Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
권호 표지
DOI QR코드

DOI QR Code

Effect of omega-3 plus methylphenidate as an alternative therapy to reduce attention deficit-hyperactivity disorder in children

  • Mohammadzadeh, Soleiman (Child and Adolescent Psychiatrist, Neurosciences Research Center, Kurdistan University of Medical Sciences) ;
  • Baghi, Narmin (Neurosciences Research Center, Kurdistan University of Medical Sciences) ;
  • Yousefi, Fayegh (Neurosciences Research Center, Kurdistan University of Medical Sciences) ;
  • Yousefzamani, Bahar (Besat Hospital, Kurdistan University of Medical Sciences)
  • 투고 : 2018.09.01
  • 심사 : 2019.05.15
  • 발행 : 2019.09.15
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Background: Attention deficit-hyperactivity disorder (ADHD) is one of the most common chronic behavioral disorders in school-aged children. Purpose: This study aimed to evaluate the effect of omega-3 supplementation as an alternative therapy for ADHD, which can be caused by vitamin and mineral deficiencies. Methods: This was a double-blinded clinical trial study. Sixty-six children with ADHD (aged 6-12 years) referred to our child and adolescent psychiatric educational and therapeutic clinic were selected based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. Instruments including the Parent ADHD Rating Scale were used to assess ADHD at 0, 2, 4, and 8 weeks during the study. Results: The results showed no statistically significant difference between the methylphenidate with omega-3 group and methylphenidate with placebo group based on the Parents ADHD Rating Scale between week 0 ($P{\geq}0.96$) and week 8 ($P{\geq}0.75$). There were no significant intergroup differences between the Inattention ($P{\geq}0.48$) and hyperactivity/impulsivity ($P{\geq}0.80$) subscale scores on the Parents ADHD Rating Scale. The most common drug complications in the methylphenidate with placebo and methylphenidate with omega-3 groups were anorexia (27 [54%] vs. 41 [60.29%], respectively) and diarrhea (10 [20%] vs. 8 [11.76%], respectively), but the differences were not statistically significant (P>0.05). Conclusion: Our results demonstrate that a specific dose of omega-3 for 8 weeks had no effect on ADHD.

