Omega-3 Supplementation in Children with Attention-Deficit Hyperactivity Disorder (ADHD)
Belanger, SA et al., Paediatr. Child Health , 14 : 89-98 , 2009
Dept. of Pediatrics , Research Ctr., CHU Ste-Justine ; Dept. of Nutrition, Univ. of Montreal; Dept. of Epidemiology, McGill Univ., Montreal, Quebec, Canada
The purpose of the present clinical trial was to investigate the potential efficacy of supplementation with omega-3 fatty acids (as EPA plus DHA) on the core symptoms of French Canadian children with ADHD. Some but not all past trials in children with ADHD have indicated improvement in some symptoms with omega-3 supplementation. The present study also included blood plasma monitoring of the fatty acid, incl. omega-3 PUFA (polyunsaturated fatty acid ) , status of the children.
The children (average age of 9.2 yrs) were assigned to receive a placebo supplement or supplemental EPA/DHA (ratio of 2.5/1) daily which provided a total intake (EPA plus DHA) ranging from 700 mg (for lighter children) and up to 1400 mg (for heavier children) over a 8-week period. After this period, the placebo group was transferred to omega-3 supplementation for 8 weeks while the omega-3 (n-3) group stayed on omega-3 supplementation for an additional 8 weeks. A total of 26 children completed the 16 week study. Clinical measures of ADHD symptoms were assessed throughout via Conners’ questionnaires and other parameters.
Following 8 weeks of supplementation, the average levels of EPA plus DHA in the blood samples were 2.5 times higher in the children supplemented with omega-3 as compared to those receiving the placebo capsules. The results from the Conner’s questionnaire (parent version) showed a modest but statistically-significant improvement in some subscales at 8 weeks in the omega-3 group relative to the placebo (control) group. An overall 7-9 % improvement (relative to initial measures) was found for hyperactivity and hyperactive-impulsivity with omega-3 but not with placebo. Other measured parameters (incl. social problems, anxious-shyness, psychosomatic) did not show differences between the omega-3 and placebo groups.
The authors concluded that ‘a subgroup of children with ADHD maintain and achieve symptom control using dietary supplementation with n-3 PUFA ‘. They indicated also that their study supported the safety and tolerability of n-3 administration.
Dr. Holub's Comments:
This study adds to the growing number of published trials wherein omega-3 supplementation has been evaluated in children with ADHD. Any safe and natural nutritional/nutraceutical strategies which could be used in a complimentary manner in addition to conventional clinical management would be of considerable interest since the ADHD incidence rates typically run in the 2-12 % range (in Canada). The present study was somewhat compromised since neither a fixed daily dose was used in all subjects and the attempt at fixing a constant daily dose according to body weight was not possible because the omega-3 capsules could not be divided. Nonetheless, evidence for a modest but statistically-significant benefit in some of the measured parameters support the need for both larger and longer-term studies with varying doses and ratios of EPA and DHA. Such studies are needed before any clinical consensus can be reached on the therapeutic use of EPA/DHA omega-3 supplementation in children with ADHD. It is noted that typical daily dietary intakes of EPA plus DHA are well below 100 mg in North American children yet are several times above such intakes amongst many Japanese children.