Levels Of Hyperactivity Research Articles

An intervention to improve social participation for adolescents with autism spectrum disorder: Pilot study

Objective: To increase flexible thinking, self-regulation and empathy for adolescents with ASD.Method: Five adolescents (M = 13.5 years; SD = 0.84 years; four males) were assessed pre and post intervention for flexible thinking and social competence (as measured by the SSIS). Parents rated their adolescent’s social competence pre and post intervention.Results: A large decrease was found in parent rating of their child’s level of hyperactivity (12.8, SD = 2.3; 11, SD = 2.2) (p = 0.034) (Cohen’s d = 0.95). Parents increased their rating of their child’s cooperation and empathy (Cohen’s d = 0.71 and 0.56, respectively). A medium effect for flexible thinking was observed in three items (Cohen’s d = 0.5 to 0.62) and a large effect for one item (Cohen’s d = 1.35). Adolescents decreased self-scoring on the social scale post intervention.Conclusion: Improvements were observed in adolescents’ flexible thinking and social insights, and parent’s perception of their child’s self-regulation.

Outcomes of an acceptance and commitment therapy-based skills training group for students with high-functioning autism spectrum disorder: A quasi-experimental pilot study

Autism spectrum disorder is characterized by social impairments and behavioural inflexibility. In this pilot study, the feasibility and outcomes of a 6-week acceptance and commitment therapy-based skills training group were evaluated in a special school setting using a quasi-experimental design (acceptance and commitment therapy/school classes as usual). A total of 28 high-functioning students with autism spectrum disorder (aged 13-21 years) were assessed using self- and teacher-ratings at pre- and post-assessment and 2-month follow-up. All participants completed the skills training, and treatment satisfaction was high. Levels of stress, hyperactivity and emotional distress were reduced in the treatment group. The acceptance and commitment therapy group also reported increased prosocial behaviour. These changes were stable or further improved at the 2-month follow-up. Larger studies are needed to further evaluate the benefits of acceptance and commitment therapy for autism spectrum disorder.

Does Gender Matter? A One Year Follow-up of Autistic, Attention and Anxiety Symptoms in High-Functioning Children with Autism Spectrum Disorder

Gender differences in autism spectrum disorder (ASD) symptoms and associated problem behaviours over development may provide clues regarding why more males than females are diagnosed with ASD. Fifty-six high-functioning children with ASD, and 44 typically developing controls, half of the participants female, were assessed at baseline (aged 7-12years) and one-year later, collecting measures of autism, attention and anxiety symptoms, school placement and support information. Findings indicated no gender differences in autistic symptoms. Males were more hyperactive and received more integration-aide support in mainstream schools, and females were more socially anxious. Overall, similar gender profiles were present across two time points. Lower hyperactivity levels in females might contribute to their under-identification. Implications are discussed using a biopsychosocial model of gender difference.

Calibración del Índice de Hiperactividad de Conners mediante el modelo de Rasch

The aim of this study was focused on the calibration of the Spanish version of the 10-item Conners Hyperactivity Index or Conners 3-AI using the Rasch model. The participants in this study were 482 children aged 5 and 6 years old. Results showed that the IHC has good psychometric properties. The fit of both items and persons data to Rasch model was good, and the response categories were functioning properly. Boys scored significantly higher than girls. Three of the items were at risk of gender-specific DIF. The Conners 3-AI has an obvious floor effect, which prevents the evaluation of children with low levels of hyperactivity.

Erratum to: A randomized controlled trial investigating the effects of PCSO-524®, a patented oil extract of the New Zealand Green Lipped Mussel (Perna canaliculus), on the behaviour, mood, cognition and neurophysiology of children and adolescents (aged 6–14 years) experiencing clinical and sub-clinical levels of hyperactivity and inattention: study protocol ACTRN12610000978066

Erratum to: A randomized controlled trial investigating the effects of PCSO-524®, a patented oil extract of the New Zealand Green Lipped Mussel (Perna canaliculus), on the behaviour, mood, cognition and neurophysiology of children and adolescents (aged 6–14 years) experiencing clinical and sub-clinical levels of hyperactivity and inattention: study protocol ACTRN12610000978066

