Abstract
Children with attention deficit/hyperactivity disorder (ADHD) exhibit blood docosahexaenoic acid (DHA) deficits and cortical network pathology. This neuroimaging study investigated the effects of DHA supplementation on cortical attention network integrity in medication-free children with ADHD. Children (mean age 9.6 years, n=30) with ADHD were randomized to DHA (1,200 mg/d) or placebo for 10 weeks. Blood DHA levels and ADHD symptom severity ratings were obtained from all participants (n=30). Cortical network integrity was evaluated in a subset of patients (n=20) using functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI). Erythrocyte DHA levels increased significantly in patients receiving DHA (+60%, p≤0.0001) but not placebo (-4%, p=0.77). There were no group differences in baseline-endpoint change in ADHD symptom severity scores, sustained attention performance, or voxelwise cortical activation patterns during performance of a sustained attention task. In the region-of-interest (ROI) analysis, patients treated with DHA but not placebo exhibited significant endpoint reductions in left amygdala activation. At study endpoint, but not at baseline, DHA-treated patients exhibited significantly greater event-related functional connectivity between the pregenual and subgenual anterior cingulate cortex and regions within the cortical attention network including the inferior parietal lobe and dorsolateral prefrontal cortex compared with placebo. Trends with large effect sizes for reductions in medial and radial diffusivity in the left corpus callosum were observed in DHA-treated patients. These preliminary findings suggest that DHA supplementation may be associated with subtle changes in cortical attention networks of medication-free children with ADHD which warrant additional investigation in a larger patient sample.
Highlights
Attention deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders [1]
The present pilot study evaluated the effects of 10week docosahexaenoic acid (DHA) supplementation on cortical attention network integrity and attentional symptoms in medication-free children with ADHD
Baseline-endpoint change in measures of sustained attention performance, ADHD symptom severity, and voxelwise cortical activation patterns during performance of the sustained attention task did not differ between DHA- and placebo-treated patients
Summary
Attention deficit/hyperactivity disorder (ADHD) is one of the most common childhood psychiatric disorders [1]. Meta-analyses indicate that ADHD youth exhibit significantly lower blood levels of DHA compared with healthy youth [21,22], and that supplementation with DHA containing formulations produce a modest but significant benefit over placebo for reducing ADHD symptoms [21,22,23]. While these associations support a potential link between early. A placebo-controlled fMRI study found that DHA supplementation significantly increased prefrontal cortex activation during sustained attention in healthy children [25]. Based on the evidence reviewed above, the overarching hypothesis was that 10-week DHA supplementation would increase cortical attention network integrity and improve associated impairments in attention
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