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Most kids have difficulty sitting still, organizing tasks or maintaining focus from time to time. But for children with attention deficit hyperactivity disorder, symptoms of inattention, hyperactivity and impulsivity interfere with daily life.

According to a recent U.S. survey, nutritional therapies are the most commonly used alternative treatment among children diagnosed with the disorder.

While some reports suggest that certain diet modifications are worth a try, there is no solid evidence that special diets or supplements like megavitamins consistently improve symptoms of ADHD.

If you're a parent coping with a child who has ADHD, you need to be informed before trying nutritional remedies. While some therapies might be helpful to some kids, others are not worth trying.

A child is considered to have ADHD if he or she demonstrates symptoms of inattention, hyperactivity and impulsivity for at least six months in two settings, such as home and school.

No single cause has been identified, but researchers believe both genetics and environmental factors play a role. ADHD tends to run in families.While it can't be cured, it can be managed. Currently, the only therapies proven effective in scientific studies are medications and behavioural therapy.

A number of nutritional approaches have been promoted to help manage ADHD, with most involving some form of food restriction or dietary supplementation.

Studies have not found a consistent link between dietary interventions and symptom improvement, but the following approaches may benefit some children. (Dietary modification and nutritional supplements should not be used instead of the usual medication without a doctor being involved.)

Food additives

and allergens

In 1973, Benjamin Feingold, an allergist from California, suggested that avoiding artificial colours, flavours and preservatives as well as naturally occurring salicylates (compounds found in apricots, berries, cherries, raisins and tomatoes) could dramatically improve ADHD symptoms.

A 1986 review of the Feingold diet determined that only 1 per cent of children consistently improved on the diet, and 10 per cent developed symptoms when dyes were consumed.

Since then, numerous well-designed studies have found that the behaviour of some children improved when food colouring and common food allergens (corn, milk, fish, eggs, peanuts, soy, wheat, oranges) were removed and significantly worsened when the foods were reintroduced.

Last year, a British study of 300 children between the ages of 3 and 9 who did not have ADHD found that consuming different amounts of food dye added to fruit drinks - equivalent to what is found in two or four 56-gram bags of candy - significantly exacerbated hyperactive behaviours.

The additives studied (also permitted for use in Canada) included sodium benzoate (a preservative); the yellow food dyes tartrazine, quinoline and sunset yellow, and the red dye allura red.

Elimination diets are thought to benefit only 5 per cent of kids with ADHD. Children most likely to respond are those with a history of allergic conditions such as asthma or eczema, a family history of migraine, or a family history of food sensitivities.

If you think certain foods affect your child's behaviour, eliminate them one at a time to see if the symptoms improve. Elimination diets that remove many suspect foods should be used under the guidance of a registered dietitian to ensure nutritional needs are met.

Artificial sweeteners

and sugar

No studies support the widespread belief that sugar and aspartame cause or worsen ADHD symptoms. Even so, it is wise to limit your child's intake of sugar from candy, soft drinks, fruit drinks and frozen desserts, because these foods may contain preservatives and dyes linked to hyperactive behaviour.

Magnesium

Research suggests that many children with ADHD are deficient in magnesium, a mineral that helps brain chemicals work properly. In a study of 116 magnesium-deficient children with ADHD, magnesium supplements improved behaviour.

One study isn't enough to justify routine magnesium supplementation in ADHD. However, it is wise to add magnesium-rich foods to your child's diet since most diets don't supply enough of the mineral. The best food sources include wheat germ, sunflower seeds, almonds, legumes, figs, spinach and Swiss chard.

Zinc

Two studies revealed that children with ADHD have lower blood levels of zinc than others. One small study also found that school-aged kids taking the medication Ritalin, along with a 15-milligram zinc supplement, had greater improvement than those who took the medication alone.

The body relies on zinc for the activity of brain chemicals, fatty acids and melatonin (a naturally occurring hormone related to sleep), all of which are related to behaviour.

Kids with ADHD should take a children's multivitamin with zinc. Zinc-rich foods include beef, pork, yogurt, wheat germ, bran cereals, baked beans, chickpeas, lentils and pumpkin seeds.

Children with erratic eating habits and reduced appetite from medication will also benefit from a daily multivitamin and mineral supplement.

Fatty acids

Omega-3 fatty acids DHA and EPA, found in salmon, trout, sardines, mackerel, herring and fish-oil capsules, become concentrated in the brain and play an essential role in cognition and behaviour.

Kids with ADHD are more likely to have low levels of omega-3s in their blood than children without ADHD. Some, but not all, clinical studies using omega-3 supplements have demonstrated improvement in symptoms of inattention and hyperactivity.

Look for a fish-oil supplement that contains both DHA and EPA. Most experts agree than a daily intake of 250 to 500 milligrams of combined DHA plus EPA is a reasonable target for children and adults.

Children who are allergic to fish, have a bleeding disorder or take anticoagulant medications should not take fish oil.

Leslie Beck, a Toronto-based dietitian at the Medcan Clinic,

is on CTV's Canada AM every Wednesday. Her website is

lesliebeck.com.