Evaluation of single nucleotide polymorphisms in the miR-183–96–182 cluster in adulthood attention-deficit and hyperactivity disorder (ADHD) and substance use disorders (SUDs)

Attention deficit-hyperactivity disorder (ADHD) is a neuropsychiatric disorder characterized by inappropriate and impaired levels of hyperactivity, impulsivity and inattention. Around 75% of adults with ADHD show comorbidity with other psychiatric disorders such as disruptive behavior disorders or substance use disorders (SUDs). Recently, there has been growing interest in studying the role of microRNAs (miRNAs) in the susceptibility to complex disorders. Interestingly, converging evidence suggests that single nucleotide polymorphisms (SNPs) within miRNAs or miRNA target sites may modulate the miRNA-mediated regulation of gene expression through the alteration of the miRNA maturation, structure or expression pattern as well as the silencing mechanisms of target genes. Genetic studies and animal models support the involvement of the serotonin receptor (HTR1B) in ADHD. We evaluated the contribution of one SNP in the miR-96 target site at HTR1B and eight tagSNPs within the genomic region containing this miRNA in 695 adults with ADHD (266 and 396 subjects with and without comorbid SUD, respectively), 403 subjects with SUD without life-time diagnosis of ADHD and 485 sex-matched controls from Spain. Single and multiple marker analyses revealed association between two SNPs located at the 3′ region of miR-96 (rs2402959 and rs6965643) and ADHD without SUD. Our results provide preliminary evidence for the contribution of two sequence variants at the miR-183–96–182 cluster to ADHD without comorbid SUD, and emphasize the need to take comorbidities into account in genetic studies to minimize the effect of heterogeneity and to clarify these complex phenotypes.

A randomized controlled trial investigating the effects of PCSO-524®, a patented oil extract of the New Zealand green lipped mussel (Perna canaliculus), on the behaviour, mood, cognition and neurophysiology of children and adolescents (aged 6–14 years) experiencing clinical and sub-clinical levels of hyperactivity and inattention: study protocol ACTRN12610000978066

BackgroundThe prevalence rate of attention-deficit/hyperactivity disorder (ADHD) within Western cultures is between 5% and 12%, and is the most common psychiatric illness among school-aged children, with an estimated 50% of these children retaining ADHD symptoms for the rest of their lives. Children with ADHD have lower blood levels of long-chain Poly Unsaturated Fatty Acids (LC PUFAs) compared with children without ADHD, and following PUFA supplementation, have shown improvements in ADHD-related symptoms. One highly promising marine based LC PUFA preparation is the Omega-3-rich Lyprinol/Omega XL which is a natural formulation containing standardised lipid extract of the New Zealand green lipped mussel (Perna canaliculus) known as PCSO-524® which contains a unique combination of free fatty acids, sterol esters, polar lipids and carotenoids. It is this unique combination of marine lipids that may assist in correcting the decreased levels of LC PUFA levels in children with symptoms of ADHD. The compound is a mixture belonging to a lipid group called sterol esters (SE). The fatty acids in the SE fraction are mainly myristic acid, palmitic acid, palmitoleic acid, stearic acid, oleic acid, linoleic acid, eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Lyprinol/Omega XL has previously been shown to contain a potent group of Omega-3 lipids that block the 5 - lipoxygenase metabolic pathway responsible for inflammation in the body.MethodsA randomized double blind placebo controlled trial will be utilized to assess the effects of 14 weeks administration of Lyprinol/Omega XL versus placebo in 150 children aged 6 to 14 years with high levels of hyperactivity and inattention. Additionally, a range of cognitive, mood and central electrophysiological measures will be undertaken during the 14 week supplementation trial. The primary outcome measure, the Conners’ Parent Rating Scales will be completed initially at baseline, then in weeks 4, 8, 10, 14 and then again at 4 weeks post-administration (week 18). The results will contribute to our understanding of the efficacy of marine based Omega-3 s with high anti-inflammatory actions on inattention and hyperactivity in children aged 6 to 14 years.

