Glucose tolerance and hyperkinesis.

-The medical records of 265 hyperkinetic children carefully selected from out-patients at a treatment centre during the period 1973-1976 were studied for clinical blood chemistry, haematology and results of 5-hr glucose tolerance tests. All the children had been diagnosed as hyperkinetic at least twice including at least one occasion by a physician. Children with other known physical or emotional disturbances were excluded from the study as were adopted children. Of the 16 parameters studied, 13 revealed significant deviations from normal values in very few cases, but haematocrit levels were low in 27~ of the cases, eosinophil levels were abnormally high in 86~ and in a majority of cases glucose tolerance test results were abnormal, 50~ being characterized by low flat curves and 15~o by excessive peaks and rapid declines. Some 11~o of the remaining abnormal curves were characterized by excessive peaks with slow recovery. Over half of this latter group had elevated cholesterol levels and glucose in the urine. Flat curves with terminal values higher than any others in the curve were seen in about 11~ of the subjects. Additional studies should be conducted to investigate the occurrence of abnormal glucose-metabohsm patterns as a possible factor in the aetiology of hyperkinesis. I N T R O D U C T I O N Hyperkinesis has received much attention over the past decade and is being diagnosed with increasing frequency. The term hyperkinesis refers to a broad range ofbehavioural symptoms seen in children but not found in adults. The syndrome is characterized by inappropriate and excessive physical activity, a short attention span, and an excessive response to environmental stimuli (Ho!vey, 1972). It has been associated with trauma at birth (Hoffman, 1971; Towbin, 1971), excessive body burdens of lead (David, 1974), emotional stress (Wender, 1971) and diet (Feingold, 1976). In the latter case, hyperkinesis has been claimed to be specifically associated with food colourings and food additives. However, no conclusive evidence exists that bears out a strong cause and effect relationship between the ingestion of food colourings or other additives and hyperkinesis (Kolbye, 1976; Lipton, 1975). A review of the literature did not reveal any studies of hyperkinesis based on the clinical chemistry of those affected with the syndrome. Here we report a clinical study of 265 carefully screened children diagnosed as hyperkinetic. E X P E R I M E N T A L Patients and method. The data used in this study were obtained from the medical records of 265 hyperkinetic children aged 7-9 years, all out-patients at The New York Institute for Child Development between 1973 and 1976. Each child had been diagnosed as hyperkinetic at least once by a parent, teacher or physician. Before being admitted to the Institute for treatment, the diagnosis of hyperkinesis was confirmed by a physician at the Institute. Hyperkinetic children with other known emotional or motor disturbances were excluded from the study. Nine years was used as the upper age limit to eliminate the onset of puberty as another potential variable in the study. Adopted children were not used in the study because of the difficulty of obtaining family histories. No attempt was made to select any particular sex or ethnic ratio among the children studied. The fact that 249 of the children were Caucasian, nine were black and seven were Hispanic is not necessarily an indication that hyperkinesis is more prevalent among whites than among other ethnic groups, but rather reflects the socio-economic level of the children which was predominantly middle stratum. At the Institute each child was evaluated by a physical therapist, a nutritionist and a physician. The patient's dietary and drug history was recorded as well as his medical history, which included any incidenee of colic, allergies, anaemia, gastro-intestinal problems, thyroid dysfunction, diabetes and low blood sugar. The medical history of the patient's family was also recorded as far as possible. Blood chemistry. Serum samples from the children were analysed for bilirubin, urea nitrogen, calcium, cholesterol, protein-bound iodine, phosphorus, total protein, glutamic-oxalacetic transaminase, glutamicpyruvic transaminase, and uric acid: Five-hour oral glucose tolerance test (GTT) results were also studied, and urine samples taken at the same intervals as G'IT blood samples were analysed for glucose and acetone. Data analysis. The information on each subject was analysed using a computer to examine distributions, trends and correlations. The normal values for each parameter of clinical chemistry studied were based on those in Todd & Sanford (1969) and the Merck