Journal of Consulting and Ginical Psychology 1988, Vol. 56, No.

4, 583-589

Copyright 1988 by the American Psychological Association, Inc. 0022-Q06X/88/J00.75

Effects of Sugar (Sucrose) on Children's Behavior

Lee A. Rosen
Colorado State University Sharon R. Booth Virginia Polytechnic and State University

Mary E. Bender
Department of Psychiatry University ofCaliforniaIrvine

Melanie L. McGrath
Department of Psychiatry and Human Behavior University of Mississippi Medical Center

Sue Sorrell
Early Education Center Outreach Project Jackson, Mississippi

Ronald S. Drabman
Department of Psychiatry and Human Behavior University of Mississippi Medical Center

We examined the effects of sugar on the behavior of 45 preschool and elementary school children. Using a double-blind within-subject challenge design, we provided all children with a basic breakfast that included a challenge drink containing either 50 gof sucrose, a placebo (aspartame) of comparable sweetness, or only a very small amount of sucrose. The results indicated that high amounts of sugar caused a small increase in the children's activity level (as rated by their teachers) and a small decrement in the performance of the female subjects on a simple learning task and that sugar affected the cognitive performance of the preschoolers differently than that of elementary school children. All of these effects, however, were quite small in magnitude and were not considered clinically significant. The results did not support the view that sugar causes major changes in children's behavior.

Parents and teachers often report that foods containing large amounts of refined sugar (sucrose) produce detrimental effects on children's behavior. Anecdotal reports of increased activity levels, irritability, and impairment in the ability to sustain attention and inhibit impulses are common. In addition, several articles and books written for the general public have popularized the view that sugar exerts negative effects (e.g., Duffy. 1975; Tauraso, 1983). Many of these have stated that sugar is a primary cause of attention-deficit hyperactivity disorder as it is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R; American Psychiatric Association, 1987) in children. In fact, according to a study by Bennett and Sherman (1983), 45% of pediatricians and family practitioners have recommended a low-sugar diet for at least some of the hyperactive children they treat. Scholarly writings have also made unfounded pronouncements regarding sugar's effects. For instance, in a comment in the American Psychologist, Buchanan (1984) labeled sugar "the most ubiquitous toxin." Only recently, however, have investigators begun to seriously examine this important issue. Unfortunately, the few controlled experiments that have been conducted have reported conflicting results. Some have shown detrimental effects of sugar on behavior (e.g., Conners & Blouin, 1982; Conners etal., 1985; Goldman, Lerman, Contois, & Udall, 1986), whereas others have shown either salutary

effects (e.g., Behar, Rapoport, Adams, Berg, & Cornblath, 1984; Conners et al., 1985) or no effects (e.g., Ferguson, Stoddart, & Simeon, 1986; Milich & Pelham, 1986; Wolraich, Milich, Stumbo, & Schultz, 1985). Interestingly, these findings appear to bear no relation to the types of children studied, to the measures collected, or to the amounts of sugar ingested. Given the current state of knowledge in this area, firm conclusions regarding sugar's effects on children's behavior are clearly premature. Thus, the present investigation further evaluated the effects of sugar on children's behavior.

Method Subjects
The experiment was conducted at two private, church-run schools: a preschool and an elementary school. At the preschool, 30 children participated (20 boys and 10 girls, mean age = 5 years, 4 months) who were white and from middle- to upper-middle-class families. Fifteen elementary school children also participated (6 boys and 9 girls, mean age = 7 years, 2 months) who were first- and second-grade (regular education) Black children from predominately working class families. None of the children had been identified for mental deficiency; however. 2 of the preschool boys were reported (by the preschool director) to be hyperactive, and I of these was being treated with Ritalin.

Procedure
Pretesting. Prior to the onset of the experiment, each child's mother The authors wish to thank the principals and staff of the Christ the King Elementary School and of the Broadmoor Kindergarten and Preschool for their patience and cooperation. Correspondence concerning this article should be addressed to Lee A. Rosen, Department of Psychology, Colorado State University, Fort Collins, Colorado 80523 or to Ronald S. Drabman. Division of Psychology, University of Mississippi Medical Center. 2500 North State Street, Jackson. Mississippi 39216-4505. and teacher were asked to indicate whether they thought the child was behaviorally sensitive to sugar. Nineteen of the 30 preschool mothers indicated that they thought their child was behaviorally responsive to sugar, and 11 of the 30 preschoolers were identified by their teachers as possible responders. Eight of the 15 elementary school children were identified by their mothers as behaviorally responsive 10 sugar, and 7 of the 15 were identified as such by their teachers. In addition, each child's teacher rated the child using the Conners Teacher Rating Scale (CTRS;

583

584

ROSEN ET AL.

