ADHD Attention Deficit Hyperactivity Disorder: The Benefits of Omega-3 for Kids

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

One child per class of 25 students: this is the frequency of attention deficit/hyperactivity disorder (ADHD, from English Attention Deficit Hyperactivity Disorder) in the child population in Italy. The data is reported by the Higher Institute of Health (ISS), citing the Guidelines published in 2002 by the Italian Society of Child and Adolescent Neuropsychiatry (SINPIA).

To date, 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 now recognized. Less often, attention is paid to the potential role of nutrition, which should be managed to avoid nutritional deficiencies often associated precisely with ADHD.

Among the nutrients to pay attention to are Omega 3. Indeed, the HS-Omega-3 Index® (an indicator of Omega 3 levels in the blood) is associated with behavioral and cognitive self-regulation abilities, precisely involved in the manifestations of ADHD. Moreover, there is also an association between ADHD diagnosis and Omega 3 deficiency.

Let us discover why ensuring an adequate intake of these essential fats is important for children and adolescents living with this syndrome.

Omega 3, allies of the brain 

It is worth first deepening the reasons why Omega 3 can be considered true allies of the proper functioning of the brain and nervous system. The evidence supporting this statement is not lacking, so much so that the European Food Safety Authority (EFSA) authorized some time ago the health claim that DHA (or docosahexaenoic acid, one of the biologically active Omega 3s) contributes to normal brain function.

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

Infants do the same. That is why the DHA requirement also increases in breastfeeding women (+100-200 mg per day) and, precisely, in infants (+100 mg per day). But the role of Omega 3 does not end even with the end of breastfeeding; in older children and adolescents, these polyunsaturated fats continue to be important both to guarantee good cognitive functions and in terms of behavior.

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

Scientific literature therefore suggests that Omega 3 contribute to ensuring the best possible brain, cognitive, and behavioral development.

ADHD: what is it?

The fact that Omega 3 deficiencies are associated with ADHD further supports the belief that an adequate supply of these nutrients is fundamental for proper development and equally adequate brain functionality.

Indeed, as mentioned, this syndrome is associated with alteration of behavioral and cognitive self-regulation abilities. Consequently, those living with ADHD deal with levels of hyperactivity, impulsivity, and inattention inappropriate for their age.

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

The symptoms, which generally manifest before age 12 and may persist (though milder) into adulthood, include:

• lack of attention;
• lack of concentration;
• disorganization;
• difficulty completing tasks;
• forgetfulness;
• tendency to lose objects;
• oppositional-defiant behaviors.

The symptoms significantly interfere with quality of life and manifest in more than one context, for example at home and school, or school and after-school activities. Their basis includes 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 3

Pharmacological treatment is considered a true pillar in managing ADHD. The active ingredients used can be stimulants that modulate dopamine action (amphetamines and methylphenidate) or non-stimulants (antidepressants and alpha-agonists).

Stimulants are effective in about 70% of patients. Unfortunately, however, they are associated with risks of addiction and other side effects (blood pressure alteration, appetite reduction, insomnia, increase of tics in those affected) and are not free from contraindications (in particular, they may not be suitable in cases of epilepsy).

Antidepressants may represent a valid alternative for children who do not tolerate stimulants. Alpha-agonists, instead, are associated with various cardiovascular side effects.

The ISS emphasizes that «drug therapy should only be undertaken 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 their family». Moreover, 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 context, adequate intake of Omega 3 in the form of dietary supplements could represent valid support to traditional pharmacological therapies, precisely because of their importance for brain functionality, their link with behavioral and cognitive self-regulation abilities, and the association between their deficiencies and ADHD.

Recent studies suggest they may also be useful as monotherapy, but this hypothesis still needs confirmation. Experts already stated several years ago that «given their relatively benign side effect profile and moderate efficacy evidence, it may be reasonable to use Omega 3 supplementation to support traditional pharmacological treatments or in families that refuse other psychopharmacological interventions».

The final decision, in this regard, lies with the psychiatrist caring for the patient. Regarding the nutritionist, what seems certain is that just as nutritional deficiencies can contribute to the genesis of this syndrome, a targeted nutritional intervention ensuring adequate Omega 3 intake can help manage it.

If you are interested in these and other benefits of DHA and EPA during childhood, do not miss episode 5 of “Pearls of Wellness”, the podcast on the world of Omega 3 produced by Omegor. It is entitled “Growing Healthy” and you can listen to it here.

Bibliographic 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

Istituto Superiore di Sanità. EpiCentro - L'epidemiologia per la sanità pubblica. Sindrome da deficit di attenzione. https://www.epicentro.iss.it/deficit-attenzione/. Ultima visualizzazione: 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

Società Italiana di Nutrizione Umana-SINU, 2014. LARN – Livelli di assunzione di riferimento per la popolazione italiana: LIPIDI

Tammam JD et al. A randomised double-blind placebo-controlled trial investigating the behavioural 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