Woman's Hour - Parenting: Using fish oils for ADHD

Episode Date: December 18, 2019

People with ADHD are more likely to have lower levels of omega-3 fatty acids, which are crucial for healthy brain function. This led to fish oils being tested as a possible treatment - but results have been very mixed. Consultant psychiatrist Prof Carmine Pariante from King's College London talks to Jane Garvey about why they work for some people and not others. She's also joined by Prof Ilina Singh of Oxford University, who reveals what children with ADHD think about using medication to control their symptoms.

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BBC Sounds. Music, radio, podcasts. Hi, this is the Woman's Hour Parenting podcast and this is about ADHD. Now, the NHS website defines ADHD as a behavioural disorder. It's thought to affect around one in 20 children. An FOI request by The Guardian last year showed that almost 75,000 children between the ages of 6 and 17 had a prescription for ADHD drugs in England in 2017 to 18. Now, some parents are genuinely quite concerned about their children taking medication. And research has shown that children with ADHD are more likely to be deficient in omega-3 fatty acids. But there was conflicting evidence that taking supplements could help the symptoms. Until now.

I talked to Professor Carmine Pariente, Professor of Biological Psychiatry at King's College London, who led that research, and to Professor Ilana Singh, Professor of Neuroscience and Society at Oxford. And we started with Ilana defining ADHD. ADHD is a disorder, as you've noted. It's most commonly diagnosed in childhood, but it has also recently in the last few years been recognised as an adult disorder. And it's made up of what we think of as three components,

inattention, hyperactivity and impulsivity. And it can manifest itself with or without the problem of hyperactivity. So you can have ADHD with hyperactivity or without, and without is known as inattentive type ADHD. Now, is this something that is becoming more common simply because it is being more widely diagnosed or are there more children being born with this condition? Well in the UK the data seems to be fairly consistent actually. We have about two to five percent children who appear to meet criteria for ADHD but we only treat with medications actually about one percent of those children and that's been fairly

consistent over the years. Right so most children have the condition but are not on any kind of medication? Yes so the the nice recommended first line treatment is actually parent training and medication is meant to be kept for the most severe end of ADHD And it does seem that the UK clinicians are abiding by that. Right, that's interesting because that statistic does suggest, I mean, 75,000 children sounds like a lot of children to me, but you've put it in perspective. So why, can I ask you, Professor Pariante, what is the benefit or the perceived benefit of omega-3?

Well, there have been quite a lot of clinical studies testing whether fish oil supplement or omega-3 can improve ADHD. And the results in the past have been quite variables. I mean, if you put all the studies together, we have shown that it's a small beneficial effect. But many studies found no benefit at all. Some even found some negative effect. We never really understood why. So one possibility is that, of course, you need to match the treatment with fish oil or omega-3 to whether or not the children have enough omega-3 in their body in the first place, which comes from diet.

Purely from diet. Purely from diet. Right. It's not a genetic thing of any... you can't be born with low levels of it or anything like that. There are genetic profiles that tell the body how much it can metabolize, how much it can hold it, but it's basically coming from diet. Okay, so we might differ in the way we process it. But if we don't eat fish or the nuts or some vegetables that have

it, then we don't have it. Right. Okay. And the sorts of omega-3 supplements that might help, and we have to be careful here, you can just buy them in your average chemist, can you? Well, yes, but all the clinical trials have shown that the dose you need to take are quite high compared to the one that you would normally buy into a pharmacy. So, for example, in our study, we use 1.2 gram of EPA. That's the chemical substance. The two most important, omega-3, are EPA and DHA. And you really need kind of grams of this substance every day.

And that's across all beneficial effects for mental health problems. So, for example, in depression, equally, you need at least one to one and a half gram of omega-3 to have a beneficial effect. So it's not only unique for ADHD. And you couldn't substitute taking that supplement by just eating a huge amount of oily fish or loads of nuts? Well, actually, that would be the recommendation. And we know that for depression, for example, having a diet which is full of fish protects from the risk of developing depression. I think once you get into the presence of a disorder, so again, I'm talking about depression where most of the data are, if you

