Mother and daughter in allotment picking fruit and veg in the summer.

ADHD in children – how does nutrition play a part?

ADHD in children is a recognised neurodevelopmental condition characterised by hyperactivity and impulsiveness. It tends to begin in childhood but can often persist into adulthood. This blog examines the role of diet and nutrition on both the development of and supporting the symptoms of ADHD.

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by impairing levels of hyperactivity and impulsiveness that tends to begin in childhood but can often persist into adulthood. ADHD is one of the most common disorders in school-aged children, estimated to affect 7.6% of children aged 3-12 worldwide1.

Boys are three times as likely to receive a diagnosis than girls, which may be, in part, due to significant differences in how the condition reveals itself in each gender. Boys with ADHD usually show externalised symptoms, such as running and impulsivity, whereas girls typically show internalised symptoms such as low self-esteem and inattentiveness2.

Skip to key takeaways

ADHD symptoms in children

According to the NHS, symptoms of ADHD can fall into two categories, and children may exhibit symptoms of both or just one of these types of behaviour3:

1)            Inattentiveness

  • Having a short attention span or being easily distracted
  • making careless mistakes – for example, in schoolwork
  • appearing forgetful or losing things
  • being unable to stick to tasks that are tedious or time-consuming
  • appearing to be unable to listen to or carry out instructions
  • constantly changing activity or task
  • having difficulty organising tasks

 

2)            Hyperactivity and impulsiveness

  • Being unable to sit still, especially in calm or quiet surroundings
  • constantly fidgeting
  • being unable to concentrate on tasks
  • excessive physical movement
  • excessive talking
  • being unable to wait their turn
  • acting without thinking
  • interrupting conversations
  • little or no sense of danger

In the UK, for ADHD to be formally diagnosed by a doctor a child must exhibit at least six symptoms of inattentiveness, or six symptoms of hyperactivity and impulsiveness in at least two settings (at home and at school for instance) and should be considerably interrupting the child’s ability to learn, affecting their social skills and behaviour and disrupting both home and school life3.

Causes of ADHD

The causes of ADHD are multifactorial and involve both genetic and environmental factors. It has been suggested that genetics play a role in up to 80% of cases. Environmental factors implicated in the pathogenesis of the condition include heavy metal exposure, chemical exposure, lifestyle, and psychosocial factors47.

Genetic factors can also interact with environmental risk factors to influence ADHD development and outcomes46. Adequate nutrition positively impacts child growth and development, whereas poor nutrition slows growth and brain function, and reduces learning and memory capacities, and therefore it has been suggested that diet can contribute to the pathogenesis of ADHD – as well as being one of the tools to support the symptoms and comorbidities of the condition47.

ADHD has several common comorbidities. For example, as many as 80% of adults with ADHD are reported to have at least one comorbid psychiatric disorder, with substance misuse, mood disorder, anxiety and antisocial personality disorder being the most common4.

Up to 70% of children with ADHD experience sleep problems, having, on average, between 30- and 60-minutes shorter sleep duration and significantly more nightly awakenings compared to healthy peers, which can then affect their daytime functioning and quality of life5.

Other common comorbidities include autism spectrum disorder, learning disabilities such as dyslexia and dyspraxia and Tourette’s syndrome6. There is much evidence of co-occurrence with immune mediated conditions, such as atopic dermatitis7, autoimmune conditions and allergies, suggesting that hyper-reactivity of systemic immune pathways and neuroinflammation may contribute, in part to the core behavioural features of ADHD8.

ADHD is highly heterogenous, with behavioural characteristics that exist on a spectrum. Indeed, there is an increasing acceptance that ADHD is a dimensional disorder, and that not all symptoms are associated with deficits or functional impairments9. In fact, many have argued that adults with ADHD are ‘hyper-focused’ on their interests and may produce remarkable achievements or display outstanding creativity, as well as displaying high skill level in their occupations, demonstrating that there are several positive aspects of ADHD10.

Interventions early in life are important to improve quality of life and help achieve effective strategies to deal with the functional impact of ADHD symptoms.

In this blog we will examine the role of diet and nutrition on both the development of and supporting the symptoms of ADHD.

How does nutrition play a part in ADHD in children?