Motivational incentives and methylphenidate enhance electrophysiological correlates of error monitoring in children with attention deficit/hyperactivity disorder

Background Children with attention deficit hyperactivity disorder (ADHD) are characterised by developmentally inappropriate levels of hyperactivity, impulsivity and/or inattention and are particularly impaired when performing tasks that require a high level of cognitive control. Methylphenidate (MPH) and motivational incentives may help improve cognitive control by enhancing the ability to monitor response accuracy and regulate performance accordingly.Methods Twenty-eight children with DSM-IV ADHD (combined type) aged 9–15 years and pairwise-matched typically developing children (CTRL) performed a go/no-go task in which the incentives attached to performance on no-go trials were manipulated. The ADHD group performed the task off and on their usual dose of MPH. CTRL children performed the task twice but were never medicated. EEG data were recorded simultaneously and two electrophysiological indices of error monitoring, the error-related negativity (ERN) and error positivity (Pe) were measured. Amplitudes of each ERP were compared between diagnostic groups (CTRL, ADHD), medication days (Off MPH, On MPH) and motivational conditions (baseline – low incentive, reward, response cost).Results Error rates were lower in the reward and response cost conditions compared with baseline across diagnostic groups and medication days. ERN and Pe amplitudes were significantly reduced in ADHD compared with CTRL, and were significantly enhanced by MPH. Incentives significantly increased ERN and Pe amplitudes in the ADHD group but had no effect in CTRL. The effects of incentives did not interact with the effects of MPH on either ERP. Effect sizes were computed and revealed larger effects of MPH than incentives on ERN and Pe amplitudes.Conclusions The findings reveal independent effects of motivational incentives and MPH on two electrophysiological markers of error monitoring in children with ADHD, suggesting that each may be important tools for enhancing or restoring cognitive control in these children.

Neuroimaging and ADHD: fMRI, PET, DTI Findings, and Methodological Limitations

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by pervasive and developmentally inappropriate levels of inattention, impulsivity, and hyperactivity. There is no conclusive cause of ADHD although a number of etiologic theories have been advanced. Research across neuroanatomical, neurochemical, and genetic disciplines collectively support a physiological basis for ADHD and, within the past decade, the number of neuroimaging studies concerning ADHD has increased exponentially. The current selective review summarizes research findings concerning ADHD using functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and diffusion tensor imaging (DTI). Although these technologies and studies offer promise in helping to better understand the physiologic underpinnings of ADHD, they are not without methodological problems, including inadequate sensitivity and specificity for psychiatric disorders. Consequently, neuroimaging technology, in its current state of development, should not be used to inform clinical practice.

부모공동양육 및 어머니의 양육스트레스와 유아의 불안 및 과잉행동 간의 관계

The main purpose of this study was to examine the relationship among co-parenting, maternal parenting stress, and preschoolers' anxiety and hyperactivity with a sample of 155 mothers with 3 to 4 year old children (83 boys and 72 girls) living in Seoul. They completed a questionnaire on co-parenting, maternal parenting stress, and preschoolers' anxiety and hyperactivity. The results were analyzed by means of correlations and regressions. Co-parenting was positively correlated with preschoolers' anxiety and hyperactivity but affectionate, integrated co-parenting was negatively correlated with preschoolers' anxiety and hyperactivity. Maternal stress of parental suffering, dysfunctional interaction, and difficult temperament were positively related to preschoolers' anxiety and hyperactivity. Conflicting co-parenting was positively correlated with maternal stress of parental suffering, but affectionate and integrated co-parenting was negatively correlated with maternal stress of parental suffering and difficult temperament. Furthermore, maternal parenting stress mediated the relationship between co-parenting and preschoolers' anxiety and hyperactivity. Especially, maternal stress of parental suffering tended to play a perfectly mediating role between conflicting and integrated co-parenting and preschoolers' anxiety, between conflicting co-parenting and preschoolers' hyperactivity. Maternal stress of difficult temperament tended to play a perfectly mediating role between integrated co-parenting and preschoolers' anxiety and between conflicting co-parenting and preschoolers' hyperactivity. These results clearly indicate that maternal parenting stress plays a crucial role in the levels of preschoolers' anxiety and hyperactivity.

