ADHD Attention-deficit/hyperactivity disorder: the benefits of omega-3 for children

Omega 3 for childhood: what are the benefits in attention deficit or hyperactivity disorder?

One child for every class of 25 pupils: this is the frequency of attention-deficit/hyperactivity disorder(ADHD, from Attention Deficit Hyperactivity Disorder) in the child population in Italy. Reporting the figure is the Istituto Superiore di Sanità (ISS), citing the Guidelines published in 2002 by the Italian Society of Childhood and Adolescent NeuroPsychiatry (SINPIA).

To date, the management of this syndrome is based on pharmacological treatments and specific psychological approaches. The importance of adequate support and involvement of parents and teachers is also now recognized. Less often, however, attention is paid to the potential role of nutrition, which should be taken care of to avoid nutritional deficiencies often associated precisely with ADHD.

Among the nutrients to pay attention to are Omega 3. In fact, theHS-Omega-3 Index® (an indicator of Omega 3 levels in the blood) is associated with behavioral and cognitive self-regulatory abilities, which are involved precisely in the manifestations of ADHD. Not only that, there is also an association between ADHD diagnosis and Omega 3 deficiency.

Let's find out why to ensure adequate intake of these essential fats for children and teens living with this syndrome.

Omega 3, allies of the brain 

It is worth delving first into the reasons why Omega 3s can be considered true allies in the proper functioning of the brain and nervous system. There is no shortage of evidence to support this claim, so much so that the European Food Safety Authority (the Efsa) authorized a health claim some time ago that DHA (or docosahexaenoic acid, i.e., one of the biologically active Omega 3s) contributes to the normal functioning of the brain.

The benefits in this regard begin already during gestation. That is why among the ingredients in the supplements recommended for pregnant women is DHA: during pregnancy its daily requirement increases significantly (+ 100-200 mg in addition to the 250 mg of DHA + EPA - eciosapentaenoic acid, the other biologically active Omega 3 - normally needed by a woman of childbearing age), and this increased requirement reflects the needs of the fetus, which - as certified, again, by Efsa - also uses it to develop its nervous system.

Infants also do the same. That is why DHA requirements have also increased in breastfeeding women (+ 100-200 mg per day) and, indeed, in infants (+ 100 mg per day). But the role of Omega 3 does not end with the end of breastfeeding either; in older children and teens, these polyunsaturated fats continue to be important both in ensuring good cognitive function and in terms of behavior.

• At preschool age, these polyunsaturated fats enable the brain to function at its full potential. In a randomized controlled trial published in Clinical Pediatrics in 2008 by two Omega 3 experts (Alan Ryan and Edward Nelson), results obtained in cognitive tests by 4-year-old children who had taken either 400 mg per day of DHA or a placebo for 4 months were compared with blood levels of this Omega 3. They found that higher blood concentrations of DHA corresponded to better scores on tests assessing lexical quotient, i.e., comprehension ability and vocabulary acquisition.
•  In school age, Omega 3 deficiencies are associated with antisocial behaviors.
• Duringpreadolescence andadolescence, Omega 3 intake has been associated with improved behavior. See, in this regard, the study published in the British Journal of Nutrition in 2016 by a group of researchers from the University of Oxford who had boys aged 13 to 16 years take either a placebo or a supplement containing EPA (165 mg) and DHA (116 mg) for 12 weeks and compared their behavior with that of peers who had been given a placebo for the same time.

The scientific literature suggests, therefore, that Omega 3 helps ensure the best possible brain, cognitive and behavioral development.

ADHD: what is it all about?

The fact that Omega 3 deficiencies are associated with ADHD further supports the belief that adequate intake of these nutrients is critical for adequate development and equally adequate brain function.

In fact, as mentioned, this syndrome is associated with impaired behavioral and cognitive self-regulatory abilities. As a result, those living with ADHD are dealing with levels of hyperactivity, impulsivity, and inability to pay attention that are not congruent with their age.

According to theAmerican Psychiatric Association's DSM 5 (the Diagnostic and Statistical Manual of Mental Disorders), there are 3 subtypes of ADHD: one in which attention deficit disorder prevails; one in which hyperactivity disorder prevails; and one in which the two disorders are combined.

Symptoms, which typically occur before age 12 and may persist (although more nuanced) into adulthood, include:

• Lack of attention;
• Lack of concentration;
• disorganization;
• Difficulty in completing tasks;
• forgetfulness;
• Tendency to misplace objects;
• Oppositional-provocative behaviors.

