Omega-3 Essential Fatty Acids in ADHD. Ruth Cooper Final Year PhD Student

Transcription

1 Omega-3 Essential Fatty Acids in ADHD Ruth Cooper Final Year PhD Student

2 1. Skirrow & Asherson (2012), 2. Wilcutt et al (2005) ADHD Inattention Hyperactivity/Impulsivity Emotional lability 1 Cognition 2

3 Treatment It felt as if between me and the world was a plastic window friends/family told me that I had lost my spark I was concerned about the effect it would have on my kidneys Completely unable to control my temper Damaged my self-esteem..can I really only function if I am on drugs?

4 Alternative Treatment Omega 3 essential fatty acid supplementation (omega-3 EFA)

5 Omega-3 EFAs and ADHD Brain: 60% lipid 1 Cell membrane: omega-3/6 1 Omega-3/6 cannot be synthesised de novo 2 Omega-3 EFA anti-inflammatory and assists cellular communication 3 Dopamine and serotonin in the frontal cortex 4-5 < Omega-3 EFA ADHD vs controls 6-7 Symptoms of EFA deficiency 1.Brookes et al (2006), 2. Simopoulos (1991), 3. Simopoulos et al (2002), 4. Chalon (2006), 5. Wainwright (2002), 6. Young et al (2004), 7. Chen et al (2004),

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7 Randomised Controlled Trial (RCT) Random allocation to placebo/active Double blind Treatment effect = An effect above placebo Meta-analysis Combines the results of RCTs Produces an overall (weighted) effect

8 ADHD Inattention Hyperactivity/Impulsivity Emotional Lability Cognition

9 Omega-3 EFA supplementation on ADHD Symptoms Bloch & Qawasmi (2011) 10 trials 699 children with ADHD + Related disorders Bloch & Qawasmi (2011) Journal of the American Academy of Child and Adolescent Psychiatry, 50 (10),

10 Heterogeneity More Publication variation in bias betweenstudy The publication effect sizes of than research would depends be expected on whether by chance it is positive alone (or negative) Treatment effect: SMD = 0.31, p <.0001 Dose effect No effect of trial duration No heterogeneity/publication bias

11 Omega-3 EFA supplementation on ADHD Symptoms Sonuga-Barke et al (2013) 11 trials 646 children with ADHD Sonuga-Barke et al (2013) The American Journal of Psychiatry, 170,

12 Treatment effect: SMD = 0.21, p =.007 No heterogeneity 9 trials no/low medication Treatment effect: SMD = 0.17

13 Summary: Omega-3 EFA and ADHD Symptoms Small effect ( ) P <.0001, P =.007 No heterogeneity/publication bias

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15 ADHD Inattention Hyperactivity/Impulsivity Emotional Lability Cognition

16 Gesch et al (2002), British Journal of Psychiatry, 181, 22-28

17 Meta-Analysis: Omega-3 EFA Emotional Lability, Conduct Problems and Aggression 16 studies 2,243 participants ADHD and related disorders (ADHD+RD) 10 studies 1,104 children Typically developing individuals (TD) 6 studies 1,139 children/adults Cooper et al (in prep)

18 Emotional Lability 5 studies (All ADHD+RD) 689 participants No heterogeneity No Effect 3 studies (All ADHD+RD) 607 participants No heterogeneity

19 Oppositional/Conduct Problems 10 studies (9 ADHD+RD, 1 TD) 1281 participants No heterogeneity 7 studies (6 ADHD+RD, 1 TD) 1165 participants No heterogeneity No Effect

20 Aggression 7 studies (2 ADHD+RD, 5 TD) 801 participants No heterogeneity No Effect

21 Summary: Omega-3 EFA and Emotional Lability No evidence that omega-3 EFA supplementation improves emotional lability, conduct/oppositional problems or aggression No heterogeneity/publication bias No effect of treatment duration

22 ADHD Inattention Hyperativity/Impulsivity Emotional Lability Cognition

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24 Meta-Analysis: Omega-3 EFAs and Cognition 23 studies 3,230 participants ADHD and related disorders (ADHD+RD) 11 studies 1,130 children Typically developing individuals (TD) 12 studies 2,100 children/adults Cooper et al (in prep)

25 IQ Reading Inhibition Attention Overall accuracy Omission errors Spelling Memory Working memory Short-term memory Reaction time Mean reaction time Reaction time variability

26 IQ/Inhibition 4 studies (3 ADHD+RD, 1 TD) 384 participants No heterogeneity 12 studies (6 ADHD+RD, 6 TD) 822 participants No heterogeneity No effect

27 Attention 7 studies (6 ADHD+RD, 1 TD) 384 participants No heterogeneity 11 studies (4 ADHD+RD, 7 TD) 1463 participants Heterogeneity (ADHD+RD) No effect

28 Memory 7 studies (3 ADHD+RD, 4 TD) 1258 participants No heterogeneity 13 studies (5 ADHD+RD, 8 TD) 1737 participants No heterogeneity No effect

29 Reading/Spelling 7 studies (4 ADHD+RD, 3 TD) 1529 participants No heterogeneity 6 studies (3 ADHD+RD, 3 TD) 1167 participants No heterogeneity No effect

30 Reaction Time 12 studies (5 ADHD+RD, 6 TD) 1100 participants No heterogeneity 3 studies (All ADHD+RD) 154 participants No heterogeneity No effect

31 Summary: Omega-3 EFA and Cognition No effect of omega-3 EFA supplementation on the ten domains of cognition Almost no evidence of heterogeneity/publication bias No effect of treatment duration

32 Overall Summary ADHD symptoms: Omega-3 EFA supplementation has a small but significant effect on improving ADHD symptoms Cognition: Omega-3 EFA supplementation did not improve cognition Emotional lability and related domains: Omega-3 EFA supplementation did not improve emotional lability, conduct problems or aggression

33 Limitations Blinding Individual differences: Homogeneity 1 Sex dimorphism 2 Low blood omega-3 EFA levels2, 3, 4 Length of supplementation 1.Richardson et al (2012) 2. Stonehouse et al (2013) 3. Kennedy et al (2009) 4. Osendarp et al (2007)

34 Omega-3 EFA and ADHD Omega-3 EFA ( ) Stimulant medication ( ) 1-3 Adjunctive treatment No difference monotherapy or augmentation National Institute of Clinical Excellene (NICE) 1.Schachter et al (2001), 2Connor et al (1999), 3. Cheng et al (2007), 4. Bloch & Qawasmi (2011)

35 Acknowledgements Supervisors: Philip Asherson Charlotte Tye Co-Authors Evangelos Vassos Jonna Kuntsi Participants Placement students: Emma Williams Charlotte Scott Rose Scott ADHD group