Almost 40 million prescriptions were written last year for ADHD drugs in the US alone. Parents deserve to know if these drugs won’t improve the long-term success of their children. They also deserve to know if most of the kids these drugs long term will have permanent side effects. Both of these appear to be true. While these ADHD drugs may provide immediate relief of ADHD symptoms, after two years or so the kids on average are not better off than those who didn’t get the drugs at all. And those who take the drugs for three years or more appear to end up almost an inch shorter than they would have otherwise. Their growth rate slows and does not appear to rebound. These results come from a large federal study called the Multimodal Treatment Study of Children with ADHD (MTA). The latest news from this long-term study, the 8-year snapshot, was just released in the Journal of the American Academy of Child & Adolescent Psychiatry. At the beginning of the study, the children were randomly assigned to get medication alone, behavior therapy and parent training alone, medication and therapy combined, or routine community care for 14 months. At the end of the first year, those who got medication with or without the behavior therapy and parent training were doing significantly better than the others. But by three years, these differences had largely evaporated whether or not the child continued to take the medications.

Now we know that eight years later the type of treatment received initially made no difference in their long-term outcome, whether looking at grades earned in school, arrests, other psychiatric problems, or other ADHD symptoms – as assessed by parents, teachers, or the kids themselves. The specific question of substance abuse is being analyzed separately, and results are not yet available.

Some of the kids remained on the medications continuously for 6 to 8 years. Those children fared no better than those who never received meds or who used them briefly when comparing on almost all measures of success, including school grades, homework completion, quiz and test performance, school office visits, disciplinary actions, conflicts with parents, and so on. They did score a couple points higher score on a math achievement test. They also ended up shorter. Of course, these are averages. Some individuals may benefit significantly more from the medications. Or less.

To me, this suggests that when ADHD medications are used their greatest benefit would not be to “solve” ADHD, but rather to provide a window of relief and focus for a year or two in which to pursue lifestyle changes that can make a long-term difference. These might include changes in nutrition, in physical activity, in sleep, in chemical exposures, in peer groups, in study strategies, in parenting strategies, and in school environments.

“MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study.” MOLINA, BROOKE S.G. Ph.D.; HINSHAW, STEPHEN P. Ph.D.; SWANSON, JAMES M. Ph.D.; ARNOLD, L. EUGENE M.D., M.Ed.; VITIELLO, BENEDETTO M.D.; JENSEN, PETER S. M.D.; EPSTEIN, JEFFERY N. Ph.D.; HOZA, BETSY Ph.D.; HECHTMAN, LILY M.D.; ABIKOFF, HOWARD B. Ph.D.; ELLIOTT, GLEN R. Ph.D., M.D.; GREENHILL, LAURENCE L. M.D.; NEWCORN, JEFFREY H. M.D.; WELLS, KAREN C. Ph.D.; WIGAL, TIMOTHY Ph.D.; GIBBONS, ROBERT D. Ph.D.; HUR, KWAN Ph.D.; HOUCK, PATRICIA R. M.S.; the MTA Cooperative Group. Journal of the American Academy of Child & Adolescent Psychiatry. Published ahead of print, March 24, 2009. DOI: 10.1097/CHI.0b013e31819c23d0.  “Effects of Stimulant Medication on Growth Rates Across 3 Years in the MTA Follow-up.” SWANSON, JAMES M. Ph.D.; ELLIOTT, GLEN R. Ph.D., M.D.; GREENHILL, LAURENCE L. M.D.; WIGAL, TIMOTHY Ph.D.; ARNOLD, L. EUGENE M.D.; VITIELLO, BENEDETTO M.D.; HECHTMAN, LILY M.D.; EPSTEIN, JEFFERY N. Ph.D.; PELHAM, WILLIAM E. Ph.D.; ABIKOFF, HOWARD B. Ph.D.; NEWCORN, JEFFREY H. M.D.; MOLINA, BROOKE S.G. Ph.D.; HINSHAW, STEPHEN P. Ph.D.; WELLS, KAREN C. Ph.D.; HOZA, BETSY Ph.D.; JENSEN, PETER S. M.D.; GIBBONS, ROBERT D. Ph.D.; HUR, KWAN Ph.D.; STEHLI, ANNAMARIE M.P.H.; DAVIES, MARK M.S.; MARCH, JOHN S. M.D., M.P.H.; CONNERS, C. KEITH Ph.D.; CARON, MARK Ph.D.; VOLKOW, NORA D. M.D. Journal of the American Academy of Child & Adolescent Psychiatry, August 2007. 46(8):1003-10014.

