Food and Behaviour Research

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Correlation between brain function and ADHD symptom changes in children with ADHD following a few-foods diet: an open-label intervention trial

Hontelez S, Stobernack T, Pelsser L, Baarlen P, Frankena K, Groefsema M, Kleerebezem M, Pereira R, Postma E, Smeets P, Stopyra M, Zwiers M, Aarts E (2021) Scientific Reports Nov 12;11(1):22205 doi: 10.1038/s41598-021-01684-7 

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Research into the effect of nutrition on attention-deficit hyperactivity disorder (ADHD) in children has shown that the few-foods diet (FFD) substantially decreases ADHD symptoms in 60% of children. However, the underlying mechanism is unknown.

In this open-label nutritional intervention study we investigated whether behavioural changes after following an FFD are associated with changes in brain function during inhibitory control in 79 boys with ADHD, aged 8-10 years.

Parents completed the ADHD Rating Scale before (t1) and after the FFD (t2). Functional magnetic resonance imaging (fMRI) scans were acquired during a stop-signal task at t1 and t2, and initial subject-level analyses were done blinded for ARS scores.

Fifty (63%) participants were diet responders, showing a decrease of ADHD symptoms of at least 40%. Fifty-three children had fMRI scans of sufficient quality for further analysis. Region-of-interest analyses demonstrated that brain activation in regions implicated in the stop-signal task was not associated with ADHD symptom change. However, whole-brain analyses revealed a correlation between ADHD symptom decrease and increased precuneus activation (p
FWE(cluster) = 0.015 for StopSuccess > Go trials and pFWE(cluster) < 0.001 for StopSuccess > StopFail trials).

These results provide evidence for a neurocognitive mechanism underlying the efficacy of a few-foods diet in children with ADHD.


Previous studies - including randomised, double-blind, placebo-controlled trials - have shown that various dietary interventions can help to reduce symptoms in children with ADHD, and among these, the use of a 'few foods' diet is one of the most well-supported by clinical trial evidence

This study used brain imaging in addition to standard ADHD symptom ratings to investigate possible mechanisms underlying any behavioural changes associated with a few-foods diet. 

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