Food Additives and Hyperactive Children

172 Pages·1980·13.46 MB·English

by  C. Keith Conners (auth.)

FOOD ADDITIVES AND
HYPERACTIVE CHILDREN
FOOD ADDITIVES AND
HYPERACTIVE CHILDREN
C. Keith Conners
Children's Hospit»tNational Medical Center
Washington, D.C.
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Conners, C Keith.
Food additives and hyperactive children.
Includes index.
1. Hyperactive children. 2. Food additives-Toxicology. I. Title.
RJ506.H9C65 618.92'85890654 80-66
ISBN-13: 978-1-4684-3688-4 e-ISBN-13: 978-1-4684-3686-0
001: 10.1007/978-1-4684-3686-0
© 1980 Plenum Press, New York
A Division of Plenum Publishing Corporation
227 West 17thStreet,NewYork,N.Y.10011
Softcover reprint of the hardcover 1st edition 1980
All righ ts reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted,
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
To Anthony, Rachel, Becky, and Sarah, and to Karen
PREFACE
The purpose of this book is to present an account of several different
studies of the relationship of food additives to child behavior and learn
ing problems. Because the outcome of these studies has deep, personal
interest for many parents and their children, I have tried to present the
studies in such a way that the logic and evidence of the studies is com
prehensible to informed adults interested in weighing the facts for
themselves. Unfortunately, the facts do not always follow a straightfor
ward course. Part of my purpose has been to show the complexities
lying in the way of the answers to apparently simple questions. I believe
it is healthy and important for parents to examine the scientific evidence
on issues affecting their daily lives, and to become aware of the process
of research surrounding controversial claims regarding new therapies.
New ideas in behavioral science are often difficult to track down and
evaluate, and consequently there may be a large gap between therapeu
tic claims and evidence bearing on those claims. The mother who won
ders whether her child should be treated with a special diet is unlikely to
have the facts necessary to make a judgment of the costs and benefits.
She should however, know some of the major pitfalls in coming to a
conclusion for or against such a course.
The professionals--psychologists, pediatricians, teachers--who are
asked to render judgment on the food additive controversy, will find
themselves immersed in a welter of contradictory studies and claims.
Unless they have had specific training in clinical behavioral research,
they are unlikely to be aware of the numerous pitfalls awaiting data col
lection relevant to therapeutic efficacy and side effects. I have frequently
been astounded, when presenting some of the studies in this book to
audiences of physicians and others working with behaviorally impaired
children, at how easily one's own anecdotal experience outweighs sub
stantial evidence collected under relatively controlled conditions. I have
presented a carefully documented study having a negative outcome,
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PREFACE
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only to have a doctor stand up later and say, "But I had this case of a
child who became a different person after only five days on the
diet .... " Or a mother who will say, "But my son turns into a little
monster if he so much as sniffs a red gumball ...." Or contrarily, I have
presented a positive outcome study only to have a member of the audi
ence say, "Well, I tried it on five kids and it didn't work."
It is precisely because such anecdotes can be misleadingly convincing
that consumers must learn the rudiments of experimental logic and must
become familiar with some of the threats to the validity of a claim, no
matter how charismatic its advocates, or how much the weight of au
thority is cited in support of the claim. Science is not an end state but a
process. No single study is usually sufficient in clinical therapeutics to
establish the cause or the cure of a problem. Often the context in which
assertions are put forth-hallowed halls of the academe, prestigious
medical meetings, public hearings in legislative committees--creates
more confidence in the findings than is deserved upon careful inspec
tion of the logic of the argument being set forth.
On the other hand, science tends to be a conservative process, and
it is not at all uncommon to have important discoveries ignored until the
proper atmosphere and climate of opinion make scientists receptive. The
idea that food additives cause behavioral and learning impairments is a
