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Findings Support Omega-3s’ Ability to Aid Kids with Attention Disorders
6/3/2006
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New evidence indicates that fish oil may rival Ritalin in short term and surpass it in the long run 
by Craig Weatherby 

A little over a year ago, we reported the results of a clinical trial conducted in British schoolchildren diagnosed with attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and/or developmental coordination disorder (DCD). (See “UK Study Finds Fish Oil Benefits Kids with Cognitive Deficits".)


Key Points

  • New UK study in teens confirms results of prior UK research indicating omega-3s help younger children ADD/ADHD.
  • Aussie researchers made similar findings in young children, and say omega-3s appeared to beat Ritalin’s typical short-term results, and unlike Ritalin, may provide increasing benefit over time.

This trial was one of a now-famous, ongoing series of studies—conducted under the auspices of the Local Educational Authority (LEA) of Durham, England by researchers from the Durham LEA, Oxford University, and the US National 
Institutes of Health—and designed to determine the value of omega-3 and omega-6 essential fatty acids in treating learning and behavior disorders (Richardson AJ 2005, Richardson AJ 2002).


The May, 2005 study involved 117 primary school children with an attention-deficit-like condition called developmental coordination disorder (DCD), who received either dietary supplements with omega-3 and omega-6 fatty acids—80 percent fish oil (558 mg EPA and 174 mg DHA) and 20 percent evening primrose oil—or near-identical-looking placebo (olive oil) capsules. 

 

After three months, the kids receiving the placebo capsules received omega-3 capsules for another three months. (This so-called “crossover” phase was designed to further confirm any findings.)

 

The authors came to very positive conclusions: “Results showed… significant improvements in reading, spelling, and behavior for active treatment versus placebo during 3 months of treatment in parallel groups. After a 1-way treatment crossover (placebo to active [fish oil + evening primrose oil]), similar changes were seen in the placebo crossover group, whereas children continuing with active treatment maintained or improved their progress.”



Those results supported findings from an earlier study by the same authors, involving children with dyslexia and attention deficit symptoms, which yielded these comments, among others, from parents:

 

  • “Mark has turned into a more confident child when mixing with other children and adults. His writing has improved and he enjoys asking questions, or reading to improve his knowledge. I will always give Mark the supplements as I believe they have made a huge difference in his life.” —Christine Hodgson
  • “I felt that Joseph benefited greatly from the trials with an increase in concentration.” —Elaine Jennings
  • “I was really pleased when it said on Thomas’ report that the biggest improvement in Thomas” literacy skills was his reading. I am sure that this can be attributed to the Fatty Acid Trials.” —Wendy Moffett
  • “Absolutely amazing. After Elliot started taking the tablets, the first two or three months, he was more interested in work. He would go to the library. Not so much interested in the TV.” —Sheila Best

These before-and-after writing samples demonstrate, graphically, the difference that EFA supplements made to one developmentally challenged child named Joe:

 

Joe's writing before taking fish oil

Joe's writing after taking fish oil


 

The rationale for omega-3 intervention

This hypothesis that omega-3s might help children suffering from developmental disorders such as ADD, ADHD, and DCD—and the state of the evidence supporting it—were summarized last April, in a literature review published by the lead author of the Durham study we covered last year (Richardson AJ 2006):

 

  • “Omega-3 fatty acids are dietary essentials, and are critical to brain development and function. Increasing evidence suggests that a relative lack of omega-3 may contribute to many psychiatric and neuro-developmental disorders. Theory and experimental evidence support a role for omega-3 in ADHD, dyslexia, developmental coordination disorder (DCD) and autism.
  • “Results from controlled treatment trials are mixed, but the few studies in this area have involved different populations and treatment formulations. Dietary supplementation with fish oils (providing [omega-3] EPA and DHA) appears to alleviate ADHD-related symptoms in at least some children, and one study of DCD children also found benefits for academic achievement.
  • “Larger trials are now needed to confirm these findings, and to establish the specificity and durability of any treatment effects as well as optimal formulations and dosages.
  • “Omega-3 is not supported by current evidence as a primary treatment for ADHD or related conditions, but further research in this area is clearly warranted. Given their relative safety and general health benefits, omega-3 fatty acids offer a promising complementary approach to standard treatments.”

