Category — ADHD: Health

A study published in the June 14 edition of the Journal of Developmental and Behavioral Pediatrics has sparked controversy regarding ADHD medication and the brain’s power to regulate itself.

The study was funded by the National Institutes of Health and conducted by Dr. Adrian Sandler, a developmental-behavioral pediatrician and medical director of the Olson Huff Center for Child Development at Mission Children’s Hospital in Asheville, North Carolina.  The research was performed over the course of eight years using 99 patients from Western North Carolina.

Sandler found that children with ADHD can do just as well on half their medication when the medication is combined with a placebo. They performed as well even when parents and children had full knowledge they were taking a placebo.

[Placebo --  A substance containing no medication and prescribed or given to reinforce a patient's expectation to get well. The placebo in this research was akin to a harmless inert pill].

Previous studies have shown that common stimulant medication causes side-effects like tics, weight loss, stunted growth, and even heart complications in some instances. This often causes trepidation in parents afraid of the possible side-effects on their children.

Sandler compared fully medicated children, children on reduced medication, and children on reduced medication with a known placebo. The results were quite intriguing.  Both the fully medicated and reduced medication groups had increased side-effects while the reduced medication with placebo demonstrated decreased side-effects. Furthermore, the reduced medication group reported decreased control of their ADHD symptoms. However, the control of ADHD symptoms was no different in the reduced medication with placebo group than in the full dose group, i.e. the reduced medication with placebo performed as well as the fully medicated group with less side-effects as well.

“I’ve been getting a lot of calls and e-mails,” said Sandler,, who conducted the research with James Bodfish, a professor in the departments of psychiatry and pediatrics at UNC Chapel Hill School of Medicine, and study coordinator Corrine Glesne.

“Medications work,” Bodfish said in a statement. “The question is whether we always need to use them at the highest dose. Many parents are concerned about placing their child on medication. Some choose not to treat their child because of concerns about side effects.”

While the research doesn’t address it, the obvious question is, Why? Parents and children in this study knew they were taking a placebo. Why then did they perform as well as their peers without the side-effects — at essentially half the dose as their peers? While the placebo effect has been studied widely, the exact mechanisms are unknown. We do know that the mechanism is governed by the brain. This clearly tells us that having ADHD or not, our brain is still a powerful weapon in our arsenal.

We also cannot exclude the influence of the parents during this research. Did they expect their child to do better? The authors suggest that this was so. This dynamic cannot be overlooked in your family either.

The bottom line is that we likely have far more control over our behaviors and cognitive processes than we are given credit for. Modern medicine, as this research suggests, is just beginning to understand the brain’s role in shaping our lives. We’ve known this for years at Play Attention. Cognitive training. Memory training. Motor skills. Attention training. Behavioral shaping. It’s time to take control over our lives. We’ve all got the power to do it. It lies right behind our eyes.

Research published in the July issue of Pediatrics reveals that too much time spent watching television and playing video games can cause attention problems.

A graduate student at Iowa State University, Edward Swing, found that excessive screen time, whether in front of a computer or TV, could double the risk of attention problems in children and young adults.

Swing’s research confirms previous findings from Dr. Dimitri Christakis, the George Adkins Professor of Pediatrics at the University of Washington in Seattle.  Christakis’ research found that faster-paced shows increased the risk of attention problems.  "You prime the mind to accept that pace. Real life doesn’t happen fast enough to keep your attention,” says Christakis.

The  American Academy of Pediatrics (AAP) has long recommended that children over the age of 2 view less than two hours of TV or computer per day. Prior to that age, they suggest no TV viewing or computer.

Swing compared data of 1300 children in grades three, four, and five who watched TV or played video games less than two hours a day to children who watched more.  He found that more video time could nearly double the risk of attention problems in children and young adults

"The children were reporting their TV and video game use and the parents were also reporting TV and video game use," Swing said. "The teachers were reporting attention problems," he said of the middle school students.