Conners, 1969). Seven preschool children and 1 elementary school child scored above 15 on the Hyperactivity Index of this scale, which is a cutoff traditionally used as an indicator of attention deficit disorder. Experimental conditions. Three conditions were manipulated in this investigation: a high-sugar condition, a low-sugar condition, and a control aspartame condition (low in sugar but with a sweet taste). The experiment was conducted on 15 consecutive school days at each site, with 5 days spent on each condition. The specific condition for any particular day was randomly selected for each child (i.e., the 5 days of each condition that each child received were not necessarily 5 consecutive days) and was independent from the conditions selected for the other subjects. Double-blind control was observed throughout the experiment by keeping experimenters, teachers, and parents unaware of the children's conditions. In addition, children were kept unaware of the conditions through the use of the sweet-tasting (but low in sugar) control condition. These conditions were delivered by manipulating the amount of sugar the children received in a breakfast they were fed at their schools (the children fasted from bedtime the night before).1 The breakfast each child received is outlined in Table 1. The amount of carbohydrates (sucrose, other simple sugars, starches, etc.) in the basic breakfast totaled 40.75 g. In addition, each child received 4 oz of an orange-flavored drink. The amount of sugar each child received vvas manipulated by varying the amount of sucrose in this breakfast drink from 0 to 50 g of sucrose (approximately equal to the sucrose in 2 candy bars). The highsugar drink contained 50 g of sucrose; the Ion-sugar drink contained 6.25 g of sucrose (just enough to make it palatable): and the sweet-butlow control drink contained no sucrose (see Table I). The total amount of carbohydrates and other nutrients contained in the entire breakfast (basic breakfast plus drink) for each condition is also displayed in Table 1. The high-sugar breakfast contained 90.75 g of carbohydrates (mostly sucrose and other simple sugars); the low-sugar breakfast contained 47.0 g, and the sweet-but-low control breakfast contained 40.75 g. This control condition was made possible through the use of an aspartamesweetened (Nutrasweet) drink. The intensity of sweetness for the two sweet-tasting drinks was equated so that the 4-oz sweet-but-low breakfast drink contained 122 mg of aspartame. Because children sometimes failed to eat their entire breakfasts (although virtually all children did consume their drinks), the amount of each food stuff that was actually ingested was measured for each child following each breakfast by subtracting the amount of food left from the original amount served. This value was used to determine the ingested dose of sucrose (and the total amount of carbohydrate ingested) for each child for each day. These data are presented in the Results section. Cognitive measures. On 2 days (determined randomly )of each condition, approximately 20-30 min following the completion of breakfast, children were tested on several measures sensitive to cognitive functioning.2 First, children completed a paired-associate learning task in which they were asked to learn and then to recall a number of animal names paired with certain zoo numbers. This procedure has been advocated by Swanson and Kinsbourne (1976,1979), and our use of the procedure in this context was consistent with their instructions (i.e., for pretesting, for the use of alternate forms, etc.). The number of errors in recall was scored for each of the two administrations conducted during each condition and was averaged to derive a mean score on this task. Second, children worked on a matching task in which each child was asked to indicate the one picture of a set of six that exactly matched a model picture. This task was similar to the traditional Matching Familiar Figures Test (Kagan, Rosman, Day. Albert. & Phillips. 1964) and used the same stimulus items and procedures (except that only 3 items were used during each administration instead of the traditional 12). This allowed us to use alternate forms so that no child viewed any particular item more than once. Both latency to first' response and number of errors were scored for each administration and were averaged to derive a single mean score on this measure for each condition. Third, during each day of each condition, children completed various product-measure tests designed to measure their performance on simple academic tasks. The

Table 1 Nutrient Content of Breakfast

Food Basic Breakfast Toasted oats (7oz) Whole milk (6oz) Toasted bread ( 1 slice) Margarine (Itsp) Grape jelly ( 1 tsp) Total Drink (4 oz) Low sugar Control High sugar Total nutrient Protein Fat Carbohydrate Calories

