Journal of the American Academy of Child & Adolescent Psychiatry
Volume 50, Issue 10 , Pages 991-1000 , October 2011

Omega-3 Fatty Acid Supplementation for the Treatment of Children With Attention-Deficit/Hyperactivity Disorder Symptomatology: Systematic Review and Meta-Analysis

  • Michael H. Bloch, M.D., M.S.

      Affiliations

    • Yale Child Study Center and Yale University
    • Corresponding Author InformationCorrespondence to Michael H. Bloch, M.D., M.S., Child Study Center, Yale University School of Medicine, P.O. Box 2070900, New Haven, CT 06520
    • ,
  • Ahmad Qawasmi, M.D.

      Affiliations

    • Yale Child Study Center and the Child Institute at Al-Quds University

,Accepted 7 June 2011.

References 

  1. Diagnostic and Statistical Manual of Mental Disorders. 4th ed.. Washington, DC: American Psychiatric Publishing, Inc; 1994;American Psychiatric Association
  2. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder (American Academy of Pediatrics). Pediatrics. 2000;105:1158–1170
  3. Goldman LS, Genel M, Bezman RJ, Slanetz PJ. Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents (Council on Scientific Affairs, American Medical Association). JAMA. 1998;279:1100–1107
  4. Spencer T, Biederman J, Wilens T, Harding M, O'Donnell D, Griffin S. Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle. J Am Acad Child Adolesc Psychiatry. 1996;35:409–432
  5. 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;165:1475–1488
  6. Connor DF, Fletcher KE, Swanson JM. A meta-analysis of clonidine for symptoms of attention-deficit hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 1999;38:1551–1559
  7. Cheng JY, Chen RY, Ko JS, Ng EM. Efficacy and safety of atomoxetine for attention-deficit/hyperactivity disorder in children and adolescents-meta-analysis and meta-regression analysis. Psychopharmacology (Berl). 2007;194:197–209
  8. Coyle JT. Psychotropic drug use in very young children. JAMA. 2000;283:1059–1060
  9. Dunnick JK, Hailey JR. Experimental studies on the long-term effects of methylphenidate hydrochloride. Toxicology. 1995;103:77–84
  10. Klein RG, Landa B, Mattes JA, Klein DF. Methylphenidate and growth in hyperactive children (A controlled withdrawal study). Arch Gen Psychiatry. 1988;45:1127–1130
  11. Nasrallah HA, Loney J, Olson SC, McCalley-Whitters M, Kramer J, Jacoby CG. Cortical atrophy in young adults with a history of hyperactivity in childhood. Psychiatry Res. 1986;17:241–246
  12. Chan E, Gardiner P, Kemper KJ. At least its natural: herbs and dietary supplements in ADHD. Contemp Pediatrics. 2000;17:116–130
  13. Raz R, Gabis L. Essential fatty acids and attention-deficit-hyperactivity disorder: a systematic review. Dev Med Child Neurol. 2009;51:580–592
  14. Simopoulos AP. Omega-3 fatty acids in health and disease and in growth and development. Am J Clin Nutr. 1991;54:438–463
  15. Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21:495–505
  16. Freeman MP, Rapaport MH. Omega-3 fatty acids and depression: from cellular mechanisms to clinical care. J Clin Psychiatry. 2011;72:258–259
  17. Chalon S. Omega-3 fatty acids and monoamine neurotransmission. Prostaglandins Leukot Essent Fatty Acids. 2006;75:259–269
  18. Peet M, Stokes C. Omega-3 fatty acids in the treatment of psychiatric disorders. Drugs. 2005;65:1051–1059
  19. Freeman MP, Hibbeln JR, Wisner KL, et al. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry. 2006;67:1954–1967
  20. Stevens LJ, Zentall SS, Deck JL, et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr. 1995;62:761–768
  21. Antalis CJ, Stevens LJ, Campbell M, Pazdro R, Ericson K, Burgess JR. Omega-3 fatty acid status in attention-deficit/hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids. 2006;75:299–308
  22. Chen JR, Hsu SF, Hsu CD, Hwang LH, Yang SC. Dietary patterns and blood fatty acid composition in children with attention-deficit hyperactivity disorder in Taiwan. J Nutr Biochem. 2004;15:467–472
  23. Colter AL, Cutler C, Meckling KA. Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: a case-control study. J Nutr. 2008;7:8
  24. Laasonen M, Hokkanen L, Leppamaki S, Tani P, Erkkila AT. Project DyAdd: fatty acids in adult dyslexia, ADHD, and their comorbid combination. Prostaglandins Leukot Essent Fatty Acids. 2009;81:89–96
  25. Stevens L, Zhang W, Peck L, et al. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors. Lipids. 2003;38:1007–1021
  26. Young GS, Maharaj NJ, Conquer JA. Blood phospholipid fatty acid analysis of adults with and without attention deficit/hyperactivity disorder. Lipids. 2004;39:117–123
