Omega-3's for Kids with ADHD... do they help?
Parenthood is a joy like no other. With kids, the fun never stops. So much energy. So many great ideas.
Before having children of my own, I didn’t know what an amazing toy my face could make. I never realized how wide apart my lips could be stretched. I never considered how far back into my skull my eyeballs could be pressed. I knew my nose was a little larger than average, but I never knew it could house three whole legos, sideways.
Thanks to parenthood, now I know.
Kids naturally possess a ton of energy. Their enthusiasm for life is unparalleled. It’s fun to watch, especially when it’s not your kid.
Back before I had my own children, I was a fun uncle (a Funcle). I used to enjoy heading over to my sister’s house to visit with my nephews. When the oldest was still only 30lbs, I would waltz into her house, scoop him up, and toss him into the air a few times. Each toss would be higher than the last, just until his long blond hair grazed the ceiling.
Every visit was the same routine: Pick him up, give him a spin, and watch him go. I’d relish his deep belly laugh. After the fun, I let the warmth of that moment wash over me. Then, like every respectable Funcle, I’d plop down on my sister’s couch and ask her what kind of snacks she had.
Meanwhile, my nephew’s brain would be stuck on overdrive. He’d be all revved up, running wildly throughout the house, wide-eyed and determined to keep the fun going. It took a while, but from these encounters, I learned a valuable lesson. You really should inquire about the snacks before getting someone else’s kid all riled up.
Snack foods and over-stimulated children lead us to the topic of omega-3’s for kids with ADHD.
Omega 3’s are fat-based nutrients commonly found in whole foods such as salmon, tuna, eggs, grass-fed beef, nuts and seeds. Unfortunately, omega-3’s aren’t commonly found in snack foods. The exception to that rule would be nuts and seeds.
Omega-3’s are technically called fatty acids, or “essential fatty acids.” The omega-3’s include alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) (Linus Pauling Institute, 2018). EPA and DHA are the major players in the brain, and most of the studies on supplemental omega-3’s included a combination of EPA and DHA.
Omega-3’s are especially important for developing brains (Sambra et al., 2021). This should be no surprise, as omega-3’s serve as key raw material building blocks for neurons (the cells that do all the communicating in our brains).
We want our kids to be as healthy and functional as possible. Once they become adults, what happens is on them. But before they reach adulthood, it is up to us as parents to prepare them the best way we know-how. This is where omega-3’s come into play. Omega-3’s help build strong and functional neurons. That’s one of the great things about omega-3’s. They are literally part of the brain tissue.
Unfortunately, in the standard American or Western-pattern diets, omega-3’s are generally lacking. With our typical modern-day diets being full of convenience (pasta, rice, chicken fingers, crackers, and a small selection of cut-up fruits and vegetables), there’s a significant risk of not getting enough.
With our modern-day diets, it can be a real challenge to get enough food-based omega-3’s into our children’s daily foods.
Deficits of omega-3’s have been connected to many major chronic physical illnesses (Simopoulos, 2002). Now children tend to be in relatively good physical health. We do not usually develop chronic diseases, such as cancer, heart disease, or diabetes until we are well into adulthood. Yet, rates of mental illness in children have been on the rise in the developed world (Collishaw, 2014).
Failing to get enough of the nutrients our brains crave can set us up for mental and emotional difficulty now (Jacka et al., 2011, LaChance & Ramsey, 2018), and a host of chronic illnesses later on in life (USDA, 1990).
In addition to convenience and comfort, modern-day life has brought us suboptimal diets and fast-paced, stress-inducing lifestyles. These are two big factors that ruin our health but play out in the background and almost go unnoticed. Poor diet and lifestyle can definitely invite mental and emotional dysfunction into our lives.
Poor diets may not cause mental illness on their own, but a diet lacking in nutrients the brain needs can for sure worsen the severity of any mental illness. ADHD provides one such example.