Diet

Ultra-processed foods (UPFs) can be defined as “food that has undergone intense industrial physical, chemical, or biological processes, or that contains industrial substances not usually found in domestic kitchens, cosmetic additives or flavouring agents”.

This includes all foods and drinks made using intense physical or chemical processes or containing cosmetic food additives and other industrial ingredients (e.g., artificial flavours, hydrogenated oils, glucose/fructose corn syrup etc.). These foods are generally convenient, affordable, highly palatable, and often intensively advertised11.

Here in the UK, UPFs account for 56.8% of total energy intake, but among children and adolescents, this figure rises to 63.5% and 68% respectively – with under a third of energy intake coming from unprocessed or minimally processed foods.

These dietary patterns correlate with a greater dietary content of free sugars, with 74% of children and 83% of adolescents consuming excessive free sugars (greater than 10% of total energy intake) and over half of excessive intake of free sugars can be attributed to ultra-processed foods12.

It is well known that excessive consumption of free sugars is associated with several health conditions such as obesity, type 2 diabetes and dental caries, but an unhealthy diet with high levels of refined sugars and ultra-processed foods has been seen to directly increase the risk for ADHD, whereas a healthy diet of fruits, vegetables and wholegrains can have a protective effect against hyperactivity or ADHD13.

In a meta-analysis published last month, the authors concluded that consuming junk food can increase ADHD symptoms in children and adolescents14.

Excessive consumption of ultra-processed foods is a characteristic of an unhealthy diet due to the increased intake of saturated fats and added sugars and decreased intake of essential micronutrients including zinc, calcium, magnesium, vitamins A, C, D, E, B12, and niacin as well as omega-3 fatty acids15.

It has been suggested that, alongside these nutrient deficits, UPFs contain high levels of contaminants such as mercury, lead, copper, pesticides and organophosphates and these two factors combined can result in increased oxidative stress and disturbance in DNA methylation that may affect child health and learning across generations, creating conditions for ADHD15.

In adolescence, as the brain matures, processes that occur in brain regions responsible for cognitive control and reward seeking may underpin excessive consumption of palatable “junk” foods during adolescence.

Recent studies have highlighted the negative impact of these foods on brain function, resulting in cognitive impairments, and the increased neuroplasticity during adolescence may render the brain more vulnerable to the negative effects of these foods on cognition and behaviour16.

Specific nutrients of note in supporting ADHD in children

Fatty Acids

The Omega-3 fatty acids eicosapentaenoic acid (EPA) and particularly docosahexaenoic acid (DHA) are essential for brain and eye development, and additionally, DHA plays a significant role in mental health through early childhood and even into adulthood.

In the brain, DHA is important for cellular membrane fluidity, function and neurotransmitter release17. Estimates indicate that during the Palaeolithic era, our EPA and DHA consumption was around 660-14,250mg/day, compared to round 100-200mg/day today.

Moreover, the omega-6 to 3 ratio has increased from around 4:1 in our hunter-gatherer ancestors to 20:1 today17 in part due to our decrease consumption of oily fish and increased consumption of seed oils such as soy, corn and rapeseed.

These dietary patterns are likely to contribute, in part, to the health, wellbeing and cognitive performance of our children, as omega-3 fatty acids and their derivatives are required for the proper structure and function of almost all cells and systems in the brain and body18.

Supplementation with omega-3 fatty acids has been shown to improve clinical symptoms in children with ADHD, measured by parental reports, inattention and hyperactivity symptom scores, as well as improving cognitive performance in these children19.

Lower levels of DHA have also been observed in children with ADHD20 and supplementing with DHA has demonstrated improvements in both quality and duration of sleep in children18.

ADHD & micronutrients

A sufficient supply of micronutrients, such as minerals and vitamins is required for normal brain development and function. Deficiencies may contribute to dysfunction of the prefrontal cortex and other brain regions believed to play a role in the pathophysiology of ADHD21 with diet being suggested as a relevant factor in the high incidence and prevalence of mental disorders22.

Magnesium

The mineral magnesium is essential for optimal health and is used in over 300 metabolic reactions in the body. Magnesium is necessary for sufficient brain energy and aids smooth transmission of communications through the central nervous system, calms the central nervous system and is an important component in the making of serotonin; a neurotransmitter involved in mood and sleep23.