2.8 g 6.4 g 2.0 g 0.0 g

l.4g
6.5 g

14.0 g 8.25 g 14.5

g

77.0
119.0

1-Og
2.3 g

75.0

0.0 g 4.0 g 40.75 g

0.2
15.6 286.8 27.0

I I .2 g 0.0 g 0.0 g 0.0 g

11.2g
0.0 g 0.0 g 0.0 g

6.25 g 0.0 g 50.0 g

4.0
202.0

content
Low sugar Control High sugar ll.2g 11.2g ll.2g ll.2g 11.2g ll.2g

47.0 g 40.75 g 90.75 g

313.8 290.8 488.8

Note. Dashes indicate that only trace amounts were present.

preschool children completed a tracing task that was scored for the mean number of correctly traced items for each child for each condition. This task consisted of several work sheets, more than the child could possibly complete, on which the child was told to trace as many letters (A's and Os) as possible. The elementary school children worked simple arithmetic worksheets that were scored for the mean number of problems completed and the mean accuracy for each child for each condition. Each child was told to work as quickly and accurately as possible. These worksheets were geared to the individual child's academic level. Teacher ratings. Each day teachers completed the Abbreviated Conners Teacher Rating Scale (ACTRS) and a 10-point global rating scale. These scales were completed immediately preceding the child's lunch time (or morning snack) and were to reflect the child's behavior for the entire morning. The ACTRS is a 10-item checklist that is sensitive to hyperactive behavior (Conners, 1973). This measure was used by Behar et al. (1984) in their study of sugar's effects, and a variant of it was used by Ferguson et al. (1986). Scores on this measure range from 0 to 30, with a score of 15 or above generally accepted as one sign of attention deficit disorder (Ross & Ross, 1982). The ACTRS has been used widely in studies examining the effects of food additives and stimulant medication on attention deficit disorder children (Rumsey & Rapoport, 1983). The global rating scale is a 1-10-point Likert-type scale on which the respondent rates any global changes in the child's behavior. For example, the anchor for a score of I is skw, lethargic, very inactive and quiet.

' Parents were carefully instructed not to feed their children before school during the period that the experiment was in progress, and each child was regularly quizzed regarding prior ingestion of food that morning. If the child stated that she or he had eaten that morning, the parents were contacted to verify this information and the child was rescheduled for testing. This, however, occurred rarely. - The 20-30-min delay between the completion of breakfast and the onset of cognitive testing was similar to the delay used in other studies that have examined the effects of sugar on children's behavior (e.g., Wolraich et al., 1985) and is the length of time needed for most children's blood sugar levels to peak (Pickens, Burkeholder, & Womack, 1967).

EFFECTS OF SUGAR Table 2 Mean Dose of Carbohydrate by Site Carbohydrate dose Drink Site Preschool" Low sugar Control High sugar Elementary school" Low sugar Control High sugar Overall" Low sugar Control High sugar Breakfast'

585

SD

SD

0.31 0 2.49 0.23 0 1.81 0.28 0 2.26

0.05 0 0.43 0.09 0 0.67 0.06 0 0.51

2.05 1.72 4.11 1.54 1.19 3.63 1.88 1.54 3.95

0.39 0.36 0.67 0.48 0.37 1.00 0.42 0.36 0.78

a Sucrose plus other carbohydrates. b n = 20. Mean weight = 20.0 kg (SD = 3.5). 'n = 15. Mean weight = 27.6 kg (SD = 9.9). " n = 45. Mean weight = 22.5 kg (SD = 5.6).

and the anchor for a score of 10 is extremely active, constantly moving, loud or disruptive Scales of this type (e.g., theGlobal Impressions Scale) have been advocated for use in studies of the behavioral effects of diet on children (Rumsey & Rapoport, 1983). Observational measures. Observations were scheduled for each child for each day of the experiment. Children were observed after their cognitive testing was completed but not before '/ hr following breakfast. Children were observed in a variety of sites, and for this reason different behaviors were targeted for observation depending on the site, with the exception of fidgeting, a behavior thai was common to all sites. At the preschool, children were observed during a freeplay period and, thus, the following behaviors were scored: (a] fidget, defined as any repetitive motor act not part of an approved task (e.g., foot tapping, scratching face, tapping fingers); (b) change in activity, defined as movement from one activity area to another (e.g., from block area to art area): (c) active movement, defined as gross body movements propelling Ihe entire body (e.g., walking, running, jumping): (d) vocalization, defined as any audi-