There are many factors that contribute to the development of ADHD. Genetic predisposition is a big one. Researchers tend to stop short of saying that poor diets (including excessive sugar intake and deficits in nutrients like omega-3’s), can cause ADHD. However, there is good evidence that the greater the sugar intake, the worse the behavioral symptoms will be in children diagnosed with ADHD (Johnson et al., 2000).
The same is true for omega-3’s. Deficits in omega-3’s have been linked to the presence of ADHD as well as the severity of ADHD symptoms in children. On average, children diagnosed with ADHD, compared to children without ADHD, have much lower blood levels of omega-3’s (Hawkey & Nigg, 2014). Further, the greater the deficiency of omega-3’s in the blood, the greater the severity of symptoms observed in children diagnosed with ADHD (Colter et al., 2008).
All of this makes a lot of common sense. We need to feed our bodies and our brains so that we can respond to life’s demands.
Maybe it’s safe to say that we all should be eating/taking in more Omega 3’s. Our kids especially need omega-3’s in their diet so their brains can grow and function optimally - now and over time.
So what does the research say about omega-3 supplements for children with ADHD? Does consuming omega-3’s help children diagnosed with ADHD feel and function better?
Some research says yes, some research says no.
A major review of several studies found EPA/DHA supplementation did not move the needle at all for ADHD symptoms in kids. No benefit was found. Unfortunately, this big review of studies did not consider the dose. The average dose in these studies was relatively low - just 500mg/day for EPA and 187mg/day for DHA (Gilles et al., 2012).
Other studies demonstrated a clear benefit (a reduction in the severity and frequency of ADHD symptoms). Those researchers used much higher doses of omega-3 supplements (Chang, 2019).
It’s important to note that there can be a risk with high doses of omega-3’s. Some research has identified an increased risk of bleeding and suppression of the immune system with higher doses of omega-3’s (NIH, 2021). However, these negative effects did not occur in a few studies with high doses in children (between 3000mg and 16,200mg of combined EPA and DHA) (European Food Safety Authority, 2012).
One thing to consider is that omega-3’s and omega-6’s should remain in a certain balance - in our diets, as well as in our bodies. Traditional or ancestral diets featured a ratio of omega-6’s to omega-3’s closer to 1:1. Modern-day diets are much different, typically delivering a ratio of 16:1 (Simopoulos, 2006).
That's a really big relative deficiency of omega-3’s. Starting out with a huge deficiency may be why most can tolerate higher doses of omega-3’s.
In addition, we are talking about a food substance here. It seems likely that it’s safe to consume more omega-3’s in the diet and supplement wisely. Due to the distinct taste/smell, it’s unlikely that we could get our kids to chug fish oil by the pint anyways
Let’s dig deeper. Why exactly should we care about omega-3’s? What good things omega-3’s do for the brain?
To better understand the role of Omega 3’s in the brain, let’s travel back in time to the heyday of reality TV. Remember the Supernanny?
In this irresistible reality drama, Jo Frost (the Supernanny) would swoop into a family home filled with chaos. She’d assess the scene, criticize/judge the parents for our viewing pleasure, and then bring order to chaos.
Regardless of her style, Jo got the job done. At the end of the episode, the chore chart was hanging on the fridge, the parents were bent down at eye level speaking in soft tones, and the children were seated quietly while displaying the tight-lipped fake smiles - just like the show’s producers made them practice before each take.
Everyone knew their role. Nobody got out of line. Everything was in order.
As it turns out, Jo’s keys to success are the same ones that Omega 3’s use to bring order to chaos in our brains. Yes, omega-3’s are literally the Supernanny of the human brain.
Like the Supernanny, Omega 3’s work by ensuring structure, communication, and limits on excitation within the brain. Let’s take a look at each of these Supernanny roles, one by one, to better understand the mechanism of action of omega-3’s in the brain.
Structure equals function.
Once Jo gained entry into the family’s home, she began teaching the children what they were supposed to do. Equally important, she also taught them what they were not supposed to do. She had these same tough conversations with the parents. Jo laid the foundation of structure within the family. Kids had their roles and responsibilities. Parents had their roles and responsibilities.