The Impact of Idle Time in the Classroom

Objective: Studies have identified an exacerbation of ADHD deficits under specific laboratory conditions. Less is known about the significance of such contextual factors in relation to everyday functioning in naturalistic settings. Method: This study investigated the differential impact of classroom “idle time”—periods when students are not actively engaged or waiting for a task—on the behavior of 31 children with ADHD (25 boys and 6 girls; aged 6-12 years) and 31 sex- and age-matched typically developing classmates, who were simultaneously observed in their normal classroom during two school days. Results: Both groups experienced the same amount of idle time (12% of the time). During idle time, however, levels of hyperactivity and noisiness increased significantly more in children with ADHD than in their classmates (p < .05). Conclusion: Findings highlight the differential susceptibility of ADHD children to classroom idle time. Classroom interventions might consider targeting specifically these periods to reduce disruptive behavior in these children.

Neurobehavioural development of preschool‐age children born to addicted mothers given opiate maintenance treatment with buprenorphine during pregnancy

To study the neurobehavioural development and somatic growth of children at preschool-age born to opioid-addicted mothers given opiate maintenance treatment (OMT) with buprenorphine during pregnancy. Twenty-eight children, whose 21 opiate-addicted mothers were treated with OMT during pregnancy and accepted participation to the study, went through a battery of neurobehavioural tests (WPPSI-R, McCarthy, BROWN and SDQ). Twenty-five children fulfilled the tests at an age of 5-6 years. The children showed evidence of serious visual motor and attention problems in the field of performance (WPPSI-R scales) and major problems in the field of motor skills and memory abilities (McCarthy Scales). The results of behavioural tests also showed significantly elevated levels of hyperactivity, impulsivity and attention problems on the attention deficit hyperactivity disorder (ADHD) scale in BROWN and in SDQ tests estimated by the teachers, while the parents estimated no problems for their children. Regarding the outcomes, there were no significant differences in terms of neonatal abstinence syndrome, gender or socio-economic factors. The somatic growth of the children corresponded to the mean values of the normal population in weight, length and head circumference at birth and at preschool-age, respectively. Children to opiate-addicted mothers with buprenorphine maintenance treatment during pregnancy constitute a risk population, which should be recognized before start of the school. Whether the effects are associated with buprenorphine exposition during foetal life or not are discussed and need further investigation.

The Longitudinal Course of Attention Deficit/Hyperactivity Disorder in Velo-Cardio-Facial Syndrome

To evaluate predictors of persistence of attention deficit/hyperactivity disorder (ADHD) in a large sample of children with velo-cardio-facial syndrome (VCFS) with and without ADHD followed prospectively into adolescence. Children with VCFS with (n = 37) and without (n = 35) ADHD who were on average 11 years old at the baseline assessment and 15 years old at the follow-up assessment were comprehensively assessed with structured diagnostic interviews and assessments of behavioral, cognitive, social, school, and family functioning. Control participants both with and without ADHD were also followed prospectively. In adolescence, 65% of children with VCFS continued to have findings consistent with ADHD. Childhood predictors of persistence were higher rates of familial ADHD, having childhood depression, having higher levels of hyperactivity, and a larger number of intrusion errors on a verbal list learning test at baseline. Approximately 15% of children with VCFS who did not have ADHD at Time 1 met diagnostic criteria for ADHD at Time 2. All of these children had subthreshold ADHD symptoms at Time 1. These findings prospectively confirm that persistence of ADHD into adolescence in VCFS is predicted by childhood variables that have been previously documented in the non-VCFS ADHD literature.

