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I’m in Raleigh, preparing to teach an ADHD workshop in the morning. As I write this, I can hear the peals of the Memorial Bell Tower of North Carolina State University, and I am reminded of Denny Chimes on the campus of the University of Alabama, where I did my graduate work. I’m reflecting tonight on a particular course in History and Systems of Psychology and of an important principle regularly driven home to students: “Correlation does not imply causation.” It’s a simple enough principle and one that is fairly regularly ignored.
Recently an investigation at Yale University discovered that among 1,649 middle school students in a large Connecticut city, consumption of sugary and caffeinated energy drinks was associated with increased symptoms of inattention and hyperactivity. By the time these findings are presented in the popular press, we were treated with headlines like Sugar-Sweetened Energy Drinks Might Prompt Higher Risk of ADHD and Energy Drinks Cause Hyperactivity and Attention Disorders.
Yikes. It seems important to remind ourselves here that correlation does not imply causation. It may well be, for example, that students with symptoms of ADHD are more likely to consume sugary foods and beverages or to use more caffeine than their same-age peers. Alternatively, some third variable might drive both hyperactivity and higher consumption of energy drinks.
Are Energy Drinks Safe?
So if this recent study does not in fact suggest that energy drinks cause ADHD, should we then conclude for now that these drinks are safe? We might offer a cautious “good grief, no.”
For starters, protein supports cognition over a longer period of time and should be preferred at every snack and meal over simple carbohydrates. And because caffeine is a drug, parents and their pediatricians should carefully review the ways in which children use the substance and consider whether more appropriate pharmacotherapy may be indicated. While individuals without ADHD demonstrate improved cognitive performance and report enhanced mood, with low to moderate doses of caffeine, the drug should not be considered a substitute for stimulant medications, which are intended for the treatment of ADHD.
What About 12 -Year-Olds?
Perhaps the feature that struck me most about the Yale study was the average age of the subject: 12.4 years old. While adults can reasonably be expected to consider the ways in which they will use drugs, including caffeine, the unregulated and unsupervised use of these products by children may not be in their best interest. In fact, the American Academy of Pediatrics recommends that children not use these products.
Children and adolescents are in the process of mastering a range of self-regulation skills required for successful adult adjustment, including the ability to regulate arousal, motivation, and emotional functioning. Drugs interfere with these states and may prevent children from maximally benefiting from the opportunities in school and home and community to learn self-regulation.
In Summary
Does the recent Yale study suggest that energy drinks cause ADHD? Not at all. Are sugary drinks with lots of caffeine a wise choice for students (with or without ADHD)? No way.
