EPA [fish oil] supplementation improves teacher rated behavior and oppositional symptoms in children with ADHD – Source: Acta Paediatrica, May 19, 2010

Aim: Measure efficacy of EPA in children with ADHD. [Note: EPA is eicosapentaenoic acid – an omega-3 essential fatty acid derived from oily fish or fish oil (or for nursing infants, breast milk). Physiologically it is required in high levels in the brain and is essential for optimal neuronal functioning.]

Methods: Randomized controlled trial of 0.5g EPA or placebo (15 weeks) in 92 children (7-12 years) with ADHD. Efficacy measure was Conners’ Parent/Teacher Rating Scales (CPRS/CTRS).

Fatty acids were analyzed in serum phospholipids and red blood cell membranes (RBC) at baseline and endpoint with gas chromatography.


• EPA improved CTRS inattention/cognitive subscale (p = 0.04), but not Conners’ total score.

• In oppositional children (n = 48) CTRS total score improved 25% or more in 48% of the children receiving EPA vs. 9% for placebo (ES 0.63, p = 0.01). [Note: oppositional children may express defiance and anger along with attention/hyperactivity problems.]

• In less hyperactive/impulsive children (n = 44), 25% or greater improvement was seen in 36% vs. 18% (ES 0.41, n.s.),

• And with both these types of symptoms 8 of 13 with EPA vs. 1 of 9 for placebo improved 25% or more (p = 0.03).

• Children responding to treatment had lower EPA concentrations (p = 0.02), higher AA/EPA (p = 0.005) and higher AA/DHA ratios (p = 0.03) in serum at baseline.

• Similarly, AA/EPA (p = 0.01), AA/DHA (p = 0.038) and total omega-6/omega-3 ratios (p = 0.028) were higher in RBC, probably due to higher AA (p = 0.011).


• Two ADHD subgroups (oppositional and less hyperactive/impulsive children) improved after 15 weeks EPA treatment.

• Increasing EPA and decreasing omega-6 fatty acid concentrations in phospholipids were related to clinical improvement. [Note: plant oil-derived omega-6 fatty acids are also essential, but the average Western diet includes more than 10 times the proper amount via commercial/processed foods.]

Source: Acta Paediatrica, May 19, 2010. PMID: 20491709, by Gustafsson PA, Birberg-Thornberg U, Duchén K, Landgren M, Malmberg K, Pelling H, Strandvik B, Karlsson T. Departments of Child Psychiatry, Behavioral Sciens and Learning, and Pediatrics, Linköping University; Dept of Pediatrics, Mariestad, Dept of Child Psychiatry  Karolinska Institute,  Uppsala University ;  Dept of Pediatrics, Gothenburg University; Dept of Biosciences and Nutrition, NOVUM, Karolinska Institute, Stockholm, Sweden.  [Email: Per.A.Gustafsson@liu.se]

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