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Review
. 2023 Apr 14;4(4):CD007986.
doi: 10.1002/14651858.CD007986.pub3.

Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents

Donna Gillies  1 , Matthew J Leach  2 , Guillermo Perez Algorta  3
Affiliations
Review

Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents

Donna Gillies et al. Cochrane Database Syst Rev. .

Abstract

Background: Attention deficit hyperactivity disorder (ADHD) is a major problem in children and adolescents, characterised by age-inappropriate levels of inattention, hyperactivity, and impulsivity, and is associated with long-term social, academic, and mental health problems. The stimulant medications methylphenidate and amphetamine are the most frequently used treatments for ADHD, but these are not always effective and can be associated with side effects. Clinical and biochemical evidence suggests that deficiencies of polyunsaturated fatty acids (PUFA) could be related to ADHD. Research has shown that children and adolescents with ADHD have significantly lower plasma and blood concentrations of PUFA and, in particular, lower levels of omega-3 PUFA. These findings suggest that PUFA supplementation may reduce the attention and behaviour problems associated with ADHD. This review is an update of a previously published Cochrane Review. Overall, there was little evidence that PUFA supplementation improved symptoms of ADHD in children and adolescents.

Objectives: To compare the efficacy of PUFA to other forms of treatment or placebo in treating the symptoms of ADHD in children and adolescents.

Search methods: We searched 13 databases and two trials registers up to October 2021. We also checked the reference lists of relevant studies and reviews for additional references.

Selection criteria: We included randomised and quasi-randomised controlled trials that compared PUFA with placebo or PUFA plus alternative therapy (medication, behavioural therapy, or psychotherapy) with the same alternative therapy alone in children and adolescents (aged 18 years and under) diagnosed with ADHD.

Data collection and analysis: We used standard Cochrane methods. Our primary outcome was severity or improvement of ADHD symptoms. Our secondary outcomes were severity or incidence of behavioural problems; quality of life; severity or incidence of depressive symptoms; severity or incidence of anxiety symptoms; side effects; loss to follow-up; and cost. We used GRADE to assess the certainty of evidence for each outcome.

Main results: We included 37 trials with more than 2374 participants, of which 24 trials were new to this update. Five trials (seven reports) used a cross-over design, while the remaining 32 trials (52 reports) used a parallel design. Seven trials were conducted in Iran, four each in the USA and Israel, and two each in Australia, Canada, New Zealand, Sweden, and the UK. Single studies were conducted in Brazil, France, Germany, India, Italy, Japan, Mexico, the Netherlands, Singapore, Spain, Sri Lanka, and Taiwan. Of the 36 trials that compared a PUFA to placebo, 19 used an omega-3 PUFA, six used a combined omega-3/omega-6 supplement, and two used an omega-6 PUFA. The nine remaining trials were included in the comparison of PUFA to placebo, but also had the same co-intervention in the PUFA and placebo groups. Of these, four trials compared a combination of omega-3 PUFA plus methylphenidate to methylphenidate. One trial each compared omega-3 PUFA plus atomoxetine to atomoxetine; omega-3 PUFA plus physical training to physical training; and an omega-3 or omega-6 supplement plus methylphenidate to methylphenidate; and two trials compared omega-3 PUFA plus dietary supplement to dietary supplement. Supplements were given for a period of between two weeks and six months. Although we found low-certainty evidence that PUFA compared to placebo may improve ADHD symptoms in the medium term (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.47 to 2.60; 3 studies, 191 participants), there was high-certainty evidence that PUFA had no effect on parent-rated total ADHD symptoms compared to placebo in the medium term (standardised mean difference (SMD) -0.08, 95% CI -0.24 to 0.07; 16 studies, 1166 participants). There was also high-certainty evidence that parent-rated inattention (medium-term: SMD -0.01, 95% CI -0.20 to 0.17; 12 studies, 960 participants) and hyperactivity/impulsivity (medium-term: SMD 0.09, 95% CI -0.04 to 0.23; 10 studies, 869 participants) scores were no different compared to placebo. There was moderate-certainty evidence that overall side effects likely did not differ between PUFA and placebo groups (RR 1.02, 95% CI 0.69 to 1.52; 8 studies, 591 participants). There was also moderate-certainty evidence that medium-term loss to follow-up was likely similar between groups (RR 1.03, 95% CI 0.77 to 1.37; 13 studies, 1121 participants).

