The impact of diet on children's behaviour problems: the relative and combined impact of the Simplified Elimination Diet and a Behaviour Parent Training Program
Creators: name: Schelleman, Mickaela
Publisher: name: RMIT University
Year: 2024

description: Despite a multitude of studies over decades, methodological differences in subject selection, diets and their implementation, and outcome measures, have prevented a consensus on the impact of diet on children's behaviour being reached. Parents use diet as an intervention, necessitating accurate information and relevant professional support.<br><br>This dissertation investigated the relative and combined impact of the Simplified Elimination Diet (SED) and a Behavioural Parent Training program (BPT) on clinically significant behaviour problems in children aged 4-12 with average (or above) IQ. The SED excludes a wide range of foods linked to behavioural and physical symptoms whilst remaining manageable for children and families. It is available publicly in Australia, allowing parents access without professional support. It excludes food additives and is low in salicylates, amines and glutamates; grains, beans and legumes, meats, eggs, specific dairy products and seafood, one fruit (pears), and a restricted variety of vegetables are permitted, along with selected drinks and snack foods. The BPT was designed by the researcher to encompass evidence-based strategies employed in standard BPT programs and was evaluated prior to the main study.<br><br>Following Baseline (Phase 1), participants were randomised to either the BPT+SED or SED+BPT group. Nineteen of the 23 participants commencing the BPT program in Phase 2 returned the primary outcome measure; all 19 commenced the SED in Phase 3 (maintaining BPT strategies) and 12 completed the SED (BPT+SED group). Fourteen of the 32 participants commencing the SED in Phase 2 returned the primary outcome measure; 10 commenced the BPT in Phase 3 (maintaining the SED), with 8 completing Phase 3 (SED+BPT group).<br><br>A sequential clinical trial approach was used to analyse the primary outcome measure, the Rowe Behaviour Rating Inventory (RBRI) Total score. Non-parametric statistics were used to analyse secondary outcome measures assessing general clinical behaviour, hyperactivity related behaviours, social skills, sleep, physical symptoms proposed to be related to diet, and parental psychopathology.<br><br>The findings indicate that the SED was superior to the BPT program in normalising clinically significant behaviour problems. This conclusion was supported by primary and secondary outcome measures; overall both per protocol and intention-to-treat analyses concurred. <br><br>The hypothesis that the combination of the interventions would be superior to either intervention alone was not supported. Instead, results indicated that the SED itself led to improvements, regardless of whether it was undertaken prior to, or following the BPT program. <br><br>Parental belief that diet affected their child's behaviour was not related to the SED's success in normalising behaviour, nor did it preclude the BPT program from improving behaviour. Considerations of natural fluctuations in children's behaviour, the impact of increased parental attention or decreased child responsibility for their behaviour, and the potential punitive nature of restricting the child's diet, did not offer alternative explanations for the findings. <br><br>Findings suggest that the SED should be considered a treatment option for families wishing to pursue dietary intervention for behaviour problems falling in the Clinical range on the RBRI. Limitations and clinical implications of the present study and recommendations for future research are discussed. <br>