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Recent concern involving treatment of ADHD is the increased prevalence of stimulant medications. In 1995, 2.8% or 1.5 million U.S. youths ages 5 to 18 were receiving Ritalin (Safer et al., 1996). Alternative treatments have become increasingly popular due to the possible negative side effects of Ritalin as well as little evidence that stimulant medication will improve the long-term prognosis of ADHD (Voigt et al., 2001). Vitamin and nutritional supplements are being sold to the American public with claims of treating ADHD; however, many do not have empirical support for effectiveness of treatment. Information included on this web page will hopefully provide you with more information on the treatment and effectiveness of fatty acid supplementation and the management of ADHD.

B. Quick facts on ADHD:

Attention Deficit Hyperactive Disorder (ADHD) is the most common neurobehavioral disorder of childhood, and it is among the most prevalent chronic health conditions affecting school-aged children (Voigt et al., 2001). It is estimated to affect well over 4% of the school-age population in the United States (Richardson & Puri, 2002). Although hyperactivity was originally thought to diminish in adolescence, more recent data shows rates of 2% to 4% among adults (CHADD, 2003).

ADHD may have serious social, behavioral and psychological consequences without proper treatment. The core symptoms of ADHD include inattention, hyperactivity, and impulsivity.

II. What information will you find on the web?

The first site that came up on my search for fatty acids and ADHD was the LCP solution homepage. This site provides information about the book The LCP Solution by B. Jacqueline Stordy, Ph.D. and Malcolm J. Nicholl, which reveals a stunning new treatment, based on nutritional supplementation with LCPs (long chain polyunsaturated fatty acids). There are many links from this homepage including supplement product choices, reasons Americans are deficient in fatty acids, as well as some information on research in the field of fatty acid supplementation.

Since fatty acid supplements are thought of as alternative treatments for ADHD, I then came across a site for the ADD action group. This site was created by a non-profit organization that provides information on alternative treatments for ADHD, learning differences, dyslexia, and autism. Their web site provides many more links of information. There is a link to find more information about empirical studies, many of which I have summarized and critiqued later on this site.

If you search for “fatty acid supplements” you will come up with retail sites such as: Find Supplements Organization and Your Nutrition Shop. These sites have a variety of essential fatty acid supplements that they are trying to sell; however, they do not have much information regarding their fatty acid products and ADHD.

The link to supplements on the LCP solution site has a list of six supplements recommended by the solution. These products claim to decrease symptoms of ADHD.

To locate informative articles regarding substances, I looked at the Dietary Supplement Information Bureau. An article focusing on fatty acid supplementation can be found as a link from this page as well. This article mentions the findings of the pilot study conducted by Richardson and Puri which is later summarized and critiqued.

Palmitic acid

III. Why are fatty acids necessary for a healthy brain and body?

Essential Fatty Acids and lipids have important structural and functional roles in the central nervous system. Some EFAs cannot be synthesized in the body, so they must be provided in the diet (linoleic and linolenic acid). Early in life, fatty acids are extremely important to the neurological development of the brain. EFA deficiency in the early years of childhood may be a contributing factor to future symptoms of ADHD (Richardson & Puri, 2000).

IV. How do we know fatty acids and ADHD are even related?

A. Early studies:

Many empirical studies focus on the supplementation of fatty acids and their effect on children with ADHD-related symptoms. Researchers first hypothesized that children with hyperactivity might have deficient levels of omega-6 fatty acids because they showed greater thirst than children without hyperactive symptoms, and greater thirst is a symptom of this deficiency (Colquhoun & Bunday, 1981). This idea escalated, when in 1987, researchers found that children with lower levels of omega-6 fatty acids and hyperactivity also reported more health and learning problems than children without hyperactivity (Mitchell et al., 1987). This preliminary research led to further empirical studies involving essential fatty acids (EFA) and their association with ADHD.

B. More recent research:

A 1996 study compared the behavior, learning, and health problems in boys ages 6 to 12 with lower EFA (essential fatty acids) levels to those with higher EFA levels. Behavior problems such as temper tantrums, hyperactivity, impulsivity, anxiety, and sleep problems as well as more learning and health problems were found more often in subjects with lower EFA concentrations than those with higher EFA concentrations (Stevens et al., 1996). This study involved 100 volunteer participants from north central Indiana, so it is not a large enough subject pool to make generalizations of the entire U.S. population; however it does provide some evidence of a correlation between low EFA levels and ADHD.

C. Other evidence that fatty acids are related to ADHD:

In a review by Richardson & Puri (2000), they also found clinical features of ADHD to be consistent with fatty acid deficiency. Three of these features are listed: 1.There is a higher prevalence of ADHD in males than females, just as there is a higher vulnerability of fatty acid deficiency in males than females. 2.EFAs have an important role in regulation of sleep, and children with ADHD have a high likelihood of sleep problems. 3.Somatic complaints such as headaches and stomach-aches are reported in ADHD, and EFA deficiency is known to contribute to general health problems (Richardson & Puri, 2000)

V. Do supplements make a difference?

A. Evidence that supplements do increase the blood levels of fatty acids:

A 2001 study tested the affect of supplements on symptoms of ADHD (Voigt et al., 2001). The object of this study was to test whether 4 months of treatment of an essential fatty acid, DHA (docosahexaenoic acid which is a long-chain, polyunsaturated fatty acid), decreases the symptoms of ADHD. Sixty-three children ages 6 to 12 were assigned randomly to receive DHA or a placebo for 4 months. Tests were administered throughout the trial to monitor levels of ADHD symptoms in the participants. After the 4 month period, the participants that received the DHA had 2.6 times more fatty acid content in their body than those who received the placebo. A possible reason for a lack of change in ADHD symptoms could be the low dosage and short length of the trial. The discussion section of this article does suggest that future research focus on supplementation with other EFAs, DHA supplementation earlier in life as a preventative of ADHD, and a higher dose or longer period of DHA supplementation.

