ADHD Treatment in Teens: The Role of Diet

If you’re the parent of a child or teen with attention-deficit/hyperactivity disorder (ADHD), you most likely know a great deal about ADHD treatment in teens. You’ve also most likely had your share of people in your life who suggest alternative treatments for ADHD, or offer explanations about why your teen has ADHD that have nothing to do with evidence, research, or the data collected, and published by mental health experts who dedicate their lives studying ADHD treatment in teens.

Here are some of the things we’re sure you’ve heard:

ADHD isn’t real, because it didn’t exist before the 70s – at least no one I knew had it

The only reason kids get diagnosed with ADHD is they don’t get enough exercise

ADHD only happens because parents and teachers don’t discipline their kids properly

When they phased out PE class in school, suddenly everyone had ADHD

The best way to treat ADHD is through diet

Food dyes and additives cause ADHD, it has nothing to do with the brain

High-fructose corn syrup definitely caused ADHD in my kid, you should totally cut that out of your teen’s diet and I’m 100% sure they’ll improve

Those statements – in clinical circles – are mostly considered nonsense. However, parents listen to them and believe them because although they are not evidence-based, they’re also not entirely wrong. It’s true: ADHD diagnoses have increase over the past thirty years. It’s also true that exercise, understanding how to talk to a child or teen with ADHD – read discipline properly – and diet can have a significant impact on the overall health and well-being of a developing child or teen. The health benefits of diet and exercise also redound to children or teens with ADHD, but not licensed clinician would recommend those as primary treatment approaches.

That begs the question: what are the primary, evidence-based approaches for ADHD Treatment in teens?

Evidence-Based ADHD Treatment in Teens

The most common, evidence-based, clinically proven, time-tested treatments for ADHD include:

• Behavioral therapy
  • Cognitive behavioral therapy
  • Mindfulness-based cognitive behavioral therapy (MBCBT)
• Parent training in behavior management
• Behavioral intervention in the classroom, in coordination with the families and kids
• Medication, both stimulant and non-stimulant
• Lifestyle modifications, such as exercise and diet

This article will focus on two new studies published recently that focus on diet. One study focused on the effect of increased fruits and vegetables on symptoms of ADHD in teens, and the other focused on the addition to a multivitamin/mineral supplement on the symptoms of ADHD in teens. We’ll discuss that data, and how it’s relevant to ADHD treatment in teens in a clinical context. To learn more about ADHD before we continue, we encourage you to read our following articles:

Evolve Parent Guide: ADHD

Diagnosing ADHD: Different Countries, Different Approaches

How ADHD Can Lead to Depression in Teens

Research Report: Study Defines Stages of Engagement in ADHD Treatment

Exercise for Children With ADHD

Healthy Foods for Kids With ADHD

Those articles are filled with helpful information and will give you a good start on understanding ADHD from several different angles. Before we start our analysis of the new research on the effect of diet on ADHD treatment in teens, we’ll make sure we’re all on the same page. We’ll talk about the known causes and risk factors for ADHD, how clinicians diagnose ADHD in teens, and present the latest data on the prevalence and treatment rates of ADHD among teens in the U.S.

We’ll start with the prevalence data.

ADHD in the U.S.: Facts and Figures

We retrieved the following data from Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD), the National Survey of Children’s Health (NSCH), and the Centers for Disease Control (CDC). We include data from the 2016 NSCH and the 2020 NSCH, since there are slight variations in the metrics, measures, and variables between the two publications. Researchers collected data in some areas in 2016 and not in 2020, and vice-versa. Overall, the data below give a reliable, comprehensive picture of the prevalence of ADHD in teens in 2016 and 2020.

Prevalence of ADHD: U.S. Teens

• Ever received an ADHD diagnosis:
  •  2016:
    • 3.3 million, or 13.6%
  •  2020:
    • Data n/a
• Current ADHD diagnosis:
  •  2016:
    • 2.93 million, or 11.9%
  •  2020:
    • • 2.91 million, or 11.8%
• ADHD severity:
  • 2016:
    • Mild ADHD: 1.34 million, or 5.5%
    • Moderate/Severe ADHD: 1.52 million, or 6.2%
  • 2020:
    • • • Mild ADHD: 1.33 million, or 5.4%
        • Moderate/Severe ADHD: 1.57 million, or 6.3%
• ADHD and co-occurring disorders:
  • 2016:
    • Any disorder: 64%
    • Conduct disorder (CD)/oppositional defiant disorder (ODD)/other behavioral disorder: 52%
    • Anxiety: 33%
    • Depression: 17%
•  2020:
  • Data n/a

That data shows us that rates of ADHD among teens in the U.S. have remained relatively stable over the five-year period for which we have data. After decades of increase, the prevalence rates have levelled off, and we see that as a positive development.

