Potential Nutritional Treatment for ADD/ADHD

Dr. David Rabin­er’s Atten­tion Research Update drew my atten­tion to some recent research arti­cles on the poten­tial of fat­ty acid dietary sup­ple­men­ta­tion to help treat ADD/ADHD.

Stim­u­lant med­ica­tion for chil­dren with ADD/ADHD has been the pre­dom­i­nant treat­ment for years. Thus far, it has been quite suc­cess­ful, but we have yet to see the long term effects of chron­ic med­ica­tion. Giv­en that, it is worth at least inves­ti­gat­ing alter­na­tive ther­a­pies that can be used either in place of or in con­junc­tion with tra­di­tion­al phar­ma­ceu­ti­cal and behav­ioral treatment.

As one of the four pil­lars of brain health, nutri­tion has a sig­nif­i­cant impact on both phys­i­cal struc­tures in the body and behav­ior. Stud­ies sug­gest chil­dren with ADHD have low­er lev­els of both omega‑3 and omega‑6 essen­tial fat­ty acids.

Omega‑3 fat­ty acids are found main­ly in flaxseed oil, canola oil, soy­beans, wal­nuts, hemp seeds, dark green leafy veg­eta­bles, and cold-water fish (salmon, trout, sar­dines, mack­er­el, her­ring, hal­ibut, and cod). These fat­ty acids tend to be low­er in Amer­i­can diets.

Omega‑6 fat­ty acids tend to be more com­mon in Amer­i­can diets than the omega-3s. These are found in cook­ing oils includ­ing saf­flower, sun­flower, soy­bean, corn, and cot­ton­seed; meat; egg yolks; and oth­er ani­mal products.

While both types are essen­tial to a human diet, a close bal­ance between the types is impor­tant. The ratio should be in the range of 1:1 to 4:1 (in favor of omega-6s), while the typ­i­cal North Amer­i­can diet nor­mal­ly pro­vides exces­sive omega‑6 fat­ty acids in the range of 11:1 to 30:1.

Dr. Rabin­er sum­ma­rizes the results of these stud­ies look­ing at fat­ty acid sup­ple­men­ta­tion saying:

* There was lit­tle change in chil­dren’s motor skills and no indi­ca­tion that treat­ed chil­dren showed greater improve­ment than chil­dren receiv­ing placebo.

* Before treat­ment, aver­age read­ing and spelling achieve­ment scores were about 1 year below age lev­el for chil­dren in both groups. After 3 months, chil­dren receiv­ing fat­ty acid sup­ple­men­ta­tion gained an aver­age of 9.5 months in read­ing and 6.6 months in spelling. Chil­dren receiv­ing place­bo, in con­trast, gained only 3.3 months in read­ing and 1.2 months in spelling. Thus, com­pared to the place­bo group, gains made by treat­ed chil­dren were high­ly significant.

* At base­line, the aver­age score on the ADHD scale of the Con­ners was ele­vat­ed in both groups. Scores for treat­ed chil­dren showed a sig­nif­i­cant decline while scores for place­bo chil­dren were essen­tial­ly unchanged. With­in the treat­ed group, 16 chil­dren ini­tial­ly had scores on the ADHD scale in the clin­i­cal­ly ele­vat­ed range; after 3 months, 7 no longer fell in this range. Among chil­dren in the place­bo group, only 1 of 16 chil­dren showed this same improvement.

…

* ADHD symp­toms declined sig­nif­i­cant­ly in chil­dren who began receiv­ing sup­ple­men­ta­tion. Scores con­tin­ued to decline among chil­dren con­tin­u­ing on active treatment.

…

* On the one hand, par­ents who were blind to their child’s treat­ment sta­tus observed sig­nif­i­cant improve­ment in their child’s core ADHD symp­toms, as well as reduc­tions in cog­ni­tive prob­lems and oppo­si­tion­al behav­ior. By the end of 30 weeks, the mag­ni­tude of this improve­ment was sub­stan­tial, and not dis­sim­i­lar from what is often seen in med­ica­tion treat­ment stud­ies. As not­ed above, these ben­e­fits were linked to fat­ty acid sup­ple­men­ta­tion alone, as the addi­tion of a mul­ti-vit­a­min pro­vid­ed no addi­tion­al benefit.

* On the oth­er hand, how­ev­er, no com­pa­ra­ble improve­ments were evi­dent in the teacher rat­ings of chil­dren’s behav­ior. Thus, despite clear improve­ments observed by par­ents, chil­dren’s behav­ior at school did not change, at least as report­ed by their teachers.

…

* The authors note that because treat­ment with fat­ty acid sup­ple­men­ta­tion can take 8–12 weeks before any improve­ment is observed, it would not be advis­able as a stand alone treat­ment when a child’s symp­toms are espe­cial­ly severe, and where more imme­di­ate symp­to­matic relief is required.

The net con­clu­sion seems to be: inter­est­ing and promis­ing research, but not con­clu­sive­ly estab­lished at this point in time.

Ref­er­ences

• Richard­son AJ, Puri BK. A ran­dom­ized dou­ble-blind, place­bo-con­trolled study of the effects of sup­ple­men­ta­tion with high­ly unsat­u­rat­ed fat­ty acids on ADHD-relat­ed symp­toms in chil­dren with spe­cif­ic learn­ing dis­abil­i­ties. Progress in Neu­ro-Psy­chophar­ma­col­o­gy & Bio­log­i­cal Psy­chi­a­try. 2002;26:233–9.
• Richard­son AJ, Mont­gomery P. The Oxford-Durham Study: A ran­dom­ized, con­trolled tri­al of dietary sup­ple­men­ta­tion with fat­ty acids in chil­dren with devel­op­men­tal coor­di­na­tion dis­or­der. Pedi­atrics. 2005;115:1360–6.
• Sinn N, Bryan J. Effect of sup­ple­men­ta­tion with polyun­sat­u­rat­ed fat­ty acids and micronu­tri­ents on learn­ing and behav­ior prob­lems asso­ci­at­ed with child ADHD. Jour­nal of Devel­op­men­tal and Behav­ioral Pedi­atrics. 2007;28:82–91.
• Voight RG, Llorente AM, Jensen CL, Fra­ley JK, Berret­ta MC, Heird WC. A ran­dom­ized, dou­ble-blind, place­bo con­trolled tri­al of docosa­hexaenoic acid sup­ple­men­ta­tion in chil­dren with AD/HD. The Jour­nal of Pedi­atrics. 2001;139:189–96.