Attention Deficit Hyperactivity Disorder (ADHD) is by far one of the most pervasive neurodevelopmental disorders worldwide. It is characterized by age-inappropriate symptoms of inattention, hyperactivity (also as in disorganization) and impulsivity. It is thought to affect approximately 6-13% of all children, across cultures, and has an estimated 4:1 higher prevalence in males than females [1, 2]. The term neurodevelopment describes a series of sensitive processes which are both complex and closely interwoven with a number of simultaneous developments such as neuronal migration, neurogenesis, synaptogenesis and myelination, all of which implicate the role of omega-3 highly unsaturated fatty acids (HUFAs).
The process of neural development is mediated by a multitude of factors including genetic and metabolic diseases, immune disorders, infectious diseases, deprivation, physical trauma, toxicity and environmental influences and undoubtedly nutritional factors. Any interruption as a result of any of these factors may result in adverse neurodevelopmental outcomes.
ADHD is highly heritable within families with an estimated 3-5 times greater risk in first-degree relations. So, what this means is if you are a parent with ADHD you will have a better than 50% chance of having a child with ADHD. Similarly, about 25% of children with ADHD have parents who meet the formal diagnostic criteria for ADHD.
ADHD often co-occurs with other behavioral or learning differences such as dyslexia, oppositional defiant disorder and autistic spectrum disorders. There are 3 recognized sub-types: (1) the predominantly inattentive (ADD), (2) the hyperactive-impulsive and (3) the combined. Symptoms are present before the age of 12, commonly manifest around the age of 5-6 years but can be observable in children as young as 2 years.
In regards to the hyperactive-impulsive subtype, characteristic behaviors include an inability to sit still for any period of time, for example on a mat for story time at nursery, fidgeting, tapping, squirming and general restless behavior in particular in a classroom environment. Children with ADHD have immense difficulty following instructions, are prone to talking excessively and make frequent and repetitive interruptions during the conversations of others. In addition, they seem unable to play quietly, are constantly on the go – as if driven by a motor – and can be highly impulsive.
The inattentive subtype can be described metaphorically as the child with their head in the clouds. These children seemingly have an inability to pay close attention to detail unless it is something of immense personal interest. They often make careless mistakes, fail to complete school and homework, struggle to pay attention for any length of time and appear not to be listening even when spoken to directly. Additionally, children with ADD often fail to complete chores around the home and are prone to wondering off, easily distracted. They frequently lose everyday items necessary for everyday functioning, are often messy and disorganized, and have little or no concept of time. This general absent-minded behavior can be utterly debilitating and often lead to chaos in the young person’s life .
Children for whom ADHD is not identified, diagnosed or-managed have an even greater risk of adverse outcomes including educational failure, substance misuse and the development of conduct disorder-related and anti-social related behaviors . The calculated cost of ADHD to society and healthcare systems is substantial in the region of tens of billions of U.S. dollars per annum .
According to the National Institute for Clinical Excellence (2008), the first stage of intervention for school children are group-based education programs and parent-training sessions (NICE, 2008). Drug treatment is meant to be reserved for those young people with more severe symptoms and impairment, or those with moderate severity who have declined other non-drug treatments or have not responded sufficiently to group psychological treatment or parent-training/education programs (NICE, 2008). However, for many reasons, parents often seek natural alternatives and a much debated area of research is the potential role of omega-3 in ADHD .
Omega-3 HUFAs play a critical role throughout the central nervous system and docosahexaenoic acid (DHA) is particularly abundant in neuronal membranes. These fats are involved in complex and varied functions including but not restricted to cell-signaling (e.g., 75% of the myelin sheath coating neurotransmitters is made up of these specialized fats), gene expression and regulation of serotonin and dopamine. DHA is thought to specifically increase neuronal responses by enhancing the flexibility of cell membranes. Several randomized clinical trials have found that supplementation with omega-3 fats can help improve symptoms of ADHD in children [6-8]. Our research team in the Section of Nutritional Neurosciences at the National Institutes of Health are about to test the potential role of omega-3 in reducing clinical symptoms of ADD/ADHD in adults, for further information please visit clinical trials.gov: http://clinicaltrials.gov/show/NCT02156089
DISCALIMER: In no way or form does the content of this article represent any policy or position of the US Federal Government. All material is referenced to its appropriate source or is solely the opinion of the author.
References J. Biederman, S.V. Faraone, Attention-deficit hyperactivity disorder, The Lancet, 366 (2005) 237-248.  R.V. Gow, J.R. Hibbeln, Omega-3 Fatty Acid and Nutrient Deficits in Adverse Neurodevelopment and Childhood Behaviors, Child and adolescent psychiatric clinics of North America, 23 (2014) 555-590.  S. Effat, N. Mohamed, H. Hussein, H. Azzam, A. Gouda, H. Hassan, 670 – ADHD symptoms: relation to omega 3 serum levels before and after supplementation, European Psychiatry, 28, Supplement 1 (2013) 1.  W.E. Pelham, E.M. Foster, J.A. Robb, The economic impact of attention-deficit/hyperactivity disorder in children and adolescents, Ambul Pediatr, 7 (2007) 121-131.  N. Parletta, C.M. Milte, B.J. Meyer, Nutritional modulation of cognitive function and mental health, J Nutr Biochem, 24 (2013) 725-743.  M.H. Bloch, A. Qawasmi, 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, 50 (2011) 991-1000.  A.J. Richardson, J.R. Burton, R.P. Sewell, T.F. Spreckelsen, P. Montgomery, Docosahexaenoic acid for reading, cognition and behavior in children aged 7-9 years: a randomized, controlled trial (the DOLAB Study), PloS one, 7 (2012) e43909.  A.J. Richardson, P. Montgomery, The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder, Pediatrics, 115 (2005) 1360-1366.