Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis.

Randomized, placebo-controlled trials (with some crossover) in children with ADHD symptomatology or diagnosed ADHD; ages roughly 7–12 years; predominantly male; some trials allowed concurrent ADHD pharmacotherapy (augmentation).

Oral omega-3 fatty acid supplements (EPA-, DHA-, and/or ALA-containing) taken daily for 4 weeks to 4 months; dosage varied by trial; no standardized regimen.

Omega-3 fatty acid supplementation produced a small but significant improvement in ADHD symptoms (SMD 0.31; 95% CI 0.16-0.47; N=699; p<0.001). Higher EPA dose within supplements was associated with greater efficacy (beta 0.36; 95% CI 0.01-0.72; p=0.04). No evidence of publication bias or heterogeneity. Parental ratings improved similarly (SMD 0.29); inattention (0.29) and hyperactivity (0.23) also improved. DHA and ALA were not significantly associated with efficacy. The effect is modest compared with standard ADHD medications; omega-3 may augment pharmacotherapy or be considered by families seeking non-pharmacologic options; large, high-quality trials are needed to confirm and optimize EPA-rich formulations (estimated ~330 participants for adequate power).

Trials were generally small and of low methodological quality (many JADAD scores 2–3), with incomplete handling of dropouts and potential blinding issues (fishy aftertaste in early fish-oil trials). Variation in supplement composition and dosing; limited reporting of teacher ratings; potential biases may exist despite no statistical evidence of publication bias; larger, high-quality RCTs are needed (e.g., ~330 participants) to confirm findings and define optimal EPA-rich formulations.