To better understand the thought process that a stakeholder, such as a parent of a child with ADHD, might go through as they attempt to understand what role chocolate should play in their child’s life, this project simulates the experience from the point of view of the parent. To that end, this project first explores a typical informational website that a parent might find through a simple web search with the keywords ‘chocolate’ and ‘ADHD,’ since that would likely be how many parents would start their journey of information gathering. Then, anticipating that some parents might wish to further explore the relevant scientific literature, this project explores a couple of representative scientific studies on PubMed that a parent might find. In order to best reflect the agency of the parent as they try their best to make complex decisions for their children, this project attempts to narrate the diverse range of potential considerations for the parent to grapple with as they progress through their journey of information gathering.
For both the educational websites and the scientific articles, parents can find multiple legitimate reasons to second guess the trustworthiness, especially when pharmaceutical advertisements and industry ties create, at least appearance of, potential influence. While the information on chocolate and ADHD was relatively sparse for both educational websites and scientific literature, the general consensus was that chocolate, and other dietary choices, do not cause ADHD or worsen the symptoms. There were a small number of studies that suggested various mechanisms in which chocolate could in fact be therapeutic, but these studies all appeared to be isolated from each other, suggesting that this specific line of research is still in its infancy stages; parents of an ADHD children should probably wait for these studies to be reliably replicated by other studies before putting too much faith in any preliminary study’s findings.
III Online Resources: ADDitude Website
One of the few articles online that explicitly mentions chocolate and ADHD is an article from ADDitude5. The website describes itself as being “the trusted resource for families and adults living with ADHD and related conditions and the professionals who work with them”1. They further elaborate, “since 1998, millions have trusted ADDitude to deliver expert advice and caring support, making us the leading media network [emphasis added] for parents and adults living with attention-deficit disorder, and for professionals working in the field.”
Before reading what the article states about chocolate and ADHD, parents of children with ADHD often first make decisions regarding how trustworthy the content is. If they do not find it trustworthy, they might not even bother to read the article.
One factor to promote trust is the stamp of medical authority. Next to the author’s name is the author’s title (‘PH.D.’), and underneath that is a note “Reviewed on January 18, 2019,” which seems to echo the language of a peer-review scientific process5. At the bottom of the website is a disclaimer that “ADDitude does not provide medical advice, diagnosis, or treatment. The material on this web site is provided for educational purposes only”5. This disclaimer appears to flatly contradict the website’s claim that they “deliver expert advice,” and arguably undercuts the importance of highlighting the author’s authority status. Of course, this is assuming that the reader actually scrolls down to the bottom of the page to read the disclaimer, which is probably unlikely overall. This suggests that the disclaimer’s primary aim to avoid future legal risk, rather than to inform the current reader about the nature and limitations of the website.
Another factor to consider is the pharmaceutical advertising, and whether the revenue from pharmaceutical companies could influence the website’s content. The screenshot (see above) captures at least once incident in which the article displays an advertisement for Vyvanse â, which is a prescription stimulant medication for ADHD. There is a hint of irony that right above the headline (which is about ADHD brains craving stimulation) is an advertisement with bright green colors meant to grab the reader’s attention. A purple button pops out in contrast against this bright green background, beckoning the reader to click to “Learn more.” The section for “important safety information” is quietly placed to the side in small font, perhaps so that a parent might overlook the warning that Vyvanse is a controlled substance with risk for abuse/dependence.
III Online Resources: Pharmaceutical Advertisements
Parents may wish to better understand the history of marketing ploys that the makers of Vyvanse have employed in the past as they decide whether they can trust ADDitude in spite of the website’s financial relationship with Vyvanse. In other instance of Vyvanse attempting to incorporate their ads against the backdrop of an ostensibly educational medium, readers may wish to take a look at a live TV interview on ABC News featuring Ty Pennington, a celebrity who is open about having ADHD (see clip above)2. At the end of the segment, the interviewer asks him for recommendations for ADHD resources. Pennington repeatedly struggles to recall the exact name of a certain ADHD support website; he ultimately settles on recommending ‘Vyvanse.com,’ which suggests that Vyvanse could have played a financial role for Pennington and/or the ABC News interview. Given that Pennington misspelled Vyvanse with a ‘c’, it could suggest that he does not personally make it a habit to visit that website, and that instead he was coached to give this shout out to the Vyvanse website.
