Dr. David Rabiner’s Attention Research Update drew my attention to some recent research articles on the potential of fatty acid dietary supplementation to help treat ADD/ADHD.

Stimulant medication for children with ADD/ADHD has been the predominant treatment for years. Thus far, it has been quite successful, but we have yet to see the long term effects of chronic medication. Given that, it is worth at least investigating alternative therapies that can be used either in place of or in conjunction with traditional pharmaceutical and behavioral treatment.

As one of the four pillars of brain health, nutrition has a significant impact on both physical structures in the body and behavior. Studies suggest children with ADHD have lower levels of both omega-3 and omega-6 essential fatty acids.

Omega-3 fatty acids are found mainly in flaxseed oil, canola oil, soybeans, walnuts, hemp seeds, dark green leafy vegetables, and cold-water fish (salmon, trout, sardines, mackerel, herring, halibut, and cod). These fatty acids tend to be lower in American diets.

Omega-6 fatty acids tend to be more common in American diets than the omega-3s. These are found in cooking oils including safflower, sunflower, soybean, corn, and cottonseed; meat; egg yolks; and other animal products.

While both types are essential to a human diet, a close balance between the types is important. The ratio should be in the range of 1:1 to 4:1 (in favor of omega-6s), while the typical North American diet normally provides excessive omega-6 fatty acids in the range of 11:1 to 30:1.

Dr. Rabiner summarizes the results of these studies looking at fatty acid supplementation saying:

* There was little change in children’s motor skills and no indication that treated children showed greater improvement than children receiving placebo.

* Before treatment, average reading and spelling achievement scores were about 1 year below age level for children in both groups. After 3 months, children receiving fatty acid supplementation gained an average of 9.5 months in reading and 6.6 months in spelling. Children receiving placebo, in contrast, gained only 3.3 months in reading and 1.2 months in spelling. Thus, compared to the placebo group, gains made by treated children were highly significant.

* At baseline, the average score on the ADHD scale of the Conners was elevated in both groups. Scores for treated children showed a significant decline while scores for placebo children were essentially unchanged. Within the treated group, 16 children initially had scores on the ADHD scale in the clinically elevated range; after 3 months, 7 no longer fell in this range. Among children in the placebo group, only 1 of 16 children showed this same improvement.

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* ADHD symptoms declined significantly in children who began receiving supplementation. Scores continued to decline among children continuing on active treatment.

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* On the one hand, parents who were blind to their child’s treatment status observed significant improvement in their child’s core ADHD symptoms, as well as reductions in cognitive problems and oppositional behavior. By the end of 30 weeks, the magnitude of this improvement was substantial, and not dissimilar from what is often seen in medication treatment studies. As noted above, these benefits were linked to fatty acid supplementation alone, as the addition of a multi-vitamin provided no additional benefit.

* On the other hand, however, no comparable improvements were evident in the teacher ratings of children’s behavior. Thus, despite clear improvements observed by parents, children’s behavior at school did not change, at least as reported by their teachers.

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* The authors note that because treatment with fatty acid supplementation can take 8-12 weeks before any improvement is observed, it would not be advisable as a stand alone treatment when a child’s symptoms are especially severe, and where more immediate symptomatic relief is required.

The net conclusion seems to be: interesting and promising research, but not conclusively established at this point in time.

References

• 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 disabilities. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002;26:233-9.
• 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;115:1360-6.
• Sinn N, Bryan J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. Journal of Developmental and Behavioral Pediatrics. 2007;28:82-91.
• Voight 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 AD/HD. The Journal of Pediatrics. 2001;139:189-96.