Magnesium deficiency is typified by a number of reductions in cognitive ability and processes, and in particular a reduced attention span, along with increased instances of aggression, fatigue and lack of concentration. Other common symptoms of magnesium deficiency include becoming easily irritated, nervousness, fatigue and mood swings23. We can see that several of these symptoms overlap with those of ADHD.

In one study, 72% of ADHD children were found to have a magnesium deficiency, and supplementing with magnesium demonstrated an improvement in symptoms23.

Another study, in which children with ADHD supplemented with vitamin D (also commonly deficient in those with ADHD) alongside magnesium, those with low serum levels of the two nutrients saw improvements in behavioural function and mental health24.

Vitamin D

Vitamin D deficiency has been estimated to affect roughly 30-50% of the global population and has thus been labelled as a silent pandemic. There is a widespread distribution of vitamin D receptors throughout the brain, and consequent evidence for vitamin D’s involvement in brain function and its ability to affect proteins in the brain known to be directly involved in learning, memory and behaviour25.

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In a review of 8 trials, encompassing 11,324 children, all 8 trials reported significantly lower serum concentrations of vitamin D in patients diagnosed with ADHD compared to healthy controls26,28. Supplementing with vitamin D has demonstrated improvement in cognitive function, inattention, opposition, hyperactivity, and impulsivity amongst children with ADHD27.

Zinc

Zinc deficiency is involved in a variety of neurological disorders including autism, seizures, depression, and anxiety disorders29 and is thought to contribute to the pathophysiology of ADHD in a number of ways; including its role in the production of the neurotransmitter dopamine and because it is a cofactor for several enzymes in the brain involved with neurotransmitter production30.

Zinc deficiency has been suggested to increase the risk of ADHD, while sufficient zinc supply is thought to improve ADHD symptoms. In a recent systematic review and meta-analysis of 22 studies, circulating zinc levels were significantly lower in individuals with ADHD than healthy controls30. Supplementing with zinc may have beneficial effects on symptoms for children with ADHD31.

Iron

Iron deficiency has been positively associated with various neurodevelopmental disorders, with the underlying pathophysiology being derived from iron’s central role in the brain as a cofactor in neurotransmitter (dopamine and serotonin) synthesis, as well as in ATP production and myelination34. Both low serum, and ferritin levels have been observed in children with ADHD32.

Supplementing with both iron and zinc has demonstrated improvements in ADHD symptoms in children and adolescents33.

ADHD & the gut-brain link

Consisting of several trillion commensal microbes, the human microbiome plays an essential role in maintaining health throughout life. There is constant communication between the gut and the brain (gut-brain axis) and this crosstalk, established through microbiota metabolites, may be critical to the development of the central nervous system, including the brain36. Gut microbiota composition and function have recently been associated with several mental and neurodevelopmental disorders, including ADHD35,45. Increased gastrointestinal symptoms, such as constipation and flatulence have been associated with ADHD, which may be indicative of an altered microbiome37.

Different species of bacteria have been shown to synthesise different neurotransmitters38 and can thereby influence brain function and behaviour:

  • Lactobacillus species produce acetylcholine (working memory, focus and emotional regulation) and gamma-amino butyric acid (GABA) (inhibitory neurotransmitter to calm the nervous system)
  • Bifidobacterium species also produce GABA
  • Streptococcusand Enterococcus produce serotonin (mood, sleep and the digestive system)
  • Bacillus species produce norepinephrine and dopamine (learning and motivation). ADHD is associated with altered dopamine transmission39.
  • Escherichia produce noradrenaline, serotonin and dopamine

Probiotics are live microorganisms found in fermented foods (such as yogurt, miso, or sauerkraut) or nutritional supplements that provide several health benefits to the host. In addition to producing short‐chain fatty acids (SCFAs) and antimicrobial compounds, probiotics have a variety of beneficial effects on health including improvement of gut barrier integrity, enzyme production, and immune function40.

There have been a number of studies examining a positive effect of probiotic supplementation on the symptoms of ADHD.

For example, Lactobacillus rhamnosus supplementation in infancy may reduce the risk of development of the condition, as well as improving emotional, physical, social, and academic functioning and improved health‐related quality of life for ADHD children and adolescents compared with placebos41. One study, examining the use of a multi-strain probiotic supplement, in children, over an 8-week period, found a considerable decrease in the ADHD rating scale and anxiety symptoms42.