B. Decrease in symptoms of ADHD:

Richardson and Puri (2002) completed a study on Highly Unsaturated Fatty Acid (HUFA) supplementation. The 41 participants aged 8 to 12 went to a special school for literacy problems. These participants were not diagnosed with ADHD prior to the study; however, they did have high ratings for ADHD-related symptoms and dyslexia (these disorders are highly likely to occur together in children). The children were tested on a variety of scales at baseline, or the beginning of the study, and after the 12 weeks of supplementation or placebo. For this study, one group of children received the HUFA supplement while the placebo group received olive oil. This study found that HUFA supplementation was found to be significantly better than placebo in reducing many ADHD symptoms. This study did test a smaller sample size and focused on a population of children with learning disabilities, but it does show some empirical evidence of fatty acids helping with management of ADHD.

C. A review of other studies on the management of ADHD:

Consistant findings of both biochemical and clinical signs of fatty acid deficiency in at least a portion of children with ADHD indicates that supplementation with fatty acids might be helpful in the management in some cases of ADHD. Richardson and Puri (2000) reviewed 9 studies in determining if fatty acid supplements are helpful in ADHD management. They found two studies on triglyceride GLA supplementation (a type of fatty acid) that reported only modest benefits over placebo. These researchers suggest that this minor difference between supplementation and placebo may be due to the treatment duration needing to be longer for an effect. Richardson and Puri (2000) did however review the results of 2 Purdue studies as well. The first of these two studies involved a supplementation of a combination of fatty acids. This study successfully changed the blood fatty acid profile in the group that received supplementation and showed a decrease in ADHD symptoms. The second Purdue trial used a purely DHA supplementation instead of a combination, and this supplementation was ineffective.

VI. What do I conclude?

Even though more evidence is needed to determine the recommended dose and exact supplement combination, there is little evidence of negative effects of fatty acid supplementation. After reviewing the evidence in favor of the possibilities of decreased ADHD symptoms, I suggest considering the possibility of trying a fatty acid treatment with the permission of a primary care physician. Clinicians and teachers are preparing to recommend dietary supplementation of fatty acids for ADHD management, and there should be many advances in this area in the next few years.

VII. Resources:

Attention Deficit Disorder Action Group. Retrieved on September 18, 2003

from the World Wide Web http://www.addgroup.org

Children and Adults with Attention Deficit/Hyperactive Disorder (CHADD).

Retrieved September 23, 2003 from the World Wide Web. http://www.chadd.org

Colquhoun, I. & Bunday, S. (1981). A lack of essential fatty acids as a

Possible cause of hyperactivity in children. Medical Hypotheses, 7,

673-379.

Dietary Supplement Information Bureau. Retrieved September 20, 2003

From the World Wide Web. http://www.supplementinfo.org

Find Supplements.org. Retrieved September 20, 2003 from the World Wide

Web. http://www.findsupplements.com/Nutrients/Nutrients.htm

LCP Solution Homepage. Retrieved September 15, 2003 from the World

Wide Web. http://www.lcpsolution.com

Mitchell, E. A., Aman, M. G., Trubott, S. H., & Manku, M. (1987). Clinical

Characteristics and serum essential fatty acid levels in hyperactive

Children. Clinical Pediatrics, 26, 406-411.

Richardson, A.J. & Puri, B.K. (2002). 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 difficulties. Progress in Neuro-Psychopharmacology

& Biological Psychiatry, 26, 233-239. http://www.sciencedirect.com/science?_ob=MImg&_imagekey=B6TBR-44PC749-16-3&_cdi=5149&_orig=search&_coverDate=02%2F28%2F2002&_qd=1&_sk=999739997&view=c&wchp=dGLbVlz-zSkWW&_acct=C000006878&_version=1&_userid=86629&md5=502cdf148dc89f885f61f73654bc506d&ie=f.pdf

Richardson, A.J. & Puri, B.K. (2000). The potential role of fatty acids in

Attention-deficit/hyperactivity disorder. Prostaglandins,

Leukotrienes and Essential Fatty Acids, Harcourt Publishers Ltd.

79-87.

Safer, D.J., Zito, J.M., and Fine, E.M. (1996). Increasing methylphenidate

Usage for attention deficit disorder in the 1900s. Pediatrics, 98,6,

1084-1088.

Stevens, L.J., Zentall, S.S., Abate, M.L., Kuczek, T., & Burgess, J.R. (1996).

Omega-3 fatty acids in boys with behavior, learning, and health

Problems. Physiology & Behavior, 59, 915-920.

Voigt, R.G., Llorente, A.M., Jensen, C.L., Fraley, J.K., Berretta, M.C., Heird,

W.C. (2001). A randomized, double blind, placebo-controlled trial of

Docosahexaenoic acid supplementation in children with attention-

Deficit/hyperactivity disorder. The Journal of Pediatrics, 139 (2),

189-196.

Your Nutrition Shop. Retrieved September 23, 2003 from the World Wide

Web. http://www.yournutritionshop.com/Supplement_Type/essential_fats_m.htm

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