Authors' conclusions: Although we found low-certainty evidence that children and adolescents receiving PUFA may be more likely to improve compared to those receiving placebo, there was high-certainty evidence that PUFA had no effect on total parent-rated ADHD symptoms. There was also high-certainty evidence that inattention and hyperactivity/impulsivity did not differ between PUFA and placebo groups. We found moderate-certainty evidence that overall side effects likely did not differ between PUFA and placebo groups. There was also moderate-certainty evidence that follow-up was similar between groups. It is important that future research addresses the current weaknesses in this area, which include small sample sizes, variability of selection criteria, variability of the type and dosage of supplementation, and short follow-up times.

Trial registration: ClinicalTrials.gov NCT01554462 NCT03542643 NCT00770627 NCT01796262 NCT00874536 NCT01807299 NCT01795040 NCT01777048 NCT01233856 NCT01778647 NCT02999503 NCT02114632 NCT02248948 NCT02348073 NCT02986672.

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Conflict of interest statement

Donna Gillies is a former Editor of Cochrane Developmental, Psychosocial and Learning Problems. She was not involved in the editorial process for this review.

Matthew Leach: has declared that he has no conflicts of interest.

Guillermo Perez Algorta: has declared that he has no conflicts of interest.

Figures

1
1
Study flow diagram for review update.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
4
4
Funnel plot for the comparison of PUFA versus placebo for ADHD symptoms ‐ total, parent rated. Footnotes
ADHD: attention deficit hyperactivity disorder; PUFA: polyunsaturated fatty acids; SE: standard error; SMD: standardised mean difference.
5
5
Funnel plot for the comparison of PUFA versus placebo for ADHD symptoms ‐ inattention, parent rated. Footnotes
ADHD: attention deficit hyperactivity disorder; PUFA: polyunsaturated fatty acids; SE: standard error; SMD: standardised mean difference.
6
6
Funnel plot for the comparison of PUFA versus placebo for ADHD symptoms ‐ hyperactivity/impulsivity, parent rated. Footnotes
ADHD: attention deficit hyperactivity disorder; PUFA: polyunsaturated fatty acids; SE: standard error; SMD: standardised mean difference.
1.1
1.1. Analysis
Comparison 1: PUFA versus placebo, Outcome 1: ADHD symptoms ‐ improvement
1.2
1.2. Analysis
Comparison 1: PUFA versus placebo, Outcome 2: ADHD symptoms ‐ total, parent rated
1.3
1.3. Analysis
Comparison 1: PUFA versus placebo, Outcome 3: ADHD symptoms ‐ inattention, parent rated
1.4
1.4. Analysis
Comparison 1: PUFA versus placebo, Outcome 4: ADHD symptoms ‐ hyperactivity/impulsivity, parent rated
1.5
1.5. Analysis
Comparison 1: PUFA versus placebo, Outcome 5: ADHD symptoms ‐ total, teacher rated
1.6
1.6. Analysis
Comparison 1: PUFA versus placebo, Outcome 6: ADHD symptoms ‐ inattention: teacher
1.7
1.7. Analysis
Comparison 1: PUFA versus placebo, Outcome 7: ADHD symptoms ‐ hyperactivity/impulsivity, teacher rated
1.8
1.8. Analysis
Comparison 1: PUFA versus placebo, Outcome 8: ADHD symptoms ‐ total, clinician rated
1.9
1.9. Analysis
Comparison 1: PUFA versus placebo, Outcome 9: ADHD symptoms ‐ inattention, clinician rated
1.10
1.10. Analysis
Comparison 1: PUFA versus placebo, Outcome 10: ADHD symptoms ‐ hyperactivity/impulsivity, clinician rated
1.11
1.11. Analysis
Comparison 1: PUFA versus placebo, Outcome 11: Behaviour ‐ internalising, parent rated
1.12
1.12. Analysis
Comparison 1: PUFA versus placebo, Outcome 12: Behaviour ‐ externalising, parent rated
1.13
1.13. Analysis
Comparison 1: PUFA versus placebo, Outcome 13: Behaviour ‐ conduct, parent rated
1.14
1.14. Analysis
Comparison 1: PUFA versus placebo, Outcome 14: Behaviour ‐ oppositional, parent rated
1.15
1.15. Analysis
Comparison 1: PUFA versus placebo, Outcome 15: Behaviour ‐ socialisation, parent rated
1.16
1.16. Analysis
Comparison 1: PUFA versus placebo, Outcome 16: Behaviour ‐ conduct, teacher rated
1.17
1.17. Analysis
Comparison 1: PUFA versus placebo, Outcome 17: Behaviour ‐ oppositional, teacher rated
1.18
1.18. Analysis
