ng 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, as well as foods such as corn, wheat, and milk regardless of additive content. After a preliminary trial, this type of defined diet was then modified by reintroducing individual food items one at a time and evaluating the effects of such additions upon the subject's behavior.
Is There Empirical Evidence for an Effect of These Diets on Hyperactivity?
Parents and other observers have frequently reported dramatic improvements in many hyperactive children during uncontrolled trials of various defined diets. However, such dramatic improvements were not observed in a number of controlled trials reported at the conference.
While differences and inadequacies in the design of the controlled trials make analysis difficult, these studies did indicate a limited positive association between "the defined diets" and a decrease in hyperactivity. Some hyperactive children demonstrated less evidence of hyperactivity on defined diets, or modifications thereof, than on an appropriate control diet. Such decreases involved only a small proportion of patients; furthermore, the decreases in hyperactivity were not observed consistently. Studies also indicated that some hyperactive children on a defined diet experienced an increase in hyperactivity when given moderate doses of artificial food dyes, and did not experience similar increases after receiving a placebo. This increase in hyperactivity was also experienced by only a small group of patients, and the increase was not consistently reported by teachers, parents, and other observers.
Clinical observations also indicated that children who were successfully managed on a defined diet experienced hyperactivity after dietary noncompliance. Controlled challenge studies have primarily involved the administration of food dyes to children, but have not included other food flavors or preservatives that are allegedly implicated in the causation of hyperactivity. Therefore, these controlled challenge studies do not appear to have addressed adequately the role of diet in hyperactivity.
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