It has been a popular notion since the 1970s that behavioural manifestations of ADHD, especially hyperactivity, resulted from the consumption of various food additives, food colorings, and sugar. In September of 1999, the Center for Science in the Public Interest, an independently funded, U.S. based non-profit society devoted to research, information, and advocacy programs concerning nutrition, alcohol problems, and food safety, published an extensive research paper entitled “Diet, ADHD & Behavior” (Jacobson & Schardt, 1999). Information about the Center for Science in the Public Interest may be found in Appendix 4.
Interestingly enough, but perhaps not surprising, the food and drug industry-supported agencies and organizations flatly deny that there can be any connection between ADHD and food additives. In 1993, for example, a pamphlet entitled “Food Color Facts,”written by the International Food Information Council (IFIC), was published by the U.S. Food and Drug Administration (FDA). The pamphlet states that “although the theory was popularized in the 1970s, well-controlled studies conducted since then have produced no evidence that food color additives cause hyperactivity or learning disabilities in children” (Jacobson & Schardt, 1999, p. 25). It is worth noting that representatives of General Mills, Kraft, Proctor and Gamble, Pepsi-Cola, Coca-Cola, Monsanto, and Ajinomoto (maker of monosodium glutamate) sit on the board of directors of the IFIC.
In a pamphlet entitled Fast Facts About Hyperactivity published in the 1990s by the Sugar Association and endorsed by the Academy of Family Physicians Foundation, states:
It used to be thought that ADHD could be caused or made worse by food additives and/or sugar in the diet. The truth is … Scientific studies do not support any connection between diet and ADHD. Forbidding children with ADHD to eat certain foods will not change their behavior, and is not recommended. (cited by Jacobson & Schardt, 1999, p. 27)
The connection between CHADD and Monsanto has already been mentioned, so it’s not surprising that they, too, would deny any connection between diet and ADHD. “Fact Sheet 4” (CHADD, 1999b) states: “Numerous studies have debunked the notion of an additive-free diet as a treatment of ADD.” Not surprisingly, one of the most noted associates of CHADD, Dr. Russell Barkley, also debunks any connection between diet and ADHD (Jacobson & Schardt, 1999, p. 28).
In “Appendix 3: The Conventional Wisdom on Diet and ADHD” in the Science in the Public Interest review, no less than 13 significant organizations and researchers are quoted as denying dietary influences on childhood behaviour. At the same time, some 28 out of 34 studies cited in the review show at least some positive results in linking food additives, especially food dyes, to children’s behaviour.
During the recent past, reports the review, the production of food dyes, according to the U.S. Food and Drug Administration, has increased from 12 mg per capita in 1955, to 47 mg per capita in 1998 (Jacobson & Schardt, 1999, p. 11). It is well known that children are major consumers of artificially collared, flavoured, and sweetened beverages, candies, and snack foods, and given the recent increase in ADHD diagnoses noted earlier, the simple numerical correlation should at least give us pause, if for no other reason than concern over our children’s diet. Based upon the studies cited in its review and a general concern for public health, the Center for Science in the Public Interest recommends that:
The FDA should consider banning the use of synthetic dyes in foods (for example: cupcakes, candies, sugary breakfast cereals, and children’s vitamin pills, drugs, and toothpaste) widely consumed by children, because dyes adversely affect some children and do not offer any essential benefits. (Jacobson & Schardt, 1999, p. 15).
The studies cited in Diet, ADHD & Behavior, (Jacobson & Schardt, 1999) while not showing a consistent or dramatic correlation between diet and ADHD, do show that diet does affect some children’s behaviour. Therefore it would seem prudent to take diet into account when considering treatments for ADHD. As the review says, “Of course, the overall percentage of children affected by foods does not matter when it comes down to your child” (Jacobson & Schardt, 1999, p. 10).
The Center for Science in the Public Interest calls for new and better research to determine which foods and food additives affect children’s behaviour, and that fast food chains, hospitals and others supplying food to children eliminate foods which contain dyes and other additives as a pre-cautionary measure. It is also recommended that diet be considered as the first line of treatment for ADHD, in lieu of the immediate prescription of stimulant drugs. This is also the line taken by those who favour the humanistic model of ADHD.