While both Swing’s and Christakis’ studies do merit attention, they are quite limited.  For example, Swing used teacher rating reports to assess whether children had problems paying attention, if they interrupted classmate’s work, if they had trouble staying on task, or showed problems in other areas related to inattention. Teacher reports typically vary over time and from teacher to teacher. They are also highly subjective. To account for this, Swing had more than one teacher rate the children and that the ratings tended to be in agreement.

The greatest flaw in this research is that Swing did not account for content, i.e. what were the students watching or playing? Were the students watching educational TV or playing educational games? Were they playing race car games? Shooting games? Were they playing problem solving games?  Were the games fast paced? Slow? Did they require reasoning skills? We’ll never know and that’s problematic because it leaves so many questions unanswered. As we are what we eat, we are what we stimulate ourselves with.

"These media aren’t going away," Christakis said. "We do have to find ways to manage them appropriately."  On this I can agree. Limiting time to the AAP recommendations is prudent parenting.

Research tells us that during the summer, the average student loses one to three month’s math and reading gains made over the prior year. Academic losses are so common among students that educators have given the phenomena a name: Summer Brain Drain.

Summer Brain Drain may even be worse for ADHD students already having trouble at school.

Going to school daily provides schedules and routines. The summer break means those routines aren’t there. Expectations are lowered or relaxed. Even sleep schedules are often totally abandoned.

Unfortunately, exercise is often replaced with computer time, watching movies, or playing video games with friends. That’s a bad idea. While there’s nothing wrong with playing video games or watching movies, sedentary activity must always be balanced with exercise. This is especially important for an ADHD student. 

I’ve included some specific articles that approach this topic from varying perspectives. Enjoy and gain the benefits this summer!

Children with ADHD benefit from time outdoors enjoying nature

(http://www.news.uiuc.edu/NEWS/04/0827adhd.html)

News Bureau at the University of Illinois at Urbana-Champaign from May 15 through June 8. — Kids with attention deficit hyperactive disorder (ADHD) should spend some quality after-school hours and weekend time outdoors enjoying nature, say researchers at the University of Illinois at Urbana-Champaign.

The payoff for this “treatment” of children 5 to 18 years old, who participated in a nationwide study, was a significant reduction of symptoms. The study appears in the September issue of the American Journal of Public Health.

“The advantage for green outdoor activities was observed among children living in different regions of the United States and among children living in a range of settings, from rural to large city environments,” wrote co-authors Frances E. Kuo and Andrea Faber Taylor. “Overall, our findings indicate that exposure to ordinary natural settings in the course of common after-school and weekend activities may be widely effective in reducing attention deficit symptoms in children.”

ADHD is a neurological disorder that affects some 2 million school-aged children, as well as up to 2 to 4 percent of adults, in the United States. Those with ADHD often face serious consequences, such as problems in school and relationships, depression, substance abuse and on-the-job difficulties.

“These findings are exciting,” said Kuo, a professor in the departments of natural resources and environmental sciences and of psychology at Illinois.

“I think we’re on the track of something really important, something that could affect a lot of lives in a substantial way,” she said. “We’re on the trail of a potential treatment for a disorder that afflicts one of every 14 children – that’s one or two kids in every classroom.”

If clinical trials and additional research confirm the value of exposure to nature for ameliorating ADHD, daily doses of “green time” might supplement medications and behavioral approaches to ADHD, the authors suggest in their conclusion.

Kuo and Faber Taylor, a postdoctoral researcher who specializes in children’s environments and behavior, recruited the parents of 322 boys and 84 girls, all diagnosed with ADHD, through ads in major newspapers and the Web site of Children and Adults with Attention Deficit/Hyperactivity Disorder. Parents were interviewed by means of the Web and asked to report how their children performed after participating in a wide range of activities. Some activities were conducted inside, others in outdoor places without much greenery, such as parking lots and downtown areas, and others in relatively natural outdoor settings such as a tree-lined street, back yard or park.

The researchers found that symptoms were reduced most in green outdoor settings, even when the same activities were compared across different settings.

“In each of 56 different comparisons, green outdoor activities received more positive ratings than did activities taking place in other settings, and this difference was significant or marginally significant in 54 of the 56 analyses,” Kuo said. “The findings are very consistent.”

