Hyperactivity is behavior characterized by over-activity, impulsivity, distractibility, and decreased attention span. A popular but controversial belief is that children are more likely to be hyperactive if they eat sugar.

Description

Hyperactive children tend to be overly active, and have constant difficulty paying attention. Activity levels in children vary with their age. It is entirely normal for a 2-year old to be more active, and to have a shorter attention span, than an older child. Attention levels also vary depending on the child’s interest for a given activity. Hyperactive children are those whose activity levels for their age are consistently higher than expected.

The hyperactivity-sugar controversy is due to numerous claims made by parents after observing hyperactivity in children who eat foods containing sugar, or artificial sweeteners such as aspartame. However, most researchers steadfastly reported that the effects of sugar on children were negligible, with several studies reporting that sugar does not cause hyperactivity in children. From a physiological point of view however, sugar should affect children’s activity, simply because it can enter the bloodstream quickly, while producing rapid changes in blood glucose levels and triggering adrenaline. Adrenaline is the substance made by the body when under stress and it provides a short-term energy boost to cope with fight or flight situations. A new study by pediatric researchers at Yale University recently confirmed the sugar-adrenaline link. The study showed that within hours

Names for added sugars that appear on food labels

• Brown sugar	• Honey
• Corn sweetener	• Invert sugar
• Corn syrup	• Lactose
• Corn syrup frutose	• Maltose
• Dextrose	• Malt syrup
• Fructose	• Molasses
• Fruit juice concentrates	• Raw sugar
• Galactose	• Sucrose
• Glucose	• Sugar
• High-fructose corn syrup	• Syrup

(Illustration by GGS Information Services/Thomson Gale.)

after healthy children were given large doses of sugar on an empty stomach, their bodies released large amounts of adrenaline, which induced shakiness, anxiety, excitement and concentration problems. These reactions were observed only in children, and an examination of their brain waves revealed significant changes in their ability to pay attention. However, no direct link was established with dietary sugar, since the study involved the ingestion of large amounts of sugar on an empty stomach. Thus, it can only be concluded that sugar can cause hyperactivity in children only if taken in large quantities.

Demographics

Hyperactive children vary from three to 15% of all children depending on the studies. Comparative U.S. Department of Agriculture (USDA) data shows that sugar consumption increased by 30% between 1983 and 1999. According to the most recent data, Americans eat or drink on average approximately five pounds of sugar a month. USDA stated in 2000 that the average American, who consumes about 2,000 calories per day, can eat up to 10 teaspoons of added sugars, if he or she eats a healthful diet containing all the recommended servings of fruits, dairy products, and other foods. In fact, though, the average American is not eating that healthful diet and consumes at least 20 teaspoons per day of sugar.

Causes and symptoms

The causes of hyperactivity can include:

Attention hyperactivity deficit disorder (ADHD). Behavior characterized by inattentiveness, overactivity, and impulsivity. An ADHD diagnosis requires that children should have at least 6 attention symptoms or 6 activity and impulsivity symptoms. These should be present for at least 6 months, observable in 2 or more settings, and not caused by another problem.
Emotional disorders. When a child is unhappy or stressed, hyperactivity is a common response, often combined to aggressive behavior.
Brain or central nervous system disorders. Schizophrenia, bipolar disorder (manic depression), obsessive compulsive disorder, panic disorder, borderline personality disorder, autism, pervasive developmental disorders, and Tourette’s syndrome are all neurological disorders for which hyperactivity is a symptom.
Hyperthyroidism. Hyperthyroidism is a condition caused by the effects of too much thyroid hormone on tissues of the body. Palpitations, nervousness and hyperactivity are common symptoms of this disorder.
Lead contamination. Exposure to high levels of lead can lead to hyperactivity in children. Children who live in old buildings in which lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

Diagnosis

It can be difficult to distinguish between hyperactivity and the normal activity level of a child. This is because supervising adults are rarely as active as children may be, and so it can happen that a child is normally active for his or her age, but in the care of an adult with little tolerance for childhood rambunctiousness.

A medical evaluation will reveal whether the hyperactivity is due to neurological disorders or hyperthyroidism. As for ADHD hyperactivity, the American Academy of Pediatrics (AAP) has issued guidelines for pediatricians to clarify the issue. Likewise, child psychologists can determine whether the hyperactivity has an underlying emotional origin. The following tests may be used to evaluate hyperactivity:

Parent and teacher questionnaires
Psychological evaluation of the child and of the family
Developmental, mental, nutritional, physical, and psychosocial examinations

Treatment

If the hyperactivity is related to an underlying neurological or psychological cause, treatment of the condition will result in improvement. For hyperactivity unrelated to a medical condition, the following measures will help:

limit stimulation in the child’s environment
provide instruction on an individual basis
ensure that the child gets enough sleep

KEY TERMS

Adrenaline— Hormone produced by the adrenal glands that increases heart and respiration rates.