When each member of the family stuck to their roles and did the jobs that were assigned to them, the family unit transformed into a well-oiled machine.
Jo helped to reset the structure of the family to improve its function. If parents saw that their kid was getting squirrely, they stepped forward to redirect their energy into something more constructive. If the kids were able to get out their energy in a constructive and healthy way, then the parents could move on to chores and other responsibilities. Structure equaled function.
Structure equals function in the brain as well. Structure in the brain means that neurons are connected to other neurons in the right configuration. Communication flows in the brain along what is called circuits (Tau & Peterson, 2009). Various circuits within the brain are associated with specific functions, such as vision, emotion, memory, and even impulse control.
For a circuit to be activated, all of the neurons within that circuit need to pass a message along the entire circuit. In order to get the message from point A to point B, each neuron within that circuit needs to do its job and help pass along the message. To get the job done, neurons need raw materials - key nutrients such as amino acids, vitamins, minerals, and fats like omega-3’s.
It all comes down to optimal communication. When Jo first entered a family home, it was always gut-wrenching chaos. Everyone was yelling at one another. No one was really listening. Everyone was upset. Jo would stare at the chaos for a moment and take it all in. She’d give the camera a knowing glance, and then get to work. The biggest tool in her toolbox, in fact, was communication. She’d listen to each member for a few moments and then in a very direct manner point out what they were doing wrong. Communication is where the healing began.
As with families, each member has to communicate (speaking and listening) for the family to function harmoniously. Just like a family, the brain is a collection of parts. This collection of parts is the various circuits that dictate brain function. Within those circuits are a collection of parts - thousands of neurons. Each individual neuron is also a collection of parts.
The parts of the neuron that matter most for communication include the outer membrane, the ends of the neurons (end terminals and dendrites), and protein transporters and receptors. These parts are essential for concentration, sustained attention, and impulse control.
Let’s take a closer look at these three key parts of the neuron.
The outer layer of the neuron, also known as the membrane, is critically important for neuron function. This outer surface is where all the magic happens. Without a surface layer, there would be no ability for one neuron to communicate with another neuron. For optimal communication, the membrane needs to be able to bend and flex in order to branch out and talk to other neurons. The membranes need to get close to one another and start talking and listening to one another.
End Terminals & Dendrites
These ends of the neurons are also important for communication. A neuron has two ends. One end is called the end terminal. On the other end is a collection of numerous dendrites. The end terminals send messages, and the dendrites receive messages. These endings send and receive chemical messengers called neurotransmitters. The end terminals squirt out neurotransmitters, and receptors on the dendrites receive them.
These endings of neurons need to be flexible and responsive so that messages can jump from one neuron to the next.
Flexibility means that these endings of neurons are able to move close to one another. They have to move closer to one another because those neurotransmitters shooting out from end terminals can only reach dendrites that are close by.
Unlike the food from our toddler’s dinner plate, neurotransmitters can only travel so far. If the end terminals and dendrites are too far apart, communication is unsuccessful. So, the end terminals and dendrites need to be flexible. They need to bend, reach over, and get closer to one another in order for messages within the brain to travel down the entire circuit. All of the neurons within a circuit need to be close enough to one another for communication to happen successfully.
Protein Transporters & Receptors
The protein transporters and receptors are the third important part of the neuron, as it relates to communication. These proteins are embedded in the membrane of neurons. The essential characteristic of neurons here is fluidity. The membranes need to remain fluid in order to house these proteins (DiNicolantonio & O’Keefe, 2020).
The protein transporters shuttle in and out various chemicals. This exchange of chemicals in and out of the neuron enhances communication and sustains the overall health of neurons.
The protein receptors are also embedded in the neuronal membrane. However, they play a more active role in communication. Protein receptors are the ears that hear the neurotransmitters being sent over from neighboring neurons. To keep communication flowing within the brain, these transporters and receptors need to maintain the correct shape and sit in the right spot inside the neuronal membrane. To accomplish this, membranes need to remain fluid.
