Long chain polyunsaturated fatty acids influence emotional processing in boys with ADHD
Long chain polyunsaturated fatty acids influence emotional processing in boys with ADHD1.
Intervention studies have previously shown that omega-3 long chain polyunsaturated fatty acids (LC-PUFAs), docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) from fish oil can influence behaviour in people with learning disorders1,2,3. However, for the first time the influence of blood levels of these fatty acids on electrical activity within the body and brain that also corresponds with interpretation of emotional stimuli has been confirmed in three observational studies in children and adolescent with attention deficit hyperactivity disorder (ADHD).
The collaborative studies among six Universities in the UK (King’s College, Nottingham Trent, Kingston, Imperial College, London Metropolitan, Worcester) and the National Institute on Alcohol Abuse and Alcoholism followed a 2009 pilot study by some of the same researchers showing that higher blood EPA levels made boys with ADHD more likely to correctly interpret facial expressions of happiness than of sadness or fearful faces4. In addition, higher DHA levels enabled them to more correctly identify expressions of fear while a higher ratio of arachidonic acid (AA)/DHA made it more difficult for them to correctly interpret expressions of fear.
The first in this latest series of studies included 31 children and adolescent (mean age 14 =/- 1.1 years) with ADHD and 32 age and sex matched controls (mean age 14.46 +/- 1.12 years) from the Maudsley Adolescent ADHD Fatty Acid (MAAFA) trial5. Their brain activity was recorded during an emotional perception task that included four viewings of eight different individuals showing expressions of happiness, sadness, fear, anger and disgust relative to neutral faces. In addition, their plasma fatty acid profile was determined. There was no difference in the blood levels of the parent essential fatty acids, linoleic acid (LA) and alpha-linolenic acid (ALA) between the ADHD group and controls. However, nearly all the omega-3 and omega-6 long chain polyunsaturated fatty acids (LC-PUFAs) derived from them were below normal in the ADHD group. In addition, the children with ADHD had brain activity abnormalities when interpreting facial expressions relative to normal control children that were significantly associated with lower omega-3 LC-PUFA levels.
The second study included 29 children or adolescents between 12 – 16 years with ADHD and 43 age matched controls6. They had their blood fatty acid status determined and were given a variety of standardized tests to assess personality traits including childhood depression, anxiety, stress, anger, disruptive behaviour, self-concept, hostility, aggression, impulsivity in three main areas; motor control (acting without thinking), cognitive (ability to make decisions quickly), non-planning (present orientation), anti-social behaviour and psychopathy. Lower blood EPA and total omega-3 LC-PUFAs were associated with callous-unemotional traits in the ADHD group.
The third study included 20 right-handed adolescent boys (aged 12-16 years) with behavioural problems recruited from a school for children with emotional and/or behavioural problems7. Red blood cell fatty acids were determined and a personality test to assess neuroticism, agreeableness, conscientiousness, extraversion and openness was completed. The first three items indicate cognitive and emotional stability [Stability = Agreeableness + Conscientiousness – Neuroticism] and the last two are a measure of ability to change and adapt [Extraversion + Openness = Plasticity]. The results showed that stability was greater in the boys with higher adrenic acid (derived from AA) while plasticity was greater in those with higher blood oleic acid status. (Oleic acid, found in abundance in olive oil, is most highly concentrated in white matter including the myelin sheath, while omega-3 LC-PUFAs are more prominent in grey matter.)
Previous studies have reported that poor responses to facial expressions of fear are associated with conduct problems including violent behavior in children and adults8. The results of these recent studies suggest this behavior may be directly associated with abnormally low omega-3 LC-PUFA status. In addition, higher omega-6 LC-PUFA status is associated with both agreeableness and conscientiousness . Supplementation with products such as Efalex, that provide both omega-3 and omega-6 LC-PUFAs may be a simple way of helping to correct these social problems.
References:
1. Stevens, L., Zhang, W., Peck, L., et al. EFA supplementation in children with inattention, hyperactivity, and other disruptive disorders. Lipids 2003;38: 1007-1021.
2. Vancassel S, Durand G, Barth EC et al. Plasma fatty acid levels in autistic children. Prostagland Leuk Essent Fatty 2001;65:1-7.
3. Richardson AJ, Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2002;26:233-239.
4. Gow RV, Matsudaira T, Taylor E, Rubia K, Crawford M et al. Total red blood cell concentrations of omega-3 fatty acids are associated with emotion-elicited neural activity in adolescent boys with attention-deficit hyperactivity disorder. Prostaglandins, Leukotrienes and Essential fatty Acids. 2009;80:151-56.
