Though pediatricians acknowledge the limited effectiveness that some patients see with diet changes, most were against including the elimination diet, which can be a harrowing experience for parents and children, as standard of care.
"People seem to think that dietary modification is essentially 'free,' but it is difficult, socially disruptive, and presents the risk for nutritional deficiency," said Dr. Michael Daines, a pediatric allergist-immunologist at the University of Arizona.
Currently, food elimination diets are not standard of care in the U.S. or in the Netherlands, where the study was performed. They are used limitedly when parents specifically request to attempt this alternative treatment for the hyperactivity disorder.
Though Daines is willing to work with families who want to try an elimination diet for treating ADHD, he feels it will only have an effect if the child is having a true food allergy or intolerance.
Edris felt similarly: Because ADHD can only be diagnosed by a cluster of symptoms (and not something biological such as a blood test), she thought that it was more likely that some children had allergy-related ADHD and it was only such children who would see a benefit from the diet.
This could be the case for some children, agreed Dr. Anne Francis, a pediatrician in the Elmwood Pediatric Group in Rochester, N.Y.
There is "no question that allergic children show symptoms very similar to ADHD in terms of behavior," she said.
Edris was drawn to try the elimination diet because she was hoping to be able to avoid giving her young son prescription medication for his ADHD. While dietary changes are seemingly a non-invasive treatment option to explore, pediatricians, even those who support the diet as a type of ADHD treatment, warn against parents trying it alone.
"Restricted diets should be undertaken with caution and under close medical supervision to assure appropriate nutrition," said Dr. Karen Warman, an associate professor of Clinical Pediatrics at Children's Hospital at Montefiore.
Given the difficulty most parents may have with getting their kids to eat such a bland, restricted diet, many pediatricians feared that even trying the diet would prove impractical for many parents.
While Dr. Michael Manos, head of the center for Pediatric Behavioral Health at Cleveland Clinic Children's Hospital, said the new study was well done, it didn't dismiss the fact that pharmaceutical and behavioral interventions are much more effective than even the benefit noted by some in the study.
"I would not go so far as to say this ... should be 'standard of care'," added Dr. Kathi Kemper, director of program in complementary and integrative medicine at Wake Forest University Baptist Medical Center.
"What is standard of care is to take the entire child, including lifestyle, family values and culture, into consideration when helping them meet the challenge of ADHD so they can have better attention, focus, self-discipline and patience to help them succeed in school and in life," she said.