Leaky gut

Intestinal permeability, or “leaky gut” has been associated with the pathophysiology of mental disorders such as ADHD.

With increased intestinal permeability, increased intestinal bacteria can pass into the blood then to the brain and trigger neuroinflammation response, contributing to the aetiology of ADHD43.

The low-grade systemic inflammation caused by the disruption of the intestinal barrier in leaky gut may affect the brain–gut axis profoundly and subsequently impair cognitive development in children44.

Supporting leaky gut nutritionally should focus on diet modification, avoiding unhealthy fats, sugars, additives, and ultra-processed foods and the appropriate supplementation of pre/probiotics, L-Glutamine, vitamins A and D and polyphenols such as quercetin, curcumin and resveratrol.

Key takeaways

  • ADHD is a neurodevelopmental disorder characterised by impairing levels of hyperactivity and impulsiveness that tends to begin in childhood but can often persist into adulthood
  • ADHD has several common comorbidities including other neurodevelopmental disorders, mood disorders, disrupted sleep and immune mediated conditions
  • ADHD has behavioural characteristics that exist on a spectrum, and not all symptoms are associated with deficits or functional impairments – there are several positive aspects of ADHD
  • Diet may play a role in the pathophysiology of ADHD, with a “junk food” diet shown to contribute to the condition, whereas a healthy diet of fruits, vegetables and wholegrains can have a protective effect against ADHD
  • Specific nutrients may be implicated in the ADHD – omega-3 fatty acids, magnesium, zinc, vitamin D and iron
  • Gut microbiota composition and function have been associated with ADHD, and supporting gut health, including leaky gut, can support symptoms

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All of our blogs are written by our team of expert Nutritional Therapists. If you have questions regarding the topics that have been raised, or any other health matters, please do contact them using the details below:

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Last updated on 21st August 2024 by cytoffice


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14 thoughts on “ADHD in children – how does nutrition play a part?”

  2. Your description of ADHD leaves much to be desired.

    It exists from birth and it is only diagnosed later, sometimes as a child and sometimes much later in life. It doesn’t just happen at some random time.

    Ther is no mention of Hyperfocusing which is just as much a symptom of ADHD as h the two that you state.

    I am not an academic but my experience is as a parent of a now 40 year old. Your article leaves me wondering at the veracity of your other articles.

    Reply

    1. Hi There – thank you for your feedback. I’m sure you can appreciate that the focus of the blog was a brief introduction to the condition, followed by a focus on the most up to date research detailing how nutrition can play a role, as opposed to an extensive analysis of the condition – but we will certainly take your feedback on board for future blogs.

      Reply

  3. Being a long term fan of Cytoplan I was excited to see this article title. This excitement soon turned to deep sadness upon reading several sections which showed lack of understanding, outdated views and key omissions (ie executive functioning).

    Stating ‘It tends to begin in childhood but can often persist into adulthood’ and making reference to ‘healthy peers’ are particular points of concern.

    Reply

    1. Thank you so much for your feedback – we absolutely take it on board. The purpose of the blog was to offer a very brief introduction to the condition, and then take a deep dive into the latest research in terms of the role nutrition plays in ADHD. Some of the language has been taken from the studies referenced in the blog, but we will certainly be mindful of this in future blogs.

      Reply

  4. Following a healthy diet is obviously the most important thing to do but what supplements, including Omega 3 fatty acids, would you recommend for children with ADHD who are under the age of 8 ?

    Reply

    1. Hi There – our Little People multivitamin is suitable from 4 years, so could be a great option – providing zinc and iron, alongside excellent levels of vitamins and minerals. In terms of omegas – our Vegan Omega 3 is suitable from 4 years, or we do have it in liquid form. For magnesium, Magnesium Citrate can be taken from 4 years, and for gut support, our Acidophilus Plus is suitable from 4, or if you prefer a powder, our Vegan Biotic would be a great option.

      I do hope this helps, but if you would like to discuss a tailored protocol, please get in touch with our team of NTs on nutrition@cytoplan.co.uk

      Reply

  7. Have a client that has a daughter really suffering which is what is thought to be ADHD not yet diagnosed can we complete a health questionnaire for her

    Reply

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