www.ADHDBasics.info/library

(the download files are incorrectly marked ADHDBasics.org)

   This is called a paradigm library because it contains the research papers from 1974-1981 that set all future mainstream medical thinking about what ADHD* is, how to treat it and what further research should be funded.

   The main body of publications is listed under "1974-1981 Closed," with summaries that followed under "Post 1981". Publications from the opposing Feingold proponents are listed under "1974-1981 Open". They controlled false negatives. The mainstream researchers controlled false positives. The bottom most heading "Other" lists the references made in the front page of this web site.

   Wender's 1986 report is by far the most succinct and thorough summary of the formative 1974-1981 placebo-controlled research. It capsulizes the original 1980 Nutrition Foundation report and then adds a quite useful summary table with which one can peruse the 14 studies and 11 journal papers from seven research groups on a single page.

    Wender's reference numbers are included in parentheses in the left column of this library. And the pdf versions of Wender1986 and NutritionFoundation1980 have been software upgraded to make them more readable on screen with hypertext links.

   The papers are not hard to read technically, though some are long and most contain a paragraph on statistics. To read the latter just keep in mind that small values of p mean that the data is giving a firm conclusion. p is the probability of finding an effect when there really is none, i.e. the probability of a false positive finding. The double-blind trials generally did have data with small p, but the suggestion here is that those small p's can result from faulty protocol that enhanced the likelihood of null result.

[To set PDF file display size hover the mouse near the bottom center of this page.]

[The left-hand index column of this page can function in two ways according to the top action button in that column.]


 

CongressBeallFeingold1973:
October 30, 1973, compiled pages S 35401-7 (same as dailies pages S 19736-42)
Sen. J. Glen Beall Jr. entered a paper by Dr. Feingold, an article from the Washington Post, his letter to Sen.Ted Kennedy concerning pending action in the Senate Health Committee, and he contacted the FDA and NIMH. (This entry should not be referred to as "a Senate hearing.")

 

NutritionFoundation:

NutritionFoundation1980 (OCR converted to ASCI and then navigation links added)
"Final Report to the Nutrition Foundation, by the National Advisory Committee on Hyperkinesis and Food Additives," co-chaired by Wender EH & Lipton M. [Contains diet test results from their sponsored seven study groups plus in vitro and animal studies].
NutritionFound1980.jpg (large 15MB as scanned with no possible OCR errors)

NutritionFoundation1980
"1975 Report to the Nutrition Foundation Nutrition Foundation by the National Advisory Committee on Hyperkinesis and Food Additives," Contained as Appendix A of the 1980 Nutrition Foundation Publication.

1980 Journal version of Nutrition Foundation report:

Wender1986 (OCR converted to ASCI and then navigation links added)
Wender EH, "The food additive-free diet in the treatment of behavior disorders: a review," J Dev Behav Pediatrics, Feb, 1986 7:35-42. (A capsualization of the 1980 Nutrition Foundation report of which she was coeditor + a table of double-blind studies and a recommendation to clinicians on how to handle diet-inclined parents.)
Wender1986 jpg (large 5.2 MB as scanned with no possible OCR errors)

Google HTML 2009 (link to a Google page)
Here is a more readable version: GoogleNF_HTML2009 0.2MB

FDA1975

apparently unavailable
Proceedings of Sept. 30, 1975, Meeting of Interagency Collaborative Group on Hyperkinesis," Washington, DC, US Department of Health Education and Welfare - Food and Drug Administration, 1975.
"Interagency Collaborative Group on Hyperkinesis: First Report of the Preliminary Findings and Recommendations of the Interagency Collaborative Group on Hyperkinesis," US Dept of Health, Education and Welfare, 1976.
ERIC shows the correct abstract but downloads an incorrect pdf file.

Spring1976DeptEduCA
Spring C & Sandoval J, "Food Additives and Hyperkinesis: A Critical Evaluation of the Evidence," Journal of Learning Disabilities, Nov, 1976 9/9:560-565.