I’ve joined with a number of distinguished physicians and research scientists to send a letter to the FDA urging them to begin proceedings to end the use of artificial food dyes, which mounting evidence suggests are not safe for our children. There is no need for these chemical dyes because excellent natural food colorings exist, and are often already in use in the same products when they are sold in England. In the US, Whole Foods Markets and Trader Joe’s have taken a leadership role and already do not sell foods that contain artificial dyes.

We also wrote several members of Congress urging them to investigate this matter and to take action to protect our children from unnecessary harm. These letters are in strong support of a formal petition to the FDA submitted by Michael Jacobson, PhD on behalf of the Center for Science in the Public Interest. The petition asks the FDA to ban the use of Yellow 5 and other artificial food dyes, and to require warnings on all artificially dyed products in the interim. The FDA’s own regulations say that for a dye to be allowed there must be “convincing evidence that establishes with reasonable certainty that no harm will result from the intended use of the color additive.”

The British Food Standards Agency (the FSA) decided to fund two careful, randomized, double-blind, placebo controlled studies to see whether artificial dyes in typical amounts consumed by typical kids physically worsen children’s behavior. These studies were on healthy British kids, not those diagnosed with ADHD or suspected of having sensitivity to the dyes. The results prompted the FSA to call for the elimination of the dyes. “It is the Agency’s duty to put consumers first. These additives give colour to foods but nothing else. It would therefore be sensible, in the light of the findings of the Southampton Study, to remove them from food and drink products.” And these steps are already spreading beyond Britain. Last month the Environment Committee of the European Union voted to ban artificial colors in foods for babies and small children throughout Europe. The measure will soon come before the European Parliament.

Companies that do business both here and in England have been able to adjust, and have taken voluntary action ahead of legislation. Mars has removed some or all of the artificial dyes from M&M’s, Skittles, and Starbursts – but not for American children. Kraft has removed artificial colors from Lunchables – but not for American children. Kellogg’s has removed the dyes from their cereal and Pop-Tarts – but not for American children. A hint, McDonald’s uses caramel and strawberries and beet juice to color shakes and syrups in England; they use Yellow 5, Yellow 6, and Red 40 here.

I urge you to support stores and products and members of Congress and non-profit organizations like the Center for Science in the Public Interest that put consumers – and especially children – first.

ADHD is one of the most common behavioral and learning problems in childhood. It can affect the school experience, families, and friendships. It’s often associated with other problems as well, including learning disabilities and mood problems. Wouldn’t it be great if there were nutritional ways to help?

The relationship between what kids eat and their behavior is complex, and something we are learning a lot about in the 21st century. One emerging link is that between ADHD and other neurodevelopmental disorders with deficiencies in omega 3 fats.

Researchers in Australia, aware that EPA, DHA and other beneficial fats affect the brain, and aware that many kids get too little in their typical diets, decided to see what would happen to kids with ADHD if they got supplements of healthy fats. The results are published in the lead article of the April 2007 Journal of Developmental and Behavioral Pediatrics.

To measure the possible benefit, some kids got capsules containing EPA, DHA and other beneficial fats, while their counterparts got placebo pills containing palm oil. Their behavior was followed for 15 weeks, using the Connors Rating Scales. Those who got the supplements showed improvement in the core ADHD symptoms of inattention, hyperactivity, and impulsivity compared to their matched peers.

After the 15 weeks were up, those in the placebo group were switched to the real supplements, and they then showed similar improvement. Those who received the real supplements from the beginning continued to show sustained improvement after the full 30 weeks.

This preliminary study suggests that some children with ADHD might experience reduced symptoms if they get the healthy fats they need.

