affect Disord. 2019;243:290-296. doi:10.1016/j.jad.2018.09.051
[14] Moghadas M, Essa MM, Ba-Omar T, Al-Shehi A, Qoronfleh MW, Eltayeb EA, Guillemin GJ, Manivasagam T, Justin-Thenmozhi A, Al-Bulushi BS, Al-Adawi S, Edalatmanesh MA. Antioxidant therapies in attention deficit hyperactivity disorder. Front Biosci (Landmark Ed). 2019 Jan 1;24:313-333. PMID: 30468658.