Neuro beneficial effects of Pimpinella anisum against lead exposure

Background: The essential oil of Pimpinella anisum has been widely used in traditional medicine to treat a variety of diseases, including some neurological disorders. Aims: This study was aimed to test, in vivo, the possible anxiolytic and antidepressant effects, of the essential oil of Pimpinella anisum against chronic lead acetate (0.2%) intoxication during the gestation and lactation period, in Wistar rat pups. Settings and Design: Wistar rat pups were exposed to lead via their dams’ drinking water from postnatal day (PND) 1 to (PND) 21. After weaning, the lead‑exposed rats received injections of essential oil of Pimpinella anisum (0.5 ml/kg) for 15 days. The level of anxiety, depression and locomotor activity were studied. Materials and Methods: The behaviours evaluated were: Locomotor activity (open‑field test), anxiety (dark and light compartment and elevated plus maze tests), and depression (forced swimming test). Statistical Analysis: The data were analysed by two‑way analyses of variance (ANOVAs). When a significant difference was found, the Student‑Newman‑Keuls post‑hoc test was conducted. For all analyses, the difference was considered to be significant at P ≤ 0.05. Results: The results of the present study demonstrate that developmental lead exposure induces, on the one hand, impairments of body (P < 0.001) and brain weight (P < 0.05), respectively, and on the other hand, increases the level of anxiety (P < 0.001), depression (P < 0.001) and locomotor hyperactivity (P < 0.001), compared to control rats. Administration of the essential oil of Pimpinella anisum entrains reduction in the level of anxiety (P < 0.001), depression (P < 0.001) and correct locomotor hyperactivity (P < 0.001) in rats exposed to lead beforehand. Conclusion: In conclusion, our results demonstrate that developmental lead exposure induces significant perturbation of emotional reactivity that can be improved by treatment with the essential oil of Pimpinella anisum. Further evaluation of the use of anise oil in the treatment of neurological disorders is suggested. Key words: Anxiety, depression, lead acetate, locomotor activity, Pimpinella anisum

Estimating the passage of minutes: Deviant oscillatory frontal activity in medicated and unmedicated ADHD.

Attention-deficit/hyperactivity disorder (ADHD) is a common and extensively treated psychiatric disorder in children, which often persists into adulthood. The core diagnostic symptoms include inappropriate levels of hyperactivity, impulsivity, and/or pervasive inattention. Another crucial aspect of the disorder involves aberrations in temporal perception, which have been well documented in behavioral studies and, recently, have been the focus of neuroimaging studies. These functional magnetic resonance imaging studies have shown reduced activation in anterior cingulate and prefrontal cortices in ADHD using a time-interval discrimination task, whereby participants distinguish intervals differing by only hundreds of milliseconds. We used magnetoencephalography (MEG) to evaluate the cortical network serving temporal perception during a continuous, long-duration (in minutes) time estimation experiment. Briefly, medicated and unmedicated persons with ADHD, and a control group responded each time they estimated 60 s had elapsed for an undisclosed amount of time in two separate MEG sessions. All MEG data were transformed into regional source activity, and subjected to spectral analyses to derive amplitude estimates of gamma-band activity. Compared to controls, unmedicated patients were less accurate time estimators and had weaker gamma activity in the anterior cingulate, supplementary motor area, and left prefrontal cortex. After medication, these patients exhibited small but significant increases in gamma across these same neural regions and significant improvements in time estimation accuracy, which correlated with the gamma activity increases. We found deficient gamma activity in brain areas known to be crucial for timing functions, which may underlie the day-to-day abnormalities in time perception that are common in ADHD.

Effects of Cochlear Trauma on BDNF Expression in Guinea Pig Cochlear Nucleus and Inferior Colliculus

Hearing loss caused by cochlear damage results in a variety of plastic changes in the central auditory pathways. One of these is hyperactivity, i.e. increased spontaneous firing rates, which may be involved in the generation of tinnitus, a phantom auditory sensation. The mechanism behind this synaptic plasticity is still uncertain but there may be a role for Brain Derived Neurotrophic Factor (BDNF). The expression of BDNF is activity dependent and BDNF can modulate synaptic plasticity leading to changes in excitability. In the present study we investigated the effects of two different types of cochlear trauma, mechanical and acoustic, at two different time points after trauma, on 1) peripheral hearing loss, 2) hyperactivity in inferior Colliculus (IC) and 3) BDNF protein expression in Cochlear Nucleus (CN) and IC of guinea pigs. BDNF protein expression was determined using ELISA. Although there was no significant difference in the amount of hearing loss between acoustic trauma and mechanical trauma animals, single neuron recordings showed higher levels of hyperactivity after mechanical trauma than after acoustic trauma at two weeks post-recovery from cochlear trauma.In addition, results showed an increase of BDNF levels in the ipsilateral CN and contralateral IC at 2 weeks after mechanical but not after acoustic trauma. BDNF levels recovered to sham control levels in both structures at 6 weeks after cochlear trauma even though hyperactivity remained higher compared to sham surgery animals at the same timepoint. The results suggest a possible time dependent role for BDNF in modulating synaptic plasticity and excitability after mechanical trauma to the cochlea.