One part of the brain can send a message, but if the other part cannot hear that message, communication suffers. Think about it. How many times should we ask our children to put on their shoes before giving up? If they aren’t hearing us the first 100 times, should we ask one more time?
In the brain, just like in the home, structure equals function.
The right structure allows for optimal function. To maintain that adequate functioning, neuronal membranes need to be flexible, fluid, and responsive.
Interestingly, the nature of omega-3 molecules allows for all three - membrane flexibility, membrane fluidity (so proteins can embed within the membrane), and receptor responsiveness (Sinclair, 2019).
Omega-3’s populate the outer surface of neurons, and their unique chemical shape allows for the needed flexibility and fluidity. Although it seems as if omega-3’s do all these magical things in the brain, their benefit actually comes down to their shape and ability to allow the neuronal membrane to bend, flex, and allow proteins to sit within the membrane. By creating the right landscape, omega-3’s also enhance the ability of receptors to respond to neurotransmitters (Patrick & Ames, 2015).
With ample amounts of omega-3’s in the brain, neurons can retain the necessary flexibility, and function essential for smooth and efficient communication between various parts of the brain. No wonder the omega-3’s heavily populate the membranes of neurons inside our brains (Chang et al., 2009).
In sum, omega-3’s help the neurons remain flexible, fluid, and responsive to environmental stimuli. This means keeping messages flowing without interruptions. When our brains can keep information flowing we are much better at tempering our impulses and maintaining awareness of our surrounding environment.
Just like a family, each part of the neuron needs to fulfill its role so there can be optimal communication within the brain. Just as structure equals function, optimal communication equals harmony.
Communication is key.
Jo often argued that a child’s behavior is a reflection of their wants and needs. For better or worse, children do not depend on language to communicate their wants and needs - at least not to the same degree that most adults do. Instead, children are compelled to let their behavior do all the talking.
Ironically, the behaviors we find problematic are often kids' ways of asking for more connection, stronger limits, and safety. From the parental perspective, however, it looks like our kids are not only trying to rearrange our faces, they are trying to take us down altogether.
An essential aspect of communication is letting others know what is important to you. If you don’t speak up about it, they might not know that they’re stepping on your toes. Optimal communication equals harmony.
As mentioned above, omega-3’s improve communication by ensuring the integrity of the messages being sent and received within the brain. If a message from one part of the brain doesn’t reach its destination in another part of the brain, then that thought, feeling, or behavioral impulse is lost forever. Ever walk into a room and as soon as you’re past the doorway you realize you forgot what you went in that room to get or do?
With greater signal clarity in the brain, kids can seek things they want without getting stuck in irrational emotional states. When messages travel unimpeded across their brains, children (and adults) are better able to hang in there and stay on track.
So, signal integrity is important. But, certain signals need to take priority over others. For example, children can struggle to focus on schoolwork, but be completely locked in while playing their video games. Video games are far more exciting, which is how they tend to capture children’s attention. After experiencing highly stimulating screen-based entertainment, it can be hard for a kid to go back to regular old paper and pencil. In a way, it’s incredibly hard to sit and focus on boring schoolwork when totally awesome video games are calling your name. In order to resist that urge, the drive towards pleasure and reward must be blocked.
Sometimes a signal reaching its destination means that other signals are blocked (Edden et al., 2012), With improved communication within the brain, as well as improved control over which messages in the brain should take priority at a given moment in time, children will then have the tools they need to communicate and exert self-control. In addition, they’ll be better able to get across their wants and needs without resorting to Defcon 5 tactics.
One of the areas of the brain that is essential for impulse control is the frontal cortex. The frontal cortex sits right behind our eyes. It’s our brain’s brake. When things are coming at us from all directions, it is our frontal cortex that kicks into gear and helps us sort through the mess. The frontal cortex helps us focus on one thing at a time.