5. Gow RV, Sumich A, Vallee-Tourangeau F, Crawford MA, Ghebremeskel K, Bueno AA, Hibbeln JR, Taylor E, Wilson DA, Rubia K. Omega-3 fatty acids are related to abnormal emotion processing in adolescent boys with attention deficit hyperactivity disorder. Prostaglandins Leukotrienes and Essential Fatty Acids. 2013;88:419- 429.
6. Gow RV, Sumich A, Vallee-Tourangeau F, Crawford MA, Taylor E, Ghebremeskel K, Bueno AA, Hibbeln JR, Sumich A, Rubia K. Omega-3 fatty acids are inversely related to callous and unemotional traits in adolescent boys with attention deficit hyperactivity disorder. Prostaglandins Leukotrienes and Essential Fatty Acids. 2013;88:411-418.
7. Sumich A, Matsudaira T, Heasman B, Gow RV, Ibrahimovic A, Ghebremeskel K, Crawford MA, Taylor E. Fatty acid correlates of temperament in adolescent boys with attention deficit hyperactivity disorder. Prostaglandins Leukotrienes and Essential Fatty Acids. 2013;88:431-436.
8. Perry RJ, Rosen HR, Kramer JH, Beer JS, Levenson RL. Hemispheric dominance for emotions, empathy and social behaviour: evidence from right and left handers with frontotemporal dementia. Neurocase 2001;7:145- 60.
NEWS FROM THE RESEARCH FRONT No 147 June 2013
Topics: Omega-3 fatty acids, docosahexaenoic acid (DHA), Eicosapentaenoic acid (EPA), Omega-6 fatty acids, arachidonic acid (AA), long chain polyunsaturated fatty acids (LC-PUFAs),attention deficit hyperactivity disorder (ADHD), behaviour
Relevance to: Efalex, Efalex Concentrate
Reference 1: Gow RV, Sumich A, Vallee-Tourangeau F, Crawford MA, Ghebremeskel K, Bueno AA, Hibbeln JR, Taylor E, Wilson DA, Rubia K. Omega-3 fatty acids are related to abnormal emotion processing in adolescent boys with attention deficit hyperactivity disorder. Prostaglandins Leukotrienes and Essential Fatty Acids. 2013;88:419-429.
Background: Abnormalities in the way emotional stimuli are perceived have been reported in
people with ADHD, depression, anxiety and conduct disorder. Brain activity in
certain areas of the brain or “event-related potential” (ERP) and behavioural studies suggest there is an exaggerated bias in the automatic processing towards fear-
related stimuli in anxiety. There is some evidence that children and young adults with ADHD have lower than normal omega-3 LC-PUFA levels and that supplementation with these nutrients improves their emotional behaviour.
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Objective: To determine the relationship between omega-3 LC-PUFA status and brain function involving emotional responses in adolescent boys with ADHD. Specifically, this study measured ERP responses to the presentation of facial expressions of happiness, sadness, fearfulness, anger and disgust to determine how these expressions were interpreted by adolescents with ADHD. These responses were then correlated with their fatty acid profiles in plasma total lipids.
Method: This case-control observational study included 31 children/adolescent (mean age 14 =/- 1.1 years) who met the ADHD criteria based on DSM-IV and 32 age and sex matched controls (mean age 14.46 +/- 1.12 years) from the Maudsley Adolescent ADHD Fatty Acid (MAAFA)trial.
Inclusion criteria for ADHD Group: Both Parent and Teacher Connor Rating Scales had to be equal to or above 65.
Inclusion criteria for all: IQ greater than 70 as assessed using the Kaufman Brief Intelligence Test.
Exclusion criteria for all:If they took omega-3 or 6 supplements in the last 3 months.
Special note: 22 of the ADHD participants had never been treated with medication and the remaining 9 underwent a 48 hr wash out period prior to testing.
Assessments:
1) Fatty acids status in plasma phosphatidylcholine
2) Electroencephalographic/ Event-related potentials (EEG/ERP) recording during an emotional perception task that included four viewings of eight different individuals showing expressions of happiness, sadness, fear, anger and disgust relative to neutral faces.
Findings: There was no difference in the blood levels of linoleic acid (LA) and alpha-linolenic acid (ALA) between the ADHD group and controls. However, nearly all the omega-3 and omega-6 LC-PUFAs after delta-6-desaturase in the metabolic pathway were below normal in the ADHD group. Children with ADHD had ERP abnormalities in facial expression emotional processing relative to normal control children. These ERP abnormalities were significantly associated with lower omega-3 LC-PUFA levels.
Conclusion: Lower omega-3 fatty acid status is associated with impaired emotional processing in ADHD children.