Conference1980
"1980 International Conference on the Treatment of Hyperactive and Learning Disordered Children: Current Research," Knights R & Bakker D, Editors, (University Park Press, Baltimore). A section of the proceedings on diet includes reports by   Conners, Harley, Swanson and Trites.

 

1974-1981 Closed, Placebo-Controlled Trials

Stokes JD & Scudder CL, "The effect of butylated hydroxyanisole and butylated hydroxytoluene on behavioral development of mice," Dev Psychobiol, 1974 Jul;7(4):343-50 --- This is apparently the only study ever done on behavior effects of BHA and BHT.(FAUS eNews) Some kids clearly react.

ConnersNF
A copy of five pages from the 1980 Nutrition Foundation report

ConnersConf1980
A copy of 8 pages from the 1980 Conference,
Conners CK, "Artificial colors in the diet and disruptive behavior, Current status of research"

Conners1976
Conners CK, Goyette CH, Southwick DA, Lees JM & Andrulonis PA, "Food additives and hyperkinesis: A controlled double-blind experiment," Pediatrics, Aug. 1976 58/2:154-166.
abstract

Goyette CH, Conners CK, Petti TA & Curtis LE, "Effects of artificial colors on hyperkinetic children: A double-blind challenge study," Psy chopharmacology Bulletin, 1978 14:39-40.

Conners1980Book
Conners CK, "Food Additives and Hyperactive Children," (Plenum Press, N.Y.).

Conners CK (1980), Goyette CH & Neuman EB, "Dose-time effect of artificial colors in hyperactive children," J Learn Disab, 13:512-516.

not available - Harley JP et al., "An Experimental Evaluation of Hyperactivity and Food Additives. Phase I," Private Publication, University of Wisconsin, Madison, Wisconsin, 1977. pg. 92.

HarleyNF
A copy of six pages from the 1980 Nutrition Foundation report

HarleyConf1980
A copy of 10 pages from the 1980 Conference,
Harley JP & Matthews CG, "Food Additives and Hyperactivity in Children, Experimental Investigations"

Harley1978a
Harley JP, Ray RS, Tomasi L, Eichman PL, Matthews CG, Chun R, Cleeland CS & Traisman E, "Hyperkinesis and food additives: Testing the Feingold hypothesis," Pediatrics, June, 197861/6:818-828.
abstract

Harley1978b
Harley JP, Matthews CG & Eichman P, "Synthetic food colors and hyperactivity in children: A double-blind challenge experiment," Pediatrics, Dec. 1978 62/6:975-983.
abstract

LevyNF
A copy of two pages from the 1980 Nutrition Foundation report

Levy1978a
Levy F, Dumbrell S, Hobbes G, Ryan M, Wilton N & Woodhill JM, "Hyperkinesis and diet: A double-blind crossover trial with a tartrazine challenge," Med J of Aust, 1978 1:61-64, Jan 28.

Levy1978b
Levy F & Hobbes G, "Hyperkinesis and diet: A replication study," Am J of Psychiatry, Dec, 1978 135:1559-1560.

MattesNF
A copy of two pages from the 1980 Nutrition Foundation report

Mattes1978
Mattes J & Gittelman-Klein R, "A crossover study of artificial food colorings in a hyperkinetic child," Am J Psychiatry, 1978 135:987-988.

Mattes1981
Mattes JA & Gittelman R, "Effects of artificial food colorings in children with hyperactive symptoms: A critical review and results of a controlled study," Arch Gen Psychiatry, June, 1981 38:714-718.

listed below after 1981

SwansonNF
A copy of three pages from the 1980 Nutrition Foundation report

SwansonConf1980
A copy of 19 pages from the 1980 Conference
Swanson JM & Kinsbourne M, "Artificial color and hyperactive behavior"

Swanson J & Kinsbourne M, "Artificial food colors impair the learning of hyperactive children." See the 1975 appendix of the 1980 Nutrition Foundation report.

not available - Swanson, JHL "The Effect of Food Dyes on the Behavior of Hyperactive Children," unpublished manuscript, Oct. 31, 1979.