Now let’s take a look at the data on ADHD treatment in teens.

ADHD Treatment: Medication, Behavioral Therapy, or Both

• Treatment for ADHD, Among All Teens:
  • Medication
    •  2016:
      • 7.4%, or 1.79 million
    •  2020:
      • 6.9%, or 1.72 million
• Behavioral therapy:
  •  2016:
    • 5.0%, or 1.21 million
  •  2020:
    • 5.5%, or 1.37 million
• Treatment for ADHD among teens age 12-17 with ADHD:
  • Any treatment: 77%
  • Medication: 62%
  • Behavioral treatment: 42%
  • Medication + behavioral treatment: 32%
  • No treatment: 23%

That data tells use two important things. First, around three million teens in the U.S. have ADHD that meets the clinical threshold, and among those, around 50 percent have moderate to severe ADHD, which means it significantly disrupts their day to day lives. Second, we see that just over three-quarters of teens with ADHD receive treatment. That’s good but could be better. Among those teens who do receive treatment, we see that more teens receive medication than behavioral treatment, and that less than a third receive a combination of medication and behavioral treatment.

Now let’s move on to the known causes, risk factors, and diagnostic approaches for ADHD in teens.

What Causes ADHD?

The specific causes and factors that increase risk for developing ADHD are unknown. However, the latest evidence indicates all of the following may be possible causes/risk factors for developing ADHD:

• Brain injury
• Exposure to environmental risks in utero, during infancy, or as a toddler
• Alcohol and tobacco use during pregnancy
• Low birth weight
• Premature birth

Although no data offers a definitive explanation of the causes and risk factors for ADHD, mental health experts know how to diagnose ADHD – and they’ve been improving over the years. The Diagnostic and Statistical Manual of Behavioral Disorders, Volume Five (DSM-5) – the go to diagnostic reference for mental health professionals –  defines the following criteria for a clinical diagnosis of ADHD:

Diagnosing ADHD in Teens: Clinical Criteria

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.

Common Symptoms of Inattention

• To meet clinical criteria:
  • Children/teens up to age 16 must show six or more symptoms
    • Teens 17 and older must show five or more symptoms must
    • Symptoms must be present for at least 6 months
    • Symptoms must be inappropriate for developmental level
    • Possible symptoms include:
  • Frequent failure to focus on details/makes careless mistakes in tasks at school, at home, and in other context
  • Consistent trouble focusing on tasks, whether play, academic, or other
  • Consistent trouble listening to directions or when spoken to directly
  • Frequent failure to follow through/ finish schoolwork, home responsibilities, or work task
  • Consistent trouble organizing personal tasks and/or activities
  • Consistent avoidance of tasks that require sustained focus
  • Frequent loss of things necessary for tasks and activities, including:
    • School supplies
    • Wallet
    • Glasses
    • Phone
  • Forgetfulness in typical daily activities
  • Frequent distraction

Common Symptoms of Hyperactivity and Impulsivity:

• To meet clinical criteria:
  • Children up to age 16 years must show six or more symptoms
    • Teens 17 and older must show five or more symptoms must
    • Symptoms must be present for at least 6 months
    • Symptoms must be disruptive and inappropriate for their developmental level
    • Possible symptoms include:
  • Frequent fidgeting with hands of feet
  • Frequent squirming in seat
  • Leaving seat when expected to remain seated
  • Running or climbing in situations where it is not appropriate
    • For adolescents, this may manifest as restlessness
  • Inability to play or relax quietly
  • Constantly being on the go or constantly having the engine revving
  • Excessive talking
  • Often answers before speaker finishes asking a question
  • Frequent trouble waiting their turn
  • Constant interruption/intrusion on others’ conversations or activities

For clinical diagnosis, children/teens must also meet the following additional criteria:

• Several Inattentive/hyperactive-impulsive symptoms appear before age 12
• Symptoms must be present in two or more settings, including any combination of the following:
  • Home
  • Relatives
  • School
  • Work
  • Sports
  • Clubs/activities
  • Social situations
• Symptoms disrupt or reduce the quality of functioning at home, school, or in social situations
• Another mental disorder does not explain the more accurately
• Symptoms are unrelated to schizophrenia or psychosis

Based on the previous two sets of symptoms, there are three distinct types of ADHD, all three of which can be mild, moderate, or severe:

1. Combined Presentation:

• • Symptoms of inattention and hyperactivity-impulsivity present for at least 6 months prior to assessment

2. Predominantly Inattentive Presentation:

• • Symptoms of inattention – not hyperactivity-impulsivity – present for at least six months prior to assessment

3. Predominantly Hyperactive-Impulsive Presentation:

• • Symptoms of hyperactivity-impulsivity – but not inattention – present for at least six months prior to assessment

At this point, we’ve covered the basics of ADHD treatment in teens, presented the prevalence rates of ADHD and ADHD treatment in teens, and shared the clinical criteria mental health professionals use to diagnose ADHD in teens.

