Mental health of children and adolescents

Maintaining mental health and wellness is a rather complex task- and the possible problems associated with mental health can be rather debilitating depending on their severity. Mental health is described as including the emotional and behavioral areas of health and is crucial to a given child’s well being1. More over, mental health can vastly impact various areas of life including, personal relationships, work and school and physical health1. The prevalence of mental health issues among the United States’ children is vast and is seemingly increasing. Data from the 2005- 2006 National Health Interview Survey indicated that about 8.3 million children (14.5%), from ages 4 to 17 had parents who spoke with either a health care provider or school staff about their child’s behavioral or emotional difficulties1. Such emotional or behavioral difficulties indicate difficulties with emotions, concentration behavior or being able to socialize and get along with others1. Parental concerns about their children’s difficulties were more often than not about males1. In 2009, Simpson, Cohen, Bloom and Blumberg describe the odds of having emotional or behavioral difficulties were described as being greater in non-Hispanic white children than non-Hispanic black or Hispanic children and greater in children living with single mothers as opposed to children living with both parents2. Moreover, about, 2.9 million children (5.1%) were prescribed medication for their difficulties- with more males being prescribed such medication1. Interestingly enough, about 9 in 10 children had difficulties that were analogous to symptoms of ADHD and were prescribed medication accordingly1. While there are about 5% U.S. children with emotional or behavioral difficulties only a fraction are receiving the mental health services they require2. There are several reasons that prevent children from seeking the mental health services that they need- the first being that seeking care for mental health carries a strong social stigma. The next being that cost of and the restriction of their parent’s health insurance benefits and lastly, the methodology in the delivery of mental heath care2.

Children with mental health issues such as emotional and behavioral difficulties are often dealing with a myriad of problems. These difficulties have been described to affect the child or parents in a variety of ways such as affecting the interaction with others, increasing home life difficulty, the child’s learning ability or the child becomes perceived as a burden to the family2. There are a wide variety of reasons a child is afflicted with emotional or behavioral problems such as genetics, poor health and socioeconomic status. However, the child’s family income can exacerbate emotional or behavioral problems. Poor children suffer more from emotional or behavioral difficulties as compared to non-poor children3. Brooks-Gunn and Duncan (1997) described that children from consistently poorer families are more likely to suffer from internalizing and externalizing behavior problems than children who had never been poor3. Poverty, which affects both physical and mental health, will in turn affect the child’s normal development resulting in lower IQ, learning disabilities, grade retention, and school dropout in older children3. Despite their cause, all children suffering from behavioral difficulties are at risk for reduced academic achievement. Breslau et al. (2009) conducted a longitudinal study examining the effect of behavioral difficulties on academic success4. Children were assessed for behavioral problems at age 6 and then reexamined at age 17 for academic success. Evening after adjusting for potential confounding variables (IQ, parental marital status, maternal education, teacher’s rating of attention), academic success indicated by math and reading levels at age 17, were predicted by behavioral problems at age six4.

Mental health of children and adolescents has continued to decline over the past quarter century and many have suspected that changes in dietary intake have been a contributory factor5,6. Proper nutrition is key in the developmental process of a child and should a child’s intake wavier from adequate amount severe consequences can result. More specifically, during the first two to three years of life, the brain is very susceptible to malnutrition- the longer the malnutrition the greater damage will result5. Aside from worsened academic attainment, poor dietary intake can increase anti-social activity and may play a rather significant role in attention-deficit hyperactivity disorder (ADHD) 5,6. ADHD is thought to occur in roughly 1 in 20 U.S. children with 3-5% children exhibiting hyperactivity7. ADHD is identified by overactivity, impulsiveness, difficulties when socializing, and a lowered attention span5. Given that the characteristics of ADHD are typically those of behavioral or emotional disturbances, the rest of this review will focus on literature that evaluates the role of diet in emotional and behavioral difficulties that are often used to define the diagnosis of ADHD.

The role of food in behavioral disturbances

Prior research examining the role of food in children’s mental heath generally focuses on sugar and food additives in hyperactivity and the possible deficiencies and supplementation in ADHD children. More often than not studies examining either areas in child mental health have yielded varying results. Correlation studies have been described to show that children consume the large amount of sugar was associated lowered attention spans 8,9. However, controlled experimental studies have indicated otherwise in that children in who consumed greater amounts of sugar, often in the form of sucrose, were not overly active 8,9. Others after review have indicated that, sugar does not affect the behavior or cognitive abilities of children when consumed in high amounts10. In fact, it has even been described that the strong belief that sugar results in hyperactivity may be a result of the expectancy of this perturbed association by parents and other professionals that interact with children10. Furthermore, a cohort study which examined “junk food,” described as highly processed with high amounts of refined sugar and saturated fats, and hyperactivity in 4 ½ years olds found that high junk food diets results in hyperactivity when the children were 7 years of age.11

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The examination of the role of food additives in children is accredited to Dr. Feingold. Feingold (1975) indicated that hyperactivity in children was linked to allergies to certain food additives and preservatives 8,12. As such, the Feingold diet, which eliminates said components, has been examined in children and its role in hyperactivity and ADHD 12. Diets rich in artificial food colorings and additives have been described to increase hyperactivity in children. One randomized, double- blinded, placebo controlled, cross over study indicated that such food additives do in fact increase the hyperactivity of both the three year old children group and the 8/ 9 year aged group 6,13.

Individuals with ADHD have been described to have lower plasma levels of essential fatty acids and increased cognitive and behavioral problems9. Studies have indicated that that PUFA supplementation can in fact reduce symptoms of hyperactivity and ADHD14. A study with which examined PUFA supplementation in children aged 7-12 years old that have been diagnosed with ADHD, found that there was a decrease in hyperactivity, impulsivity and inattention symptoms14.

Dietary intake of children with behavioral disturbances

Several investigations sought to identify the dietary intakes of children. More specifically, researchers have tried to identify the dietary intakes of children with mental health problems. One longitudinal study examined the dietary patterns of children and intelligence, only to find that fish, bread and cereals were positively associated with intellegnce15. Another study found that poorer mental health, measured by a behavioral index, was associated with increased Western dietary intakes, especially fast foods, meat and candy16. Furthermore, it was found that greater vegetable and fruit intake was associated with improved behavioral scores16.

These investigations often focus on older children and adolescents, choose to investigate limited amounts of foods and do not necessarily address the dietary intake and differences of children with behavioral disturbances. Given the increasing prevalence of children suffering with mental health issues, it is important to adequately identify potential dietary intake problems that can exacerbate these issues. Therefore, the focus of this research proposal is to try to evaluate the role dietary intake in children and presence of behavioral issues, gender and status in hopes to elucidate dietary recommendations within this population.