키워드

참고문헌

  1. Antai-Otong D, Zimmerman ML. Treatment approaches to attention deficit hyperactivity disorder. Nurs Clin North Am 2016;51:199-211. https://doi.org/10.1016/j.cnur.2016.01.005
  2. Connor DF. Preschool attention deficit hyperactivity disorder: a review of prevalence, diagnosis, neurobiology, and stimulant treatment. J Dev Behav Pediatr 2002;23(1 uppl):S1-9. https://doi.org/10.1097/00004703-200202001-00002
  3. Rowland AS, Lesesne CA, Abramowitz AJ. The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view. Ment Retard Dev Disabil Res Rev 2002;8:162-70. https://doi.org/10.1002/mrdd.10036
  4. Mick E, Biederman J, Prince J, Fischer MJ, Faraone SV. Impact of low birth weight on attention-deficit hyperactivity disorder. J Dev Behav Pediatr 2002;23:16-22. https://doi.org/10.1097/00004703-200202000-00004
  5. Mick E, Biederman J, Faraone SV, Sayer J, Kleinman S. Case-control study of attention-deficit hyperactivity disorder and maternal smoking, alcohol use, and drug use during pregnancy. J Am Acad Child Adolesc Psychiatry 2002;41:378-85. https://doi.org/10.1097/00004583-200204000-00009
  6. Kidd PM. Attention deficit/hyperactivity disorder (ADHD) in children: rationale for its integrative management. Altern Med Rev 2000;5:402-28.
  7. Chen JR, Hsu SF, Hsu CD, Hwang LH, Yang SC. Dietary patterns and blood fatty acid composition in children with attention-deficit hyperactivity disorder in Taiwan. J Nutr Biochem 2004;15:467-72. https://doi.org/10.1016/j.jnutbio.2004.01.008
  8. Rather YH, Sheikh AA, Sufi AR, Qureshi AA, Wani ZA, Shaukat TS. ADHD presenting as recurrent epistaxis: a case report. Child Adolesc Psychiatry Ment Health 2011;5:13. https://doi.org/10.1186/1753-2000-5-13
  9. Banaschewski T, Roessner V, Dittmann RW, Santosh PJ, Rothenberger A. Non-stimulant medications in the treatment of ADHD. Eur Child Adolesc Psychiatry 2004;13 Suppl 1:I102-16.
  10. Barkley RA, McMurray MB, Edelbrock CS, Robbins K. Side effects of methylphenidate in children with attention deficit hyperactivity disorder: a systemic, placebo-controlled evaluation. Pediatrics 1990;86:184-92.
  11. DuPaul GJ, RA Barkley, DF Connor. Stimulants. In: Barkley RA, edior. Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment. 2nd ed. New York: Guilford Press; 1998. p. 510-51.
  12. Elia J, Borcherding BG, Rapoport JL, Keysor CS. Methylphenidate and dextroamphetamine treatments of hyperactivity: are there true nonresponders? Psychiatry Res 1991;36:141-55. https://doi.org/10.1016/0165-1781(91)90126-A
  13. Sinn N, Bryan J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. J Dev Behav Pediatr 2007;28:82-91. https://doi.org/10.1097/01.DBP.0000267558.88457.a5
  14. Aben A, Danckaerts M. Omega-3 and omega-6 fatty acids in the treatment of children and adolescents with ADHD. Tijdschr Psychiatr 2010;52:89-97.
  15. Bloch MH, Qawasmi A. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 2011;50:991-1000. https://doi.org/10.1016/j.jaac.2011.06.008
  16. Perera H, Jeewandara KC, Seneviratne S, Guruge C. Combined ${\omega}3$ and ${\omega}6$ supplementation in children with attention-deficit hyperactivity disorder (ADHD) refractory to methylphenidate treatment: a doubleblind, placebo-controlled study. J Child Neurol 2012;27:747-53. https://doi.org/10.1177/0883073811435243
  17. Johnson M, Ostlund S, Fransson G, Kadesjo B, Gillberg C. Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: a randomized placebo-controlled trial in children and adolescents. J Atten Disord 2009;12:394-401. https://doi.org/10.1177/1087054708316261
  18. Antalis CJ, Stevens LJ, Campbell M, Pazdro R, Ericson K, Burgess JR. Omega-3 fatty acid status in attention-deficit/hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids 2006;75:299-308. https://doi.org/10.1016/j.plefa.2006.07.004
  19. Colter AL, Cutler C, Meckling KA. Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: a case-control study. Nutr J 2008 Feb 14;7:8. doi: 10.1186/1475-2891-7-8.
  20. Bazinet RP, Laye S. Polyunsaturated fatty acids and their metabolites in brain function and disease. Nat Rev Neurosci 2014;15:771-85. https://doi.org/10.1038/nrn3820