The two researchers have been pursuing the ADHD issue as an extension of a long line of previous research they’ve conducted on the nature-attention connection among the general population in mostly urban settings.

“The medications for ADHD that are currently available work for most kids, but not all,” Kuo said. “They often have serious side effects. Who wants to give their growing child a drug that kills their appetite day after day and, night after night, makes it hard for them to get a decent night’s rest? Not to mention the stigma and expense of medication.”

Simply using nature, Kuo said, “may offer a way to help manage ADHD symptoms that is readily available, doesn’t have any stigma associated with it, doesn’t cost anything, and doesn’t have any side effects – except maybe splinters!”

There are a number of exciting possible ways in which “nature treatments” could supplement current treatments, she said.

Spending time in ordinary “urban nature” – a tree-lined street, a green yard or neighborhood park – may offer additional relief from ADHD symptoms when medications aren’t quite enough. Some kids might be able to substitute a “green dose” for their afternoon medication, allowing them to get a good night’s sleep.

“A green dose could be a lifesaver for the 10 percent of children whose symptoms don’t respond to medication, who are just stuck with the symptoms,” Kuo said. As Kuo and Faber Taylor wrote, a dose could be as simple as “a greener route for the walk to school, doing classwork or homework at a window with a relatively green view, or playing in a green yard or ball field at recess and after school.”

The National Urban and Community Forestry Advisory Council, U.S. Forest Service, and the U.S. Department of Agriculture’s Cooperative State Research, Education, and Extension Service supported the project.

Exercise Improves Learning and Memory
Chalk up another benefit for regular exercise. Investigators from the Howard Hughes Medical Institute (HHMI) have found that voluntary running boosts the growth of new nerve cells and improves learning and memory in adult mice.
"Until recently it was thought that the growth of new neurons, or neurogenesis, did not occur in the adult mammalian brain," said Terrence Sejnowski, an HHMI investigator at The Salk Institute for Biological Studies. "But we now have evidence for it, and it appears that exercise helps this happen."
USA Today (http://www.usatoday.com/news/health/2006-03-26-adhd-treatment_x.htm)

ADHD treatment is getting a workout

http://www.usatoday.com/news/health/2006-03-26-adhd-treatment_x.htm
Doctors haven’t done many definitive studies about exercise and ADHD, says David Goodman, an assistant professor of psychiatry at the Johns Hopkins University School of Medicine. But Goodman says it makes sense that working out would help people cope with the condition. Studies show that exercise increases levels of two key brain chemicals — dopamine and norepinephrine — that help people focus.

"Your cognitive function is probably better for one to three hours after exercise," Goodman says. "The difficulty is that by the next day, the effect has worn off."

If kids could exercise strenuously three to five times a day, they might not need medications at all, says John Ratey, an associate clinical professor of psychiatry at Harvard Medical School. Ratey is so intrigued by the question that he’s writing a book about how exercise can reduce symptoms of ADHD or at least help patients cope.

Team sports might help children with ADHD in several ways, says James Perrin, a professor of pediatrics at Boston’s MassGeneral Hospital for Children. Children with the condition benefit from following a regular schedule. Coaches who lead kids through structured exercises also might help build concentration and organizational skills.

The November issue of the medical journal Pediatrics published research from Dr. Robert Kahn et al regarding the relationship between tobacco smoke, lead concentrations, and ADHD.

Kahn, a physician and researcher at Cincinnati Children’s Hospital Medical Center, Ohio, found that two risk factors: 1) exposure to tobacco in the womb and 2) exposure to lead in childhood significantly increased the likelihood of ADHD developing  in children.

The researchers used data from the National Health and Nutrition Examination Survey. Tobacco exposure in the womb was measured by reports of cigarette use during pregnancy, and childhood lead exposure was assessed by blood levels. Of the 2588 cases they reviewed, the researchers determined that children aged 8 – 15 who were exposed to tobacco smoke in the womb were 2.4 times more likely to have ADHD. Children with lead blood levels in the top third of the population had a 2.3-fold increased likelihood of ADHD diagnosis.