ble sound from the child's mouth (e.g., talking, whistling, singing); and (e) aggression, defined as any intense movement toward another person, either directly or by using a material object as an extension of the hand (e.g., hitting, throwing rock) that results in contact. At the elementary school, the children were observed during in-seat independent work time. The behaviors observed at this site were (a) fidget and (b) on-task behaviors, defined as those appropriate to the classroom task assigned by the teacher (e.g.. sitting and working quietly, watching the teacher give group instructions). Observational data were collected by several observers watching the children each morning of the experiment. Observations were broken into continuous 10-s intervals, with each child observed 2-4 min each day (for a total of 10-20 min for each condition). If any of the target behaviors occurred during the 10-s interval, the entire interval was scored as an instance of that behavior (with the exception of on-task behavior, for which an interval was scored as on-task only if no instance of off-task behavior was observed during that interval). Reliability. Reliability checks were conducted on each observer for each type of behavior observed. An occurrence reliability score for each behavior was derived by dividing the number of agreements on the occurrence of a particular behavior by the number of these agreements plus the number of disagreements. In addition, when it was possible, a Cohen's kappa coefficient was calculated to correct for chance agreements (see Kent & Foster, 1977). At the preschool site, reliability on the fidget code was collected on 50i of the fidget data, yielding an occurrence reliability of 89% (range = 63-100; = .93). Reliability was assessed on 46% of the data for change in activity, active movement, vocalization, and aggression. The occurrence reliabilities for these behaviors were 99% (range = 92-100; K = not computable), 88% (range = 83-100; = .88), 82% (range = 66-100: = .82), and 94% (range = 83-100;K = not computable), respectively. At the elementary school site, 40""o of the fidget data were checked for reliability, yielding an 84% (range = 70-95; K = .79) occurrence reliability; 80% of the on-task data were checked, yielding an 85<S> (range = 67-99; = .82) occurrence reliability.

Results Dose Levels

To determine the differences in sucrose intake between the high, low. and control conditions, the amount of sucrose in the breakfast drink that each child ingested each morning was di-

Table 3 Means and Standard Deviations by School, Sex, and Condition Boys Low sugar Measure Preschool" PAL errors MT latency MT errors Tracing completed Elementary school6 PAL errors MT latency MT errors Math completed Math accuracy Control
A/

Girls

High sugar
A/

Low sugar

Control
.(/

High sugar
M
SD

SD

SD

SD

SD

SD

14.0 5.8 6.2 96.6 10.8 5.8 6.3 31.6 94.8

6.9 2.9 2.7 57.1 5.1 2.1 2.3 5.0 10.3

14.6 5.3 6.5 89.3 11.4 6.9 5.8 35.7 95.0

6.4 1.9 1.9 56.3 4.1 4.2 2.0 7.8 7.0

13.3 5.4 6.9 108.5

8.6 6.9 4.9 32.8 95.8

5.0 2.6 2.6 68.3 2.9 2.6 2.2 9.9 5.7

11.9 6.2 7.2 82.6

9.7 7.8 5.5 51.9 92.3

6.6 4.6 2.2 45.6 4.4 3.0 2.0 25.8 15.0

13.8 5.5 7.2 88.5

9.6 8.7 5.4 52.6 91.3

4.9 5.1 2.0 64.0 3.9 3.4 1.7 25.9 15.2

14.4 4.4 5.9 98.2 11.6 8.5 6.4 53.8 90.3

4.7 3.4 2.1 66.0 4.8 3.7 2.5 24.5 16.8

Noie. MT = matching task; PAL = paired-associate learning. For boys, n = 20; for girls, n = 10. b For boys, n = 6: for girls, n - 9.

586
Low

ROSEN ET AL.

