What supplements are recommended for children with Attention Deficit Hyperactivity Disorder (ADHD)?

Supplements for Children with ADHD

There are no supplements specifically recommended as first-line treatment for children with ADHD according to current clinical practice guidelines. 1

Evidence-Based Treatment Approaches

First-Line Treatments by Age Group

• Preschoolers (4-5 years):

  • Evidence-based parent and/or teacher-administered behavioral therapy is the first-line treatment 1, 2
  • Methylphenidate may be considered only if behavioral interventions don't provide significant improvement and moderate-to-severe functional impairment persists 1, 2

• Elementary School-Aged Children (6-11 years):

  • FDA-approved medications for ADHD along with behavioral interventions 1, 2
  • Stimulant medications have the strongest evidence, followed by atomoxetine, extended-release guanfacine, and extended-release clonidine 1, 2

• Adolescents (12-18 years):

  • FDA-approved medications with the adolescent's assent 1, 2
  • Behavioral interventions as adjunctive treatment 1, 2

Omega-3/6 Fatty Acids: The Most Studied Supplements

Evidence for Omega-3/6 Supplements

• High-quality evidence shows no effect: A 2023 Cochrane systematic review found high-certainty evidence that polyunsaturated fatty acids (PUFA) had no effect on parent-rated total ADHD symptoms compared to placebo 3
• No improvement in core symptoms: The same review found high-certainty evidence that parent-rated inattention and hyperactivity/impulsivity scores were no different compared to placebo 3

Potential Limited Benefits

• Some smaller studies have shown modest improvements in attention symptoms with omega-3 supplementation in both children with ADHD and typically developing children 4
• A 2017 review suggested potential benefits as an adjunctive therapy to traditional medications, possibly allowing lower medication doses 5

Formulations Studied

• Some studies have used supplements containing a 9:3:1 ratio of eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and gamma-linolenic acid (GLA) 5
• Dosages and formulations vary widely across studies, making definitive recommendations difficult 3, 6

Clinical Implications

Current Guideline Position

• No major clinical practice guideline currently recommends supplements as first-line or even adjunctive treatment for ADHD 1
• The American Academy of Pediatrics guidelines focus on FDA-approved medications and behavioral interventions 1, 2

Safety Considerations

• Omega-3/6 supplements generally have a favorable safety profile with minimal side effects 3, 6
• Moderate-certainty evidence indicates that overall side effects likely do not differ between PUFA and placebo groups 3

Practical Approach

For Parents Interested in Supplements

• Emphasize that supplements should not replace evidence-based treatments 1
• If parents wish to try omega-3/6 supplements, they should:
  • Continue prescribed medications and behavioral interventions 2, 5
  • Use supplements with higher EPA than DHA content 4, 5
  • Monitor for any changes in symptoms or side effects 3
  • Understand that high-quality evidence does not support their effectiveness 3

Common Pitfalls to Avoid

• Delaying evidence-based treatments while trying supplements 1
• Stopping prescribed medications without medical supervision 1, 2
• Expecting supplements alone to manage significant ADHD symptoms 3, 6

Conclusion

While some parents may be interested in supplements for ADHD, current evidence and guidelines do not support their use as primary treatment. FDA-approved medications and behavioral interventions remain the evidence-based standards of care for children with ADHD 1, 2.