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Evidence summaries

Polyunsaturated Fatty Acids (Pufa) for ADHD in Children and Adolescents

There is insufficient evidence on the effect of polyunsaturated fatty acids (PUFA) for ADHD in children and adolescents. Level of evidence: "D"

The quality of evidence is downgraded by study limitations (unclear allocation concealment and selective outcome reporting), by inconsistency (unexplained variability in results), and by indirectness (lack of long-term studies).

Summary

A Cochrane review [Abstract] 1 included 13 studies with a total of 1 011 subjects. Eight of the included trials had a parallel design: 5 compared an omega-3 PUFA supplement to placebo; 2 compared a combined omega-3 and omega-6 supplement to placebo, and one compared an omega-3 PUFA to a dietary supplement. Five of the included trials had a cross-over design: 2 compared combined omega-3/6 PUFA to placebo; 2 compared omega-6 PUFA with placebo; 1 compared omega-3 to omega-6 PUFA, and one compared omega-6 PUFA to dexamphetamine. Supplements were given for a period of between 4 and 16 weeks.

There was a significantly higher likelihood of improvement in the group receiving omega-3/6 PUFA compared to placebo (RR 2.19, 95% CI 1.04 to 4.62; 2 studies, n=97). However, there were no statistically significant differences in parent-rated ADHD symptoms (SMD -0.17, 95% CI -0.38 to 0.03; 5 studies, n=413); inattention (SMD -0.04, 95% CI -0.29 to 0.21; 6 studies, n=469) or hyperactivity/impulsivity (SMD -0.04, 95% CI -0.25 to 0.16; 5 studies, n=416) when all participants receiving PUFA supplements were compared to those receiving placebo.There were no statistically significant differences in teacher ratings of overall ADHD symptoms (SMD 0.05, 95% CI -0.18 to 0.27; 4 studies, n=324); inattention (SMD 0.26, 95% CI -0.22 to 0.74; 3 studies, n=260) or hyperactivity/impulsivity (SMD 0.10, 95% CI -0.16 to 0.35; 3 studies, n=259).There were also no differences between groups in behaviour, side effects or loss to follow-up.

Clinical comments

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