Control BOYS

High

sugar level indicated that girls made significantly (Tukey p < .05) more errors during the high-sugar condition (M = 13.1, SD = 4.75) compared with the low-sugar condition (M = 10.9, SD = 5.56) (see Figure 1). For boys, however, there were no significant differences between errors made during either the highsugar condition (M = 12.2, SD = 4.49), low-sugar condition (M = 13.2, SD = 6.49), or control condition (M = 13.9, SD = 5.79). There were also no significant differences between the control condition (M = 11.8, SD = 4.42) and either the highor low-sugar conditions for the girls. In addition to the Sex x Sugar Level interaction, a significant multivariate interaction between site and sugar level was found, f\6, 36) = 2.99, p < .05. However, none of the univariate analy-

14

GIRLS
13

12

11

10

ses on the individual dependent measures were significant. Thus we are unable to interpret this finding clearly except to note that when the cognitive measures were taken as a whole, sugar ingestion appeared to affect the preschoolers differently than it affected the elementary school children. No other significant interactions or main effects were found for the cognitive measures. Teacher ratings. Table 4 shows the results of the sugar manipulations on the teacher ratings. A main effect of sugar condition was revealed by the multivariate analysis on these measures, F\4, 38) = 3.44, p < .05. The only significant univariate difference contributing to this overall effect was seen on the global rating scale, F(2, 82) = 7.89, p < .001 (with GreenhouseGeisser adjusted df, p < .01). An analysis of the means for this measure revealed that the ratings during the high-sugar condition (M = 6.2, SD = 1.08) were only slightly, although significantly (Tukey p < .05) higher than those during the low-sugar condition (M = 5.9, SD = 1.04) (see Figure 2). The control condition (M = 6.0, SD = 1.07) was not significantly different from either the high or low condition. No other significant differences were observed for the teacher rating measures. Observational measures. The one observational measure that was common to both sites was the fidget measure. The results obtained from this measure were analyzed using a 2 x 2 x

PAIRED ASSOCIATE LEARNING TASK

Figure I. Mean number of errors on the paired-associate learning task for boys and girls during each condition.

vided by that child's weight (mean weight = 22.5 kg). This yielded the dose per kg of sucrose for each day for each child. These amounts were averaged, providing the mean amount of sucrose ingested during each condition (across children and across days). The means for the high, low, and control conditions were 2.26, 0.28, and 0.00 g/kg sucrose, respectively. In addition, total carbohydrate intake (sucrose from breakfast drink plus other carbohydrates included in the basic breakfast) for the high, low, and control conditions averaged 3.95, 1.88, and 1.54 g/kg, respectively. Finally, in no case was an individual child's sucrose intake or total carbohydrate intake on a lowsugar condition day or on a control condition day higher than the intake during a high-sugar condition day; in fact, they were always quite discrepant. (See Table 2 for the mean carbohydrate dose of preschool and elementary school children). Overall Effects

Due to the large number of dependent measures, multivariate analyses of variance (MANOVAS) were conducted. We conducted 2 x 2 x 3 MANOVAS for both cognitive measures and teacher ratings to compare the effects of site (preschool vs. elementary school) by sex (boy vs. girl) by sugar level (high vs. low vs. control), with repeated measures across the last variable. When these analyses indicated that significant differences existed, the univariate differences contributing to this effect were examined for significance using a repeated-measures analysis of variance (ANOVA) and a Tukey post hoc test. Cognitive measures. Results of the cognitive testing are displayed in Table 3. The multivariate analysis of the cognitive measures indicated a significant Sex x Sugar Level interaction for the cognitive measures as a whole, F(6, 36) = 2.85, p < .05. An examination of the univariate differences contributing to this multivariate finding indicated a significant interaction between sex and sugar level on the paired-associate learning task, F\2, 82) = 3.69, p < .05 (with the more conservative Greenhouse-Geisser adjusted df, p < .05). An analysis of the mean paired-associate learning task scores for boys and girls for each
ALL SUBJECTS
Low

Control

High

f=

GLOBAL RATING
Figure 2. Mean rating on the global rating scale for each condition (for all subjects).