Now we’re ready to talk about those two new studies on the effect of diet on ADHD symptoms.

ADHD Treatment in Teens: Can Changes in Diet Reduce Symptoms?

Two recent studies on this topic caught our attention. The first is a sub-study of the data published in full in the second study, which was designed to gauge the effect of a micronutrient/ vitamin supplement on the symptoms of ADHD. As whole, the main research effort and its sub-studies are known as The MADDY Study.

The title of the sub-study contains information about both the study and the results: “Fruit and Vegetable Intake is Inversely Associated With Severity of Inattention in a Pediatric Population With ADHD Symptoms: The MADDY Study.”

The title of the second study contains information about the study itself, but does not give away the conclusions: “Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial.”

Let’s take a look at the data from the sub-study, which examined the specific eating habits of teens with ADHD, before the introduction of the micronutrients examined in the main study.

Fruits, Vegetables, and ADHD: Results

• As measured by the Healthy Eating Index-2015 (HEI-15), higher scores – meaning healthier overall eating habits – were not associated with decreased symptoms of inattention.
• Higher scores on the HEI-15 were not associated with decreased symptoms of hyperactivity
• High consumption of fruit was associated with lower levels of inattention
• High consumption of vegetables was associated with lower levels of inattention
• Higher consumption of refined grain was associated with higher levels of inattention

All that aligns with what we know about healthy eating and ADHD. It’s important to note that consumption of fruits and vegetables at a level considered healthy by the HEI-15 was not sufficient to affect ADHD symptoms. The data shows that higher levels of fruits and vegetables make a difference, as opposed to levels that are considered as baseline acceptable or healthy.

Now let’s look at the second study. To obtain these results, researchers collected data on teens with ADHD after the introduction of a complete vitamin/micronutrient supplement into their diets, and compared the frequency and severity of symptoms of ADHD and other behavioral disorders against a placebo group of teens who also had ADHD after a period of eight weeks. In addition, researcher collected data on growth – as in height – of all teens in the study.

Micronutrients and ADHD: Results

• Clinician-rated ADHD symptoms:
  • 54% of supplement group showed much or very much improvement in ADHD symptoms
  • 18% of the placebo group showed much or very much improvement in ADHD symptoms
• Parent-rated ADHD symptoms:
  • Both the supplement group and the placebo group showed much or very much improvement in ADHD symptoms
    • Researchers explain this by pointing out that the placebo response is a well-known phenomenon among parent-rated scales that measure behavioral symptoms in children and teens
  • Parent-rated disruptive mood dysregulation disorder (DMDD) symptoms:
    • Parents of teens in the micronutrient group were twice as likely to report a reduction in the symptoms of DMDD than parents of teens in the placebo group
  • Growth:
    • Teens in the micronutrient group grew an average of 6mm more than teens in the placebo group

Those results teach us more about the role of diet in ADHD and other behavioral disorders. They also help scientists discover exactly what’s causing the symptom reduction. That’s the point of formulating a micronutrient supplement. It allows researchers to quantify their results with more specificity than five servings of vegetables as opposed to three. Combined with the data from the sub-study, we can now answer the real question at the core of both these studies:

Can changes in diet reduce symptoms?

The answer:

Yes.

How This Information Helps Parents

If your teen has ADHD, these results affirm what you’ve most likely already heard from most mental health professionals. While therapy and medication are considered first-line treatments, a healthy diet can also help reduce symptoms.

It affirms that but adds nuance. A healthy diet is not sufficient. It also takes an increase in fruit and vegetable consumption beyond what’s considered healthy by the existing USDA Healthy Eating Index. That’s practical, actionable advice you can use almost immediately. If your teen has ADHD, then we encourage you to consult with your family physician about a reasonable increase in fruit and vegetable consumption. You should also consult with all members of your teen’s treatment team, including any therapists, counselors, or psychiatrists. They’re the professionals: this article simply helps you by sharing information from the latest peer-reviewed research on the subject.

We’ll close with the words of the lead researcher on the MADDY study, Dr. Jeannette Johnstone. Interviewed in the online science magazine Science Daily, here’s what she says about the next step for her research:

“Future studies will focus on the micronutrients’ mechanisms of action and subgroup responses to understand for whom and why this intervention works. Mechanistic hypotheses to be tested include changes in the gut microbiome and its metabolome, reductions in inflammatory markers, replenishment of minerals, and optimization of neurotransmission.”

Finding Help: Resources for ADHD Treatment in Teens

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.