Swanson1978
Swanson J, Kinsbourne M, Roberts W and Zucker MA, Time Response Analysis of the Effect of Stimulant Medication on the Learning Ability of Children Referred for Hyperactivity," Pediatrics, 1978 61:21.

Swanson1980
Swanson JM & Kinsbourne M, "Food dyes impair performance of hyperactive children on a laboratory learning test," Science, 1980 207:485-1487.

Tryphonas H (1979) & Trites R, "Food allergy in children with hyperactivity, learning disabilities and/or minimal brain dysfunction," Annals of Allergy, 42:22-27.
IgE antibodies measured in blood samples.

TritesConf
A copy of 13 pages from the 1980 Conference
Trites RL, Tryphonas H & Ferguson HB, "Diet Treatment for Hyperactive Children with Food Allergies"

Wender EH, "Minimal Brain Dysfunction: An Overview," in Lipton, MA, DiMascio, A, Killam, KF (eds.), "Psychopharmacology: A Generation of Progress," Raven Press, New York, 1978. Suggests that some forms of ADD/ADHD "may be manifestations of a genetically determined abnormality of manoamine metabolism... related to alcoholism, Briquet's syndrome and sociopathy..."

Wender1986
listed above with Nutrition Foundation

WeissNF
A copy of two pages from the 1980 Nutrition Foundation report

Weiss1980
Weiss B, Williams JH, Margen S, Abrams B, Caan B, Citron LJ, Cox C, McKibbern J, Ogar D & Schultz S, "Behavioral responses to artificial food colors," Science, March, 1980 207:1487-1489.

WilliamsNF
A copy of two pages from the 1980 Nutrition Foundation report

Williams1978
Williams JI, Douglas MC, Tausig FT & Webster E, "Relative Effects of Drugs and Diet on Hyperactive Behaviors: An Experimental Study," Pediatrics, June, 1978 61/6:811-817.
abstract

 

Post 1981:

Kavale1983
Kavale KA & Forness SR, "Hyperactivity and Diet Treatment: A Meta-Analysis of the Feingold Hypothesis," J Learn Disabl, 1983 16:324-330.

Mattes1983
Mattes JA, "The Feingold Diet: A Current Reappraisal," Journal of Learn Disab, 1983 16/6:319-323, June/July.

Wender1986
listed above under Nutrition Foundation

Rowe1994
Rowe KS & Rowe KJ,
"Synthetic food coloring and behavior: A dose response effect in a double-blind, placebo-controlled, repeated-measures study,"
J Pediatrics, Nov. 1994 125/5/1:691-698.
abstract

Rowe1997
Rowe KS & Rowe JR,
" Norms for parental ratings on Conners' Abbreviated Parent-Teacher Questionnaire: Implications for the design of behavioral rating inventories and analyses of data derived from them,"
Journal of Abnormal Child Psychology, 25/3:425-451.

NIH1982ConsensusRep
"Defined Diets and Childhood Hyperactivity,"
National Institutes of Health
Consensus Development Conference Statement
January 13-15, 1982,   NIH web site

NIMH1994DecadeOfTheBrain&ADHD
L. Eugene Arnold, M.D.; F. Xavier Castellanos, M.D. and Alan J. Zametkin, M.D.
NIMH staff technical reviewers
"ATTENTION DEFICIT HYPERACTIVITY DISORDER, Decade of the Brain,""
NIH #94-3572, 1994, GPO Stock No. 017-024-01543-1

NIH 1998 Consensus Report on "Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder." Versions of this NIH report are: web news release (duplicated from the left here as NIH1998Concensus); web abridged summary pdf or html; or the complete 239 page hard copy from consensus@iqsolutions.com, 888-644-2667. Even the complete version does seem to include public comment speakers, such as a lady who claimed to show that two-terminal EEG can discern challenge onset of ADHD.
Some of the conclusions of NIH1998Consensus are:
  "The 3 to 5 percent of school age children grappling with ADHD   experience an inability to sit still and pay attention in class, peer rejection, and disruptive behaviors, which can lead to academic and social difficulties. Other long-term consequences include higher rates of accidents as well as alcohol and drug abuse and criminal behaviors when ADHD is accompanied by conduct problems."
  "There is no evidence that treatment improves academic achievement or long-term outcomes and research is needed in these areas."

