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A Parent’s Guide to ADHD & Fish Oil Supplements

A Parent’s Guide to ADHD & Fish Oil Supplements

This guide was designed to be a definitive guide for parents with children who have ADD, or ADHD type symptoms. If you find yourself short on time, I’ve posted a shorter version of this guide here.

Introduction

Attention Deficit/Hyperactivity Disorder, or ADHD occurs in a fairly large subset of school aged children. Over the years, numerous studies and news reports have asked the question “Is your teen’s diet giving them ADHD?“,  and continue to explore the possible relationship between ADHD and Polyunsaturated fatty acids, in particular the omega-3s. There are two different types of omega-3s. They are short-chain and long-chain, both of which describe the length of the carbon chain on each acid. The two long- chain fatty acids are Eicosapentaenoic Acid (EPA) which contains 20 carbons, and Docosahexaenoic Acid (DHA) which contains 22 carbons. Together these long- chain fatty acids are the omega-3s that we take fish oil for. This purpose of this guide is to focus on this relationship between omega-3s and ADHD symptoms.

What are the symptoms of ADHD?

While it may be harder to detect in very early childhood, the symptoms of hyperactivity, impulsivity, and inattentiveness characterizing this disorder are often pervasive and cause significant disruptions both at home and in school for many children. Although there is no simple and straightforward test for ADHD, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) has established specific criteria for diagnosing the disorder. These criteria include:

(1) Inattention (at least 6 required from category 1 or 2 for diagnosis)

  • failure to pay attention to details or carelessness at home or school
  • inability to remain attentive during play or other tasks
  • difficulty following instructions
  • trouble with organization
  • avoidance of tasks/activities requiring focus
  • frequently losing things
  • is distracted easily
  • difficulty remembering daily tasks

(2) Hyperactivity-Impulsivity (at least 6 required from category 1 or 2 for diagnosis)

  • fidgeting or squirming
  • frequently getting up from seat
  • running or climbing excessively
  • difficulty playing quietly
  • high-energy
  • extremely talkative
  • answers questions prematurely
  • inability to wait for his/her turn
  • frequently interrupts others

In addition, some of these symptoms must be present in early childhood (before the age of 7, but not before the age of 3), must effect the child in multiple settings, and lastly, must cause significant disruptions in social, academic, or work performance

Prevalence

It is estimated that an average of 5% of school aged children suffer from some form of ADHD. Unfortunately, this is not a disorder you can “grow out of”. Instead, many individuals carry the disorder with them into adulthood (DSM-IV-TR).

Causes

While ADHD appears to be more common among families with relatives who also have the disorder, a wide variety of external influences such as home life, academic settings, and friends appear to have some impact on the severity of the symptoms as well as the likelihood of another disorder being present (DSM-IV-TR). One of the external influences currently under intense scrutiny is that of omega-3 fatty acids.

Some researchers, like Stevens et al (1996) discovered in a clinical study of nearly 100 boys, that those with lower levels of omega-3s demonstrated more learning and behavioral problems (such as temper tantrums and sleep disturbances) than boys with normal omega-3 levels. In animal studies, low levels of omega-3 fatty acids have been shown to lower the concentration of certain brain chemicals (such as dopamine and serotonin) related to attention and motivation.

Current Research

One of the reasons ADHD is so difficult to diagnose early in childhood is because very young children are often not expected to endure long periods of self-restraint and attention. As a result, when children enter a formal school setting these attention-deficits and hyperactivity symptoms may seem to appear out of the blue, catching many parents off guard.

Frequently, these symptoms quickly escalate into behaviors that cause significant academic impairments. It is these types of problem-behaviors that cause many parents to feel pressured into experimenting with treatments like stimulants so their children do not fall behind at school. Fortunately, current research suggests fish oil for kids may be a safer alternative parents can try first.

For example, one clinical study led by Richardson & Montgomery (2005) used omega-3 and omega-6 fatty acid supplementation in 117 children with DCD (a disorder very closely related to ADHD). The study did not reveal any changes in motor conduct, however significant improvements in reading, spelling, and behavior were seen in the children following the 3 months of therapy.

In another study by Richardson (2006), he concluded that both theoretical and applied research seem to suggest omega-3 plays a part in childhood pervasive developmental disorders such as ADHD. Controlled studies offer a variety of outcomes, however many of these studies do not focus on the same populations and/or treatment details. The one thing that is clear at this point is that ADHD symptoms can be effectively treated in a subset of these children.