Comparison 1: PUFA versus placebo, Outcome 18: Behaviour ‐ socialisation, teacher rated
1.19
1.19. Analysis
Comparison 1: PUFA versus placebo, Outcome 19: Quality of life: medium term
1.20
1.20. Analysis
Comparison 1: PUFA versus placebo, Outcome 20: Side effects
1.21
1.21. Analysis
Comparison 1: PUFA versus placebo, Outcome 21: Loss to follow‐up
2.1
2.1. Analysis
Comparison 2: PUFA versus stimulants, Outcome 1: ADHD symptoms ‐ total
2.2
2.2. Analysis
Comparison 2: PUFA versus stimulants, Outcome 2: ADHD symptoms ‐ inattention
2.3
2.3. Analysis
Comparison 2: PUFA versus stimulants, Outcome 3: ADHD symptoms ‐ hyperactivity/impulsivity
3.1
3.1. Analysis
Comparison 3: Subgroup analysis by PUFA, Outcome 1: ADHD symptoms ‐ total, parent rated
4.1
4.1. Analysis
Comparison 4: Sensitivity analyses, Outcome 1: Risk of attrition bias
4.2
4.2. Analysis
Comparison 4: Sensitivity analyses, Outcome 2: Inclusion criteria
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    1. Raz R, Carasso RL, Yehuda S. The influence of short-chain essential fatty acids on children with attention-deficit/hyperactivity disorder: a double-blind placebo-controlled study. Journal of Child and Adolescent Psychopharmacology 2009;19(2):167-77. [DOI: 10.1089/cap.2008.070] [PMID: ] - DOI - PubMed
Rodriguez 2019 {published data only}
    1. Rodríguez C, García T, Areces D, Fernández E, García-Noriega M, Domingo JC. Supplementation with high-content docosahexaenoic acid triglyceride in attention-deficit hyperactivity disorder: a randomized double-blind placebo-controlled trial. Neuropsychiatric Disease and Treatment 2019;15:1193-209. [DOI: 10.2147/NDT.S206020] [PMID: ] [PMID: ] - DOI - PMC - PubMed
Salehi 2016 {published data only}
    1. Salehi B, Mohammadbeigi A, Sheykholeslam H, Moshiri E, Dorreh F. Omega-3 and zinc supplementation as complementary therapies in children with attention-deficit/hyperactivity disorder. Journal of Research in Pharmacy Practice 2016;5(1):22-6. [DOI: 10.4103/2279-042X.176561] [PMCID: PMC4776543] [PMID: ] - DOI - PMC - PubMed
Sinn 2007 {published data only}
    1. Sinn N, Bryan J, Wilson C. Cognitive effects of polyunsaturated fatty acids in children with attention deficit hyperactivity disorder symptoms: a randomised controlled trial. Prostaglandins Leukotrienes and Essential Fatty Acids 2008;78(4-5):311-26. [DOI: 10.1016/j.plefa.2008.04.004] [PMID: ] - DOI - PubMed
    1. Sinn N, Bryan J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. Journal of Developmental and Behavioral Pediatrics 2007;28(2):82-91. [DOI: 10.1097/01.DBP.0000267558.88457.a5] [PMID: ] - DOI - PubMed
Stevens 2003 {published data only}
    1. Stevens L, Zhang W, Peck L, Kuczek T, Grevstad N, Mahon A, et al. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors. Lipids 2003;38(10):1007-21. [DOI: 10.1007/s11745-006-1155-0] [PMID: ] - DOI - PubMed
Vaisman 2008 {published data only}
    1. NCT00382616. Supplementation of phosphatidylserine (PS) and n-3 long chain fatty acids (EPA, DHA) in children with ADHD. clinicaltrials.gov/ct2/show/NCT00382616 (first received 29 September 2006).
    1. Vaisman N, Kaysar N, Zaruk-Adasha Y, Pelled D, Brichon G, Zwingelstein G, et al. Correlation between changes in blood fatty acid composition and visual sustained attention performance in children with inattention: effect of dietary n-3 fatty acids containing phospholipids. American Journal of Clinical Nutrition 2008;87(5):1170-80. [DOI: 10.1093/ajcn/87.5.1170] [PMID: ] - DOI - PubMed
Voigt 2001 {published data only}
    1. Voigt RG, Llorente AM, Jensen CL, Fraley JK, Berretta MC, Heird WC. A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. Journal of Pediatrics 2001;139(2):189-96. [DOI: 10.1067/mpd.2001.116050] [PMID: ] - DOI - PubMed
Widenhorn‐Müller 2014 {published data only}
    1. Widenhorn-Müller K, Schwanda S, Scholz E, Spitzer M, Bode H. Effect of supplementation with long-chain ω-3 polyunsaturated fatty acids on behavior and cognition in children with attention deficit/hyperactivity disorder (ADHD): a randomized placebo-controlled intervention trial. Prostaglandins Leukotrienes and Essential Fatty Acids 2014;91(1-2):49-60. [DOI: 10.1016/j.plefa.2014.04.004] [PMID: ] - DOI - PubMed

