Food Dyes, Behavior, and Autism: Does What Children Eat Color Behavior?

Background: A common dietary modification used by families with and without autism spectrum disorders (ASD) is the removal of artificial food dyes and preservatives based on studies that suggest these additives increase hyperactivity in children (Mc Cann et al, 2007; Schrab, 2004). To date no studies have investigated this association in children with ASDs. 

Objectives: The purpose of this study was to examine the association of ingestion of artificial food dye by children with ASD with parent report of symptoms of ADHD, sleep problems, and repetitive behaviors.

Methods: The prospective three-day food records of 25 children from Rochester participating in a larger study examining the diet and nutritional status of children with ASD were studied. Exposure to food dyes was quantified by number of exposures based on examination of the ingredients of all foods and beverages recorded in the food records. Behavior was quantified by the parent rating scales collected for the larger study: the Children’s Sleep Habits Questionnaire (CHSQ), the Child Behavior Checklist (CBCL), and Repetitive Behavior Scale – Revised (RBS-R).

Results: Five of the children (20% of the sample) did not ingest any food dyes during the three-day record either because of a dye free diet or secondary to ingestion of a gluten free diet. Of the remaining 20 children, the exposure to artificial food dye ranged from 1 food exposure to 50 food exposures over the 3 days of recording. There was no correlation between artificial food dye exposure and ADHD or externalizing symptoms on the CBCL or repetitive behavior on the RBS-R in the 20 children who ingested artificial food dyes. Modest to moderate correlations (r=0.75, 0.68) were found for ingestion of yellow 6 specifically and for ingestion of all yellow artificial coloring and total score on the CSHQ.

Conclusions: Limitation or elimination of food dye is a common dietary intervention in children with ASD. It is possible that the children whose families had already eliminated artificial food dyes did so because of observable behavioral responses and this would not have been detected in this study. Rating scales suggest that further examination of sleep disturbance and yellow food dye exposure might be warranted. Prospective data from a double blind, placebo controlled study would be necessary to determine if there might be an association between artificial food dye intake and hyperactivity, repetitive behaviors, or sleep.

The authors thank the Autism Treatment Network (ATN) for the use of the data collected as part of the ATN; a program of Autism Speaks. Further support was from a cooperative agreement (UA3MC11054) from the US Dept of Health and Human Services, health Research and Service Administration, Maternal and Child Health Research Program to Massachusetts General Hospital and to the National Center for Research Resources(NCRR) UL 1RRO24160