NIH 2001 Grant Application Solicitation - followed from NIH 1998 Consensus Conference
NIH web page version
Some of the statements are:
  "Variation (in treatment approaches) reflects in part the absence of a theoretical consensus of underlying mechanisms involved in ADHD."
  "Longitudinal studies find varying rates (10-60 percent) of persistent disabling ADHD symptoms into adolescence and adulthood... Children diagnosed with ADHD followed into adulthood often have high levels of academic failure, poor work histories, poor social interactions and low self-esteem. Although approximately 50 percent of children diagnosed with ADHD no longer meet diagnostic criteria for the disorder in adolescence, the persistent disorder in others often increases their risk for accidental injury, antisocial behavior and/or violence, poor school outcomes, and contact with the justice system."

NIMH Post 2010
Director's Posts about ADHD
  SPECT brain scans will provide useful diagnostics for ADHD in the future but are not quite ready yet for clinical use.

AACAP1997
AACAP Official Action, "Practice Parameters for the Assessment and Treatment of Children, Adolescents, and Adults With Attention-Deficit/Hyperactivity Disorder," Journal of the American Academy of Child & Adolescent Psychiatry 36:10, Supplement, pp 85S-121S, October 1997

AAP Diagnosis
American Academy of Pediatrics, Clinical Practice Guideline:
Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder
PEDIATRICS Vol. 105 No. 5 May 2000, pp. 1158-1170

AAP Treatment
American Academy of Pediatrics, Clinical Practice Guideline:
Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder
PEDIATRICS Vol. 108 No. 4 October 2001, pp. 1033-1044

AAP Disimination
American Academy of Pediatrics
Disseminating Improved Care for ADHD in the Community, an ongoing trial study
  The AAP guidelines can be challenging to implement in typical community-based practices. Cincinnati Children's Hospital Medical Center has developed a program called the ADHD Collaborative to promote the adoption of these guidelines among community pediatricians.

Castellanos2002
Castellanos FX, Lee PP, Sharp W, Jeffries NO, Greenstein DK, Clasen LS, Blumenthal JD, James RS, Ebens CL, Walter JM, Zijdenbos A, Evans AC, Giedd JN, Rapoport JL
"Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/ hyperactivity disorder""
JAMA 2002, Oct 9, 288/14:1740-48

APA2010BrainStruct
Shaw P
"Editorial, The Shape of Things to Come in Attention Deficit Hyperactivity Disorder"
Am J Psychiatry 2010, April, 167:363-365

Ivanov2010
Ivanov I, Bansal R, Hao X, Zhu H, Kellendonk C, Miller L, Sanchez-Pena J, Miller AM, Chakravarty MM, Klahr K, Durkin K, Greenhill LL, Peterson BS
"Morphological abnormalities of the thalamus in youths with attention deficit hyperactivity disorder""
Am J Psychiatry 2010; 167:397-408

 

Rectnt British

Bateman2004
Bateman B, Warner J, Hutchinson E, Dean T, Rowlandson P, Grant C, Grundy J, Fitzgerald C and Stevenson J,
"The Effects of a Double-Blind, Placebo Controlled, Artificial Food Colourings and Benzoate Preservative Challenge on Hyperactivity in a General Population Sample of Preschool Children,""
Archives of Disease in Childhood 2004; 89:506-611
Summary:
Aims: To determine whether artificial food colourings and a preservative in the diet of 3 year old children in the general population influence hyperactive behaviour.
Methods: A sample of 1873 children were screened in their fourth year for the presence of hyperactivity at baseline (HA), of whom 1246 had skin prick tests to identify atopy (AT). Children were selected to form the following groups: HA/AT, not-HA/AT, HA/not-AT, and not-HA/not-AT (n = 277). After baseline assessment, children were subjected to a diet eliminating artificial colourings and benzoate preservatives for one week; in the subsequent three week within subject double blind crossover study they received, in random order, periods of dietary challenge with a drink containing artificial colourings (20 mg daily) and sodium benzoate (45 mg daily) (active period), or a placebo mixture, supplementary to their diet. Behaviour was assessed by a tester blind to dietary status and by parents' ratings.
Results: There were significant reductions in hyperactive behaviour during the withdrawal phase. Furthermore, there were significantly greater increases in hyperactive behaviour during the active than the placebo period based on parental reports. These effects were not influenced by the presence or absence of hyperactivity, nor by the presence or absence of atopy. There were no significant differences detected based on objective testing in the clinic.
Conclusions: There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children which is detectable by parents but not by a simple clinic assessment. Subgroups are not made more vulnerable to this effect by their prior levels of hyperactivity or by atopy.