References to studies excluded from this review

Anonymous 2009 {published data only}
    1. Omega-3/omega-6 fatty acids and ADHD. Brown University Child & Adolescent Psychopharmacology Update 2009;11(4):4-5.
Doebel 2005 {published data only}
    1. Doebel JK, Keller G, Zierau M-T. Dietary therapy for children with ADHD. Deutsche Apotheker Zeitung 2005;145(24):54-7.
Döpfner 2021 {published data only}
    1. Döpfner M, Dose C, Breuer D, Heintz S, Schiffhauer S, Banaschewski T. Efficacy of omega-3/omega-6 fatty acids in preschool children at risk of ADHD: a randomized placebo-controlled trial. Journal of Attention Disorders 2021;25(8):1096-106. [DOI: 10.1177/1087054719883023] [PMID: ] - DOI - PubMed
    1. NCT01795040. Efficacy of omega-3/omega-6 fatty acids in pre-school children at risk for ADHD [Efficacy of a supplementary balanced diet with omega-3/omega-6 fatty acids among 3-6 year olds with symptoms of ADHD]. clinicaltrials.gov/ct2/show/NCT01795040 (first received 16 February 2013).
Greeff 2011 {published data only}
    1. Greeff J. Effects of Iron and Omega–3 Fatty Acid Supplementation on Physical Activity of Iron Deficient Primary School Children Residing in KwaZulu–Natal (Master's thesis). Potchefstroom, South Africa: North-West University, 2011. [WEB PAGE: www.semanticscholar.org/paper/Effects-of-iron-and-omega%E2%80%933-fatty-...]
Harding 2003 {published data only}
    1. Harding KL, Judah RD, Gant C. Outcome-based comparison of ritalin versus food-supplement treated children with AD/HD. Alternative Medicine Review 2003;8(3):319-30. [PMID: ] - PubMed
Johnson 2017 {published data only}
    1. Johnson M, Fransson G, Östlund S, Areskoug B, Gillberg C. Omega 3/6 fatty acids for reading in children: a randomized, double-blind, placebo-controlled trial in 9-year-old mainstream schoolchildren in Sweden. Journal of Child Psychology and Psychiatry 2017;58(1):83-93. [DOI: 10.1111/jcpp.12614] [PMID: ] - DOI - PubMed
Joshi 2006 {published data only}
    1. Joshi K, Lad S, Kale M, Patwardhan B, Mahadik SP, Patni B, et al. Supplementation with flax oil and vitamin C improves the outcome of attention deficit hyperactivity disorder (ADHD). Prostaglandins, Leukotrienes, and Essential Fatty Acids 2006;74(1):17-21. [DOI: 10.1016/j.plefa.2005.10.001] [PMID: ] - DOI - PubMed
Meguid 2016 {published data only}
    1. Effat S, Mohamed N, Hussein H, Azzam H, Gouda A, Hassan H. ADHD symptoms: relation to omega 3 serum levels before and after supplementation. European Psychiatry 2013;28(Suppl 1):1. [ABSTRACT NUMBER: 670] [DOI: 10.1016/S0924-9338(13)75914-5] - DOI
