One randomized controlled trial was excluded because it included supplementation with additional psychoactive substances including Gingko Biloba, l-glutamate, Grapine, Melissa officinalis and dimethylaminoethanol. We additionally searched for unpublished or ongoing trials on the cinicaltrials.
The goal of this meta-analysis is to examine the efficacy of omega-3 fatty acid supplementation in children with ADHD. Our goal was to conduct a meta-analysis to determine the efficacy of omega-3 fatty acid supplementation in ADHD.
A hierarchy of preferred ADHD rating scale for our primary outcome was established a priori as opposed to utilizing the ADHD rating scale indentified as primary by the trial investigator in order to avoid any possible inflation of treatment effects caused by possible reporting bias towards measures that showed the greatest efficacy.
Statistical estimates of heterogeneity were also assessed using the I-square heterogeneity statistic in RevMan. Publication bias was assessed by plotting the effect size against sample size for each trial funnel plot.
Trials were weighted using the generic inverse variance method. Effect size SMD of trials was entered as the dependent variable with the variables of interest being the independent variable. For subgroup analyses trials were stratified based on 1 whether the omega-3 supplement was given as monotherapy or given as an augmentation agent to pharmacological treatment, 2 methodological quality of trials, 3 diagnosis undiagnosed population, confirmed ADHD and ADHD symptoms in comorbid condition4 analysis method intention-to-treat or completers analysis and 5 type of placebo.
Our primary outcome measure was standardized mean difference in rating scales of ADHD severity. We conducted a sensitivity analysis to examine our decision to use a random-effects rather than fixed effects model for meta-analysis.
We conducted secondary analyses to determine the effects of dosing of different omega-3 fatty acids in supplements. We also performed several subgroup analyses and meta-regression. We also examined the effect of omega-3 supplementation on parent ratings of ADHD symptoms. When the standard deviation of the mean improvement on placebo or omega-3 fatty acid supplementation was not reported in individual studies this was imputed based on the standard deviation of reported baseline and endpoint ADHD severity using Cochrane methodology.
Any missing information was requested from the study investigators when possible. The references of eligible trials for this meta-analysis as well as any appropriate review articles in this area were additionally searched for citations of further relevant published and unpublished research.
Meta-Analytic Methods Data extraction was performed on specially designed Microsoft Excel spreadsheets. The relative efficacy of omega-3 fatty acid supplementation was modest compared to currently available pharmacotherapies for ADHD such as psychostimulants, atomoxetine or alpha-2 agonists.
Data were also collected on methods, participants, intervention and outcome measurements, and other relevant attributes and results of the studies. For all subgroup analyses and meta-regression we used the same threshold for statistical significance. The outcome measure selected from each included trial was the difference in mean improvement between omega-3 fatty acid supplementation and placebo group in a clinical rating scale measuring ADHD severity over the course of the trial.
We used a meta-regression techniques to examine the association between omega-3 and naturally continuous variables such as 1 trial duration, 2 proportion of dropouts in trials using completers analysis and 3 doses of omega-3 fatty acids in supplementation preparations. Omega-3 fatty acids have anti-inflammatory properties and can alter central nervous system cell membrane fluidity and phospholipid composition.
Omega-3 fatty acid supplementation demonstrated a small, but significant effect in improving ADHD symptoms. Results Ten trials involving children were included in this meta-analysis. Trials in which other psychoactive substances were started at the same time as omega-3 fatty acid supplementation were also excluded.
Abstract Objective Several studies have demonstrated differences in omega-3 fatty acid composition in plasma and in erythrocyte membranes in patients with ADHD compared to unaffected controls. Given the considerable heterogeneity expected in the literature, we also wanted to use meta-regression to examine how the use of different omega-3 fatty acid compositions in supplementation affected treatment efficacy.
However, given its relatively benign side-effect profile and evidence of modest efficacy, it may be reasonable to use omega-3 fatty supplementation to augment traditional pharmacological interventions or for families who decline other psychopharmacological options.
We identified 4 potentially eligible trials from the references of relevant reviews.
Heterogeneity of treatment response was assessed visually from the forest plot of weighted mean differences and relative risk of individual studies.
Method Search Strategy All meta-analytic methods and sensitivity analyses were specified prior to conducting the meta-analysis but were not registered online. As many rating scales have excellent psychometric properties in evaluating ADHD, this hierarchy of preferred rating scales for ADHD is not meant to reflect the relative merit of these measures.
Figure 1 demonstrates a flow diagram depicting our selection procedure for this meta-analysis.AACAP Policy Statement June The American Academy of Child and Adolescent Psychiatry (AACAP), a medical association representing physicians dedicated to the health of children and families around the globe, advocates putting an end to the practice of separating immigrant children from their families.
The Journal of the American Academy of Child and Adolescent Psychiatry is a peer-reviewed medical journal covering pediatric psychiatry. It is published by Elsevier and is the official journal of the American Academy of Child and Adolescent Psychiatry.
Journal of the American Academy of Child and Adolescent Psychiatry The impact of behavioral interventions for children and adolescents with attention- deficit hyperactivity disorder: A meta-analysis of randomized controlled trials across.
Find all the necessary information on AACAP MeetingAmerican Academy of Child Adolescent Psychiatry Annual Meeting. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and.
CASII Child and Adolescent Service Intensity Instrument Background information and Initial Data Analysis American Academy of Child and Adolescent Psychiatry.Download