The effect of an experimental elimination diet was examined in 24 hyperactive boys aged 3.5 to 6 years at the Alberta Children’s Hospital, and the Learning Center, Calgary, Alberta, Canada. The diet was broader than those studied previously in that it eliminated not only artificial colors and flavors but also chocolate, monosodium glutamate, preservatives, caffeine, and any substance that the families reported might affect the child. It was low in simple sugar (mono- and disaccharaides) and dairy-free if an allergy to milk was suspected. A within-subject cross-over design was divided into 3 periods: a baseline of three weeks, a placebo-control period of three weeks, and an experimental diet period of four weeks. Approximately 42% (10) of the children showed 50% improvement in behavior on the elimination diet; an additional 16% (4) had lesser degrees of improvement (12%) with no placebo effect. Headache was less frequently reported during the diet period compared to placebo but not less than the base-line phase. Other nonbehavioral variables such as night awakenings and halitosis tended to improve during the dietary treatment phase. 
COMMENT. These results of replacement diets indicate larger response rates than challenge studies with specific items. Further studies of additive-free and hypoallergenic-sugar-restricted diets are warranted in the management of attention deficit disorders with hyperactivity, and headache and sleep disorders, particularly in preschool children.