Autism— A brain disorder that begins in early childhood and persists throughout adulthood. It affects three important areas of development: communication, social interaction, and creative or imaginative play.

Bipolar disorder— A psychiatric disorder marked by alternating episodes of mania and depression.

Borderline personality disorder— A serious mental illness characterized by ongoing instability in moods, interpersonal relationships, self-image, and behavior.

Caffeine— The drug contained in coffee. A bitter white alkaloid derived from coffee (or tea) and used in medicine as a mild stimulant or to treat certain kinds of headache.

Distractibility— Inability to concentrate or attend to the task on hand; inattentiveness.

Hyperthyroidism— Over production of the thyroid hormone by the thyroid gland.

Impulsivity— Acting or speaking too quickly (upon impulse) without first thinking of the consequences.

Obsessive compulsive disorder— A disorder which causes people to experience obsessions, meaning recurring unwanted thoughts which are difficult to stop, and compulsions, meaning rituals of checking behavior or repetitive actions which are carried out in an attempt to relieve the thoughts.

Pervasive developmental disorder— An impairment in the development of social skills.

Schizophrenia— A mental illness in which the person suffers from distorted thinking, hallucinations, and a reduced ability to feel normal emotions.

Tourette’s syndrome— A neurological disorder characterized by involuntary body movements called tics, and uncontrollable speech.

Nutrition/Dietetic concerns

Children need plenty of fiber in their diet to keep adrenaline levels more constant. Fiber is found in whole grain products such as whole meal bread, brown rice, high fiber cereals, potatoes, fresh and dried fruits, vegetables, and beans. It is also recommended to limit the amount of processed sugars that children eat as much as possible. High-sugar foods tend to have fewer vitamins and minerals , and should be replaced by more nutritious foods. They are responsible for tooth decay and also contribute to obesity. It is also established that the brain of a child appears to be more sensitive than the adult brain to the effect of low blood sugar, hence children are more prone to experiencing sugar cravings . Since sugar can enter the bloodstream quickly, its effects can be reduced if it is consumed along with other nutrients like fat and protein . As a rule, sweet desserts after mixed meals that include protein, fat, complex carbohydrate and fiber are preferable to eating sweet snacks between meals. Besides sugars, many sodas also contain caffeine , a stimulant that contributes to hyperactivity. They should be avoided and replaced by water , juices and caffeine-free drinks.

Some good selections for an afternoon snack include: peanut butter on whole wheat bread, cold chicken and a glass of milk, a hard boiled egg on oatmeal bread, grilled cheese sandwich, yogurt, a bagel or muffin and a glass of milk, a bowl of cereal with milk, and raw vegetables such as carrots, celery and tomatoes with a low fat dip or chopped avocado.

Therapy

Drug therapy is not recommended for hyperactivity that has no medical cause. In particular, medications prescribed for ADHD that decrease hyperactivity, such as Concerta and Ritalin, should only be considered if the ADHD diagnosis is established.

Massage and relaxation therapies are starting to be considered beneficial in lowering hyperactivity. Studies performed on hyperactive adolescents have shown a lowering of hyperactivity and improved moods in students undergoing massage therapy for 10 consecutive school days.

Effective measures include schools that can provide a structured classroom environment, and parent education to address discipline and limit-setting. For instance, children can be taught to have “quiet time” periods so that they can learn to calm themselves at home.

Prognosis

There is no cure for hyperactivity. Hyperactive children seldom outgrow it, but some learn to put it to constructive use as they mature.

Prevention

While there is no proven way to prevent hyper-activity, early identification can prevent the development of ADHD and other developmental disorders.

Resources

BOOKS

Heller, Rachael F., Heller, Richard F. Carbohydrate-Addicted Kids: Help Your Child or Teen Break Free of Junk Food and Sugar Cravings— for Life!. New York, NY: Harper Paperbacks, 1998.

Landau, E. Sugar. New York, NY: Children’s Press (CT), 2000.

O’Dell, N. E. Stopping Hyperactivity: A New Solution. New York, NY: Avery Publishing Group, 1997.

Parker, H. C. The A.D.D. Hyperactivity Workbook for Parents, Teachers, and Kids. Chicago, IL: Specialty Press/A.D.D. Warehouse, 1999.

ORGANIZATIONS

Attention Deficit Disorder Association (ADDA). 15000 Commerce Parkway, Suite C, Mount Laurel, NJ 08054. 856-439-9099. www.add.org>

Children and Adults with Attention Deficit Hyperactivity Disorder. 8181 Professional Place, Suite 150, Landover, MD 20785. 301-306-7070. www.chadd.org>

Food and Drug Administration, Center for Food Safety and Applied Nutrition. 5100 Paint Branch Parkway, College Park, MD 20740-3835. 1-888-SAFEFOOD (1-888-723-3663). <<vm.cfsan.fda.gov>

Monique Laberge, Ph.D

The Gale Encyclopedia of Diets: A Guide to Health and Nutrition