Medication and Diet 325lamotrigine. Beyond this possible indication, there is no good evidence that
antiepileptic medications improve emotional or behavioural problems in
children and adolescents who do not have epilepsy (even if they do have
minor EEG abnormalities). However, newer medications such as prega-
balin have trial evidence of effectiveness among adults for the treatment
of anxiety disorders and have been prescribed for adolescents by specialists
with experience of the condition and the medication. For those children
and adolescents who do have definite seizures, antiepileptic medications
can have both positive and negative effects on psychopathology: reducing
seizures sometimes improves mental health, but antiepileptic medication
can also result in sedation, irritability or hyperactivity.
Benzodiazepines, antihistamines and other minor
tranquillizers
Although these are among the most commonly prescribed psychotropic
drugs for children and adolescents, they are also, arguably, the least
justified. Long-term problems with sleep or anxiety problems are much
more likely to respond to psychological approaches. Benzodiazepines may
sometimes be useful in the treatment of intense acute anxiety, for ex-
ample, before a medical procedure (though it is better still to desensitise
individuals in advance if they are going to encounter feared procedures or
situations repeatedly).
Diet
Doctors have been prescribing diets for millennia, and diets are still an
important treatment for a wide range of physical problems, including
eczema, migraine, phenylketonuria and intractable epilepsy. Specific foods
may need to be avoided, because they trigger off allergic reactions, or
because they have other sorts of adverse effects. As one example of a non-
allergic effect, fava beans contain oxidising agents that interact with an
inherited enzyme deficiency to precipitate haemolytic crises in individuals
with favism. When it is unclear how a particular dietary ingredient has
an adverse effect, it is better to speak of dietaryintolerancerather than
dietaryallergy.
Does dietary intolerance trigger child psychiatric problems? Food colours
in the diet do appear to make things worse in some children with ADHD,
though the effect size is not large. There is stronger evidence for the clinical
utility of an approach based on the ‘few foods’ diet. Individuals with ADHD
are initially started out on a very restricted diet that excludes not only
artificial additives but also many natural foods, including dairy and wheat
products and most fruits. If there is no improvement after two or three
weeks, the diet is abandoned. The few foods approach only works for some
people with ADHD.
If behaviour does improve on the few foods diet, the excluded foods are
re-introduced one at a time to identify which of them trigger behaviour