Journal of Lipids / 2017 / Article / Tab 2

Review Article

Do Omega-3/6 Fatty Acids Have a Therapeutic Role in Children and Young People with ADHD?

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

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.

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.

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.

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 ().

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 ().

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.

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.

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).

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 ().

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.

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.

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

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.

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.

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.

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.