One in five children worldwide suffer from ADHD. Attention deficit hyperactivity disorder is a neurodevelopmental disorder that affects behaviour and can be characterised by excessive impulsivity, hyperactivity and difficulty maintaining attention. Dr Maite Ferrin, child and adolescent psychiatrist in London, tells us how ADHD is currently treated and about the role of omega-3 in the management of ADHD.
Lately, there has been an increasing amount of evidence surfacing that omega-3 can improve numerous medical and psychiatric conditions like ADHD. Although the gold standard of treatment for ADHD is to use a psychosocial and pharmacological approach, the potential of omega-3 supplementation is attractive.
This is because omega-3 supplements are highly tolerable and relatively safe to use, especially for children where the use of medication raises some concerns.
How is ADHD primarily treated?
The standard approach to the treatment of ADHD is education, psychotherapy and medication.
- Psychoeducation: this is recommended for all children and young adults over the age of five and involves one-one sessions if group settings are unavailable or if the patient is a more complex case. Psychoeducation for parents of children with ADHD is also highly recommended by NICE guidelines as a first approach.
- Psychotherapy: if the child is between the age of five and 18 with moderate ADHD, psychotherapy such as cognitive behavioural therapy (CBT) and coaching or mentoring can help with social skills, self-control, listening skills and expressing emotions.
- Pharmacological treatment: in children over the age of five, medication is sometimes needed if ADHD symptoms are persistent and have a moderate to significant impact in at least one area of their life. The type of medication will depend on factors such as patient age and coexisting conditions.
One-third of children with ADHD don’t respond well to pharmacological treatments, so the idea that omega-3 supplementation can improve the symptoms of ADHD and cognitive performance is exciting news.
The role of omega-3
Although omega-3 supplementation is not among the NICE guidelines for the treatment of ADHD, research shows that it can significantly improve ADHD symptoms and that it is both safe and tolerable for children.
Researchers at King’s College London’s Institute of Psychiatry, Psychology and Neuroscience have found that fish oil supplements, omega-3 polyunsaturated fatty acids (PUFAs) improve inattention, hyperactivity and behavioural and cognitive symptoms in children and young adults with ADHD.
A study by Bloch et al in 2011 found a small, yet significant improvement in ADHD symptoms such as inattentiveness and hyperactivity compared with a placebo. Other studies by Sonuga-Barke et al in 2013 and by Stevenson et al in 2014, where Dr Ferrin has been co-author have shown that omega-3 supplements may help reduce impulsivity, hyperactivity and inattention.
A recent review on the potential benefits of Omega 3 for ADHD has been published by Dr Ferrin and her colleagues in (Supplementation with polyunsaturated fatty acids (PUFAs) in the management of attention deficit hyperactivity disorder (ADHD). Nutr Health. 2018 Jan. doi: 10.1177/02601060187721700).
How does omega-3 help symptoms of ADHD?
Studies have found that some people with ADHD have low blood and plasma levels of omega-3 polyunsaturated fatty acids. The study carried out at King’s College found that children and adolescents with ADHD have lower levels of endogenous omega-3 fatty acids, DHA and EPA in comparison to other young children and adults.
A deficiency can affect the functioning and development of the brain. Omega-3 supplements have anti-inflammatory properties and can help to protect brain cells.
Omega-3 supplementation and a diet rich in sources of omega-3 can possibly:
- Increase serotonin and dopamine in the brain, which can alter neurotransmission and help cells to survive
- Reduce oxidative stress
- Reduce inflammation in the brain. DHA and EPA are important to reduce inflammation
By reducing inflammation and protecting brain cells, supplementing with omega-3 can improve cognitive functioning and reduce symptoms of ADHD.
What about side effects?
Research suggests that there are no severe side effects of polyunsaturated fatty acids (PUFAs). Occasionally stomach discomfort, nausea and diarrhoea might be experienced.
More studies are needed to know how omega-3 can be used alongside the gold-standard approach to treat ADHD.
Your doctor can decide to use omega-3 in combination with other approaches, but not instead of current methods of treatment. If your doctor decides on supplementing with omega-3 alongside ADHD treatment, supplements should not be taken with food, to lower the risk of dyspepsia. Supplements should also contain vitamin E and have a lower omega 6/3 ratio. It’s advised to take at least 750mg of combined EPA and DHA for at least 12 weeks to know how effective supplementation is.