McCann2007
McCann D, Barrett A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchin E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner J, Stevenson J,
"Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial,"
Lancet 2007; 370:1560-1567
Summary:
Background: We undertook a randomised, double-blinded, placebo-controlled, crossover trial to test whether intake of artificial food colour and additives (AFCA) affected childhood behaviour.
Methods: 153 3-year-old and 144 8/9-year-old children were included in the study. The challenge drink contained sodium benzoate and one of two AFCA mixes (A or B) or a placebo mix. The main outcome measure was a global hyperactivity aggregate (GHA), based on aggregated z-scores of observed behaviours and ratings by teachers and parents, plus, for 8/9-year-old children, a computerised test of attention. This clinical trial is registered with Current Controlled Trials (registration number ISRCTN74481308). Analysis was per protocol.
Findings: 16 3-year-old children and 14 8/9-year-old children did not complete the study, for reasons unrelated to childhood behaviour. Mix A had a significantly adverse effect compared with placebo in GHA for all 3-year-old children (effect size 0.20 [95% CI 0.01-0.39], p=0.044) but not mix B versus placebo. This result persisted when analysis was restricted to 3-year-old children who consumed more than 85% of juice and had no missing data (0.32 [0.05-0.60], p=0.02). 8/9-year-old children showed a significantly adverse effect when given mix A (0.12 [0.02-0.23], p=0.023) or mix B (0.17 [0.07-0.28], p=0.001) when analysis was restricted to those children consuming at least 85% of drinks with no missing data.
Interpretation: Artificial colours or a sodium benzoate preservative (or both) in the diet result in increased hyperactivity in 3-year-old and 8/9-year-old children in the general population.

 

Medications

Shenker1992
Shenker A
"The Mechanism of Action of Drugs Used to Treat Attention-Deficit Hyperactivity Disorder: Focus on Catecholamine Receptor Pharmacology ""
Advances in Pediatrics 2010; 39:337-382
  In 1973, Snyder and Meyerhoff summarized what was known about the mechanism of drug action in the childhood condition now referred to as ADHD by pointing out that drugs that produced therapeutic effects (amphetamine, methylphenidate, tricyclic antidepressants) shared the ability to facilitate the synaptic effects of brain catecholamines.
  The relative roles that brain dopamine (DA) and norepinephrine (NE) play in attention-deficit hyperactivity disorder (ADHD) remain unresolved. The progress that has been made in catecholamine receptor pharmacology, including the classification of multiple receptor types for DA and NE and the development of new, selective drugs for these receptors, may be used to guide more sophisticated studies of the pathophysiology and treatment of ADHD, help identify the specific receptors that mediate the therapeutic effects of drugs used to treat ADHD, and possibly lead to the development of better pharmacologic treatments.

 

1974-1981 Open Trials

Feingold1973Book
Feingold BF, "Why your Child Is Hyperactive" (Random House, 1973).
  Feingold initially removed colorings, flavorings and salicylates from diets and on pages 69-71 states several findings. He noted first that a few with both allergies and H-LD must be treated for the allergies before restricted diet will work for the H-LD, but that this is not usually the case.
  In a group of 25 diagnosed and pharmacologically treated patients Feingold found remission of all symptoms in 50% and ability to remove medications for 75%. Then in Feingold1975 p. 800 he notes that the 50% figure had been confirmed by six other open trials besides his own.
  It was soon after this that Beatrice Trum Hunter suggested removing BHT and BHA as well, and Feingold reported test results in 1977. (Weiss1980 knew to restrict BHT/BHA from diet, but that was not done by any other experimenter of the era.)