The symptomatology significantly interferes with quality of life and manifests itself in more than one context, for example, both at home and at school, or at school and during after-school activities. Underlying it are both genetic factors and an environmental component. Contributing to the latter are viral infections, smoking and alcohol consumption during pregnancy, and nutritional deficiencies.

Treating and managing ADHD: the role of Omega 3s

Pharmacological treatment is considered a real mainstay of ADHD management. The active ingredients used can be stimulants that modulate the action of dopamine (amphetamines and methylphenidate) or non-stimulants (antidepressants and alpha-agonists).

Stimulants are effective in about 70% of patients. Unfortunately, however, they are associated with the risk of addiction and other side effects (altered blood pressure, reduced appetite, lack of sleep, increased tics in sufferers) and are not without contraindications (in particular, they may not be suitable in cases of epilepsy).

Antidepressants may be a viable alternative for children who cannot tolerate stimulants. Alpha-agonists, on the other hand, are associated with several cardiovascular side effects.

The ISS stresses that "drug therapy should be undertaken only if indicated by a child neuropsychiatrist, in accordance with evidence recognized by the international community and taking into account the psychological and social aspects of the child and his or her family." Not only that, the same Institute stresses the importance of including in the treatment program "advice and support for parents and teachers, as well as specific psychological interventions."

In this framework, an adequate intake of Omega 3 in the form of dietary supplements could be a valuable support to traditional pharmacological therapies, precisely because of their importance for brain function, their link to behavioral and cognitive self-regulatory abilities, and the association between their deficiencies and ADHD.

More recent studies suggest that they may also be useful as monotherapy, but this hypothesis still needs confirmation. What experts were quick to say as early as several years ago is that "given their relatively benign side effect profile and evidence of moderate efficacy, it may be reasonable to use Omega 3 supplementation to adjunct traditional pharmacological treatments or in the case of families who refuse other psychopharmacological interventions."

The ultimate decision in this regard lies with the psychiatrist treating the patient. As for the nutritionist, however, what there seems to be little doubt about is that just as nutritional deficiencies can contribute to the genesis of this syndrome, a nutritional intervention aimed at ensuring adequate Omega 3 intake can help manage it.

If you are interested in these and other benefits of DHA and EPA during childhood, don't miss episode 5 of "Pearls of Wellness", the podcast about the world of Omega 3 produced by Omegor. It's titled "Growing Healthy" and you can listen to it here.

Bibliographical references

Bloch MH and Qawasmi A. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2011 Oct;50(10):991-1000. doi: 10.1016/j.jaac.2011.06.008

Chang JPC et al. Omega-3 Polyunsaturated Fatty Acids in Youths with Attention Deficit Hyperactivity Disorder: a Systematic Review and Meta-Analysis of Clinical Trials and Biological Studies. Neuropsychopharmacology. 2018 Feb;43(3):534-545. doi: 10.1038/npp.2017.160

National Institute of Health. EpiCenter - Epidemiology for public health. Attention deficit syndrome. https://www.epicentro.iss.it/deficit-attenzione/. Last viewed: 15/02/2023

Magnus W et al. Attention deficit hyperactivity disorder. 2022 Aug 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. PMID: 28722868

Milte CM et al. Eicosapentaenoic and docosahexaenoic acids, cognition, and behavior in children with attention-deficit/hyperactivity disorder: a randomized controlled trial. Nutrition. 2012 Jun;28(6):670-7. doi: 10.1016/j.nut.2011.12.009

Roach LA et al. Effect of Omega-3 Supplementation on Self-Regulation in Typically Developing Preschool-Aged Children: Results of the Omega Kid Pilot Study-A Randomised, Double-Blind, Placebo-Controlled Trial. Nutrients. 2021 Oct; 13(10): 3561. doi: 10.3390/nu13103561 

Ryan AS and Nelson EB. Assessing the effect of docosahexaenoic acid on cognitive functions in healthy, preschool children: a randomized, placebo-controlled, double-blind study. Clin Pediatr (Phila). 2008 May;47(4):355-62. doi: 10.1177/0009922807311730

Italian Society of Human Nutrition-SINU, 2014. LARN - Reference intake levels for the Italian population: LIPIDS

Tammam JD et al. A randomized double-blind placebo-controlled trial investigating the behavioral effects of vitamin, mineral and n-3 fatty acid supplementation in typically developing adolescent schoolchildren. Br J Nutr. 2016 Jan 28;115(2):361-73. doi: 10.1017/S0007114515004390