If you don't see any patterns in your data, yet day-to-day fluctuations persist, he is reacting to something you aren't tracking. Look elsewhere.
As May gave way to June, we still saw occasional bursts of unexplained hyperactivity. John's last serious incident happened after three grain free days - back to the drawing board. I noticed a large intake of fruit and fruit juices just before that incident, and although these items are all free of additives, they represent rich sources of simple sugars, and unless you are very careful and very lucky, they are also saturated with yeast. This suggested a candida infection, or at least a yeast intolerance. Furthermore, the candida theory explained (retroactively) much of our data. Yeast is hidden almost everywhere: all prepared fruit juices, certain fresh fruits, anything fortified with vitamin B, almost all commercial wheat products (enriched with vitamin B), anything containing vinegar or citric acid, anything containing MSG, soy sauce, aged cheeses, leftovers with traces of mold, etc. We were feeding him yeast almost every day, in varying amounts, without realizing it. Since yeast was a new variable, something we had never tracked before, it was worth looking at.
In addition to yeast, a high carbohydrate diet allows naturally occurring yeast to multiply in the patient's intestines. Simple sugars, including fruit, can elicit the same symptoms as yeast. If John's ADHD was yeast connected, all prior elimination experiments and their resulting data were destined for the trash can.
If I hadn't already read several books on yeast-related illnesses, I never would have discovered this connection on my own, and the Feingold association has little to say on the subject. In fact, they declare "sugar is not an issue", and for many people it isn't. However, no one book has all the answers, and no single organization provides the magic bullet.
We put John on a yeast free diet and cut back on carbohydrates. We went back to the healthfood store to purchase several yeast free wheat products, including breads and pastas. John did not react to any of these, though we must serve them in moderation due to their high carbohydrate content. Apparently John does not react to wheat; it was the yeast embedded in most wheat products. We even brought rice back, although it has an extremely high carbohydrate count, so we still have to be careful.
After a couple weeks on the yeast free diet a class of symptoms virtually disappeared. To summarize, we took the H out of his ADHD. John no longer raced around the house - he didn't even fidget. Nor did he wake up early, unable to get back to sleep. But what about his remaining ADD? He still couldn't focus on an academic task, and was easily frustrated at the slightest disappointment. He was certainly not ready for a full day of school, and first grade was just two months away.
Throughout July we tested a number of simple sugars: cane, beet, honey, maple, corn syrup, banana, apple, etc. Some children are sensitive to yeast and/or specific sugars, but do not actually have a candida infection. These lucky individuals can simply use a different form of sugar to sate their sweet tooth. Not so with John. The slightest dose of refined sugar, from any botanical source, sent him into overdrive, and even natural sugar was a problem. We must restrict him to one piece of fruit per day, and the fruit must be free of yeast/mold, which rules out grapes, raspberries, and cantaloupe. Also, fruits must be rotated, and served with or shortly after a meal.
We resigned ourselves to a life of planning, shopping, cooking, cleaning up, and analyzing. Every meal must be made from scratch, three times a day, plus an afternoon snack and dessert. A lot of work to be sure, but the rewards are worth it.
In late July we sent John to a summer day camp at a local school, and he did just fine, with no psychotropics in his blood stream. Granted, they didn't ask him to perform any challenging academic tasks, but the kids did watch movies and engage in arts and crafts, activities that were beyond his capabilities a few weeks earlier.
NFF: We now know that John suffers from a chronic microbial infection that drives most of his symptoms. He's always had it, and perhaps he always will. But I now think the organism is a bacterial colony, rather than a strain of candida. Evidence for this theory will be presented later on. This microbial colony waxes and wanes, waxes and wanes, depending on the quantity and mix of carbohydrates in his diet, and other factors. The formula is very complex.
When you are counting carbohydrates, don't draw significant distinctions between "real" and "artificial" sugars. It's interesting that we (Americans) have such a strong bias in favor of fruit, honey, maple, and other "natural" sources of sugar. Why should these be particularly safer than the sugar that comes from cane, and sits, granulated, in your sugar bowl? No reason really, but this is what we believe, and marketers have picked up on it. When I was young we ate Kelloggs "Sugar Smacks". The same cereal is now called "Honey Smacks", with just a trace of honey to justify the name change. Everywhere you look, honey and/or maple syrup is added to products and pasted into the name, to make you think it is more "natural". But honey and sugar are both concentrated sucrose, and it doesn't really matter which you eat.
Fruit juice is another allegedly healthy form of sugar, but not for everyone. Whole fruit is usually ok, but juice is far too concentrated. You can easily drink the equivalent of 3 or 4 apples in one go, without the fiber and food bulk that promotes healthy digestion and regulates the flow of sugar into your blood stream. Yet we give our babies concentrated fruit juice within the first year of life. Following the trend set by honey and maple syrup, the food industry adds fruit juice to its products, and declares them "healthy". Not so! Fresh cider from the mill is an annual treat, but not a healthy staple. Fruit juice can be almost as harmful as the equivalent amount of sugar water. My advice to anyone is: eat your fruit and vegetables - don't drink them. Throw away the juicer; it's a bad idea!