Within the body of the story, some nuggets of solid health information can be found, but they can’t outshine all the cheerleading for a diet that may prove, upon much needed further study, to be bad for kids.
ADHD affects, by most estimates, 1 out of every 20 kids, and researchers are not certain what causes it or what aggravates it. As the HealthDay story on the same topic pointed out, there is controversy among researchers and clinicians about whether to put children on restrictive diets. Most parents would prefer not to treat their children with medications if possible, so dietary therapies that work are of great interest. 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 these stories, the findings demand more questions than they answer. The headline and first quote in this story suggests that children should be put on this diet immediately when, clearly, the amount of evidence supporting the diet is still too weak to justify a radical change in treatment.
This story doesn’t mention specific costs, although it at least makes a passing reference to expense: “It can be time consuming and more expensive than other diets, experts say.” The story explains that if parents are to embark on this diet, they will need to have their kids monitored by “experts” or by “a primary care doctor and, if possible, a dietician.” If so, 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. The story explained: “In the ADHD diet group, 41 of 50 children finished the first phase. In that group of 41 children, 32, or 78%, responded favorably by having fewer symptoms. Overall, 32 of 50, or 64%, responded favorably.”
The story didn’t mention 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. We do appreciate, too, that this story at least mentioned in passing concerns about malnutrition.
This story paled in comparison to HealthDay in evaluating the quality of the evidence. It provided less information about the study design and it presented less in the way of 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 does present the actual estimated prevalence of ADHD, saying, “ADHD affects about 3% to 7% of U.S. school-aged children, according to the American Psychiatric Association, but other sources put the figures higher.” This fact is lost, though, in all the boosterism in the rest of the story. The third paragraph says, “”I am of the opinion that every child deserves this diagnostic intervention,’ researcher Lidy Pelsser, PhD, of the ADHD Research Centre in Eindhoven, the Netherlands, tells WebMD.” Later, the story says that the study “is more applicable to the population as a whole.” This confusing language might lead parents to believe that if their child starts showing any signs of being hyperactive that they should put them on a restrictive diet.
The story quotes one outside expert and one expert who wrote an accompanying editorial. Eugene Arnold, MD, professor emeritus of psychiatry at Ohio State University’s Nisonger Center, Columbus, says “There is a risk of malnutrition if you don’t pay attention to the balance of nutrients.” But he also gives the impression that the diet is worth trying, even based on the limited evidence of efficacy. “If there is no improvement in two to five weeks, forget it,” he says. Jaswinder Ghuman, MD, associate professor of psychiatry and pediatrics at the University of Arizona, who wrote a commentary, says, “It is very difficult to carry out,” and added, these are interesting findings and it does present an alternative treatment option for the children.” Taken together, these comments tend to underscore the idea that people should try this diet, a very different take away from the HealthDay story, which said high up “the evidence isn’t yet conclusive.”
The story mentioned other therapies in passing. “Besides dietary restriction, medication and behavior therapy are used to treat children with ADHD.” But, given that existing therapies have been around for decades, we think the story does not meet our bar, which requires “some assessment of their relative performance.”
Both the HealthDay story and the WebMD story described the diet in broad strokes, allowing readers, especially parents, to understand the basic components. There are two problem with both stories, though. First, 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? The other key point is that a dietician has to “tailor” the diet for each child. If there were no experienced dietician available, that would be problematic. Still, we thought enough detail was presented to warrant a satisfactory rating.
We would like to give this story a passing grade on the question of novelty, but the way the information is presented only amplifies the cheerleading effect of the rest of the story. The story provides important context by saying, “While previous studies have found a link between foods and ADHD symptoms, the researchers say the studies were typically small or only included children known to have a tendency to allergies.” If the story had then gone on to quote the Lancet piece and say that all previous studies combined only included 188 children while this one study covered 100 kids, that would have been strong evidence for the study’s novelty. Instead, it says, “Their study is more applicable to the population as a whole.”
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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