Table 2: Information extracted from trials looking at LC3PUFAs and ADHD.

Reference and countrySubjects
M/F and sample size
Mean ageStudy design and methodsDose of supplementMain findings

[31]
Mexico
90 children
(60 M, 30 F)
6–12 years
Mean age 8.27 years
12-month trial (unblinded); MPH, omega-3/6 or a combinationEquazen: 558 mg EPA, 174 mg DHA, and 60 mg GLA (9 : 3 : 1 ratio)Significantly better scores on ADHD. Adverse events were numerically less frequent with omega-3/6 or MPH + omega-3/6 than MPH alone.

[41]
Netherlands
40 boys with ADHD and 39 matched, typically developing controlsAged 8–14 years16-week trial10 g of margarine daily, enriched with either 650 mg of EPA/DHA or placeboEPA/DHA supplementation improved parent-rated attention in both children with ADHD and typically developing children. Phospholipid DHA level at follow-up was higher for children receiving EPA/DHA supplements than placebo.

[32]
United Kingdom
76 M adolescents with ADHD12–16 years, mean = 13.7 years12-week trialEquazen: 558 mg EPA, 174 mg DHA, and 60 mg GLA (9 : 3 : 1 ratio)In the treatment group, supplementation enhanced EPA, DHA, and total omega-3 fatty acid levels.

[26]
Australia
90 Australian children with ADHD symptoms higher than the 90th percentile on the Conners’ Rating Scales7 to 12 years4-month crossover study evaluating literacy and behaviour up to 12 monthsSupplements rich in EPA, DHA, or LAIncreased erythrocyte EPA + DHA was associated with improved spelling () and attention (), reduced oppositional behaviour (), hyperactivity (), cognitive problems (), DSM-IV hyperactivity (), and DSM-IV inattention ().

[27]
China
179 children with lower IQs or ADHD to receive7 to 12 years3-month trial: evaluated effects on visual acuityOrdinary eggs or eggs rich in EPA and DHABoth groups of children showed a significant improvement in visual acuity (); however, visual acuity in the study group was significantly better than that of the control group ().

[37]
Germany
95 children diagnosed with ADHD according to DSM-IV criteria6–12 years16-week trialOmega-3 fatty acid mixImproved working memory correlated significantly with increased EPA, DHA, and decreased ARA.

[39]
Israel
200 children diagnosed with ADHD6–13 years15-week trial followed by an open-label extension300 mg PS-omega-3/dayStudy results demonstrate that consumption of PS-omega-3 by children with ADHD, is safe and well tolerated, without any negative effect on body weight or growth.

[38]
Malaysia
103 children6–12 years8-week trial635 mg EPA, 195 mg DHASignificant reduction in levels of CRP in the omega-3 group and significant increase in SOD and glutathione reductase. Significant improvement in ASQ-P score (measure of hyperactivity).

[33]
Sweden
75 children and adolescents with DSM-IV ADHD8–18 years3-month trial. Omega-3/6 (Equazen) or placebo, followed by 3 months of open phaseOmega-3/6 (Equazen) or placebo
Equazen: 558 mg EPA, 174 mg DHA, and 60 mg gamma linoleic acid (9 : 3 : 1 ratio)
Subjects with more than 25% reduction in ADHD symptoms were classified as responders. Compared to nonresponders, the 6-month responders had significantly greater n-3 increase at 3 months and decrease in n-6/n-3 ratio at 3 and 6 months ().

[28]
Australia
90 Australian children with ADHD symptoms higher than the 90th percentile on the Conners’ Rating Scales7 to 12 years4-month trialSupplements rich in EPA, DHA, or safflower oilIncreased erythrocyte DHA was associated with improved word reading and lower parent ratings of oppositional behaviour. These effects were more evident in a subgroup of 17 children with learning difficulties.

[29]
Sri Lanka
Children with ADHD active group, placebo6–12 years6-month trialCapsule
containing n3 and n6 (fish oil) and cold-pressed evening primrose oil
Statistically significant improvement was not found at 3 months of treatment between groups but was evident at 6 months of treatment () with inattention, impulsiveness, and cooperation with parents and teachers.

[40]
Norway
92 children with ADHD7–12 years15-week RCT0.5 g EPA versus placeboEPA improved CTRS, inattention/cognitive subscale (), but not Conners’ total score.

[34]
Sweden
75 children and adolescents with DSM-IV ADHD8–18 years3-month trial. Omega-3/6 (Equazen) or placebo, followed by 3 months of open phaseEquazen: 558 mg EPA, 174 mg DHA, and 60 mg GLA (9 : 3 : 1 ratio)A subgroup of 26% responded with more than 25% reduction of ADHD symptoms and a drop of Clinical Global Impression scores to the near-normal range. After 6 months, 47% of all showed such improvement. Responders tended to have ADHD inattentive subtype and comorbid neurodevelopmental disorders.

[30]
Israel
73 unmedicated children with a diagnosis of ADHD7–13 years7-week trial480 mg LA, 120 mg ALA, placebo: 1000 mg of vitamin CBoth treatments ameliorated some of the symptoms, but no significant differences were found between the groups in any of the treatment effects.

[35]
Japan
40 AD/HD (including eight AD/HD-suspected) children who were mostly without medication6–12 years2-month trialFoods containing fish oil (fermented soybean milk, bread rolls, and steamed bread; 3.6 g DHA/week from these foods)DHA-containing foods did not improve ADHD-related symptoms. Visual short-term memory and errors of commission (continuous performance) significantly improved in the control group compared with the changes over time in the DHA group.

[36]
USA
63 children with ADHD, all receiving effective maintenance therapy with stimulant medication6–12 years4-month trial345 mg DHANo statistically significant improvement in any objective or subjective measure of ADHD symptoms.

Key. ADHD, attention deficit hyperactivity disorder; ALA, alpha-linolenic acid; ARA, arachidonic acid; CRP, C-reactive protein; CTRS, Connor Teacher Rating Scale; DHA, docosahexaenoic acid; DSM-IV; Diagnostic and Statistical Manual of Mental Disorders; EPA, eicosapentaenoic acid; F, female; GLA, gamma linoleic acid; LA, linoleic acid; M, male; MPH, methylphenidate; PS, phosphatidylserine; SOD, superoxide dismutase.