ADHD: The role of diet and sleep

I recently had a guest post published on the CNN news blog, The Charts, entitled Calming your child's ADHD symptoms. The subject clearly needs a fresh look, given the startling statistic from a recent CDC report that diagnosis of ADHD was up by 29% from 2000 to 2009, and evidence that medication use for ADHD increased at an average yearly rate of 3.4% from 1996 to 2008.

In a nutshell, I describe ADHD as a problem of regulation of emotion, behavior and attention. I offer three points of approach. The first is to address family relationships. This is because children learn self-regulation in context of relationships with primary caregivers, and family conflict is clearly associated with increased risk for ADHD. Second, I recommend involving kids in activities that promote self-regulation including, but not limited to, horseback riding, swimming, martial arts and drumming. And last I recommend careful use of medication when a child's symptoms interfere with learning and social relationships.

A number of people commented that I had not addressed the issues of diet or sleep, both of which have been associated with symptoms of inattention and hyperactivity. I gave some careful thought to why I had not included these issues among the top three. The reason is that, in my experience, problems around sleep and diet are usually embedded in problems in relationships (the major exception is obstructive sleep apnea, a sometimes overlooked condition that can cause of hyperactivity in children. This topic is well covered in a recent post by an ENT specialist on the blog KevinMD.)

For example, I took care of one teenage girl with symptoms of inattention who met diagnostic criteria for ADHD. I learned that up until her thirteenth birthday, her mother lay in bed with her every night until she fell asleep. Then on the day of her birthday, her mother decided that her daughter was too old for this habit, and abruptly stopped, insisting that she fall asleep on her own. Not surprisingly, her brain and body had no idea how to fall asleep independently, so she was staying up until two or three o'clock every morning, sneaking her laptop into bed with her.

Many children with a range of behavior problems crave sweets. Parents describe constant battles around food choices. It is likely that these problems have complex causes: sweets may be used to reduce stress, and food is a place where children can exert absolute control by simply closing their mouths.

Certainly it is important for growth, development, and learning that children eat a healthy diet. Ideally they should have three meals a day with sufficient fresh fruits, vegetables, and protein and a minimum of processed foods. However, if all attention in management of ADHD is focused on diet, to the exclusion of relationships, then the intervention is off the mark. In addition, evidence for more specific food restrictions, such as dairy, wheat or food dyes, is more anecdotal, and some of these diets can be quite restrictive.

Similarly, getting enough sleep is essential to healthy brain function and regulation of behavior, emotions and attention. But, with the exception of obstructive sleep apnea, most sleep problems develop in the context of relationships. In my work with the teenager I describe above, we needed to understand what about family relationships, between mother and father as well as between mother and daughter, led to this problematic situation. Only then could we could begin to solve the "sleep problem." Many children I see with a diagnosis of ADHD have been engaging in battles with their parents for years around sleep, but almost always in the setting of a range of conflicts within the family.

My answer to those who question the omission of sleep and diet from my discussion of ADHD is that yes, these issues are important. In my CNN piece I describe inattention, impulsivity and hyperactivity as symptoms, and urge parents and clinicians who treat ADHD to not simply treat symptoms, but rather to address the underlying cause. Similarly, problems with sleep and diet are often symptoms of problems in relationships. Many parents describe being overwhelmed by the volume of information coming at them about this complex entity known as ADHD. I believe both parents and professional would do well to be open to a variety of ideas while maintaining a focus on supporting relationships and repairing disruptions in relationships.

Steve Jobs Dies at 56

I woke to the headlines today. Steve Jobs, the co-founder of Apple Inc. died yesterday. For technology and innovative design, this is a sad day. Jobs is the reason for the personal computer not to mention technologies that know one else could imagine. After being pushed out of Apple in 1985, he started another company. It was there that the personal computer was perfected, and as Apple began to slide, it became clear that Jobs had to be brought back.  It was all uphill from there. This visionary COE was the force behind the iPod, iPhone and iPad. The theme, create technology that people don't even know they need! No one did it better than Apple with the hands on leadership of Jobs. The hip, stylized marketing and the Apple store were also highly innovative ideas. Jobs took on the sheer force of the tech industry and the other computer guy... and succeeded. In August, two months after his public appearance at the Apple Convention, Jobs stepped down as CEO. The message was clear; the end was near. I honor Mr. Jobs today. He is one of my heroes. His achievements, innovation and ingenuity were inspiring, but even more so was his enthusiastic energy and love of what he was doing. I found it contagious. I hope that this company will be able to continue their amazing work without Steve, but either way, it is a sad day, and he will be missed by many.

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