Drugs Instead of Drugs: Is Ritalin Safe?
Because Ritalin and similar amphetamines are so widely prescribed, especially for children, it might be reasonable to assume that a substantial amount of research had been done into potentially negative side effects. This has not been the case. The surprisingly scanty number of studies that have been done are inconclusive, leading CHADD to proclaim cheerfully:
Hundreds of studies on thousands of children have been conducted regarding the effects of psychostimulant medication, making them among the most studied medications in pharmacological history. Relatively few long-term side effects have been identified. Most problems related to these medications are mild and short-term. (CHADD, 1999, d)
This statement is in direct contradiction to what was said by Dr. Coyle and Erica Goode, quoted above. In a recent article in The New Yorker, Jerome Groopman interviewed Anthony Rao, a Boston clinical psychologist specializing in child and adolescent psychology:
But Rao pointed out that no one knows precisely what the long-term effects of these drugs on children will be “especially when they are given daily for years.” This approach, he contends, is treating the brain as if it were a bad kidney, when it’s a far more complex organ, one which modifies itself continually. (Groopman, 2000)
For information on CHADD’s possible biases, I invite the reader to refer to Appendix No. 3, which presents some information from the Center for Science in the Public Interest review.
The possible side effects of Ritalin that have been identified are serious enough to suggest caution in the use these drugs on children, particularly very young children. However rare, occurrences of seizures, Tourette’s syndrome, glaucoma, delusions, and mania resulting from the use of methylphenidate (Ritalin) might cause one to think twice before administering such drugs (Armstrong, 1995). Thomas Armstrong (1995) reports “that many children simply don’t like taking these drugs” (pp. 41-42), a comment suggesting that considering the children’s point of view here might not be a bad idea.
I have already mentioned the concerns of Dr. Coyle in connection with stimulant use on very young children (Coyle, 2000), but there is further cause for concern. A 1995 study by the U.S. National Toxicology Program found that methylphenidate caused liver cancer in some mice, though not in rats. (Jacobson. & Schardt, 1999). And again, I emphasize that little is known about the long-term effects, including effects in adulthood, resulting from amphetamine use in childhood. With this in mind, again it would seem prudent to err on the side of caution when considering medications for children. “Of course, the overall percentage of children affected by foods [or drugs] does not matter when it comes down to your child” (Jacobson & Schardt, 1999 p. 10).
Funding for research into the negative aspects of amphetamine use is hard to find. Pharmaceutical companies, major funders of research, as are the purveyors of various food additives, are likely to look favourably upon researchers who will find benefits in their products. Why, after all, should they pay someone to shoot holes in their cash cow? It’s also worth remembering that these large and wealthy corporations maintain powerful lobby groups to insure that government regulations do not adversely affect their bottom line.
But that’s not all. Ritalin works on the brain by stimulating the production of dopamine in the neuro-transmitters of the pre-frontal cortex. Hallowell and Ratey (1994), in their landmark book Driven to Distraction, conclude that, “The most likely possibility is that the effect of dopamine and norepinephrine and serotonin is key and drugs that alter these neurotransmitters will have the most telling effect on the symptomatology of ADD” (Hallowell & Ratey, 1994, p. 274). It appears that cocaine and nicotine, two addictive drugs, have an almost identical effect upon the brain’s chemistry (Groopman, 2000; Boyce, 1999; Motluk, 1998; Hallowell & Ratey, 1994). This has led some researchers to speculate that the use of Ritalin in childhood will lead to cocaine or nicotine addiction in later life (Motluk 1998). Though some studies have shown that illegal drug use is less frequent among boys who are taking Ritalin, there has yet to be a well-documented follow-up study on what happens in adulthood (Boyce. 1999). It’s something to think about. And again, the likelihoods, possibilities, and percentages do not matter “when it comes down to your child.”