The frontal cortex improves our focus and self-control through inhibition (the act of slowing or stopping). When the emotional areas or reward center of our brain is highly active, we can similarly become overrun with emotions or impulses. Luckily, the frontal cortex can get involved and shush these less disciplined areas. In studies of the human brain, the frontal cortex has demonstrated an ability to mute strong (generally negative) emotions (Rajj et al., 2018) and limit impulsivity (Sebastian et al., 2014).
Control over our attention and our behavior depends upon functional communication pathways within the brain, especially the circuits that run through the frontal cortex. The frontal cortex is like a shut-off valve for our darker thoughts, feelings, and drives. With greater activity circulating through the frontal cortex, we are blessed with greater self-control.
Increased self-control is typically a good thing for individuals with ADHD. To obtain this improved self-control, we need an engaged and active frontal cortex. Some medications can help turn on our frontal cortex. We can also support these communication pathways with adequate amounts of omega-3’s in our brain. A clean, healthy brain, equipped with a fully functional frontal cortex possesses more omega-3’s (Diaz, 2018).
Researchers have even been able to prove, when it comes to frontal cortex activity, if you give more, you get more. One group of researchers gave children with ADHD omega-3 supplements and studied their brain activity. With EPA supplementation, the children’s brains were more efficient and better able to control their impulses during laboratory tests (Bauer et al., 2018). Imagine a day when our kids look both ways before crossing the street, walk instead of run on pool decks, and raise their hands to ask for help instead of raising their hands to hit their siblings. When that day comes, it’ll be their frontal cortex we should high five in delight.
Balance is best.
Jo supports the idea of fun… as long as it’s not too much fun, the fun only occurs at regularly scheduled intervals, and the type of fun was pre-sanctioned by parents.
Yet, what is fun?
Fun is one part pleasure and one part excitement. Many things feel good but aren’t exactly fun. Meditation is a good example. It’s calming and restorative, but it’s not exactly fun. Getting tickled all over is very exciting for children, but actually not all that enjoyable. It doesn’t take a team of researchers to identify that getting tickled is not that fun for kids, but deeply satisfying for the tickler (parents).
Yes, for fun, we need excitement and pleasure. Children know all about this. They know that we know this too. And, they know that we know that they know. It’s all part of the excitement about getting loose at home.
Kids often subconsciously say to themselves, “What’s gonna happen if I do this? It might end poorly for me, but at least it will be exciting... I can’t wait to see what happens!”
Excitement is an important aspect of fun. Yet, too much can be a problem (for us parents anyway).
For optimal functioning in life, limits are essential. Zero brain activity is clearly bad. Some brain activity is good. Too much brain activity can be problematic (seizures, psychosis, late-night episodes of racing thoughts).
In brain terminology, over-excitation equals overstimulation. In an overexcited state, the brain is consciously responding to too many things at one time. There’s a lot of switching back and forth. It’s too much to process.
An imbalance between excitation and inhibition in the brain (E/I imbalance) has recently emerged as a theory for what’s behind many common mental health disorders (Sohal & Rubenstein, 2019). With too much excitation going on in and across the brain, our brain activity can become dysregulated. When excitation is not adequately counterbalanced by inhibition, chaos in the brain can ensue.
Thankfully, omega-3’s can provide a degree of protection against over-excitation. Omega-3’s help our brains strike the right balance between excitation and inhibition, between fun and frazzled.
Omega-3’s help limit over-excitation in two key ways.
First, omega-3’s are anti-inflammatory. Inflammation involves the release of chemical messengers throughout the body and brain. Once inside the brain, these inflammatory messengers activate receptors on excitatory neurons. That extra and unnecessary activation produces many downstream consequences for our thinking and our emotional responses to life. Recent research has drawn a strong connection between chronic inflammation and the presence of ADHD in children has begun to emerge (Dunn et al., 2019).
Kids with ADHD commonly exhibit impulsive behaviors. They are all the more impulsive when emotional. If enough inflammatory messengers activate enough excitatory receptors in certain areas of the brain (amygdala for one), the brain will respond with a strong fear signal. That increased fear response can also lead to greater impulsivity.