have depression, then you probably need to up the dose up to a more kind of a supplementation level rather than just through diet. Now, I know you're both absolutely adamant that we are. Neither of you are suggesting in any way that a parent whose child is on any kind of ADHD medication should stop taking it and replace the medication with fish oils. You are not saying that, are you? Absolutely, we are not. And also, I want to remind everybody that the NICE guidelines, which is kind of our Bible for deciding which treatment to offer, also specifically says that fish oil supplements are not a treatment for ADHD. But what you are saying is that some omega-3 supplements might help some children with ADHD? So there's two important points. First, that if a child has symptoms of ADHD that are severe enough to require medication, in a kind of specialist assessment, as Elena was

saying before, then these children must take the medication. So there's no children that should take fish oil instead of medication if they require medication. Having said that, some children, either with milder symptoms, they would not take medication anyway, could be helped by fish oil supplement, or perhaps children that are quite severe and are taking medication and they're not getting well enough with medication, they could add fish oil on top of the medication. Right. I know I said at the beginning that some parents are concerned about their children being medicated, I suppose.

What are the side effects of the most common drug given to children with ADHD is Ritalin, isn't it? What are the side effects, potentially? Well, the side effects of Ritalin, which do vary from child to child, are that it can cause, it can suppress appetite. It can cause some sleeplessness, particularly if it's taken too late in the day, if it's still being effective in the evening hours when really children shouldn't be taking. And this is for a child who might be hyperactive. That isn't great, is it? Yes, exactly. So those are the two major side effects that parents and children worry about. I think also some parents might feel that their child's true self is being blunted in some way, that they're being made into a person they

were not meant to be. What about that? Yeah, I think that that's a really significant worry that parents do have. And we've actually spoken to children up and down the country in the UK about this. And what we found really interestingly was that children didn't identify with that concern about taking Ritalin type drugs. They did not. In fact, what they found was that when the treatment was working properly, the treatment really enabled them to re-establish what we as ethicists call moral agency. So moral agency is the idea that I can identify what I believe to be the right and the good thing to do in this situation, and I can act on that. And what children with ADHD often experience is this

lack of self-control, lack of ability to regulate their behaviour. And that's actually very deeply morally distressing to them. Yeah. So what you're effectively saying is that taking Ritalin in some cases, the children felt liberated in a way? Well, they certainly felt liberated to be able to act on their moral intuitions, act on what they believe to be the right thing to do. So, for example, if someone is bullying you in the playground, can you make a decision, a good decision about how to respond in that situation? So the child with ADHD can make a decision, do I react or do I not react?

It's not about whether or not they make a good decision that you or I might agree with, which would probably be not to react. Don't punch the kid. For the kid with ADHD, the important thing is, can I make the decision itself? And so if I decide I'm going to punch the kid, that that will be for me a good experience because I made that decision. Do you want to say anything? Sorry, I thought you were concentrating hard there. Go on. Well, I just want to stress that as much as, of course, parents are worried about the side effect of medication, we should really be worried about the consequence of ADHD. Because there are profound consequences across all spectrum of life for these children.

You know, they do worse at school. They don't interact with their peers. So they have difficulty in social relationship. They may develop other mental health problems like depression and anxiety. And when they grow up, if they still have symptoms of ADHD, they're more likely to do impulsive things. They have car accidents, they may use drugs. So there's a whole host of consequences of the disorder in itself. When it's severe, when it's moderate to severe, when it would actually, the children would be much better on medication than without.

Yes. I mean, to go back to something you said right at the very beginning, that the first port of call, if you like, is actually for parents to have training. Some of our listeners will at that point, their ears will have pricked up and they will say, well, there we go. I mean, that's what it really is. It's the fault of the parents. The parents are no good. Yeah, we hear that a lot and adhd i think is particularly stigmatized as um a condition that is really about naughty children and bad parenting and to be to be honest it's often bad mothering um mothers well mothers get blamed oh i see yes more than they get blamed yeah um fathers do in in the equation yeah um And so it is a very heavily stigmatized disorder.

And so probably one of the concerns that we have, as Carmine has just been saying, is that children are under-recognized and under-treatment because it is quite stigmatizing to be seen to have a problem of behavioral control. That was Ilana Singh, who is Professor of Neuroscience and Society at Oxford, and Carmine Pariente,

Professor of Biological Psychiatry at King's College, London. And if there's anything you'd like us to cover on the Woman's Hour Parenting Podcast, contact us via the website, bbc.co.uk forward slash Woman's Hour. I'm Sarah Trelevan, and for over a year, I've been working on one of the most complex stories I've ever covered.

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