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Diet and Attention-deficit/hyperactivity disorder (ADHD) is a complex issue in which individual tailored advice is key. Considerations in ADHD dietary management include the age of diagnosis, pre-existing conditions (such as Autism spectrum disorder), feeding challenges, meal routines and the dietary impact of specific medications. 

With increasing rates of ADHD diagnosis, diet is often looked at as part of the management. Paediatric Dietitian Miriam Raleigh discusses common dietary myths, nutritional issues, and provides take-home points for clinical practice.

While diets such as the gluten free/casein free diet and the RPAH/Failsafe diet may be commonly heard of, these diets may be overly restrictive and should be recommended on a case-by-case basis. Ruling out suspected conditions such as coeliac disease or iron deficiency is also critical before recommending an elimination diet. When diets such as a low additive or processed food diet is considered, general healthy eating principles should apply, with an emphasis on natural whole foods, as would be recommended for any child, rather than specifically for a child with ADHD.

Seeking to address any underlying common nutritional issues such as poor appetite, weight-loss and fussiness are also key, including considering the impact of medications such as methylphenidate (Ritalin) on appetite. Miriam explains that in managing these nutritional issues, considering meal timing, involving children in meal preparation and lunchbox planning, not overwhelming children with food options, focusing on nutrient-dense food options, and engaging a feeding therapist in the treatment team can also be useful. While ADHD does not usually result in fussy eating and associated deficiencies in and of itself, when alongside ASD, there may be deficiencies such as iron, vitamin D and B12, although these should be tested for on a case-by-case basis.

Overall, while there is no specific diet recommended for ADHD-management, as with every child, focusing on achieving optimal nutrition for growth, health and well-being is pertinent.

Summary

• In considering the nutritional implications of diet and ADHD, assessing each child individually is key, including discussing the impact of any potential medications on their appetite.
• Elimination diets, such as the RPAH elimination diet and gluten free and casein free diet, should be recommended with caution and on a case-by-case basis, as these often further restrict a child’s intake.
• Common nutritional concerns in children with ADHD include poor appetite, weight loss or weight plateau and potentially fussiness (more so common in children also presenting with ASD). Strategies to trouble-shoot these include engaging children in food preparation, focusing on nutrient-dense foods, and offering a select few food options to prevent the child from being overwhelmed at meals/ snacks.
• Addressing underlying deficiencies such as iron, vitamin D and B12 should be considered, although screening is mainly warranted if clinically indicated, such as in the case of fussy eating or pre-existing conditions such as ASD.

Miriam Raleigh has been working with children since she completed her certificate in paediatric dietetics from the Royal Children’s Hospital in Melbourne 16 years ago. She has extensive experience in children’s nutrition which includes the Royal Children’s Hospital in Melbourne and Great Ormond Street Hospital for Children in London and her paediatric private practice Child Nutrition.

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