And, the Web site of the Durham County Council offers this succinct summary of the reasons why researchers suspect a connection between inadequate intake of essential omega-3 (or omega-6) fatty acids (EFAs) and attention/behavior disorders:

 

  • Many children with ADHD have a deficiency of essential fatty acids (EFAs).
  • Boys are more commonly affected that girls and males require more EFAs than females do.
  • Many children with ADHD have eczema, allergies and asthma, which can be alleviated by EFAs.
  • Many children with ADHD are deficient in zinc, which is required for conversion of EFAs to prostaglandins [ephemeral hormone-like messenger chemcials with influence on major metabolic processes].
  • Many children with ADHD also show the physical signs of EFA deficiency (abnormal thirst, dry skin and hair, dandruff, soft or brittle nails).
  • A greater number of behavior problems, temper tantrums, sleep problems are reported in children with lower levels of omega-3 fatty acids.
  • Dry weight of the brain is 60 percent fat and 25 percent [omega-3 and omega-6] EFAs.
  • No benefits are seen from supplementation with omega-6 fatty acids (from evening primrose oil) alone.
  • Supplementation with omega-3 fatty acids (from fish oil) has been shown to improve the behavior related to ADHD for some children.

However, despite generally positive results, the results of clinical trials testing omega-3s in children with ADD/ADHD have been mixed, possibly due to the varying blends and doses of EFAs used.

 

For example, two trials that employed only one of the two key omega-3 EFAs in fish oil (DHA) showed no benefit (Voigt RG 2001, Hirayama S 2004).

 

Those negative results, compared with the highly positive Durham results that resulted after supplementation of kids’ diets with whole fish oil containing both omega-3 EFAs—EPA and DHA—indicate that kids may need both omega-3s, which occur together in fish oil, to attain significant improvements in their conditions.

 

New Durham study finds fish oil helps attention-challenged teens

This past March, Dr. Madeleine Portwood of the Durham Local Education Authority, reported the results of a new, as yet unpublished, study in the county’s innovative education-improvement initiative. It involved a group of adolescents with attention problems, who were given supplements containing a mix of omega-3 and omega-6 essential fatty acids (EFAs), plus a small amount of vitamin E as a preservative.

 

After three months of taking the EFA capsules, the participating teenagers’ inattentiveness improved dramatically, from an average of 94 percent showing signs of inattentiveness at the start of the trial to only 17 percent at the end.
 



Teens before fish oil


Teens after 3 months of fish oil


Note: Parents who are considering switching their child to fish oil should first consult their child's specialist, to discuss the implications of changing from medication like Ritalin to supplemental omega-3 nutrition.

 

Aussie study supports UK findings

According to the results of new, soon-to-be-published study from the University of South Australia, the same omega-3/omega-6 supplements used in the recent Durham study improved the attention span and hyperactivity scores of young children, and appear to outperform the common ADD/ADHD medication Ritalin (methylphenidate).

 

ADHD is thought to affect between three to seven per cent of children in developed countries, with the problem continuing into adulthood for up to 60 percent of sufferers. Compared with girls, boys are about three times more likely to be diagnosed with ADHD.

 

The authors of the Australian study (Sinn N 2006) recruited 132 children diagnosed with ADHD aged seven to 12.

 

During the first 15 weeks of the randomized, placebo-controlled, double-blind trial, the children were given daily supplements of either 3,000 milligrams of combined omega-3 and omega-6 EFAs, the EFAs plus multivitamins and minerals, or placebo capsules containing highly saturated palm oil.

 

After 15 weeks the placebo group switched to the capsules containing the EFAs plus multivitamins and minerals, while the other groups remained on their original regimens.

 

The EFA supplement featured “high-EPA” fish oil and virgin evening primrose oil, which is a rich source of the omega-6 fatty acid called gamma-linoleic acid or GLA, plus a small amount of vitamin E as a preservative.

 

Parents were asked to rate their child’s condition after 15 and 30 weeks using the 14 ADHD scales of the Connor’s Parent Rating Scales evaluation survey. After 15 weeks of supplements, improvements were recorded in 9 out of 14 scales.

 

As lead author Natalie Sinn said, “Supplementation with PUFA over 15 weeks resulted in significant improvements compared to placebo in parent ratings of core ADHD-related behavioral and cognitive difficulties: namely, inattention, hyperactivity and impulsivity—with medium to large effect sizes—and also in ratings of oppositional behavior.”

 

After 30 weeks the parents’ ratings of their children’s behavior improved significantly in 10 out of 14 scales.

 

The fish oil groups continued to improve after taking the supplement for a further 15 weeks, and the multivitamin/mineral supplement added no extra positive effects.

 

Since the supplements contained both omega-3s and omega-6 EFAs, the results raise an obvious question: How do we know it was the omega-3s that helped, since the capsules also contained omega-6 GLA?

 

The answer is unclear, since children with ADD/ADHD type disorders have been shown to have low red blood cell levels of both omega-6 (arachidonic acid) and omega-3 (DHA and EPA) fatty acids. Although the Durham Web site says they've seen no benefits from omega-6 fatty acids alone, we can find no published studies that tested the isolated effects of supplemental omega-6 EFAs in children with ADD/ADHD.