Long term studies also seem to yield promising results. For instance, in a placebo-controlled study, 75 children and adolescents (age 8-18) were given an omega-3/6 supplement for 6 months. At the study’s conclusion, Johnson et al (2009) found that fish oil cuts ADHD symptoms by nearly half, as 47% of all participants“responded with meaningful reduction of ADHD symptoms”.

Another clinical study found that omega-3 fatty acid supplementation helped to decrease physical aggression in school children with ADHD. More studies, including comparisons with drug therapies (such as stimulants), should be performed (see review article by Kidd, 2007).

Diet & Nutrition

Research findings suggest that one of the reasons children with ADHD may have low levels of essential fatty acids (including EPA and DHA) in their bodies because they are deficient in the minerals needed to convert them into a useable form (Dufault et al 2009).

Dosage

While there is certainly anecdotal evidence to support the view that omega-3 fatty acids result in a decrease of ADHD symptoms, randomized control studies have shown that a subset of ADHD children may actually benefit the most from omega-3 supplements. With that said, they can also be the most difficult to give it to! Many parents find that liquids are not ideal because their children have taste buds that are only receptive to the“yummy” food groups, and large capsules are hard to swallow.

I should note here that a high-quality liquid fish oil should never taste “fishy,” however if you have a picky-eater (and aren’t they all?!) they probably will not like it. Lots of brands will flavor the supplements with tastier flavors like lemon or strawberry to hide any off-putting flavor, but this may not be enough. Other creative delivery systems include mixing into yogurt or even oatmeal. Some brands are now also offering gummies, which are much more appealing to children (and even taste good!).

The exact fish oil dosage recommended for treatment of ADHD has not yet been established. However, researchers Sinn & Bryan (2007)found “medium to strong treatment effects of omega 3 fatty acids on symptoms of ADHD” after administering PUFAs on the order of 1 gram for three to six months.

Other researchers (Sorgi et al, 2007) at the Hallowell Center in Sudbury, MA have concluded that high concentrations of EPA/DHA may also be successful with treating ADHD symptoms. In a blind pilot study examining the effects of high-dose EPA and DHA supplementation on nine children, a psychiatrist (unaware of the supplements) noted significant improvements in behavior (inattention, hyperactivity, oppositional/defiant behavior, and conduct disorder)just after eight weeks. The initial dosage was 16.2 g/d. Scientist also noted a significant correlation between the reduction in the AA:EPA ratio and global severity of illness scores.

Other Tips

Apart from trying a more natural alternative to prescription drugs, parents of children with ADHD may find it helpful to encourage physical exertion before asking their children to endure long periods where they’ll need to remain attentive.

Additionally, the National Institutes of Health (2008) offer the following tips:

  • organized schedules for daily activities
  • traditional therapy
  • a behavioral system emphasizing positive & negative rewards
  • family time involving praise & encouragement
  • joining groups with other families who share similar situations

Adults, too, may find it easier to concentrate and focus for longer periods if they engage in moderate exercise before activities which will require full mental attention.

References

Aben A, Danckaerts M.Tijdschr Psychiatr. 2010;52(2):89-97.[PubMed]

DSM-IV-TR workgroup. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association.

Dufault, R,Schnoll, R, LeBlanc, B.,Cornett, C.,Patrick, L.,Wallinga, D.,Gilbert, S., Crider, R. Mercury exposure, nutritional deficiencies and metabolic disruptions may affect learning in children. Behavioral and Brain Functions. 2009;5:1744-9081[PubMed]

Kidd PM. Omega-3 DHA and EPA for cognition, behavior, and mood: clinical
findings and structural-functional synergies with cell membrane phospholipids.
Altern Med Rev. 2007 Sep;12(3):207-27. Review. PubMed PMID: 18072818.

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. [PubMed]

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. PubMed PMID: 15867048.

Richardson AJ. Omega-3 fatty acids in ADHD and related neurodevelopmental
disorders. Int Rev Psychiatry. 2006 Apr;18(2):155-72. Review. PubMed PMID:
16777670.

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 Apr;28(2):82-91. PubMed PMID: 17435458.

Sorgi PJ, Hallowell EM, Hutchins HL, Sears B. Effects of an open-label pilot
study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in
children with attention deficit hyperactivity disorder. Nutr J. 2007 Jul 13;6:16.
PubMed PMID: 17629918; PubMed Central PMCID: PMC1971271.

Stevens LJ, Zentall SS, Abate ML, Kuczek T, Burgess JR. Omega-3 fatty acids in
boys with behavior, learning, and health problems. Physiol Behav. 1996
Apr-May;59(4-5):915-20. PubMed PMID: 8778886.

U.S. department of health and Human Services, National Institutes of Health. 2008. NIH Publication No. 08-3572.