    1. Meguid N, Effat S, Hussien H, Azzam H, Gouda AS, Anwar M, et al. Role of plasma fatty acids in Egyptian children with attention deficit hyperactivity disorder. International Journal of Pharmaceutical and Clinical Research 2016;8(7):671-5. [WEB PAGE: impactfactor.org/PDF/IJPCR/8/IJPCR,Vol8,Issue7,Article6.pdf]
NCT01777048 {published data only}
    1. NCT01777048. Omega-3 fatty acids supplementation in ADHD [Augmenting the effects of methylphenidate: a randomized, placebo-controlled trial of omega-3 fatty acids supplementation in children with attention deficit hyperactivity disorder]. clinicaltrials.gov/ct2/show/NCT01777048 (first received 16 January 2013).
NCT01778647 {published data only}
    1. NCT01778647. Omega-3 fatty acids as an adjunctive therapy for stimulants in children with ADHD. clinicaltrials.gov/ct2/show/NCT01778647 (first received 30 September 2010).
Richardson 2002 {published data only}
    1. Richardson AJ, Puri BK. 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 2002;26(2):233-9. [DOI: 10.1016/s0278-5846(01)00254-8] [PMID: ] - DOI - PubMed
San Mauro Martin 2019 {published data only}
    1. NCT02999503. Attention deficit hyperactivity disorder: nutrition and environment [Nutritional and environmental conditions in attention deficit hyperactivity disorder]. clinicaltrials.gov/ct2/show/study/NCT02999503 (first received 1 December 2016).
    1. San Mauro Martin I, Sanz Rojo S, González Cosano L, Conty de la Campa R, Garicano Vilar E, Blumenfeld Olivares JA. Impulsiveness in children with attention-deficit/hyperactivity disorder after an 8-week intervention with the Mediterranean diet and/or omega-3 fatty acids: a randomised clinical trial. Neurologia 2019 Dec 26 [Epub ahead of print]. [DOI: 10.1016/j.nrl.2019.09.007] [PMID: ] - DOI - PubMed
Tan 2014 {published data only}
    1. Tan X, Lee XY, Lim CG, Fung DSS. Effectiveness of omega-3 fatty acids supplementation on sleep in children and adolescents with attention deficit hyperactivity disorder. Annals: the official journal of the Academy of Medicine, Singapore 2014;43(Suppl 9):S340. [ABSTRACT #: PP-CR-44] [WEB PAGE: www.annals.edu.sg/pdf/43VolNo9Sep2014/SHBC2014_Final.pdf]
Wilens 2017 {published data only}
    1. Wilens TE, Carrellas NW, Zulauf C, Yule AM, Uchida M, Spencer A, et al. Pilot data supporting omega-3 fatty acids supplementation in medicated children with attention-deficit/hyperactivity disorder and deficits in emotional self-regulation. Journal of Child and Adolescent Psychopharmacology 2017;27(8):755-6. [DOI: 10.1089/cap.2017.0080] [PMID: ] - DOI - PMC - PubMed