Feingold1973AMA
Feingold BF, German DF, Braham RM and Simmers F, "Adverse Reaction to Food Additives," AMA Annual Convention, New York, 1973.
  Feingold repeated his June AMA presentation at a symposium on food health in London in September, 1973. Sen. G. Glen Beal Jr. entered it with other materials into the Congressional Record.
  Also released in 1973 was his 375 page text book, "Introduction to Clinical Allergy" (Charles C Thomas, Publisher). It devotes seven pages to describing allergic reactions to aspirin, salicylate and thirteen categories chemicals added to foods, but has no mention of hyperactivity. The association of nasal polyps with aspirin and salicylate is discussed. Yet circa 2000, some members of FAUS report amazement and skepticism from their physicians who had operated on them several times, when their nasal polyps fully disappeared after the family went on the Feingold diet.

Feingold1973HospPr
Feingold BF, "Food Additives and child Development," Editorial, Hospital Practice, October, 1973.

Feingold1975
Feingold BF, "Hyperkinesis and Learning Disabilities Linked to Artificial Food Flavors and Colors," American Journal of Nursing, May 1975, 75/5:797-803.

Feingold1976
Feingold BF, "Hyperkinesis and Learning Disabilities Linked to Artificial Food Colors and Flavors," Journal of Learning Disabilities, 1976, 9/9:19-27.

Feingold1977
Feingold BF, "Hyperkinesis and Learning Disabilities Linked to Ingestion of Artificial Food Colors and Flavors," American Academy of Pediatrics, Nov 8, 1977. This is a 5 page conference proceedings report. See page 3, paragraph 3 for results when BHT and BHA were also removed from foods. Success rate went up 20-30%.

Cook1976
Cook PS & Woodhill JM, "The Feingold dietary treatment of the hyperkinetic syndrome," Med J Aust, 1976 2:85-90.

Brenner1977
Brenner A, "A Study of the Efficacy of the Feingold Diet on Hyperkinetic Children, Some Favorable Personal Observations," Clinical Pediatrics, 1977, 16/7:652-656

Findlay1980
Findlay S, "Food Color Link to Hyperactivity Debated," Pediatric News, Dec 1980, p. 35-36.

Palmer1975
Palmer S, Rapport JL & Quinn PO, "Food Additives and Hyperactivity," Clinical Pediatrics, Oct 1975 14/10:956-959.

Salzman1976
Salzman LK, "Allergy Testing, Psychological Assessment and Dietary Treatment of the Hyperactive Child Syndrome," Med J Aust, 1978 2: 248-251.

Rapp1978
Rapp DJ, "Does Diet Affect Hyperactivity?," J Learn Disab, June/July, 1978 11/6, 56-62.

Rimland1983
A more readable HTML version less references is available at FAUS
Rimland B, "The Feingold Diet: An Assessment of the Reviews By Mattes, By Kavale and Forness and Others," Journal of Learning Disabilities, June/July, 1983 16/6:331-333.

The APS proposed revision DSM-V is at:
www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=383#

 

*ADHD was referred to as "hyperkinesis," in the 1970s. Terminology and recognition of the ADHD disorder have evolved over time. These are specified by the American Psychiatric Association in its DSM, the Diagnostic and Statistical Manual of Mental Disorders.
    1952   (DSM-I)   no recognized condition
    1968   (DSM-II)   "hyperkinetic reaction of childhood" or hyperkinesis,
                hyperactivity with short attention span
    1980   (DSM-III)   ADD/H, with hyperactivity, and ADD/WO, without hyperactivity
    1987   (DSM-IIIR) ADHD (no non-hyperactivity condition recognized)
    1994   (DSM-IV)   ADD and ADHD both recognized and specified

 

 

 

 

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