Lead researcher, Tanya E. Froehlich, MD, cited that the combination from both lead and tobacco smoke created a synergistic effect, an even greater effect than smoke or lead alone. Children who were exposed to  both tobacco smoke in the womb and higher lead levels had a more than eightfold increased chance of having ADHD compared to children who weren’t exposed to either.

The study does have limitations; the researchers analyzed data on smoking that was derived from the mothers’ answers on a questionnaire. The data did not include the number of cigarettes smoked. And while the researchers found a link between tobacco, lead and ADHD, they did not prove that these factors actually caused the disorder. This is similar to previously published research on prenatal tobacco smoke and lead levels.

Curiously, smoking tobacco is twice as popular in the adult ADHD population compared to the non-ADHD adult population.  Columbia University researchers established a study to determine if smoking ameliorated ADHD symptoms in adults back in 2006.  If tobacco smoke truly increases the risk of developing ADHD, the popularity of smoking among ADHD adults may create a cycle of producing more ADHD children if smoking is done prenatally.

While a strong genetic link is still the likely cause of ADHD, environment still plays a significant role in brain development. The researchers assert that perhaps up to 35 per cent of cases of ADHD in youngsters aged between 8 and 15 could be reduced by getting rid of both prenatal exposure to tobacco and childhood exposure to lead.

Obviously, being pregnant can be stressful in itself, but current research shows that stress can affect fetal development which may lead to long-term problems including ADHD.

Dr. Vivette Glover of Imperial College London, surveyed pregnant women at her hospital. Of these, nearly one quarter felt anxious and depressed due to stressors including work, money, arguing with spouse, and moving to accommodate a larger family. When compared to their non-stressed counterparts in this research, the babies of the stressed mother had lower birth weight, lower IQ, slower cognitive development, and more anxiety. Lower birth weight has been an indicator for coronary heart disease in later life.

In 2007, research in the Journal of the American Academy of Child and Adolescent Psychiatry indicated that being stressed during pregnancy is as detrimental for the baby’s development as smoking or being obese. Glover’s research reveals why and how this happens: stress produces the hormone cortisol. An abundance of stress can actually diminish the barrier enzyme that inhibits cortisol from reaching the fetus. Costisol impacts fetal brain development.

According to Glover, “People used to think that if something was congenital, apparent at birth, it had to be genetic. In fact it can be an in-vitro reaction of genes and environment.”

Glover also contends that her research shows stress greatly increases the likelihood of a child having ADHD (attention-deficit hyperactivity disorder), cognitive delay, autism , anxiety and depression. 

Glover’s research reinforces previous data from the UK where stress was shown to increase the risk for development of ADHD. In that research, the women who experienced the most stress doubled the chances of developing ADHD.

“The organs are forming during the first trimester of pregnancy, but the brain is developing all the way through,” Glover explains. “The organs are sensitive while they are forming and, once formed, they are harder to change.”

“In evolutionary terms, stress perhaps prepares the child for survival in a stressful environment. If a child is anxious and has attention deficiency, it will be very alert to danger. This may once have been adaptive, beneficial for the child, but it isn’t any more,” Glover says.

Significantly, Glover’s research implies that the changes may be on a genetic level so that it may be passed on generation to generation.

Therefore, it’s important to realize that taking care of ourselves during pregnancy is more important now than ever. Small efforts like seeking health services early, meditating, eating a balanced diet, taking pre-natal vitamins, and laughing are good practices.

Minimizing stress by maintaining a consistent schedule both at work and at home is a good idea.

Researchers, Dr. Zylowska, et al from the University of California-Los Angeles conducted a feasibility study of an 8-week mindfulness training program for adults and adolescents with ADHD. Their report was published in The Journal of Attention Disorders (2008 May;11(6):737-46. Epub 2007 Nov 19).

The researchers sought to inquire whether mindfulness meditation could improve attention, reduce stress, and improve mood. The researchers recruited 34 adults and 8 adolescents. Study participants were given a weekly training session. They were also required to practice daily starting with 5 minutes of meditation per day and gradually increasing to 15 minutes per day.