  21. Chalon S. Omega-3 fatty acids and monoamine neurotransmission. Prostaglandins Leukot Essent Fatty Acids 2006;75:259-69. https://doi.org/10.1016/j.plefa.2006.07.005
  22. Kodas E, Galineau L, Bodard S, Vancassel S, Guilloteau D, Besnard JC, et al. Serotoninergic neurotransmission is affected by n-3 polyunsaturated fatty acids in the rat. J Neurochem 2004;89:695-702. https://doi.org/10.1111/j.1471-4159.2004.02401.x
  23. Vancassel S, Blondeau C, Lallemand S, Cador M, Linard A, Lavialle M, et al. Hyperactivity in the rat is associated with spontaneous low level of n-3 polyunsaturated fatty acids in the frontal cortex. Behav Brain Res 2007;180:119-26. https://doi.org/10.1016/j.bbr.2007.02.032
  24. Kirley A, Hawi Z, Daly G, McCarron M, Mullins C, Millar N, et al. Dopaminergic system genes in ADHD: toward a biological hypothesis. Neuropsychopharmacology 2002;27:607-19. https://doi.org/10.1016/S0893-133X(02)00315-9
  25. Durston S, Konrad K. Integrating genetic, psychopharmacological and neuroimaging studies: a converging methods approach to understanding the neurobiology of ADHD. Dev Rev 2007;27:374-95. https://doi.org/10.1016/j.dr.2007.05.001
  26. Carlson RV, van Ginneken NH, Pettigrew LM, Davies A, Boyd KM, Webb DJ. The three official language versions of the Declaration of Helsinki: what's lost in translation? J Med Ethics 2007;33:545-8. https://doi.org/10.1136/jme.2006.018168
  27. Zhang S, Faries DE, Vowles M, Michelson D. ADHD Rating Scale IV: psychometric properties from a multinational study as a clinicianadministered instrument. Int J Methods Psychiatr Res 2005;14:186-201. https://doi.org/10.1002/mpr.7
  28. Hawkey E, Nigg JT. Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials. Clin Psychol Rev 2014;34:496-505. https://doi.org/10.1016/j.cpr.2014.05.005
  29. Amiri S, Farhang S, Ghoreishizadeh MA, Malek A, Mohammadzadeh S. Double-blind controlled trial of venlafaxine for treatment of adults with attention deficit/hyperactivity disorder. Hum Psychopharmacol 2012;27:76-81. https://doi.org/10.1002/hup.1274
  30. Mohammadi MR, Mohammadzadeh S, Akhondzadeh S. Memantine versus methylphenidate in children and adolescents with attention deficit hyperactivity disorder: a double-blind, randomized clinical trial. Iran J Psychiatry 2015;10:106-14.
  31. Mohammadzadeh S, Ahangari TK, Yousefi F. The effect of memantine in adult patients with attention deficit hyperactivity disorder. Hum Psychopharmacol 2019;34:e2687. https://doi.org/10.1002/hup.2687
  32. Kuperman S, Perry PJ, Gaffney GR, Lund BC, Bever-Stille KA, Arndt S, et al. Bupropion SR vs. methylphenidate vs. placebo for attention deficit hyperactivity disorder in adults. Ann Clin Psychiatry 2001;13:129-34. https://doi.org/10.3109/10401230109148958
  33. Konigs A, Kiliaan AJ. Critical appraisal of omega-3 fatty acids in attention-deficit/hyperactivity disorder treatment. Neuropsychiatr Dis Treat 2016;12:1869-82. https://doi.org/10.2147/NDT.S68652
  34. Barragan E, Breuer D, Dopfner M. Efficacy and safety of omega-3/6 fatty acids, methylphenidate, and a combined treatment in children with ADHD. J Atten Disord 2017;21:433-41. https://doi.org/10.1177/1087054713518239
  35. Bos DJ, Oranje B, Veerhoek ES, Van Diepen RM, Weusten JM, Demmelmair H, et al. Reduced symptoms of inattention after dietary omega-3 fatty acid supplementation in boys with and without attention deficit/hyperactivity disorder. Neuropsychopharmacology 2015;40:2298-306. https://doi.org/10.1038/npp.2015.73

피인용 문헌

  1. Use of Non-Pharmacological Supplementations in Children and Adolescents with Attention Deficit/Hyperactivity Disorder: A Critical Review vol.12, pp.6, 2019, https://doi.org/10.3390/nu12061573
  2. Efficacy and Safety of Polyunsaturated Fatty Acids Supplementation in the Treatment of Attention Deficit Hyperactivity Disorder (ADHD) in Children and Adolescents: A Systematic Review and Meta-Analysi vol.13, pp.4, 2019, https://doi.org/10.3390/nu13041226
  3. A Systematic Review of Sleep and Circadian Rhythms in Children with Attention Deficit Hyperactivity Disorder vol.26, pp.2, 2019, https://doi.org/10.1177/1087054720978556