ies indicate that these diets are only occasionally efficacious. Apparent discrepancies between some clinical impressions of efficacy and much of the available scientific evidence prompted the scheduling of this Consensus Development Conference.
What Constitutes the Hyperactivity Syndrome in Children? Is It a Single Disease or a Cluster of Diseases? Can It Be Graded or Scaled in Quantifiable Variables Such as Attention Span, Learning Ability, and Social Adjustment and By Whom (Teachers, Parents, Medical Personnel)?
Innumerable definitions have been offered for the hyperactivity syndrome in children. The latest of these, in Diagnostic and Statistical Manual III (DSM III) (the American Psychiatric Association), delineates the varied symptomatology in this behavioral syndrome. According to DSM III,"the essential features are signs of developmentally inappropriate inattention, impulsivity, and hyperactivity." Other diagnostic qualifiers include onset prior to the age of 7, a duration of no less than 6 months, and a proven absence of mental illness or mental retardation.
The cluster of symptoms does not represent a single disease, nor is it likely that the etiology is singular; rather, the syndrome may be secondary to (1) organic factors such as trauma, infection, lead intoxication, and significant perinatal hypoxia; (2) predisposing genetic (familial) factors; or (3) psychosocial factors such as anxiety, inadequate parenting, and environmental stresses. In most cases the etiology is unknown and may be the result of synergism of several of the predisposing factors listed above.
The diagnostic process optimally includes the participation of parents, medical personnel, teachers, psychologists, and social workers. Several useful tests and rating scales for quantification of important variables such as attention span, learning ability, and social adjustment are available to those involved in the process; however, a need for more concise assessment tools is apparent. The recent development of electronic devices for measuring motor activity may prove helpful in providing a more refined quantitation of attention span and hyperactivity.
If progress is to continue in treatment of hyperactivity, it will be necessary to improve accuracy in diagnosis and to develop objective methods to monitor the effect of each approach to treatment and the course of the patient.
What Are the Defined Diets?
The term "defined diets" includes several dietary modifications. The basic diet described by Feingold eliminated two groups of foods: Group I consists of almonds, cucumbers, tomatoes, berries, apples, oranges, and several other fruits. These were excluded because of high levels of naturally occurring salicylates. Group II includes foods known or thought to contain artificial colors and flavors (most of these latter foods were perceived by the public as "processed"). This category was largely selected on the basis of ingredient (including additive) labeling and standards of food identity. With the exception of BHT (butylated hydroxytoluene), foods containing preservatives were not excluded from the original Feingold diet. No restrictions were placed on homemade sweets, but commercially prepared desserts and other foods to which relatively high amounts of sucrose had been added were usually disallowed on the basis of their content of artificial color and/or flavors.
Defined diets came to include certain modifications of the Feingold diet. Excluded from experimental diets were foods containing BHA (butylated hydroxyanisole) and sodium benzoate; certain Group I foods containing artificial preservatives were not excluded. Another modification appears to have occurred in some home settings. Parents of children whose behavior improved on dietary modification explained that the Feingold diet was, at times, further restricted by excluding milk, normally a permitted food, or on the basis of adverse personal experiences with individual dietary items.
Other types of studies and therapeutic trials used defined diets in which nonnutritive additives were excluded, 