Increased Intrasubject Variability in Boys with ADHD Across Tests of Motor and Cognitive Control

Increased intrasubject variability (ISV), or short-term, within-person fluctuations in behavioral performance is consistently found in Attention-Deficit/Hyperactivity Disorder (ADHD). ADHD is also associated with impairments in motor control, particularly in boys. The results of the few studies that have examined variability in self-generated motor output in children with ADHD have been inconsistent. The current study examined variability in motor control during a finger sequencing task among boys with and without ADHD as well as the relationship between intrasubject variability during motor and cognitive control tasks. Changes in performance over the course of the task and associations with ADHD symptom domains were also examined to elucidate the nature of impaired motor control in children with ADHD. Fifty-one boys (ages 8 to 12years) participated in the study, including 28 boys with ADHD and 23 typically developing (TD) boys. Participants completed a finger sequencing task and a Go/No-Go task providing multiple measures of response speed and variability. Boys with ADHD were slower and more variable in both intertap interval on the finger sequencing task and reaction time on the Go/No-Go task, with measures of speed and variability correlated across the two tasks. For the entire cohort, the only unique predictor of parent ratings of hyperactive-impulsive symptoms was variability in intertap interval during finger sequencing, whereas inattentive symptoms were only predicted by reaction time variability on the Go/No-Go task. These findings suggest that inefficient motor control is implicated in the pathophysiology of ADHD, particularly in regards to developmentally inappropriate levels of hyperactivity and impulsivity.

Time Course Analysis of Motor Excitability in a Response Inhibition Task According to the Level of Hyperactivity and Impulsivity in Children with ADHD

Short interval intracortical inhibition (SICI) of motor cortex, measured by transcranial magnetic stimulation (TMS) in a passive (resting) condition, has been suggested as a neurophysiological marker of hyperactivity in attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to determine motor excitability in a go/nogo task at stages of response preparation, activation and suppression in children with ADHD, depending on the level of hyperactivity and impulsivity. Motor evoked potentials were recorded in 29 typically developing children and 43 children with ADHD (subdivided in two groups with higher and lower levels of hyperactivity/impulsivity; H/I-high and H/I-low). In the H/I-high group, SICI was markedly reduced in the resting condition and during response preparation. Though these children were able to increase SICI when inhibiting a response, SICI was still reduced compared to typically developing children. Interestingly, SICI at rest and during response activation were comparable, which may be associated with their hypermotoric behaviour. In the H/I-low group, response activation was accompanied by a pronounced decrease of SICI, indicating reduced motor control in the context of a fast motor response. In summary, different excitability patterns were obtained for the three groups allowing a better understanding of dysfunctional response activation and inhibition processes within the motor cortex in children with ADHD.

Refining psychiatric phenotypes for response to treatment: Contribution of LPHN3 in ADHD

Attention deficit/hyperactivity disorder (ADHD) is a heterogeneous disorder characterized by inappropriate levels of attention, hyperactivity, and impulsivity. Although a strong genetic component to the disorder has been established, the molecular genetic underpinnings of this disorder remain elusive. Recently, several studies have reported an association between polymorphisms within the latrophilin 3 gene (LPHN3) and ADHD. Interestingly, the same single-nucleotide polymorphism conferring susceptibility to ADHD has also been found to predict efficacy of stimulant medication in children. The main objectives of the current article are: (i) To tackle the phenotype heterogeneity issue in ADHD by defining an objective and quantitative measure of response to treatment in a sample of ADHD children based on a hand held automatic device (Actiwatch) and (ii) to use this measure to reproduce for the first time the association between LPHN3 variants and response to methylphenidate (MPH) using a double-blind, placebo-controlled crossover experimental design. The results of our study confirm the hypothesis that LPHN3 is associated with response to MPH in ADHD children. Although this will require further validation, our work suggests that the use of an objective measure of response to treatment, such as the change in the child's motor activity measured by Actiwatch, has the potential to uncover genetic association signals that in some conditions might not be obtained using more subjective measures, such as the clinical consensus rating, for example.

Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents.