EFFECTS OF SUGAR

587

Table 4 Means and Standard Deviations by School, Sex, and Condition

Boys Low sugar Measure Preschool"
ACTRS

Girls High sugar Low sugar Control High sugar

Control

M
7.3 6.2 7.7 5.8

SD

A/

SD
5.4 1.1 4.2 1.2

M
6.7 6.1 7.9 6.7

SD
6.1 1.1 3.6 1.3

M
2.3 5.4 5.3 6.0

SO

M
3.1 5.5 4.8 6.1

SD
4.4 1.0 3.9 0.9

SD
4.1 0.9 4.8 0.9

Global Elementary school11

ACTRS

6.1 1.0 4.5 1.4

7.2 6.2 8.1 6.5

3.4 0.7 5.1 1.0

3.6 5.7 6.5 6.5

Global

Note. ACTRS = Abbreviated Connors Teacher Rating Scale. For boys, = 20; for girls, n = 10. b For boys, n = 6; for girls, n = 9.

3 repeated-measures ANOVA (Site x Sex X Sugar Level). This analysis revealed a significant main effect of site, F(], 38) = 66.48, p = .001. which was due to the much higher mean percentage of fidgeting that took place in the structured confines of the elementary school (M = 34.3, SD = 17.17) compared with the freeplay setting of the preschool (M = 10.3, SD = 11.24). No other significant differences were found (see Table 5 for these results).

dren. The magnitude of these results, however, was quite small, and they should be interpreted very cautiously. To summarize, our examination of performance on the cognitive measures revealed that, on the paired-associate learning task, girls made slightly but significantly more errors under the high-sugar condition than under the low-sugar condition. Boys did not show this decrement in performance. In addition, when the cognitive measures were analyzed as a whole, it appeared that sugar ingestion affected the preschoolers differently than it affected the elementary school children. Unfortunately, the individual dependent measures contributing to this multivariate finding were not significant; therefore, further interpretation is difficult. Finally, in their teachers' eyes (using the global rating scale), both boys and girls were more active during the highsugar condition than during the low-sugar condition. However, the observational measures and all of the other dependent measures failed to demonstrate any effects of sugar ingestion. These results are consistent with the majority of the research on sugar in failing to demonstrate any clinically significant behavioral effects. Many parents and teachers may persist in attributing detrimental changes in children's behavior to the ingestion of sugar
3

Parent and Teacher Predictions

The a priori predictions, made by each child's mother and teacher regarding that child's response to sugar, were examined for their relation to the actual results. A 2 x 3 repeated-measures MANOVA (Prediction x Sugar Condition) was conducted on the results obtained from the preschool site. There were no significant interactions or main effects regarding the children's predicted responses to sugar compared with their actual responses to sugar.3

Relation to Hyperactivity Index Scores

Some literature has suggested that hyperactive children may be more sensitive to the effects of sugar than normal children (e.g., Tauraso, 1983). Because children's scores on the ACTRS are often used as one indicator of hyperactivity, a median split analysis of the preschool children's pretest scores was conducted to create two groups: one scoring high and one scoring low on the Hyperactivity Index of the ACTRS. The median score was 5.5, with a mean of 2.2 for the low-scoring group (range = 0-5) and a mean of 14.2 for the high-scoring group (range = 626). We conducted 2 x 3 repeated-measures MANOVAS (Hyperactivity Index Group X Condition) for all measures. It should be noted, however, that the children in the high Hyperactivity Index group did not constitute a clinical group. Examination of the MANOVAS conducted on the median splits in Hyperactivity Index scores revealed that there were no significant differences between high- and low-sugar conditions for either the high- or low-rated children (on the Hyperactivity Index).4

Separate analyses were nol conducted for the children predicted to

be responders by both their mothers and their teachers because the majority of the children predicted to be responders by their teachers were also predicted by their parents. 4 An analysis of the effects of sugar on the measures not common to both sites was also conducted. These measures included a math productivity task and observations of on-task behavior for the elementary school site as well as a tracing task and observations of active movement, vocalization, activity change, and aggression for the preschool site. None of the differences found on these measures were significant. In addition, the behavior of one of the elementary school children who appeared to be particularly sensitive to sugar was examined in greater depth. This 6-year-old girl originally responded on seven of nine measures in a direction indicating an adverse sugar effect and displayed evidence of some large differences in mean performance. Therefore, an experiment was conducted in which this child was again fed high- and low-sugar breakfasts (following the design outlined previously), but this time the high-sugar juice contained 100 g of sucrose (3.45 g/kg), and the child was observed and tested over a 3-hr period on each of the 9 days of the study (4 days in the high-sugar condition, 4 days in the towsugar condition, and 1 day in the control condition). The results of this testing failed to replicate our initial findings.