Reference 2: Gow RV, Sumich A, Vallee-Tourangeau F, Crawford MA, Taylor E,Ghebremeskel K, Bueno AA, Hibbeln JR,Sumich A,Rubia K. Omega-3 fatty acids are inversely related to callous and unemotional traits in adolescent boys with attention deficit hyperactivity disorder. Prostaglandins Leukotrienes and Essential Fatty Acids. 2013;88:411-418.
Background: Many studies have reported abnormal fatty acid patterns in children with ADHD along with some benefits of LC-PUFA supplementation for symptoms of ADHD. However, few studies have correlated specific blood fatty acids with particular behaviour traits including callous and unemotional traits. These are described as individual variations in guilt, remorse and empathy and are considered to be a significant feature of aggression and psychopathy in youth.
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Objective: To determine the blood fatty acid composition of children/adolescents with ADHD compared to normal controls and to determine the relationship between these fatty acids and measures of behavior and personality.
Method: This case-control observational study included 29 children or adolescents between 12 and 16 years with either clinical or research diagnosed ADHD based on DSM-IV criteria and 43 age matched controls recruited from local (UK) schools and adverts placed on ADHD charity websites .
Exclusion criteria for ADHD Group: comorbid psychiatric condition and learning disability as assessed with the ChIPS
Exclusion criteria for all: IQ less than 70. Took omega-3 or 6 supplements in the last 3 months.
Special note: 17 of the ADHD participants were not taking medication and the remaining were asked to withhold from treatment for 24 hr before testing.
Assessments:
1) Beck’s Youth Inventory – assess childhood depression, anxiety, anger, disruptive behavior and self-concept
2) Buss-Perry Aggression Scale – assess hostility and aggression
3) Depression Anxiety and Stress Scale – assess negative states of emotional states of depression, anxiety and stress
4) Barratt Impulsiveness Scale – categorises impulsivity into three main areas; motor control (acting without thinking),cognitive (ability to make decisions quickly), non-planning (present orientation)
5) Strengths and Difficulties Questionnaire
6) Essential Fatty Acid Deficiency Questionnaire
7) Fatty acid composition of plasma phosphatidylcholine
Addition, the ADHD only group had to complete the:
8) Anti-Social Process Screening Device
9) Inventory of Callous Unemotional Traits for Youth
Bothe designed to assess anti-social behavior and psychopathy.
Findings: Callous-unemotional traits were significantly negatively correlated with both EPA and total omega-3s in the ADHD group.
Conclusion: Anti-social traits in ADHD are associated with lower omega-3 status.
Reference 3: Sumich A, Matsudaira T, Heasman B, Gow RV, Ibrahimovic A, Ghebremeskel K, Crawford MA, Taylor E. Fatty acid correlates of temperament in adolescent boys with attention deficit hyperactivity disorder. Prostaglandins Leukotrienes and Essential Fatty Acids. 2013;88:431-436.
Background: Abnormal fatty acid metabolism has been reported in ADHD, but its relationship with temperament has not been thoroughly investigated.
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.Objective: To determine the relationship between blood fatty acid status and NEO-Five Factor Inventory (FFI) personality scores of stability (neuroticism reversed, conscientiousness and agreeableness) and plasticity (openness, extraversion) in right-handed adolescent boys with behavioural problems and symptoms of ADHD.
Method: This observational study included 20 right-handed adolescent boys (aged 12-16 years) with behavioural problems recruited from a school for children with emotional and/or behavioural problems.
Inclusion Criteria: Met the criteria for ADHD based on the Children’s Interview for Psychiatric Syndrome; A score of >65 on the ADHD index of both the Parent and Teacher versions of the Comnnor’s Rating Scale; an IQ >70 assessed using the Kaufman Brief Intelligence Test.
Exclusion Criteria: If taking fatty acid supplements at the time of the study
Special note: 17 of the 20 were not taking medication.
Assessments:
1) NEO-FFI Personality Questionnaire – to assess aspects of personality: neuroticism, agreeableness, conscientiousness, extraversion and openness. The former three measures are proposed as indicators of cognitive and emotional stability [Stability = Agreeableness + Conscientiousness – Neuroticism] ; [Extraversion + Openness = Plasticity]
2) Red blood cell fatty acids
Findings: Indices of Stability (i.e. neuroticism, agreeableness and conscientiousness) are positively associated with adrenic acid (derived from arachidonic acid). Plasticity (derived from extraversion and openness) are associated with oleic acid status. (Oleic acid is most highly concentrated in white matter including the myelin sheath, while DHA is more prominent in grey matter.)
Conclusion: Higher omega-6, adrenic acid content is associated with both agreeableness and conscientiousness while higher oleic acid is associated with openness and extraversion.