 

However, it seems unlikely that few if any children would have anything but the extreme overload of dietary omega-6 EFAs typical of developed countries. The only possible exceptions would be kids with metabolic disorders that hamper conversion of the most common dietary omega-6 EFA (linoleic acid) into the forms needed by the body (arachidonic acid and gamma linoleic acid).

 

We should note that when the children’s teachers were asked to rate their behavior, they reported no significant improvements. The researchers downplayed these results, saying that parental ratings were more valid.

 

However, a study published this month in the Journal of Developmental & Behavioral Pediatrics—the same journal that’s scheduled to publish the Australian team’s findings—examined this very controversy. The authors concluded that while parent’s ratings were accurate in some respects, the ratings done by children’s teachers appeared more reliable, overall (Tripp G 2006).

 

This dispute may prove moot as we receive the results of more studies

 

Aussies rate fish oil rated superior to Ritalin

The Australian researchers also compared the effects of Ritalin to the effects observed by fish oil supplements. Using a comparison figure from an earlier meta-analysis (analysis of prior studies), they calculated that the Ritalin had a total effect on the ADHD index of 0.54.

 

A larger effect value of 0.59 was calculated for the group that took the fish oil supplements for the whole 30 weeks, while the placebo group that switched to fish oil after 15 weeks was rated at 1.03.

 

Significantly, the Australian team noted that the benefits of the EFA capsules continued past the point where Ritalin is known to stop producing additional benefits: “There is no known evidence that medication provides any benefits beyond four weeks, whereas in the present trial symptoms continued to improve after 15 weeks of supplementation.”


If this claim is true, it could be a landmark discovery. Time, we suppose, will tell. 

 


Sources

  • Richardson AJ. Omega-3 fatty acids in ADHD and related neurodevelopmental disorders. Int Rev Psychiatry. 2006 Apr;18(2):155-72.
  • Richardson AJ, Montgomery P. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics. 2005 May;115(5):1360-6. 
  • Richardson AJ, Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Prog Neuropsychopharmacol Biol Psychiatry. 2002 Feb;26(2):233-9. 
  • Sinn N 2006 (press account). Fish Oil Research and ADHD. Accessed online June 24 at http://www.abc.net.au/rn/lifematters/stories/2005/1438254.htm
  • Sinn N 2006 (press account). Fish oil wins over children with ADHD. Accessed online June 24 at http://www.unisa.edu.au/researcher/issue/2006January/story4.asp
  • Sinn N 2006 (press account). New study says fish oil helps control unruly children. Accessed online June 24 at http://www.abc.net.au/stateline/sa/content/2006/s1666219.htm 
  • Tripp G, Schaughency EA, Clarke B. Parent and Teacher Rating Scales in the Evaluation of Attention-deficit Hyperactivity Disorder: Contribution to Diagnosis and Differential Diagnosis in Clinically Referred Children. J Dev Behav Pediatr. 2006 Jun;27(3):209-18.
  • Durham County Council. Essential fatty acids: So what evidence is there? Accessed online June 24 at http://www.durham.gov.uk/durhamcc/usp.nsf/pws/D7C65B6A37022E0A80256CC5004FCB51?opendocument
  • Schachter HM, Pham B, King J, Langford S, Moher D. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. CMAJ. 2001 Nov 27;165(11):1475-88. 
  • 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. 2001 Aug;139(2):189-96.
  • Hirayama S, Hamazaki T, Terasawa K. Effect of docosahexaenoic acid-containing food administration on symptoms of attention-deficit/hyperactivity disorder - a placebo-controlled double-blind study. Eur J Clin Nutr. 2004 Mar;58(3):467-73. 
  • Itomura M, Hamazaki K, Sawazaki S, Kobayashi M, Terasawa K, Watanabe S, Hamazaki T. The effect of fish oil on physical aggression in schoolchildren--a randomized, double-blind, placebo-controlled trial. J Nutr Biochem. 2005 Mar;16(3):163-71.  
  • Stevens L, Zhang W, Peck L, Kuczek T, Grevstad N, Mahon A, Zentall SS, Arnold LE, Burgess JR. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors. Lipids. 2003 Oct;38(10):1007-21. 
  • Hamazaki T, Sawazaki S, Itomura M, Asaoka E, Nagao Y, Nishimura N, Yazawa K, Kuwamori T, Kobayashi M. The effect of docosahexaenoic acid on aggression in young adults. Feb 15 1996. Journal of Clinical Investigation. 97(4):1129-33.
  • Stevens L. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. 1995 Oct. American Journal of Clinical Nutrition. 62:761-8.
  • Willatts P, Forsyth JS, DiModugno MK, Varma S, Colvin M. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age. Lancet 1998 Aug 29;352(9129):688-9.
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