Ever witnessed your child exhibit the most pro-social and kind sharing of toys with a sibling/friend, just to take it all back a few hours later with a sudden take-no-prisoners death match over a dried-up marker that doesn’t even work? These behaviors are developmentally normal, but at that moment, they seem abrupt, out of proportion, and hard to watch.
A significant amount of research into depression has revealed that inflammation can set us up for uncomfortable emotional experiences (Dantzer, 2009). Omega-3’s are anti-inflammatory and have even proven to reduce depressive symptoms in adults (Liao et al., 2019). Omega-3’s may help us feel better by quelling inflammatory signals in the brain (Laye et al., 2018).
Omega-3’s offer a counterbalance to inflammation that helps protect the brain from overstimulation. If inflammation is the fire, omega-3’s are fire extinguishers.
The second way omega-3’s help is through dampening electrical activity in the brain directly. It sounds bad, but this is a good thing. Omega-3’s embedded in neuronal membranes have an inhibiting (calming) effect on brain activity (Vreugdenhil et al., 1996, Tigerholm et al., 2012). That limitation on activity comes in handy when we’re faced with our childrens’ dramatic upwellings of emotion, impulsive drives, and frequent distractibility.
Here’s a delightful & super easy to understand conclusion from researchers on this exact mechanism of omega-3’s:
“PUFA induced hyperpolarization of resting membrane potential was an effective approach to hyperexcitability” (Tigerholm et al., 2012).
Translation: Omega 3’s calm kids' brains down. When communication within the brain is balanced and activity is metered, then our kids have a better chance of thinking before they act.
In conclusion, omega-3’s not only perform many crucial tasks within our brains, but they are also part of our brains. Consuming omega-3’s maybe the reason why our human brains grew in size and power over the course of evolution (Bradbury, 2011). It’s safe to say that our brains won’t be able to function optimally without them in our diet. So, let’s get started.
As always, starting with the diet is the best way to go.
Fish is the #1 source. Unfortunately, that can be hit or miss for most kids' taste buds. After fish, some of the best sources include walnuts, almonds, hemp seeds, sunflower seeds, grass-fed beef, bacon, navy beans, edamame, and eggs. Focusing on nuts, seeds, eggs, and grass-fed beef is an excellent starting place.
In some of the better quality studies, the magnitude of benefit of supplemental omega-3’s for children diagnosed with ADHD was small-to-moderate. But, there was a clear benefit to supplementation (Banaschewski et al., 2018). Again, most of these experiments used relatively lower doses of omega-3 supplements.
In studies with higher daily dosage (above 500mg per day of EPA), researchers found a “modest” benefit for the reduction of ADHD symptoms (Chang, 2018). In one such study, when researchers isolated the children with the lowest blood levels of omega-3’s, the size of the benefit was large (meaning it significantly reduced the frequency and intensity of ADHD symptoms) (Chang, 2019). So, in the research, a higher dose made a big difference for most of the children diagnosed with ADHD.
So getting to the right dose is key. Another important factor is time. The studies that demonstrated benefit generally chose to measure behavioral effects of omega-3 supplementation at 3-4 months. Benefits may come sooner, but a kids’ brain (weighs about 3lbs) is 60% fat, so that’s a lot of Omega 3’s to get into the brain (Chang, 2009).
If you are considering supplements, then definitely have a conversation with your child’s pediatrician to see what they recommend. Omega-3 supplements commonly come in the form of fish oil capsules. There are liquid forms as well, but the taste is usually too distinct and strong for most kids to tolerate. Cod liver oil capsules are another option. Cod liver oil offers a fair amount, along with the benefit of Vitamins A and D.
Thanks for reading until the end. I hope that you’ve gained a better understanding of exactly what omega-3’s are doing inside the brain, and how they can help. So don’t delay, give your kids plenty of Omega 3’s so they can leave your face alone.
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