  27. Joshi K, Lad S, Kale M, et al. Supplementation with flax oil and vitamin C improves the outcome of attention deficit hyperactivity disorder (ADHD). Prostaglandins Leukot Essent Fatty Acids. 2006;74:17–21
  28. Schuchardt JP, Huss M, Stauss-Grabo M, Hahn A. Significance of long-chain polyunsaturated fatty acids (PUFAs) for the development and behaviour of children. Eur J Pediatr. 2010;169:149–164
  29. In:  Higgins J,  Green S editor. Cochrane Handbook for Systematic Reviews of Interventions 4.2.5. Chishester, UK: John Wiley & Sons; 2005;
  30. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634
  31. Moher D, Jadad AR, Nichol G, Penman M, Tugwell P, Walsh S. Assessing the quality of randomized controlled trials: an annotated bibliography of scales and checklists. Control Clin Trials. 1995;16:62–73
  32. Moncrieff J, Churchill R, Drummond C, McGuire H. Development of a quality assessment instrument for trials of treatments for depression and neurosis. Int J Methods Psychiatr Res. 2001;10:126–133
  33. Deeks J, Higgins J, Altman D. Cochrane Reviewers' Handbook 4.2.1. Chichester, UK: John Wiley & Sons; 2003;
  34. Brue AW, Oakland TD, Evans RA. The use of dietary supplement combination and an essential fatty acid as an alternative and complementary treatment for children with attention-deficit/hyperactivity disorder. Sci Rev Alternative Med. 2001;5:187–194
  35. Itomura M, Hamazaki K, Sawazaki S, et al. The effect of fish oil on physical aggression in schoolchildren—a randomized, double-blind, placebo-controlled trial. J Nutr Biochem. 2005;16:163–171
  36. 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;58:467–473
  37. Aman MG, Mitchell EA, Turbott SH. The effects of essential fatty acid supplementation by Efamol in hyperactive children. J Abnorm Child Psychol. 1987;15:75–90
  38. Arnold LE, Kleykamp D, Votolato NA, Taylor WA, Kontras SB, Tobin K. Gamma-linolenic acid for attention-deficit hyperactivity disorder: placebo-controlled comparison to D-amphetamine. Biol Psychiatry. 1989;25:222–228
  39. Johnson M, Ostlund S, Fransson G, Kadesjo B, Gillberg C. Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: a randomized placebo-controlled trial in children and adolescents. J Atten Disord. 2009;12:394–401
  40. Raz R, Carasso RL, Yehuda S. The influence of short-chain essential fatty acids on children with attention-deficit/hyperactivity disorder: a double-blind placebo-controlled study. J Child Adolesc Psychopharmacol. 2009;19:167–177
  41. 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;115:1360–1366
  42. 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;26:233–239
  43. Vaisman N, Kaysar N, Zaruk-Adasha Y, et al. Correlation between changes in blood fatty acid composition and visual sustained attention performance in children with inattention: effect of dietary n-3 fatty acids containing phospholipids. Am J Clin Nutr. 2008;87:1170–1180
  44. 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;139:189–196
  45. Sinn N, Bryan J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. J Dev Behav Pediatr. 2007;28:82–91
  46. Gustafsson PA, Birberg-Thornberg U, Duchen K, et al. EPA supplementation improves teacher-rated behaviour and oppositional symptoms in children with ADHD. Acta Paediatr. 2010;99:1540–1549
  47. Belanger SA, Vanasse M, Spahis S, et al. Omega-3 fatty acid treatment of children with attention-deficit hyperactivity disorder: a randomized, double-blind, placebo-controlled study. Paediatr Child Health. 2009;14:89–98
  48. Martins JG. EPA but not DHA appears to be responsible for the efficacy of omega-3 long chain polyunsaturated fatty acid supplementation in depression: evidence from a meta-analysis of randomized controlled trials. J Am Coll Nutr. 2009;28:525–542
  49. Brooks JD, Milne GL, Yin H, Sanchez SC, Porter NA, Morrow JD. Formation of highly reactive cyclopentenone isoprostane compounds (A3/J3-isoprostanes) in vivo from eicosapentaenoic acid. J Biol Chem. 2008;283:12043–12055
  50. Sontrop J, Campbell MK. Omega-3 polyunsaturated fatty acids and depression: a review of the evidence and a methodological critique. Prev Med. 2006;42:4–13

 This article is discussed in an editorial by Dr. J. Eugene Arnold on page 969.

 This article was reviewed under and accepted by Deputy Editor John T. Walkup, M.D.

 Disclosure: Drs. Bloch and Qawasmi report no biomedical financial interests or potential conflicts of interest to disclose.

PII: S0890-8567(11)00484-9

doi: 10.1016/j.jaac.2011.06.008

Journal of the American Academy of Child & Adolescent Psychiatry
Volume 50, Issue 10 , Pages 991-1000 , October 2011

Article Tools

* Image Usage & Resolution