Attention deficit hyperactivity disorder (ADHD) is a major problem in children and adolescents, characterised by age-inappropriate levels of inattention, hyperactivity and impulsivity, and is associated with long-term social, academic and mental health problems. The stimulant medications methylphenidate and amphetamine are the most frequently used treatments for ADHD, but these are not always effective and can be associated with side effects. Clinical and biochemical evidence suggests that deficiencies of polyunsaturated fatty acids (PUFA) could be related to ADHD. Children and adolescents with ADHD have been shown to have significantly lower plasma and blood concentrations of PUFA and, in particular, lower levels of omega-3 PUFA.These findings suggest that PUFA supplementation may reduce the attention and behaviour problems associated with ADHD. To compare the efficacy of PUFA to other forms of treatment or placebo in treating the symptoms of ADHD in children and adolescents. We searched the following databases in August 2011: CENTRAL (The Cochrane Library 2011, Issue 2), MEDLINE (1948 to July Week 3, 2011), EMBASE (1980 to 2011 Week 29), PsycINFO (1806 to current), CINAHL (1937 to current), BIOSIS (1969 to 30 July 2011), Science Citation Index (1970 to 30 July 2011), Social Science Citation Index (1970 to 30 July 2011), Conference Proceedings Citation Index - Science (1990 to 30 July 2011), Conference Proceedings Citation Index - Social Science and Humanities (1990 to 30 July 2011), Cochrane Database of Systematic Reviews (2011, Issue 7), DARE (2011 Issue 2), Dissertation Abstracts (via Dissertation Express) and the metaRegister of Controlled Trials (mRCT). In addition, we searched the following repositories for theses on 2 August 2011: DART, NTLTD and TROVE. We also checked reference lists of relevant studies and reviews for additional references. Two review authors independently assessed the results of the database searches. We resolved any disagreements regarding the selection of studies through consensus or, if necessary, by consultation with a third member of the review team. Two members of the review team independently extracted details of participants and setting, interventions, methodology and outcome data. If differences were identified, we resolved them by consensus or referral to a third member of the team. We made all reasonable attempts to contact the authors where further clarification or missing data were needed. We included 13 trials with 1011 participants in the review. After screening 366 references, we considered 23 relevant and obtained the full text for consideration. We excluded five papers and included 18 papers describing the 13 trials.Eight of the included trials had a parallel design: five compared an omega-3 PUFA supplement to placebo; two compared a combined omega-3 and omega-6 supplement to placebo, and one compared an omega-3 PUFA to a dietary supplement. Five of the included trials had a cross-over design: two compared combined omega-3/6 PUFA to placebo; two compared omega-6 PUFA with placebo; one compared omega-3 to omega-6 PUFA, and one compared omega-6 PUFA to dexamphetamine. Supplements were given for a period of between four and 16 weeks.There was a significantly higher likelihood of improvement in the group receiving omega-3/6 PUFA compared to placebo (two trials, 97 participants; risk ratio (RR) 2.19, 95% confidence interval (CI) 1.04 to 4.62). However, there were no statistically significant differences in parent-rated ADHD symptoms (five trials, 413 participants; standardised mean difference (SMD) -0.17, 95% CI -0.38 to 0.03); inattention (six trials, 469 participants; SMD -0.04, 95% CI -0.29 to 0.21) or hyperactivity/impulsivity (five trials, 416 participants; SMD -0.04, 95% CI -0.25 to 0.16) when all participants receiving PUFA supplements were compared to those receiving placebo.There were no statistically significant differences in teacher ratings of overall ADHD symptoms (four trials, 324 participants; SMD 0.05, 95% CI -0.18 to 0.27); inattention (three trials, 260 participants; SMD 0.26, 95% CI -0.22 to 0.74) or hyperactivity/impulsivity (three trials, 259 participants; SMD 0.10, 95% CI -0.16 to 0.35).There were also no differences between groups in behaviour, side effects or loss to follow-up.Overall, there were no other differences between groups for any other comparison. Overall, there is little evidence that PUFA supplementation provides any benefit for the symptoms of ADHD in children and adolescents. The majority of data showed no benefit of PUFA supplementation, although there were some limited data that did show an improvement with combined omega-3 and omega-6 supplementation.It is important that future research addresses current weaknesses in this area, which include small sample sizes, variability of selection criteria, variability of the type and dosage of supplementation, short follow-up times and other methodological weaknesses.