Discussion
The results indicated that the ingestion of dietary sugar (sucrose) may have a small effect on the behavior of young chil-

588
Table 5

ROSEN ET AL.

Observations: Means and Standard Deviations by School, Sex, and Condition Boys Low sugar Measure Preschool Fidget Change in activity Active movement Vocalization Aggression Elementary school Fidget Cm-task Control High sugar Low sugar Girls Control High sugar

SD

SD

SD

SD

SD

SD

11.8 2.9 21.3 53.9 1.1 35.6 57.1

10.3 3.2 14.0 14.1 3.1 11.4 15.7

I I .1 5.8 18.5 55.9 0.4

11.2 7.3 13.9 15.5 0.9 13.3 9.7

6.2
3.7 20.0 55.7 0.8

10.0 4.3 12.7 20.7 1.7 32.1 16.0

11.7

2.2 17.3 49.0 0.2

12.3 3.5 10.0 12.6 0.7

5.8 11.8

8.4 3.0 19.1 50.2 0.8

7.0

4.7 12.5 16.8 1.7

14.8 6.8 20.2 44.2 0.0 35.0 50.3

17.0

8.5 17.2 23.0 0.0

32.8 64.0

35.8 58.4

28.6 54.0

38.4 50.0

22.8 10.5

13.1 13.1

for several reasons. First, sugar may actually exert a strong and reliable effect on children's behavior. This possibility is unlikely, however, given the many findings to the contrary. Second, because the ingestion of large amounts of sugar is often associated with certain events (such as birthday parties) that may evoke disruptive behavior, parents and teachers may associate the two when the real cause is simply the lack of structure inherent in these situations. Third, sugar has often been considered an energy food, and parents and teachers may attribute the high activity level in children to this high energy food. A final possibility concerns the "bad press" that has resulted from the sugar controversy. The design of the current experiment was limited by our failure to titrate the dose of sucrose to the subject's weight. Instead, all subjects received the same absolute amount of sucrose within each condition. Although this approach is similar to that used by Conners and Blouin (1982), Ferguson et al. (1986), and Gross (1984). it is problematic because smaller children received larger amounts of sugar proportionately than did larger children. Each individual child, however, did receive approximately the same sugar amount per kilograms of weight during any particular condition, and we were careful to maintain the dose differences between conditions for each child for each day of the experiment. Also, the independent variable was the grams of sugar per kilograms of weight that was actually ingested. Given these provisions, the design was adequate to test the hypothesis that high amounts of sugar can affect children's behavior. The design was not adequate, however, to pinpoint the specific amount of sucrose that may or may not cause an effect. The study was also limited by our failure to obtain a complete diet history for each child prior to the onset of the study. Because some children may be accustomed to consuming high amounts of sugar and other children may not. sugar may affect these groups differently. The small sample size involved in some of the factorial analyses is also of concern, particularly when no or only minor differences were revealed and the issue of statistical power was especially important. In addition, the brevity of the observation periods calls into question the utility of the observational data. Perhaps a more extensive observational record would have shed light on the significant effect that resulted on teachers' global ratings of children's activity levels. Finally, some researchers might believe that feeding the chil-

dren a complete breakfast (albeit one controlled by us) was a limitation. However, we believe that this may have mimicked a more typical situation than fasting children all night and then allowing them to consume only a small drink without any breakfast (e.g., Goldman et al., 1986; Milich & Pelham, 1986). This approach is also important because it examines the effects of sugar following the preloading of other nutrientsin our case, carbohydrates with some protein and fat. In fact, at least one study has found that the effects of sugar are dependent on the types of foods ingested immediately prior to or simultaneously with the ingestion of sugar. Conners et al. (1985) reported that when sugar is combined with a well-balanced meal, it may have salutary effects on behavior; however, when sugar is superimposed on the ingestion of pure carbohydrates or is given after a period of fasting, it appears to have detrimental effects. The results of the present study are consistent with these findings in showing that a large carbohydrate preload (40.75 g) may interact with subsequent sucrose ingestion to cause some (slight) detrimental effects on behavior. Clearly, work concerning the biochemical and neurophysiological aspects of sugar metabolism and the possible interactions with background nutritional conditions is extremely important for developing a clear and comprehensive theoretical understanding of the behavioral effects of sugar ingestion.

References
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