Conclusion
Out of the tons of material available, I’ve tried to choose the salient features of the current arguments about ADHD. So far though, I’ve only scratched the surface. But scratching that surface has raised many questions, some of which I’ve addressed here, but many of which require further thought and an examination of contemporary society and culture. Why, for example, is ADHD so alarmingly prevalent in North America today? Has the cure (Ritalin) created the disease? Or has the fast pace of television, traffic, fashion, school, and peer interaction simply surpassed the ability of a child’s brain to cope? Like the caged animals, are our children responding in the only way they can?
The humanistic view asks us to look at the cage and consider alternatives. The medical view accepts the cage as inevitable and offers palliatives to the animals. Given the pressures that parents are under to see their children succeed in society and in school, it’s not surprising that many would opt for medication. It’s fast, it’s simple, and it works, but what does it say about the place of children in our society? On the other side, the humanistic approach asks us to take time, to pay attention to our children—and there are no guarantees of success.
When I read through the list of symptoms in the DSM-IV, I can hardly believe that grown-up human beings could have written such material, and then have proceeded to take it seriously. Are we really willing to label a child disordered because he or she doesn’t like homework? Or because we might be embarrassed by his or her impulsive behaviour? I invite the reader to consider the DSM-IV symptoms as a list of school DO NOTS. You could hardly find a better statement of forbidden activities!
In “Ritalin Nation” Richard DeGrandpre (1999) argues that the signs of ADHD are “essentially symptoms of boredom.” But they are also symptoms of a child’s rejection of arbitrary and indifferent authority and an expression of the suffering of a small person in a hostile world. A child has but few means of self-assertion available; behaviour is one of those. I would like us to look at behaviour as a form of communication. What is the ADHD child saying to us? And how can we best respond with humanity and love?
On page 4 of this paper, I quoted Dr. Russell Barkley describing what he terms various “learning and behavioral disorders.” He then makes the remarkable statement that, “these labels were based on the observable and verifiable deficits of the children they described.” Deficits? By whose standards? Most certainly not those of the child! He and his cohorts have even gone so far as to have “identified” the pathologies of Conduct Disorder and Oppositional Defiant Disorder. Since when is it pathological to stand up for your rights?
The surest way to control people and to get them to co-operate in being controlled is to call them names. Once I have labelled my child as bright or as dull, as obedient or disobedient, as attentive or inattentive, or as “just like your Uncle Charlie,” the prophesy becomes self-fulfilling. As R. D. Laing points out, children learn more from what we tell them they are rather than from what we tell them to do.
What they tell him he is, is induction, far more potent than what they tell him to do. Thus through the attribution “You are naughty,” they are effectively telling him not to do what they are ostensibly telling him to do. (Laing, 1972)
Several writers about ADHD mention the devastating effects upon the child of being branded as disordered. What the ADHD diagnosis says to the child is, “Your communications (through behaviour) are invalid; you act the way you do because there is something wrong with you.” Jerome Groopman (2000), refers to another statement made by Anthony Rao:
Rao believes that the D.S.M. label resonates in the child’s mind and among family members and friends in pejorative and embarrassing ways. “Your brain is your soul,” Rao said fiercely. “You’re telling a kid that there is something wrong with who he fundamentally is.” (Groopman, 2000, p. 55)
Attribution works is subtle unconscious ways. Once a child has been diagnosed and labelled as ADHD, he or she will be living in a world where teachers, parents, playmates, and siblings, are responding in a way that will confirm the child’s designation as “having” a pathology.
Curiously enough, in the wealthiest part of the world, where all kinds of hardware provide for our convenience and amusement, we have little time or space for the inclusion of children in everyday life. When they are not being rushed about from piano lessons to hockey practice to gymnastics, they are either confined in school or parked in front of a television set or video game. Parents are working long hours in order to pay for all this frantic activity, plus having to save up for the inevitable and essential university education for their children. Where is there space to breathe, to daydream, or simply to loaf? Our children are telling us to stop, to lay off, and to pay attention. The message is there, louder and louder, in their behaviour. When are we going to listen?
This concludes the article. A bibliography and additional information follow.