Voigt RG, Llorente AM, Jensen CL, Fraley JK, Berretta MC, Heird WC. A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. J Pediatr 139: 189-196
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.
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- "Richardson & Puri et al., 2002 RCT 41 3 mo.: 186 mg EPA, 480 mg DHA, 96 mg GLA, 60 IU Vit E, 864 mg cis- linoleic acid, 42 mg AA Hyperactivity/ Inattention Z=2.21, pG0.03 h N  Voigt et al., 2001 RCT 63 4 mo.: 345 mg DHA Inattention p90.05 b Y  Arnold et al. 1989 RCT 18 1 mo.: 2800 mg LA, 320 GLA, 104 IU Vit E Hyperactivity/ Inattention p90.05 b N  Aman et al.1987 RCT 31 8 wk.: 2160 mg LA, 270 GLA Impulsivity F=0.001–0.372, p90.05 Y GLA gamma-linoleic acid, ALA alpha-linoleic acid, AA arachidonic acid, LA linoleic acid "
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
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- "The longest duration of treatment for RED was 5 weeks (Pelsser, Buitelaar et al., 2009; Pelsser et al., 2011; Pelsser, Frankena et al., 2009). For the AFCE studies, 8 week was the maximum period of treatment (Adams, 1981), and for SFFA, it was 4 months (Milte et al., 2012; Stevens et al., 2003; Voigt et al., 2001). The dietary treatment of ADHD is only likely to be effective if it sustained over a long period of time. "
ABSTRACT: The efficacy of three dietary treatments for ADHD has been repeatedly tested in randomized controlled trials (RCTs). These interventions are restricted elimination diets (RED), artificial food colour elimination (AFCE) and supplementation with free fatty acids (SFFA). There have been three systematic reviews and associated meta-analyses of the RCTs for each of these treatments. The aim of this review is to critically appraise the studies on the dietary treatments of ADHD, to compare the various meta-analyses of their efficacy that have been published and to identify where the design of such RCTs could be improved and where further investigations are needed. The meta-analyses differ in the inclusion and exclusion criteria applied to potentially eligible studies. The range of average effect sizes in standard deviation units is RED (0.29-1.2), AFCE (0.18-0.42) and SFFA (0.17-0.31). The methodology of many of the trials on which the meta-analyses are based is weak. Nevertheless, there is evidence from well-conducted studies for a small effect of SFFA. Restricted elimination diets may be beneficial, but large-scale studies are needed on unselected children, using blind assessment and including assessment of long-term outcome. Artificial food colour elimination is a potentially valuable treatment but its effect size remains uncertain, as does the type of child for whom it is likely to be efficacious. There are additional dietary supplements that have been used with children with ADHD. A systematic search identified 11 RCTs that investigated the effects of these food supplements. Despite positive results for some individual trials, more studies are required before conclusions can be reached on the value in reducing ADHD symptoms of any of these additional supplements.Journal of Child Psychology and Psychiatry 02/2014; 55(5). DOI:10.1111/jcpp.12215 · 6.46 Impact Factor
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- "Two intervention studies were performed, supplementing ADHD children with DHA alone or with DHA-EPA with a high ratio in favor of DHA: Neither found any positive effect on behavior or cognition. "
ABSTRACT: Although most of the ADHD (Attention Deficit Hyperactivity Disorder) patients respond to stimulant drugs very well, alternative drugs are required for non respondents. It has been revealed that subgroups of patients with ADHD have omega-3 fatty acid deficiency. So, the present study was planned to illustrate the effect of omega-3 supplementation, as an add-on to methylphenidate, on ADHD patients. In this double-blind RCT, ADHD children without any co morbidity, who had been diagnosed by a child and adolescent psychiatrist in child and adolescent university clinic, participated and were randomly divided into 2 groups. The experimental group methylphenidate plus omega-3 capsule (2000mg/d), while control group took methylphenidate plus placebo. Severity of ADHD symptoms were assessed by ADHD rating scale at the baseline and after 2, 4 and 8 weeks of treatment. 69 patients (experimental = 36, control = 33) aged 7 to 15 participated. A significant reduction of both parent's and teacher's ADHD rating scale scores in both groups was observed. Bu t it couldn't show any difference between two groups. Difference score of parent's at baseline was 1.86+- (5/40), Pv 0.262, after 2 weeks -.70+- (4/30), Pv 0.668,4 weeks. 19+- (5/60), Pv 0.902 and 8 weeks. 30+- (4/42), Pv 0.845. Difference score of Teacher's at baseline was -1.56+- (3/45), Pv 0.541, after 2 weeks -.46+- (6/24), Pv 0.888, 4 weeks. 45+- (5/41), 0.868 and 8 weeks. 73+- (4/18), Pv 0.748. Omega-3 did not enhance the therapeutic results of methylphenidate in ADHD patients.Journal of research in medical sciences 08/2013; 18(8):653-8. · 0.65 Impact Factor