EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors

Abstract

This pilot study evaluated the effects of supplementation with PUFA on blood FA composition and behavior in children with Attention-Deficit/Hyperactivity Disorder (AD/HD)-like symptoms also reporting thirst and skin problems. Fifty children were randomized to treatment groups receiving either a PUFA supplement providing a daily dose of 480 mg DHA, 80 mg EPA, 40 mg arachidonic acid (AA), 96 mg GLA, and 24 mg alpha-tocopheryl acetate, or an olive oil placebo for 4 mon of double-blind parallel treatment. Supplementation with the PUFA led to a substantial increase in the proportions of EPA, DHA, and alpha-tocopherol in the plasma phospholipids and red blood cell (RBC) total lipids, but an increase was noted in the plasma phospholipid proportions of 18:3n-3 with olive oil as well. Significant improvements in multiple outcomes (as rated by parents) were noted in both groups, but a clear benefit from PUFA supplementation for all behaviors characteristic of AD/HD was not observed. For most outcomes, improvement of the PUFA group was consistently nominally better than that of the olive oil group; but the treatment difference was significant, by secondary intent-to-treat analysis, on only 2 out of 16 outcome measures: conduct problems rated by parents (-42.7 vs. -9.9%, n = 47, P = 0.05), and attention symptoms rated by teachers (-14.8 vs. +3.4%, n = 47, P = 0.03). PUFA supplementation led to a greater number of participants showing improvement in oppositional defiant behavior from a clinical to a nonclinical range compared with olive oil supplementation (8 out of 12 vs. 3 out of 11, n = 33, P = 0.02). Also, significant correlations were observed when comparing the magnitude of change between increasing proportions of EPA in the RBC and decreasing disruptive behavior as assessed by the Abbreviated Symptom Questionnaire (ASQ) for parents (r = -0.38, n = 31, P < 0.05), and for EPA and DHA in the RBC and the teachers' Disruptive Behavior Disorders (DBD) Rating Scale for Attention (r = -0.49, n = 24, P < 0.05). Interestingly, significant correlations were observed between the magnitude of increase in alpha-tocopherol concentrations in the RBC and a decrease in scores for all four subscales of the teachers' DBD (Hyperactivity, r = -0.45; Attention, r= -0.60; Conduct, r = -0.41; Oppositional/Defiant Disorder, r = -0.54; n = 24, P < 0.05) as well as the ASQ for teachers (r = -0.51, n = 24, P < 0.05). Thus, the results of this pilot study suggest the need for further research with both n-3 FA and vitamin E in children with behavioral disorders.

The Oxford‐Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental co‐ordination disorder

“…The improvements in literacy skills and behavior found here are consistent with other reports of benefits from fatty acid supplementation among children selected for dyslexia or ADHD, 5,6 but it is noteworthy that no group effect of treatment on motor skills was apparent. The similarity in the effect sizes for ADHD-related symptoms between this DCD sample and one selected with standard criteria for dyslexia 5 suggests that these results may be more widely generalizable.…”

“…An -3/-6 ratio of 4:1 was selected for this study on the basis of previous work indicating benefits in dyslexia and ADHD, 5,6 although in this case the marine oil contained a higher eicosapentaenoic acid/docosahexaenoic acid ratio. Additional studies are needed to establish both the optimal composition of fatty acid treatments and dose-response relationships.…”

“…The active treatment was a supplement containing 80% fish oil and 20% evening primrose oil (a ratio similar to that used in previous studies) 5,6 in gelatin capsules. The daily dose of 6 capsules provided -3 fatty acids (558 mg of eicosapentaenoic acid and 174 mg of docosahexaenoic acid) and the -6 fatty acid ␥-linoleic acid (60 mg) plus 9.6 mg of vitamin E (natural form, ␣-tocopherol).…”

“…3 Although this suggests that dietary supplementation with -3 fatty acids may be of benefit in these conditions, results from the few small, randomized, controlled trials published to date have been mixed. 4 Some benefits from -3/-6 supplementation were reported for children with dyslexia or ADHD, 5,6 whereas 2 studies found no benefits for ADHD with the -3 fatty acid docosahexaenoic acid alone. 7,8 No randomized, controlled trials of fatty acid treatment for either autism or DCD/dyspraxia have yet been reported, although one small open study suggested possible benefits for dyspraxic children.…”

Impaired Social Interaction in Autism Spectrum Disorders

“…Therefore, it is clear that supplements containing antioxidants that are related to lipid peroxidation may be beneficial for individuals with ASD [7]. Previous double-blind randomized placebo-controlled studies have helped to validate the efficacy of DHA or eicosapentaenoic Acid (EPA) plus small doses of ARA (42 or 40 mg/day) in reducing behavioral problems in Attention-Deficit/Hyperactive Disorders (AD/HD) [8] and learning difficulties (LD) [9]. However, there are few studies that have examined the effects of larger doses of ARA added to DHA on the core behavioral and social impairments of ASD with double-blind, randomized, placebo-controlled designs.…”