genuinely new idea within the confines of the research on hyperkinesis,
learning disability, minimal brain dysfunction, and behavior disorders
in children. The implications of a behavioral as opposed to a carcinogenic
impact of additives in foods is startling. Food is something everyone
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ingests throughout the life span, and if small amounts of additives pro
duce even minor perturbations of development or learning, this finding
must be regarded with great seriousness. Only recently have the food
industry and the government begun to take seriously the behavioral toxic
ity of chemical ingredients in foods (including certain foods themselves).
I believe that the episode of "food additives and hyperkinesis" will be a
significant chapter in the history of behavioral science because it has
turned our attention to an entirely new class of influences on behavior
and learning. This novel hypothesis may turn up quite unexpected re
sults-for different reasons than were stated in the original form of the
hypothesis. It is hoped that the studies reported in this book will con
vince parents to evaluate carefully all claims that a particular diet or
treatment can help their child, and that professionals studying children
PREFACE ix
will have a firmer basis on which to make professional, clinical judg
ments and do further research.
C. Keith Conners
ACKNOWLEDGMENTS
David Boesel of the National Institute of Education first brought my at
tention to the problem of food additives and hyperkinesis. Initial work
on the problem was supported by an NIE contract (NIE-R-74-0007).
Further work was supported by a grant from the National Institute of
Mental Health Psychopharmacology Research Branch (ROI-MH-
28458). My collaborator, Charles Goyette, Ph.D., helped me through all
stages of the problem and deserves major credit as the principal coor
dinator of many facets of the several studies reported here. In Boston,
Alan Cohen, M.D. and Janice Hubka, M.A. participated in early phases
of the program. Joanna Dwyer, D.Sc. gave valuable advice regarding
dietary control and aspects of study design. Benjamin Feingold, M.D.,
who provided the initial impetus for all these investigations, served as
an unpaid consultant in the Boston studies.
In Pittsburgh, James Lees, M.D., Paul Andrulonis, M.D., and
Theodore Petti, M.D. served as child psychiatrists for screening and
diagnosis. Deborah Southwick, M.S. and Patricia Harper, M.S. served
as nutritionists in the challenge studies, and contributed much original
work to the dietary aspects of the program. Lynn Curtis, Margaret
Klecha, Marianna Flowers, Alan Delamater, Stana Paulaskas, Sheri
Hanley, Shelly Wolynn, Barbara Seger, and Marjorie Grieshop all pro
vided research assistance. Richard Ulrich, M.P.H. gave invaluable
statistical consultations throughout my stay at Pittsburgh. Elisa New
man and Alice Sherk carried out major parts of the learning and follow
up studies, respectively, during elective time from their medical cur
riculum. Helen Lang typed much of the manuscript with great patience
and contributed in numerous ways to the smooth functioning of the
reserach team. Cathie Calvert has helped edit and arrange most of the
text and also carried out helpful library research.
William Darby, M.D., Ph.D., of the Nutrition Foundation provided
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xii ACKNOWLEDGMENTS
funds to support the packaging of the challenge materials, and Wayne
Swett of Nabisco kept the codes and packed the double-blind challenge
cookies.
CONTENTS
CHAPTER 1 BACKGROUND OF THE PROBLEM 1
Childhood Behavior and Learning Problems 1
Dr. Feingold's Hypothesis 4
Clinical Studies of the Feingold Diet 8
Clinical Case Trials 15
CHAPTER 2 CONTROLLED DIET TRIALS 21
Design of the First Controlled Trial 21
Selection of Patients 22
Procedure 25
Assessment of Prior Dietary Status 26
Monitoring Compliance and Nutrient Intake 26
The Experimental and Control Diets 27
Monitoring the Effects of the Diets 27
Comparison of Results from the Two Diets 28
Clinical Global Impressions 28
Parent and Teacher Reports 29
Ease of Following the Diets 31
Informal Comments 32
Dietary Habits and Nutrient Intake 35
Follow-Up of the Children after Two Years 35
Discussion and Interpretation 38
CHAPTER 3 THE CHALLENGE MODEL 41
The Problem of Natural Salicylates 41
Challenging with Food Dyes 42
A Food Challenge Case Study 42
The Cookie Challenge 45
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