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ADHD Caused by Sugars and Food Additives –
Fact or Fiction?

Candy pic

Attention-deficit/hyperactivity disorder (ADHD) is one of the most commonly diagnosed conditions of childhood, affecting between 7%-11% of children within the United States, varying by what you read (American Psychiatric Association, 2022; Danielson et al., 2024; Xu et al., 2018). ADHD is considered a diagnosis that persists from childhood to adulthood, resulting in both direct and indirect family, social, academic, and occupational impacts throughout one’s life. Healthcare practitioners have long known that early intervention can help in addressing ADHD-related issues and steer a child to a successful future. Given the need for early intervention, the question becomes: What interventions are more or less helpful? When caregivers (and healthcare practitioners) read about such treatments, they find an overwhelming amount of papers, websites, videos, and so-called experts giving both overlapping and different information, providing both evidence-informed recommendations and myths. As a healthcare practitioner who commonly assesses for and treats ADHD, one of the most common questions I receive is whether sugar and food additives, such as red dye 40, cause ADHD. In a singular word – no. Simply put, there is not currently convincing evidence of such a connection.

But What About Research Saying Sugar and Food Additives Cause ADHD?

The notion that ADHD is caused by sugar and food additives is one of the oldest and most persistent of the ADHD-related myths, being suggested since the 1970s (Nigg et al., 2012). Although it is true that if someone were to look hard enough in the peer-reviewed literature, which is where healthcare practitioners find a lot of their information on how to assess and treat, they will find some papers highlighting the potential for sugars and food additives to influence a child’s behavior, much of this work has been highly criticized (Nigg et al., 2012). For example, some have suggested that publication bias remains a significant concern. More specifically, journals favoring the notion of environmental causes of ADHD and other conditions are often the publishers of papers supporting the notion of sugars and food additives as a causal factor for ADHD. Additionally, when one critically evaluates such papers, they find problems with their methods, such as small and restricted sample sizes of individuals studied, limiting how well they relate to people outside of the research study. Finally, many papers fail to account for the “other” factors that could influence a diagnosis of ADHD, such as a family’s genetic makeup. Further yet, papers supporting the connection between sugar and food additives and ADHD are few and far between, with the vast majority of research spanning decades across psychology, psychiatry, medicine, nursing, and other healthcare specialties consistently finding no true association between what one eats or drinks and subsequently being diagnosed with ADHD. Ultimately, decades of research have not found conclusive connections between sugar and food additives as causes of a child developing ADHD.

But Can’t Sugars and Food Additives Cause Attention and Activity-Related Issues?

Despite research suggesting that sugars and food additives do not cause ADHD, there is, in fact, some research indicating that higher amounts of sugar intake can cause children to become less attentive and increase their activity level, behaviors often associated with ADHD. However, as with other sugar and food additive research, such findings have been suggested as inconsistent, with some field experts overtly refuting this notion (e.g., Wolraich et al., 1994; Wolraich et al., 1995). The one exception to this is if the child has a true allergy to an ingredient in the foods or drinks that contain the sugars or food additives, which could cause behavioral changes, such as not feeling well leading to irritability followed by restlessness and poorer on-task behavior (e.g., in the same way a stomach ache can cause a student to become off-task in class due to being unable to focus on anything but the feeling of being uncomfortable).

What if I want to Reduce Sugars and Food Additives Anyway?

Although removal of sugars and food additives likely won’t increase or decrease the chances of your child being diagnosed with ADHD, reducing foods that are high in sugars, which often also have the food additives for coloring, such as candy, soda, and other unhealthy foods and drinks, may be beneficial for non-ADHD, general health reasons. Before any drastic changes to a child’s diet are made, those considering the removal of specific foods or drinks are advised to consult their family pediatrician to gain great insight into both the benefits and potential issues associated with this approach.

References

  • American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders(5th ed., text rev.). American Psychiatric  https://doi.org/10.1176/appi.books.9780890425787
  • Danielson, M. L., Claussen, A. H., Bitsko, R. H., Katz, S. M., Newsome, K., Blumberg, S. J., Kogan, M. D., & Ghandour, R. (2024). ADHD Prevalence among US children and adolescents in 2022: Diagnosis, severity, co-occurring disorders, and treatment. Journal of Clinical Child & Adolescent Psychology, 53(3), 1-18. https://doi.org/10.1080/15374416.2024.2335625
  • Wolraich, M. L., Lindgren, S. D., Stumbo, P. J., Stegink, L. D., Appelbaum, M. I., & Kiritsy, M. C. (1994). Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. New England Journal of Medicine, 330, 301–307. https://doi.org/10.1056/NEJM199402033300501
  • Wolraich, M. L., Wilson, D. B., & White, J. W. (1995). The effect of sugar on behavior or cognition in children. Journal of the American Medical Association, 274, 1617–1621. https://doi.org/10.1001/jama.1995.03530200053037
  • Xu, G., Strathearn, L., Liu, B., Yang, B., & Bao, W. (2018). Twenty-year trends in diagnosed attention-deficit/hyperactivity disorder among US children and adolescents, 1997-2016. JAMA Network Open, 1(4), e181471-e181471. https://doi.org/10.1001/jamanetworkopen.2018.1471

 

About the Author

Jonathan Perle, PhD, ABPP is a board-certified clinical child and adolescent psychologist, Associate Professor, Director of Telepsychology, Director of the ADHD Assessment Clinic, and Director of the Parent Management Training Clinic within the Department of Behavioral Medicine and Psychiatry at the West Virginia University School of Medicine. He has significant experience providing youth-focused clinical assessment and intervention within diverse clinical settings (e.g., medical centers, primary care, schools, university clinics) and roles (e.g., interdisciplinary, multidisciplinary, outpatient, inpatient). In addition to his current responsibilities that include teaching, supervising, and conducting research, Dr. Perle provides both face-to-face and virtual psychological care. While treating a wide-range of presenting concerns, Dr. Perle holds a specialization in the assessment and treatment of childhood ADHD and disruptive behavior disorders

General disclaimer:
This content is not intended to address all possible diagnosis methods, treatments, follow up, drugs or their related contraindications or side effects. Standards of practice change as new data becomes available. Therefore, it is strongly recommended that practitioners independently assess and verify diagnosis, treatments and drugs for each individual patient. The authors of the WV ACC guidelines assume no liability for any aspect of treatment administered by a practitioner with the aid of this publication.

Drug disclaimer:
The authors do not endorse or recommend the use of any particular drug mentioned in this publication. Before prescribing a new drug to a patient, practitioners are advised to check the product information accompanying each drug to ensure it is appropriate for a specific patient and to identify appropriate dosage, contraindications, side effects and drug-to-drug interactions.

Standard of care disclaimer:
This publication is not intended to establish a standard of care applicable to practitioners who treated patients diagnosed with ADHD. “Standard of care” is a legal term, not a medical term, which refers to the degree of care a reasonable practitioner would exercise under the same or similar circumstances. The standard of care is a continuum and does not imply optimal care. Practitioner discretion and clinical judgment are paramount and this publication is only intended to aid practitioners’ judgment, not to serve as a substitute for said judgment.