Readers may be further surprised to learn that Shire, the company that owns Vyvanse, also owns Adderall â (they sold away the rights to the immediate release (IR) formulation, but still own the extended release (XR) versions)4. Vyvanse and Adderall both rely on amphetamine as the active drug, but Vyvanse is a prodrug formulation of amphetamine, which means that the amphetamine in Vyvanse does not become activated until it has passed through the patient’s digestive system7. Theoretically, this can reduce the temptation for the patient to abuse the medication (snorting, intravenous, etc.) compared to non-prodrugs such as Adderall. As such, Shire had hoped that the FDA would classify it as a schedule 4 substance instead of a schedule 2 substance (such as Adderall, Ritalin, and other stimulant medications)7. This lower classification would allow prescribers and patients to face fewer government regulations. For instance, prescribers would then be allowed to write scripts that include monthly refills (instead of needing to write a new prescription each month). Though Shire ultimately failed to persuade the federal government, Shire appears to have convinced the medical establishment to accept its claims about Vyvanse’s hypothetical safety advantages7.
Shire’s need to promote Vyvanse, perhaps even at the expense of their existing Adderall XR product, begins to make more sense to the reader once they understand the context of Shire’s competition from generics. After Shire’s patent protections on Adderall XR expired, Shire’s sales plummeted from nearly 300 million dollars per quarter in 2009 to 67.4 million dollars in Q2 20104. While this decline was to be expected, even desired from the public’s perspective, Shire shockingly later managed to increase its sales by 21 percent to $111 million in Q1 20114. According to legal complaints by generic competitors, Shire first further raised the price of their brand name Adderall XR, and then manipulated the complex national supply chain of the raw amphetamine such that the generic manufactures had a shortage of raw material4. Thus, even though affordable generics were theoretically available, many patients had to resort to paying for the exorbitantly expensive brand name version. Even after the shortage of generic Adderall XR eventually cleared up, Shire was able to continue to benefit long term from this chaos, due to its new product, Vyvanse. During the shortage, patients who could not afford the brand name Adderall XR, or who perhaps could not physically locate any pharmacies that had any Adderall XR, naturally could be incentivized to try Vyvanse, which was not undergoing a shortage, and which was less expensive at the time than brand name Adderall XR4. By building a long-term customer base for Vyvanse, which is still is patent protected until 2023, Shire retains a dominant share of the ADHD medication market4.
III Online Resources: Chocolate and ADHD
The factors mentioned above are just some examples of the considerations that could be in the back of the mind of an actively engaged reader who encounters this ADDitude article on ADHD and chocolate. Some might read the article with heavy skepticism (or perhaps choose to skip the article entirely), while others might decide to grant credibility to the claims made in the article.
The article explains that the impulsive ADHD brain has trouble with self-regulation, particularly in the dopamine reward center5. As such, “chocolate is appealing to ADHD brains because it increases glucose and has the added stimulation of caffeine.” The glucose satisfies the ADHD brain’s cravings, which leads to a release of dopamine in the dopamine reward center. While this can bring needed “please and greater calm” to the ADHD brain, “many people with ADHD chide themselves for indulging in [pleasurable foods], when their brains are actually demanding those foods instead of salad.” The article sympathizes, “It is no wonder that those with ADHD struggle with diet and nutrition. When they self-medicate with food, their brains enjoy a surge of dopamine,” and their various chemical imbalances are addressed, at least temporarily. Addressing more broadly the general life struggle of an ADHD individual, the article explains, “understanding what ADHD brains want makes it clear that the struggle for self-regulation is neurological, and has nothing to do with character deficiencies.”
This article does not explore treatment options, so it does not explicitly address the issues of whether chocolate (and/or poor diet) is the cause of ADHD, or whether or not it can worsen ADHD symptom severity. It does seem to suggest that the ADHD leads to the overeating, rather than the other way around, but an explicit clarification would have been helpful. Also, it broadly lumps chocolate together with carbs, pastas, and cookies as being generally unhealthy foods; the author might be scientifically justified with this system of classification, but she never cites any outside sources or evidence. One possible explanation was that her main purpose of the article was not to give dietary advice, but rather to increase self-compassion in ADHD individuals who might otherwise be berating themselves for not being able to stick to their own dietary goals. In the context of the Vyvanse ads, the reader may wonder whether this article is attempting to emphasize a chemical imbalance view of ADHD in order to render the reader more amenable to the idea of a pharmaceutical treatment.
