Diets Are Effective, How and Under What Circumstances Should They Be Employed?
Case reports of a subset of responding patients presented to this panel by parents and physicians documented improvement in the hyperactive child's condition with the use of defined diets. Because insufficient evidence is available to permit identification beforehand of this small group of individuals who may respond and to determine under what circumstances they may derive benefits, the Panel cannot answer this question unequivocally.
The Panel believes the defined diets should not be universally used in the treatment of childhood hyperactivity at this time. However, the Panel recognizes that initiation of a trial of dietary treatment or continuation of a diet in patients whose families and physicians perceive benefits, may be warranted. A defined diet should not be initiated until thorough and appropriate evaluation of the children and their families and full consideration of all traditional therapeutic options (described in the Introduction) have taken place.
The ability to describe "defined diets" precisely and to ensure proper and effective clinical use, to measure compliance, and to design studies and compare the findings from one study to another depends upon making available to consumers and investigators food and food products that are completely labeled. The Panel understands that existing law does not require identifying on the label, completely and accurately, all ingredients in food. The Panel, therefore, recommends changes in the law to require the listing on labels of all ingredients of food and food products, and that this label include substances that may migrate from wrappers and containers that come in contact with foods.
The Panel also believes that special attention must be given to individual cultural, ethnic, and socioeconomic factors to ensure the proper implementation of the diet. Since the defined diets differ from traditional dietary patterns, it is the physician's responsibility to be specific and impart the knowledge and support that individual families need in implementing these diets.
What Are the Directions for Research?
The Panel identified a number of critical gaps in knowledge which affect interpretation of the results of dietary intervention in the management of the hyperactivity syndrome. These deficiencies include nonuniform diagnostic standards and inadequate information regarding the natural history of this syndrome, lack of availability of optimal measurement instruments (behavioral, cognitive, and other), and other significant limitations in the research study designs employed to date. In addition, the full potential of animal and in vitro studies for generating relevant biologic information has not been realized. Therefore, further research in each of these areas is needed to be able to conduct meaningful investigations of the potential benefits of dietary management of hyperactivity.
The following directions for further research are recommended:
- Epidemiologic studies --Including: the development of standardized working diagnostic criteria (essential for all research in this disorder), and possible neurophysiologic, biochemical, or other diagnostic "markers." Studies of the etiology and risk factors for the condition and delineation of its natural history are needed. Such studies should address possible genetic, developmental, and environmental factors which could both be causal and also serve as predictors of prognosis and should better define those afflicted children who may be likely to respond to a given therapy. Several of these goals require longitudinal prospective studies. For this purpose, it is recommended that existing defined populations and data sources be identified and employed whenever possible.
- Psychosocial/behavioral --The development and utilization of standardized instruments for the assessment of cognitive, attentional, and behavioral changes in patients receiving different modalities of therapy is essential. This may involve the adaptation of existing instruments or the devel