References to studies awaiting assessment

Carucci 2017 {published data only}
    1. Carucci S, Romaniello R, Balia C, Demuru G, Curatolo P, Mereu A, et al. Efficacy study of an omega-3/6 combination for mild- to moderate-inattentive ADHD: a randomized, double-blind, placebo-controlled trial in Italian children. Journal of the American Academy of Child & Adolescent Psychiatry 2019;58(Suppl 10):S285-6. [ABSTRACT NUMBER: 6.45] [DOI: 10.1016/j.jaac.2019.08.437] - DOI
    1. Carucci S, Romaniello R, Masi G, Curatolo P, Gagliano A, Zuddas A. A randomized, double blind, placebo-controlled, efficacy study of omega 3/6 in children with mild to moderate inattentive ADHD-preliminary results. European Neuropsychopharmacology 2017;27(Suppl 4):S1109-10. [ABSTRACT NUMBER: P.7.d.007] [DOI: 10.1016/S0924-977X(17)31924-7] - DOI
    1. Romaniello R, Carucci S, Sanna E, Balia C, Zuddas A. Efficacy of an omega-3/6 combination on specific learning abilities in children with mild to moderate inattentive ADHD - preliminary results. European Neuropsychopharmacology 2018;28(Suppl 1):79-80. [ABSTRACT NUMBER: P.3.023] [DOI: 10.1016/j.euroneuro.2017.12.113] - DOI
    1. Sanna E, Romaniello R, Balia C, Carucci S, Zuddas A. Plasma poly-unsatured fatty acids profile in children with inattentive ADHD - preliminary results of an efficacy Italian study with omega 3/6. European Neuropsychopharmacology 2019;29(Suppl 1):S548‐9. [ABSTRACT NUMBER: P.798] [DOI: 10.1016/j.euroneuro.2018.11.809] - DOI
IRCT201104166201N1 {published data only}IRCT201104166201N1
    1. IRCT201104166201N1. Effect of zinc and omega-3 supplements as adjuvant therapy in children with attention-deficit hyperactivity disorder [Effect of zinc and omega-3 supplements in children with attention-deficit hyperactivity disorder]. en.irct.ir/trial/6635 (first received 13 May 2011).
IRCT201304035393N3 {published data only}IRCT201304035393N3
    1. IRCT201304035393N3. Omega-3 effects on patient with attention deficit hyperactivity disorder [Comparison of therapeutic effects of omega-3 and methylphenidate (ritalin) in treating patients with attention deficit hyperactivity disorder]. en.irct.ir/trial/5801?revision=5801 (first received 3 July 2013).
IRCT2016050918927N2 {published data only}IRCT2016050918927N2
    1. IRCT2016050918927N2. Effect of omega-3 on treatment of hyperactive children [Effect of omega-3 supplements as complementary treatment with methylphenidate in children with attention-deficit/hyperactivity disorder]. en.irct.ir/trial/17040 (first received 6 July 2016).
NCT00770627 {published data only}
    1. NCT00770627. Clinical trial to evaluate the efficacy and the tolerance of an omega 3 fatty acids supplementation in ADHD children [A randomized, controlled, double blind placebo trial to evaluate the efficacy and the tolerance of an omega 3 fatty acids supplementation in ADHD children]. clinicaltrials.gov/ct2/show/NCT00770627 (first received 9 October 2008).
NCT02114632 {published data only}
    1. NCT02114632. Supplementation of polyunsaturated fatty acids in children with attention deficit/hyperactivity disorder (ADHD) [A double blind, placebo controlled trial of effectiveness of omega-3 and omega-6 polyunsaturated fatty acids in treatment of children with attention deficit/hyperactivity disorder]. clinicaltrials.gov/ct2/show/results/NCT02114632 (first received 23 March 2014).
NCT02248948 {published data only}
    1. NCT02248948. Superiority of omega-3 versus placebo on the improvement of ADHD in children (ECOMEGA) [Multicenter randomized controlled trial for the evaluation of superiority of a supplement with omega-3 fatty acids versus placebo for the improvement of attention deficit and hyperactivity disorder (ADHD) in children]. clinicaltrials.gov/ct2/show/NCT02248948 (first received 22 September 2014).
NCT02348073 {published data only}
    1. NCT02348073. Efficacy of phosphatidylserine enriched with n-3 PUFA supplementation on ADHD in children with epilepsy (AGPIn3) [Efficacy of phosphatidylserine enriched with polyunsaturated n-3 fatty acid supplementation on attention deficit disorders in children with epilepsy. A randomized double-blind placebo-controlled trial]. clinicaltrials.gov/ct2/show/NCT02348073 (first received 22 January 2015).
NCT02986672 {published data only}
    1. NCT02986672. Intervention with omega-3 in children with attention deficit hyperactivity disorder (ADHD) [ADHD and nutrition: the influence of omega-3 on ADHD related symptoms]. clinicaltrials.gov/ct2/show/NCT02986672 (first received 8 January 2016).
NCT03542643 {published data only}
    1. NCT03542643. Omega-3 polyunsaturated fatty acids in youth with ADHD [A double-blind randomised controlled trial of N-3 PUFAs in children with attention deficit hyperactivity disorder]. clinicaltrials.gov/ct2/show/NCT03542643 (first received 20 May 2018).

References to ongoing studies

CTRI/2020/05/025267 {published data only}
    1. CTRI/2020/05/025267. Effect of omega-3 fatty acids in addition to methylphenidate in ADHD. trialsearch.who.int/?TrialID=CTRI/2020/05/025267 (first received 20 May 2020).

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