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.

Following this diet led to reduced ADHD symptoms in more than 60% of the children studied.

No correlation was found between reductions in ADHD symptom ratings and specific brain regions known to be involved in the attentional task the children performed during brain imaging.

However, ADHD symptom improvements were significantly linked with activation of a brain region called the precuneus - an assocation area that integrates sensory and other information from multiple brain areas, and is implicated in visuopatial attention, cognition and memory.

This brain area is thought to be involved in the inhibition of inappropriate responses, and also to play a central role in the so-called 'default mode network' (i.e. the network of brain regions that remains activated when someone is conscious but resting, and is not deliberately engaged in any sensory or motor activity). 

It is therefore at least plausible that increased activation of this brain region could help to explain a reduction in ADHD symptoms of inattention, impulsivity or hyperactivity.  

More importantly, however, this study once again shows that for many children with ADHD, a 'few foods' diet can lead to improvements in attention and behaviour. 

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