This story presented a more cautious view than the WebMD story we reviewed on a study suggesting that a restrictive diet may help ease the symptoms of attention deficit hyperactivity disorder (ADHD). It did a nice job avoiding disease mongering, evaluating the quality of the evidence, describing the benefits in both relative and absolute terms and making good use of independent experts. It also does a better job describing the diet itself and explaining the IgG antibody component of the research.
ADHD affects, by most estimates, 1 out of every 20 kids, and researchers are not certain what causes it or what aggravates it. This story noted that there is controversy among researchers and clinicians about whether to put children on restrictive diets. Many parents are eager to find efficacious therapies that are not medications. This is one of only a few studies to take a randomized, controlled trial approach to studying dietary effects on ADHD, and, according to the Lancet, it is the largest trial to date. That makes the findings important, but, as experts in the field note in this story, the findings demand more questions than they answer. This story did a good job raising those issues and making it clear to readers that they should not put their children on a restrictive diet based on this one study.
Neither story mentions specific costs. Both stories say that if parents are to embark on this diet, they will need to have their kids monitored. This story says that parents should have their children monitored by “a primary care doctor and, if possible, a dietician.” That would make this diet extremely expensive and would require significant out-of-pocket spending given that insurance companies are not currently paying parents to see their doctor for ADHD-related diet monitoring.
The story provided the benefits in both relative and absolute terms, allowing readers to see that the numbers are actually quite small. “Forty-one children completed the restrictive phase of the diet. Of those, 78 percent had a reduction in their ADHD symptoms, compared with no improvement in the controls. Nine children (22 percent) didn’t respond to the diet.”
However, why not give the absolute number for what the 78% represents, rather than expecting people to pull out a calculator. The story provided such a number for the non-response group. The jumble of how numbers are presented can be confusing.
Neither this story nor the WebMD story we reviewed mentioned that there were no adverse effects found from the study. We think that was worth mentioning given some of the understandable concerns raised by putting young children on any sort of restrictive diet.
This story did a superior job to the WebMD story in evaluating the quality of the evidence and walking people through the different phases of the study. It provided more information about the study design and better context. For example, the HealthDay story says “that clinical practice shouldn’t be changed based on the results of one study.” But the WebMD story says in the first sentence “Children with attention deficit hyperactivity disorder (ADHD) should be offered a special ADHD diet to see if eliminating certain foods might reduce their symptoms, Dutch researchers say.” This story was the only one of the two to actually explain the symptom rating scale. “On an ADHD symptom scale that ranges from 0 to 72 points, with a higher score indicating more severe symptoms, the average reduction was 24 points, according to the study.”
This story does not engage in disease mongering. It says that ADHD is common, which is a relative term given that it only occurs in an estimated 5% of children. The term, though, comes from the National Institute of Mental Health, and, unlike the WebMD story, this one did not present this diet as a cure-all for kids.
The story quotes one outside expert and one expert who wrote an accompanying editorial. Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children’s Medical Center of New York in New Hyde Park, said, “Since none of the children stayed on the diet beyond five weeks, it is hard to know if this dietary intervention offers sustained benefit. …Since it is more difficult to enforce restricted diets in older children, this approach may not be suitable for the majority of older children with ADHD.” Jaswinder Ghuman, MD, associate professor of psychiatry and pediatrics at the University of Arizona, who wrote a commentary, says, “”But, for this diet to work, you have to be very consistent with it, and you have to pay attention to nutrition. It should be done under the supervision of a primary care doctor, and if possible, a dietician.” These cautious voices are very different from the more exultant opinions in the WebMD piece.
Neither story we reviewed (neither this one nor WebMD) did a good job in this area. Some discussion of the success rate of the two standards of care — behavioral therapy and medication — would have strengthened the story.
The story described the diet, allowing readers, especially parents, to understand at least the basics of what it would entail. The problem with both stories, though, was that they did not say anything about food preparation. Is serving a child fried chicken the same as grilled? Are french fries as good as a baked potato? In fairness, the studies that are cited by this study don’t provide good detail on the food preparation, either. There are so many fad diets out there claiming to help children with a range of behavioral disorders that we thought as much guidance as possible would be important. Still, we thought enough detail was presented to warrant a satisfactory rating.
The story missed a key fact from the study itself. The researchers reviewed the literature and found seven previous clinical trials on diets and ADHD that included 188 children. This one study covered 100 kids. If presented, that would have been strong evidence for the study’s novelty.
The story didn’t rely on a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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