The majority of participants (after dropouts) reported improvements in self-reported ADHD symptoms. Independent tests on tasks measuring attention and cognitive inhibition also indicated improved symptom outcomes. Improvements in anxiety and depressive symptoms were also observed.

In yet another pilot study conducted by Sarina J. Grosswald, Ed.D., a George Washington University-trained cognitive learning specialist, a group of middle school students with ADHD were required to meditate twice a day in school. After three months, researchers found over 50 percent reduction in stress and anxiety and improvements in ADHD symptoms.

"The effect was much greater than we expected," said Sarina J. Grosswald, Ed.D., a George Washington University-trained cognitive learning specialist and lead researcher on the study. "The children also showed improvements in attention, working memory, organization, and behavior regulation."

Due to the neuroplasticity of the brain, better attention can be attained through meditation. Buddhist monks have been doing it for centuries. This seems to be true of ADHD persons as well. However, it is quite apparent that attention difficulties are just the tip of the ADHD iceberg. Other skills including organization, filtering out distractions, memory, time on-task, motor skills, visual tracking, etc, are typically diminished in ADHD persons. A complete program like Play Attention is required to teach these skills.

As for meditation, it is likely a good supplement to training in the aforementioned skill areas, but given the nature of the cited studies, a controlled clinical study is warranted.

In the wake of the deaths of 20+ children taking ADHD stimulant medication, the American Heart Association (AHA) cautioned this week that children should be screened for heart problems with an electrocardiogram(EKG) before getting drugs like Ritalin to treat hyperactivity and attention-deficit disorder.

The National Institute of Mental Health estimates that between 5% and 7% of children have ADHD. They speculate that about 2.5 million American children and 1.5 million adults take medication for ADHD to control behavior and increase focus.

Stimulant drugs like Concerta, Adderall, Ritalin, etc. are classified as schedule II drugs –the same category as cocaine. They can increase blood pressure and heart rate which is problematic for children with heart conditions. It could result in vulnerability to sudden cardiac arrest — an erratic heartbeat that causes the heart to stop pumping blood through the body — and other heart problems.

After review of these implications by the FDA, the FDA mandated that these medications carry warnings of possible heart risks in those with heart defects or other heart problems.

The AHA is now recommending children receive a thorough exam, including a family history and an EKG, before children are put on the ADHD drugs to insure that they don’t have any undiagnosed heart issues.

“We don’t want to keep children who have this from being treated. We want to do it as safely as possible.” said Dr. Victoria Vetter, a pediatric cardiologist at the University of Pennsylvania School of Medicine and head of the committee making the recommendation.

American Heart Association

AHA recommendations: http://www.americanheart.org/presenter.jhtml?identifier=3055953
http://www.americanheart.org/presenter.jhtml?identifier=3055974

The American Heart Association’s (AHA) recent recommendation that children be screened for possible heart problems before taking ADHD stimulant medication has spurred great anxiety among parents and professionals. The recommendation was given as a response to a number of deaths due to heart failure associated with ADHD stimulant medication.

In response to the AHA’s recommendation, the Pediatric Cardiology Division at the University of Virginia Children’s Hospital will begin offering electrocardiograms (ECG or EKG) for ADHD children taking stimulant medications for the disorder.

According to Dr. George McDaniel, director of the Pediatric Electrophysiology Program at UVA Children’s Hospital, this exam is important because not all children show obvious signs of a heart condition or abnormality.

The AHA also recommends that ADHD children receive a thorough family history and an EKG by their healthcare providers to screen for problems before they may arise.

Experts at UVA Children’s Hospital say the recommendations are conservative but the information is worth knowing.

Families should be reassured that there is no real urgency for a patient who is not having any difficulties,” said Dr. Paul Matherne, director of the Division of Pediatric Cardiology at UVA Children’s Hospital. “According to the guidelines parents should not stop their child’s medication and can have this screening done by their medical care provider at their next appointment.”

