ADHD and Essential Fatty Acids

It is estimated that 2 percent or more of children in Canada have symptoms that would lead them to be diagnosed with attention deficit hyperactivity disorder (ADHD), a behavioural disorder marked by impulsivity, hyperactivity, and/or inattentiveness. Essential fatty acids may be beneficial as natural interventions for ADHD.

ADHD treatment

Children with ADHD often have difficulties in school as well as in social situations, and the diagnosis can cause significant challenges for both children and their families. As awareness of this diagnosis has increased, more support has become available and more research into potential treatments has been funded. Despite increased awareness, first line treatment options for ADHD have not changed considerably in recent years, as stimulant medications remain at the top of the list of treatments offered.

Canada is one of the top countries in the world for the prescription of stimulant medications for the treatment of ADHD, and there has been an upward trend in the prescription of these medications in recent years.

Although these medications can provide relief of ADHD symptoms in many cases, many people are questioning the number of prescriptions being written. Many also have concerns about the long-term benefit and safety of using these medications. Still others, particularly many parents of children with ADHD, want to know what alternatives to medication exist and what natural interventions may be helpful either on their own, or in addition to more standard ADHD treatments.

Essential fatty acids

In the search for natural interventions, much interest has been focused on the use of essential fatty acids (EFAs). Of most interest have been docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), two types of omega-3 fatty acids with important jobs to do in our bodies. These healthy fats are particularly important for the developing brain, both in the womb and throughout childhood. As a result, much interest and research has been focused on investigating the potential role of the EFAs in ADHD and other behavioural disorders.

So far, results from these studies have been mixed. What has been consistently shown is that the use of EFAs is thought to be safe and without significant side effects, features which make them worth considering in the eyes of many parents and natural health care practitioners.

Recent research on EFAs for ADHD

Teacher-rated improvements

One study that showed beneficial effects of EFA supplementation documented positive effects on Conner’s Parent/Teacher Rating Scales when 500 mg of EPA was used for a period of 15 weeks.

The Conner’s scales are used to help evaluate ADHD symptoms. There are scales for both teachers and parents, and in each case a series of questions is answered, which helps to rate a child’s ADHD symptoms. In studies of potential ADHD treatments, administering the Conner’s scales before and after an intervention is often one of the measures used to evaluate if the treatment has had any effect.

In this case, EPA supplementation was associated with improved teacher-rated measures of inattention. In 48 percent of children who were “oppositional” (those who displayed behaviour such as frequent arguing, defiance, or refusal to comply with adult requests or rules) EPA treatment was associated with at least a 25 percent improvement in the total score on the Conner’s scale for teachers.

The authors of the study also measured blood and cell levels of fatty acids. Children who appeared to respond positively to EPA treatment were more likely to be those who had lower blood cell concentrations of EPA in measurements at the beginning of the study, before the intervention.

Parent-rated improvements

A more recent study showed other encouraging results: 90 children with a diagnosis of ADHD received either an EPA-rich supplement, a DHA-rich supplement, or placebo pills for four months. Blood cell fatty acids were measured, as well as parent-rated behaviour, reading, and learning.

After four months of treatment, increases in blood cell levels of DHA were associated with improved reading, spelling, restlessness, and oppositional behaviour in those children who had learning difficulties. Increases in EPA were associated with improvements in shyness and anxiety as assessed by parents.

A 2007 study also showed improvements in parent-rated ADHD symptoms when children ages seven to 12 supplemented with EFAs for a period of 15 weeks, with parents noting improvements in inattention, hyperactivity, and impulsive behaviour.

Although improvements demonstrated in these studies may be small, they are encouraging. The safety and multiple requirements by the body for EFAs, and particularly the omega-3 fatty acids DHA and EPA, make them worth considering for children with ADHD.

Children with ADHD may have higher EFA needs

Essential fatty acids may be especially important for these children because of a difference in the way their bodies appear to metabolize these vital fats. Children with ADHD have been shown repeatedly to have measurable differences in cell levels of omega-3 fatty acids compared to non-ADHD children. Although it is often speculated that this could be the result of decreased omega-3 intake compared to children without ADHD symptoms, the explanation looks to be more complicated than that.

At least one research study has shown that although diets may differ between adolescents with ADHD and others (as adolescents with ADHD in the study ate more calories and fats), their intake of essential fatty acids is similar. However, despite a similar intake in omega-3s, the adolescents with ADHD were more likely to have low blood levels of total omega-3s and of DHA in particular. This suggests that these teens might metabolize fats differently and/or may have an increased need for certain fats compared to those without ADHD.

Simply put, something about kids with ADHD could be making them burn through their EFAs more quickly. This in turn would increase their need for EFAs in order to maintain proper cell and tissue functions.

Obtaining sufficient EFAs

So how can interested parents increase their children’s intake of EFAs? The main source of the omega-3 fatty acids DHA and EPA are fish oils. Algae-sourced DHA is now available as well, for those who prefer to avoid fish.

Increased intake of fish in the diet can be helpful, but to get the very high doses used in the studies discussed above, use of supplements is usually required as well. Always consult a health care practitioner first, especially when giving a child high doses of essential fatty acids. Fish oil products for children are available in a variety of tasty flavours, so parents can more easily boost their children’s intake.

What about GLA?

A 2010 study suggests that some children and adolescents with ADHD may receive effective relief of symptoms when combining omega-3 fatty acids EPA and DHA with the omega-6 fatty acid gamma-linolenic acid (GLA). According to the study these three compounds in specific combination were found to achieve improvements in reading, writing, aggression, and anxious behaviour.

Get a good night’s sleep

Children with ADHD are more likely to have sleep problems than those without ADHD. Following these tips may make it easier for your child to fall asleep—and stay asleep.

• Keep a consistent schedule and bedtime routine.
• Encourage your child to get plenty of exercise during the day.
• Manage your child’s sleep environment by keeping the bedroom cool and removing or reducing possible distractions, such as noise.
• Eliminate any caffeinated foods or beverages from your child’s diet.
• If your child is taking conventional medications for ADHD, consult with your health care practitioner about changing the timing of these medications, as they may interfere with sleep.