Sinn, N., and Bryan, J. “The Effect of Supplementation with Polyunsaturated Fatty Acids and Micronutrients on Learning and Behavior Problems.” Journal of Developmental and Behavioral Pediatrics. April 2007, 28, pp. 82-9

#4 Organic Baby Foods

Picture a treasured, pristine newborn, just beginning the voyage of life. Imagine a baby who hasn’t yet picked up the habits or tastes you wish you never had. Let it sink in – the organs and metabolic settings your baby is developing will be assembled from (and in response to) the food she eats. She deserves the best.

Food quality from chemically-intensive agriculture is going down. According to USDA data²⁵, when you eat the same foods as your grandparents ate 50 years ago, you are getting less protein, iron, calcium, phosphorus, riboflavin, and vitamin C – to say nothing of the thousands of important food phytonutrients that hadn’t been discovered yet when the measurements began.

You don’t want so skimp on food for your baby. You don’t want foods with declining nutrients, grown from depleted soil. You don’t want over-processed baby foods that may prepare her to prefer processed foods as a toddler.

If I were going to pick only one time of life to eat organic, it would be from conception through age 3. Our bodies and our brains grow faster during this period than at any later time. Babies eat more than adults, pound for pound, and they are more vulnerable to environmental toxins. The EPA has concluded that carcinogens average 10 times the potency for babies than for adults, with some chemicals up to 65 times more powerful²⁶. The EPA does not yet have a formal policy addressing babies’ exposure to chemicals that affect their bodies in other ways, such as their hormones, immune systems, or their brains – even though babies are clearly more vulnerable.

For instance, a recent study is the latest to suggest that early exposure to a significant pesticide, chlorpyrifos, is linked to decreased intelligence, and an increased chance of developmental delay and of ADHD²⁷. Other research has shown that choosing a mostly organic diet can now almost eliminate exposure to chlorpyrifos and other organophosphate pesticides in children²⁸.

Baby food makes it on the list primarily for the health of your own family, but also with an eye toward raising a generation that appreciates the value and taste of organic whole foods. For our generation so far, only 0.5% of US agricultural production is organic²⁹. Let’s start now to make the percentage of organic cropland far higher in our children’s generation.

Read more from this series

• Dr. Greene’s Organic Rx — What you need to know!
• Dr. Greene’s Organic Rx — Item #1 — Milk
• Dr. Greene’s Organic Rx — Item #2 — Potatoes
• Dr. Greene’s Organic Rx — Item #3 — Peanut Butter
• Dr. Greene’s Organic Rx — Item #4 — Baby Foods
• Dr. Greene’s Organic Rx — Item #5 — Catsup
• Dr. Greene’s Organic Rx — Item #6 — Cotton
• Dr. Greene’s Organic Rx — Item #7 — Apples
• Dr. Greene’s Organic Rx — Item #8 — Beef
• Dr. Greene’s Organic Rx — Item #9 — Soy
• Dr. Greene’s Organic Rx — Item #10 — Corn
• Dr. Greene’s Organic Rx — Bonus Item #11 — Wine

 
^{25Davis D, Epp M, and Riordan H. Changes in USDA Food Composition Data for 43 Garden Crops, 1950 to 1999. Journal of the American College of Nutrition, Volume 23, Number 6, December 2004.
26EPA (U.S. Environmental Protection Agency). Supplemental guidance for assessing susceptibility from early-life exposures to carcinogens. EPA Risk Assessment Forum. EPA/630/R-03/003F. March 2005.
27Rauh VA, Garfinkel R, Perera FP, Andrews HF, Hoepner L, Barr DB, Whitehead R, Tang D, Whyatt RW. Impact of Prenatal Chlorpyrifos Exposure on Neurodevelopment in the First 3 Years of Life Among Inner-City Children. Pediatrics. 118(6):e1845-e1859. December 2006.
28Lu C, et al. Organic Diets Significantly Lower Children’s Dietary Exposure to Organophosphorus Pesticides. Environmental Health Perspectives. 114(2):260-263. February 2006
29USDA Economic Research ServiceOrganic Production Data Sets, December 15, 2006.}