IV Medical Literature: Chocolate Does Not Cause ADHD
For stakeholders who are still are looking for hard, scientific reassurance that ADHD is not caused by poor dietary habits, the general medical consensus is that diet does not cause ADHD. A metareview notes that “parents and teachers alike attribute excessive motor activity and other disruptive behaviors to candy consumption,” which are often hypothesized to harm children through a combination of sugar, food additives/coloring, and through chocolate itself3. However, after combing through numerous placebo-controlled studies, the researchers could not find a single study that supported any of those hypotheses. They conclude, “for children with behavioral problems, diet-oriented treatment does not appear to be appropriate. Rather, clinicians treating these children recommend a multidisciplinary approach. The goal of diet treatment is to ensure a balanced diet with adequate energy and nutrients for optimal growth”3.
IV Medical Literature: Dark Chocolate Can Improve Attention
A study on humans found that dark chocolate improved alertness and attentiveness as measured by EEG scans6. A negative side effect was that it raised blood pressure due to the stimulants in the cocao. However, the side effect of raised blood pressure could be offset by adding L-theanine to the dark chocolate. Unfortunately for consumers, chocolate bars with L-theanine are not yet available, so Larry Stevens, one of the authors of the paper, opines that companies should heed the results of the study and consider developing such a chocolate bar6.
Certainly, at least one chocolate company will be carefully examining the results: Hershey, which is listed in the paper as a sponsor of the study. On the website of the press release that accompanied this paper, one online visitor commented, “We’re supposed to expect unbiased results for a study on chocolate sponsored by Hershey? Hello- this isn’t good.” See screenshots below6.
Someone who is presumably Larry Stevens himself (based on the user name) responds with a long defense (see screenshots below)6. Stevens first acknowledges and thanks the commenter for raising awareness of this important issue. He unequivocally stands by the impartiality of the research and explains that “Hershey’s role was only to respond affirmatively to my request to provide the chocolate confections used in the study and to quite astutely suggest the addition of the L-Theanine additive.” He elaborates on all the effort that the research team did by themselves (without any involvement or help by Hershey), and that clarifies that the team members never received any offers of gifts or rewards.
While his explanations, if they are to accepted at face value, could adequately explain away the ethical concerns, it may not have been worth it from a public perception standpoint to have accepted the free chocolate confections, especially if the expense of chocolate confections is negligible compared to the rest of the expenses of running this human clinical experiment. Further, by accepting the advice from Hershey on adding the L-Theanine test group, it could feed a public perception that public taxpayer dollars for research are being diverted for Hershey’s own purposes; after all, if Hershey is indeed interested in experimenting with L-Theanine, they could have conducted their own private experiment with their own money. Of course, this criticism may or may not be fair, but the public’s perception of these issues can influence how receptive the public is to accepting scientific findings and to politically supporting public research funding.
Ultimately, the parents of children with ADHD must make their own judgments regarding which pieces of advice to heed and which to ignore. Parents must constantly screen for signs of potential sources of biasing influence, such as pharmaceutical or food industry ties. Similarly, educational websites and scientific articles must remain cognizant of the myriad of ways in which they can be scrutinized by parents, and they must earn the trust of the parents if they are to succeed at spreading their intended information.
- “About Us.” ADDitude, 17 Apr. 2019, http://www.additudemag.com/contact-us/about/.
- “Celebrities with ADHD: Ty Pennington.” YouTube, CBS News, 27 Feb. 2009, https://youtu.be/RKdfSqy4NOs?t=328.
- Debra A. Krummel, Frances H. Seligson, Helen A. Guthrie & Dr. Dian A. Gans (1996) Hyperactivity: Is candy causal?, Critical Reviews in Food Science and Nutrition, 36:1-2, 31-47
- Edwards, Jim. “How a ‘Shortage’ of Adderall Actually Increased Sales of the ADHD Drug.” CBS News, CBS Interactive, 13 May 2011, http://www.cbsnews.com/news/how-a-shortage-of-adderall-actually-increased-sales-of-the-adhd-drug/.
- Littman, Ellen. “Never Enough? Why Your Brain Craves Stimulation.” ADDitude, 18 Jan. 2019, http://www.additudemag.com/brain-stimulation-and-adhd-cravings-addiction-and-regulation/.
- Montopoli, M., Stevens, L., Smith, C. J., Montopoli, G., Passino, S., Brown, S., … Wu, J. (2015). The Acute Electrocortical and Blood Pressure Effects of Chocolate. NeuroRegulation, 2(1), 3–28.
- Rosack, Jim. “Novel Drug for ADHD Wins FDA Approval.” Psychiatric News, 6 Apr. 2007, psychnews.psychiatryonline.org/doi/full/10.1176/pn.42.7.0001a.