The Denver Post (www.denverpost.com) reports that Boulder police arrested three teens on felony charges of distribution and possession of a schedule II controlled substance. The incidence occurred on April 4 at Nevin Platt Middle School where the youth attended school.

Apparently one student had the drugs, gave one to another student who swallowed it and was taken ill. The sick student was then taken to the hospital and released. Other students were involved in the safekeeping of the drugs after they were brought to school.

The student that brought the drugs (Strattera and Concerta for treatment of ADHD) attempted to trade the drugs for alcohol.

The Denver Post says,

Two of the students have been charged with distribution and possession of a schedule II controlled substance and unlawful acts while the third was charged with possession of a controlled substance and unlawful act. Possession and distribution of a schedule II controlled substance is a felony, officials said.

While these students were apprehended, the incidence of ADHD drug sales and use is quite common among students at middle school, high school, and university.

The New York Times (www.nytimes.com) reported in 2005 in an article called The Adderall Advantage that:

At many colleges across the country, the ingredients for academic success now include a steady flow of analeptics, the class of prescription amphetamines that is used to treat attention deficit hyperactivity disorder [ADHD].

Since Ritalin abuse first hit the radar screen several years ago, the reliance on prescription stimulants to enhance performance has risen, becoming almost as commonplace as No-Doz, Red Bull and maybe even caffeine. As many as 20 percent of college students have used Ritalin or Adderall to study, write papers and take exams, according to recent surveys focused on individual campuses. A study released this month by the National Center on Addiction and Substance Abuse at Columbia found that the number of teenagers who admit to abusing prescription medications tripled from 1992 to 2003, while in the general population such abuse had doubled.

Dr. Robert A. Winfield, director of University Health Service at the University of Michigan, Ann Arbor, sees a growing number of students who falsely claim to be A.D.H.D. so they can get a prescription. At least once a week, a jittery, frightened, sleep-deprived student who has taken too many tablets for too many days shows up at his office. “Things have really gotten out of hand in the last four to five years,” he said. “Students have become convinced that this will help them achieve academic success.”

On campus, the drugs are either sold or given away by people with prescriptions, or they are procured by students who have learned to navigate the psychiatric exams offered by campus health centers, which usually provide the drugs at a discount. Unlike Ritalin, two newer members of the family of analeptics – Adderall and Concerta – come in time-release forms and can keep a patient medicated an entire day.

Louisiana State’s The Daily Reveille (www. media.www.lsureveille.com) reported that a survey documented in the journal Nature cites that one in five students used Adderall & Ritalin for a study booster.

Final exams traditionally have students studying long hours to cram for their final exams. But some students are now using a quick-fix for brain retention.

One in five respondents of adult professionals said they have used drugs to enhance brain power, according to a January survey in Nature journal. The online survey polled 1,400 people in 60 countries.

Ritalin and Adderall were the two drugs participants said they took.

Ritalin and Adderall are commonly used to treat attention-deficit hyperactivity disorder. They are also used to treat symptoms of narcolepsy and chronic fatigue syndrome. The stimulants are supposed to reduce impulsive behavior and facilitate concentration.

But people diagnosed with ADHD are not the only ones who can benefit from the drugs.

“It does work [for anyone]. We know that from lab studies,” said Martha Farah, director of the Center for Cognitive Neuroscience at the University of Pennsylvania, according to CNN.com

This is an international phenomenon. The reason is that low-dose stimulant medication is not a targeted approach to fixing ADHD. Instead, low-dose stimulant medication works the same for non-ADHD students. Here’s an example: if we have 50 ADHD students and 50 high functioning non-ADHD students, give them both a boring task, the both will perform better on that task.

Students know this and it helps the cram for exams. Will it help to prosecute all these students under felony charges? Not likely.

For years, parents have complained that certain artificial additives to brightly colored cakes, soft drinks, and candies, had caused their children adverse reactions such as hyperactivity, skin problems, mood volatility, headaches, etc. after consumption.

