الفهرس 
Attention Deficit Hyperactivity DisorderOnly 14 pages are availabe for public view
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Abstract
Summary
Attention deficit hyperactivity disorder (ADHD) is characterized by pervasive and impairing symptoms of inattention, hyperactivity and impulsivity according to DSM-IV. The cause of ADHD is generally acknowledged to be multifactorial, involving both biological and environmental influence.
The main aims of the current study were to compare levels of omega-3 fatty acids between children with ADHD and healthy children, correlate the levels of the omega-3 fatty acids and the severity of the symptoms of ADHD and finally to Study the efficacy of omega-3 fatty acids supplementation in alleviating symptoms of ADHD.
Accordingly, forty children (29 males and 11 females) with the diagnosis of ADHD, approving to participate in the study, with age ranges from 6 to 12 years and IQ levels above 90 with no chronic medial, neurological or fish allergy were included in the study. All cases were recruited from the outpatient clinic of the children with special needs in the National Research Center (NRC)-Cairo and the outpatient clinic of child psychiatry - The institute of psychiatry – Ain-Shams university hospital. Forty age- and sex-matched children were recruited as a control group. Both cases and controls were assessed using Mini International Neuropsychiatric Interview for Children for diagnosis of ADHD and exclusion of other psychiatric comorbidities in the patient group and exclusion of psychiatric disorders in the control group. Also their IQ was assessed using Wechsler Intelligence Scale for Children. Estimating omega-3 fatty acids - EPA and DHA – was done for both patients and controls using High performance liquid chromatography / Mass spectroscopy / Mass spectroscopy. Twenty children of the patient group were further assessed using the Conners’ parent rating scale-revised long version and Vigil continuous performance test for assessment of the severity of their symptoms. These 20 children were prescribed omega-3 fatty acid supplement in the form of gelatinous capsules with daily dose of 900 mg EPA and 600 mg DHA for 3 months. At the end of the 3 months these children were assessed again using the Conners’ parent rating scale-revised long version and Vigil continuous performance test and omega-3 fatty acids – EPA and DHA- were re-estimated.
Regarding the demographic and the clinical characteristics of the sample, the results of our study showed that males represented 72.5% and females represented 27.5% of patient group in a ratio of nearly 3:1, with mean age of 8.15 years. The mean total IQ of the patient group was 95.28. There was no statistically significant difference between them regarding gender, age, paternal consanguinity, residency and IQ. The initial assessment of the patient group with Conners’ parent rating scale showed that they had significant problems on the Inattention, Hyperactivity, Conners’ ADHD index, Conners’ global index: Restless-Impulsive, Conners’ global index: Emotional lability, Conners’ global index: total, DSM-IV: Inattentive, DSM-IV: Hyperactivity-Impulsive and DSM-IV: Total score subscales. The initial assessment of the patient group with Vigil continuous performance test revealed significant problems in total omission, total commission, total error and total reaction time.
Regarding levels of omega-3 fatty acids in children with ADHD and healthy controls, comparison between them revealed that children with ADHD exhibit statistically significant lower levels of EPA (1.343) and DHA (1.347) than in healthy controls.
On examining the correlation between level of omega-3 fatty acids and severity of ADHD symptoms of the patient group as assessed by Conner’s Parent Rating Scale and Vigil continuous performance test, there negative correlation between DHA level and Conners’ ADHD index, DSM-IV: Inattentive and DSM-IV: Total subscales of Conner’s Parent Rating Scale and of total omission and total error of the Vigil continuous performance test.
Regarding levels of omega-3 fatty acids in children with ADHD after omega-3 fatty acids supplementations, comparison of EPA and DHA levels before and after omega-3 fatty acids supplementations showed marked increase in levels of these fatty acids. This increase was of a statistically high significance.
Regarding severity of ADHD symptoms after omega-3 fatty acids supplementations as assessed by Conner’s Parent Rating Scale, there was statistically significant improvement on the Conners’ ADHD index subscale and non significant improvement on the other subscales. Assessment of symptoms using Vigil continuous performance test revealed non significant improvement of total omission and total error.
from the above mentioned we can conclude that children with ADHD exhibit low levels of omega-3 fatty acids plasma, DHA level is inversely correlated with degree of inattention in these children and finally administration of high doses of omega-3 fatty acids supplements for 3 months is successful in normalizing the levels of omega-3 fatty acids and alleviating symptoms of ADHD, especially the cognitive problems and inattention.
Finally we recommend usage of omega-3 fatty acids as complementary treatment for children with ADHD with good adherence and efficacy in alleviating their symptoms. Omega-3 is not supported by current evidence as a primary treatment for ADHD or related conditions, but further research in this area is clearly warranted. We also recommend more randomized, double-blind, placebo-controlled trials of supplementation with PUFA, but these need to be designed with several caveats in mind. In particular, there need to be clear hypotheses, subject numbers must be sufficient to test these, and both the choice of treatments and the duration (ideally, a minimum of several months) are likely to be crucial.