“Is Halloween different for a child with ADHD? Does sugar really affect hyperactivity?”

You may be getting mixed messages about the effects of sugar on a child with ADHD. This month, with a night of ‘trick-or-treating’, usually followed by eating lots of candy, we ask our panel of experts to comment on this issue.

Mary Robertson, RN, states that parents should regulate the amount of sugar their children eat, but not because it causes or increases hyperactivity. “Research does not support the myth that sugar causes hyperactive behaviors.” In 1986, the Food and Drug Administration (FDA) published a report on the effects of sugar on health. The FDA reviewed numerous human research studies from the previous twelve years at the National Institutes of Health and elsewhere, to study the relationship between sugar consumption and behavior. “The FDA found no conclusive experimental evidence that sugar consumption causes significant behavioral changes in children and adults,” explains Robertson. She adds that other studies have shown that the hyperactivity often seen in children at parties and social events is actually due to the excitement from the environment, not the food (Milich, R., Wolraich, M., & Lindgren, S. (1986). Sugar and hyperactivity: A critical review of empirical findings. Clinical Psychology Review, 6, 493-513). “Greater concerns from eating too much candy are the increased risk for cavities and obesity. It is a good idea to have all children eat a balanced meal before ‘trick-or-treating’ to so they avoid eating too much junk. Still, there are times when a child may have a sensitivity to sugar and will have a negative reaction. This is called an idiosyncratic reaction. If this is the case, it is best to strictly limit their consumption of any sweet ‘treats.’”

Dr. Jonathan Brush, a clinical psychologist, also weighs in on the subject. “Despite years of parents’ and teachers’ experience, sugar does not cause or increase hyperactivity in children with ADHD. Studies have carefully compared the behavior of children who have been given sugared soft drinks with that of children who have had artificially sweetened drinks. There was no difference in the activity level of the two groups of children,” he explained. He advises that parents limit the amount of candy consumed by the child with ADHD in the same way they would for any child, attending to their need for a balanced diet and good nutrition.

A big question still remains, though: If sugar does not increase hyperactivity, what actually accounts for the repeated observation that children become more hyperactive when they are at a birthday party, where they are eating cake and ice cream, or during Halloween?

Dr. Brush explains that children tend to become very stimulated at special events, where there are a number of other children who are also very excited. “When a child has ADHD we know that there is a tendency towards impulsivity and overactivity in the best of circumstances, and this is exacerbated in new and unfamiliar situations. In the case of Halloween, we add the experience of dressing up in costumes, going out at night, seeing other groups of children around the neighborhood. This is a recipe for the child with ADHD to become overwhelmed with stimuli, leading to less self control and increased overactivity.” He explains that the best way to manage your child’s hyperactivity is to ensure that the child has enough limits and structure, and not too much new stimulation, especially when they are going ‘trick-or-treating’ for the first time. This may mean going out while there is still daylight, going to familiar homes and staying in the near neighborhood, and keeping costumes from being too frightening. Lastly, Dr. Brush states that parents should limit the amount of time spent ‘trick-or-treating’ and be sure the child knows what to expect when the door is opened (e.g. the homeowner will ask you to take some candy, may try to guess who you are, or may even be wearing a costume themselves). This will allow the child to anticipate what is going to happen and not be overwhelmed.

Dr. Marc Atkins, a psychologist, and Dr. Peter Anderson, a clinical pharmacist, both agree that sugar does not cause hyperactivity. However, according to Dr. Atkins, sugar does, in fact, increase activity level for all children. “There is no evidence that children with ADHD respond any differently to sugar than do other children. However, because most children with ADHD have difficulty controlling their impulses, eating foods with high amounts of sugar may make it difficult for them to focus their attention and follow rules. Therefore, it makes good sense to limit the amount of candy that children eat in any one sitting,” explains Dr. Atkins. Dr. Anderson adds that excessive sugar should be avoided as part of overall good nutrition. “If sugar did indeed cause hyperactivity or an attention deficit then one would expect an high incidence of ADHD in persons with diabetes mellitus. I have seen no evidence to suggest this,” comments Dr. Anderson. “The excitement from Halloween may make a person with ADHD hyperactive. This should not be confused with hyperactivity from sugar.”

In summary, there does not seem to be a connection between sugar intake and ADHD; however, sugar intake should be limited for all children, to decrease the risks of cavities and obesity. Children with ADHD may become more excited when in unfamiliar situations, such as at parties or when dressing up and trick-or-treating, which may account for their apparent increase in energy. It is a good idea to talk to your child ahead of time about what to expect on Halloween, as well as to set limits with them.

Category: Ask The Experts