The Food Standards Agency (“FSA”) recommended ministers call for manufacturers to remove six artificial colors by the end of 2009. The FSA also urged a European Union-wide ban. This reversed the FSA’s decision last month when it dismissed calls for action on the additives.

According to The Independent, “The FSA’s advice to parents will be strengthened to warn them about the dangers of the E-numbers tartrazine (E102), quinoline yellow (E104), sunset yellow (E110), carmoisine (E122), ponceau 4R (E124) and allura red (E129).”

The Independent further reports that, “These colors and the preservative sodium benzoate (E211) were linked to hyperactivity in a £750,000 study by Southampton University, which found they made primary school children become distracted and fail a computer attention test.

The researchers estimated that 30 per cent of cases of attention deficit hyperactivity disorder (ADHD) would be prevented if companies removed the colors used in the £13bn-a-year global additives industry.

If the ministers elect to have the dyes and additives banned, the UK’s biggest producers of confections, soft drinks, ice cream, and others will have to reformulate their products.

The Independent:

The Southampton researchers had warned the seven additives were as harmful as lead in petrol, which was banned after it proved to lower children’s IQ by five points. Their research, in The Lancet in September, was the evidence that artificial additives worsened the behavior of normal children as well as those diagnosed with ADHD.

Dame Deirdre Hutton, who chairs the Food Standards Agency, said: “It is the agency’s duty to put consumers first. These additives give color to foods but nothing else. It would therefore be sensible, in the light of the… study, to remove them.”

The board decided to take no action on sodium benzoate because it was “a preservative” rather than a color. E211, which is linked with other potential health problems, is found in many soft drinks including Diet Coke, Irn-Bru, Lucozade and Fanta, and its removal would pose a significant technological and financial challenge to drinks companies.

The FSA stressed that its decision “does not mean there is an immediate ban”.

Campaigners welcomed the first decisive move in the UK against additives, whose effect on hyperactive children were first identified in 1975. Richard Watts, of the Children’s Food Campaign, said: “This decision is good news for children and parents, who have known for many years that these additives affect children’s behavior.” Anna Glayzer, an Action on Additives campaigner, said the FSA had put the consumer first. “We will be keeping a close eye on the industry to see what effect the voluntary ban has.”

The Food and Drink Federation said the recommendation was “bizarre”, as manufacturers were already removing the additives. “[Most] products don’t contain these colors,” a statement said.

The six colorings facing a ban:

Tartrazine (E102)
Description: Synthetic yellow dye found in sweets, biscuits, mushy peas
Products: Disney Winnie the Pooh Cake Kit, Lidl orange jelly, Bacardi Breezer tropical lime, Asda mushy peas
Health effects: causes hyperactivity, linked to allergic reactions and migraine.

Quinoline Yellow (E104)
Description: Synthetic dye in sweets, pickles, smoked fish
Products: Aero orange, Galaxy Minstrels, M&Ms, Bassett’s Sherbet Lemons
Health effects: Causes hyperactivity and is linked to rashes. Banned in US.

Sunset Yellow (E110)
Description: synthetic yellow dye found in sweets, ice cream, fizzy drinks
Products: Cadbury Creme Egg, Haribo Jelly Beans, Irn-Bru
Health effects: causes hyperactivity and linked to stomach upsets and swelling of skin.

Carmoisine (E122)
Description: Synthetic red dye found in ready meals, sweets
Products: Love Hearts, Galaxy Minstrels, Cadbury Mini Eggs, various lollipops
Health effects: causes hyperactivity and is alleged to cause water retention in those allergic to aspirin. Banned in US.

Ponceau 4R (E124)
Description: synthetic red dye found in sweets, biscuits, drinks
Products: Bassett’s Pear Drops, Halls Blackcurrant Soothers, Supercook Alphabet Icing
Health effects: causes hyperactivity and is believed to cause problems for asthmatics. Banned in US.

Allura red (E129)
Description: synthetic red dye found in sweets, soft drinks, Turkish delight
Products: Fry’s Turkish Delight, Cadbury Mini Eggs, Maynards Wine Gums
Health effects: causes hyperactivity and may bring on allergic reactions.