A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder.

Division of Developmental and Behavioral Pediatrics, Mayo Clinic, Rochester, Minnesota 55905, USA.
Journal of Pediatrics (Impact Factor: 3.74). 08/2001; 139(2):189-96. DOI: 10.1067/mpd.2001.116050
Source: PubMed

ABSTRACT To determine whether docosahexaenoic acid (DHA) supplementation for 4 months decreases the symptoms of attention-deficit/hyperactivity disorder (ADHD).
Sixty-three 6- to-12-year-old children with ADHD, all receiving effective maintenance therapy with stimulant medication, were assigned randomly, in a double-blind fashion, to receive DHA supplementation (345 mg/d) or placebo for 4 months. Outcome variables included plasma phospholipid fatty acid patterns, scores on laboratory measures of inattention and impulsivity (Test of Variables of Attention, Children's Color Trails test) while not taking stimulant medication, and scores on parental behavioral rating scales (Child Behavior Checklist, Conners' Rating Scale). Differences between groups after 4 months of DHA supplementation or placebo administration were determined by analysis of variance, controlling for age, baseline value of each outcome variable, ethnicity, and ADHD subtype.
Plasma phospholipid DHA content of the DHA-supplemented group was 2.6-fold higher at the end of the study than that of the placebo group (4.85 +/- 1.35 vs 1.86 +/- 0.87 mol % of total fatty acids; P <.001). Despite this, there was no statistically significant improvement in any objective or subjective measure of ADHD symptoms.
A 4-month period of DHA supplementation (345 mg/d) does not decrease symptoms of ADHD.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Dyslexie, dyspraxie, ADHD en het autistische spectrum Het is de gewoonte binnen ons opvoedings-en gezondheidszorgsysteem om verschillende diagnosecriteria te gebruiken voor dyslexie, dyspraxie, hyperactief gedrag met aandachtsstoornissen (attention deficit/hyperactivity disorder, ADHD) en autismespectrumstoornissen (autistic spectrum disorders, ASD). Elk van hen verwijst naar een specifiek gedragspatroon en leermoeilijkheden waarbij de centrale definitiecriteria vrij verschillend zijn. Voor dyslexie gaat het om specifieke leermoeilijkheden bij lezen en schrijven. Dyspraxie verwijst naar specifieke moeilijkheden in het plannen en coördineren van bewegingen. Bij ADHD zijn er blijvende en niet bij de leeftijd passende aandachtsproblemen, hyperactief en impulsief gedrag, of beide. In geval van ASD zijn er uitgesproken sociale en communicatiestoornissen en bestaat er een restrictief en stereotiep gedragspatroon. Deze ontwikkelingsstoornissen zijn vrij frequent, en treffen in meer of mindere mate tot 20% van de kinderen op schoolleeftijd. Ze vertegenwoordigen de grote meerderheid van de kinderen met bijzondere onderwijsbehoeften. De geassocieerde moeilijkheden blijven doorgaans bestaan op volwassen leeftijd, met enorme gevolgen voor de getroffen individuen, hun familie en de samenleving in haar geheel. Gezien de uiteenlopende manieren waarop de aandoeningen gedefinieerd zijn, gebeurt de diagnose en de aanpak van elk van hen gewoonlijk door verschillende specialismen. Dyslexie valt ongetwijfeld binnen het bestek van de opvoedkundige psycholoog, en de interventies spitsen zich doorgaans toe op speciaal onderwijs rond lezen, spellen en aanverwante vaardigheden. Dyspraxie wordt doorgaans aangepakt via een gedragsmatige benadering met het doel de fysieke coördinatie te verbeteren, zoals fysiotherapie en ergotherapie. De diagnose van ADHD valt in het domein van de psychiatrie, met toediening van stimulantia als standaardbehandeling. De diagnose van autismespectrumstoornissen heeft eveneens een medische oriëntatie, hoewel de aanpak een combinatie van farmacologische, gedragsmatige en psychologische behandelingen kan omvatten.
  • [Show abstract] [Hide abstract]
    ABSTRACT: No child psychiatric disorder has a single treatment that is completely satisfactory. Combinations are sometimes more beneficial than single treatments. This is well established for medication + behavioral treatment for depression and ADHD. There is wide variability in the evidence base for various treatments, from FDA-approved RCTs to open pilots. In the search for additional or alternative treatments, essential fatty acids seem especially to pass the SECS criterion: a treatment that is safe, easy, cheap, and sensible does not need as much evidence to justify patient trials as one that is risky, unrealistic, difficult, or expensive (RUDE). Not only do omega-3 fatty acids have some RCT evidence for a small effect in several psychiatric disorders, but they also are believed useful in preventing cardiac morbidity and excessive inflammation. Therefore, for ADHD, we recommend a combination of behavioral treatment (e.g., parent training, cognitive-behavioral therapy (CBT) for older patients), FDA-approved medication, (primarily stimulants), an RDI/RDA multivitamin/mineral to compensate for stimulant appetite suppression, and about a gram a day of EPA/DHA, possibly supplemented with 50-100 mg GLA. For mood disorders, we recommend a combination of mood stabilizer or antidepressant (depending on which mood disorder), CBT, RDA/RDI multivitamin/mineral (in view of reported vitamin D deficiencies and vitamin wasting from some anticonvulsant mood stabilizers), and a gram per day of EPA/DHA. For autism, we recommend applied behavior analysis, RDA/RDI multivitamin/mineral in view of the often idiosyncratic unbalanced diet, ADHD medication if a problem with hyperactivity, antipsychotic if a problem with irritability/aggression, and omega-3 for anti-inflammatory effect. For learning disorder and developmental coordination disorder, we recommend remedial tutoring or occupational therapy and EPA/DHA. For children at high risk for psychosis or mood disorder, we recommend counseling, monitoring for early indication of low-dose antipsychotic, and general nutritional support, including EPA/DHA. For Tourette’s and aggression, EPA/DHA and other nutritional support can be added to standard treatment. When using fish oil, it is important to make sure it was refined to eliminate contaminants such as mercury. The effect accumulates gradually over months. There is no convincing evidence of greater benefit but some risk from amounts over a gram or two per day.
    03/2015; 2(1). DOI:10.1007/s40501-015-0037-6
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Nutritional insufficiencies of nutrients such as omega-3 highly unsaturated fatty acids (HUFAs), vitamins and minerals have been linked to suboptimal developmental outcomes including attention deficit hyperactivity disorder (ADHD). Although the predominant treatment is currently psychostimulant medications, randomized clinical trials with omega-3 HUFAs have reported small-to-modest effects in reducing symptoms of ADHD in children despite arguable individual methodological and design misgivings. This review presents, discusses and critically evaluates data and findings from meta-analytic and systematic reviews and clinical trials published within the last 12 months. Recent trajectories of this research are discussed, such as comparing eicosapentaenoic acid and docosahexaenoic acid and testing the efficacy of omega-3 HUFAs as an adjunct to methylphenidate. Discussion includes highlighting limitations and potential future directions such as addressing variable findings by accounting for other nutritional deficiencies and behavioural food intolerances. The authors conclude that given the current economic burden of ADHD, estimated in the region of $77 billion in the USA alone, in addition to the fact that a proportion of patients with ADHD are either treatment resistant, nonresponders or withdraw from medication because of adverse side-effects, the investigation of nonpharmacological interventions including omega-3 HUFAs in clinical practice warrants extrapolating.
    Current Opinion in Clinical Nutrition and Metabolic Care 01/2015; DOI:10.1097/MCO.0000000000000140 · 3.97 Impact Factor