Supplementation with polyunsaturated fatty acids (PUFAs) in the management of attention deficit hyperactivity disorder (ADHD)

Abstract

While pharmacotherapy and psychosocial interventions are recommended as the primary frontline treatment for attention deficit hyperactivity disorder (ADHD), alternative approaches to managing ADHD are becoming increasingly popular among patients and their families. Supplementation with polyunsaturated fatty acids (PUFAs) is an example of this. PUFA supplementation is not recommended by guidelines for managing ADHD; however, patients may still decide to use it. To provide direction to healthcare professionals (HCPs) managing ADHD, eight international experts in the field of adult and child ADHD came together for the Continuum Education Board: Omega Supplements in ADHD meeting. This commentary summarises the panel's consensus that current evidence suggests PUFA supplementation has a small beneficial effect on behaviour in children with ADHD, and that further high-quality research is needed to clearly evaluate and define its role in the management of ADHD of children, adolescents and adults. The panel concluded that in cases where patients use PUFA supplementation, HCPs should be comfortable explaining the potential gains that they may have and their possible side effects. The panel also concluded HCPs should not reinforce the idea that PUFA supplementation should replace treatment approaches with a more robust evidence base for managing ADHD.

Efficacy and Safety of Polyunsaturated Fatty Acids Supplementation in the Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents: A Systematic Review and Meta-Analysis of Clinical Trials

“…Our findings displaying an inadequate effect of PUFA in the treatment of ADHD is in line with many previous reviews on the subject [ 57 , 61 , 62 , 63 , 64 , 65 ], but not all [ 66 , 67 , 68 , 69 ].…”

High-dose eicosapentaenoic acid (EPA) improves attention and vigilance in children and adolescents with attention deficit hyperactivity disorder (ADHD) and low endogenous EPA levels

“…In conclusion, our study shows some benefits of EPA monotherapy on cognitive symptoms of ADHD. As amply discussed, it is possible that a combined EPA + DHA strategy might have been more beneficial, and as such we support the recent recommendation by a panel of ADHD experts that patients who prefer omega-3 supplements over stimulants should take a combination of DHA and EPA at doses ≥750 mg per day for at least 12 weeks 50 . However, we additionally recommend that this strategy should be even more strongly advocated for children with evidence of low endogenous PUFAs levels, as indicated by direct measurement, dietary habits or symptoms of EFA deficiency.…”

Omega-3 Supplementation for Children with Learning Difficulties and Attention Deficit Disorder: Is it Beneficial?

“…In a recent report of the "Omega Supplements in ADHD" Education Board meeting, eight international experts in the field of adult and child ADHD concluded that PUFA supplementation, in particular omega-3 PUFAs, may produce small but statistically significant reductions in ADHD symptoms while having a tolerable safety. 28 It should be noted that among the experts were few who already published evidence that PUFAs may improve behavior in ADHD. The experts noted that "the variation in results from the meta-analyses conducted, however, highlights the need for caution when interpreting studies."…”