Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder which impacts behaviour and can make day to day tasks challenging for those living with it. According to the National Institute for Health and Care Excellence (NICE), between 3% and 4% of the population are estimated to have been diagnosed with ADHD in the UK alone. There are a range of medications available to people with ADHD, and alternative treatment options such as behavioural therapy may also be recommended on a case by case basis. Evidence suggests that improvements to diet and lifestyle can help to alleviate symptoms, here we will look into how omega-3 can benefit patients with ADHD. 

What is ADHD?

ADHD is a lifelong behavioural condition which is usually characterised by:¹

• Inattention
• Hyperactivity
• Impulsivity

ADHD can be diagnosed either in childhood/adolescence or adulthood. In some instances changes and improvements in symptoms have been recorded though for the majority of patients symptoms will persist into adulthood.²

There are 3 subtypes of ADHD:³

• Predominantly hyperactive
• Predominantly inattentive
• Hyperactive/inattentive combination

If left undiagnosed and untreated ADHD can negatively impact a person's life and has been linked to:⁴

• School absenteeism
• Substance abuse
• Motor vehicle collisions
• Relationship difficulties
• Occupational struggles

Causes

The exact cause of ADHD has not been established though there are a number of factors which we know can increase the risk including:

• Genetics
• Epilepsy
• Those born premature
• People who have experienced head or brain trauma

There is also a higher ratio of people assigned male at birth to be diagnosed with ADHD compared to people assigned female at birth.

Research suggests that in people with ADHD there may be dysfunctional transmission of the neurotransmitter dopamine, which could underpin the causal mechanisms of the disease. Dopamine is essential for regulating your mood, memory, motivation and learning, and is used in the brain's reward and motivation system (also known as the mesolimbic system), which enables the brain to interpret a wide range of stimuli as producing a positive result and is also thought to be involved in ADHD patients struggling with motivation.⁵

Symptoms

Clinical presentation of ADHD can vary widely depending on subtype but symptoms commonly include patients appearing restless, disorganised and unfocussed. People living with ADHD can also experience emotional dysregulation where a person may find it difficult to control their emotions which can lead to: outbursts, experiencing intense emotions, hypersensitivity, rejection sensitivity dysphoria and emotional reactions which are difficult to manage.

Diagnosis

In recent years there has been increased demand for clinical diagnoses due to greater awareness of the condition. As a result of its symptoms, ADHD can often be mistaken for bipolar, personality disorders, depression and post traumatic stress disorder. Therefore, an assessment with your GP and an ADHD specialist is crucial if you suspect you could have ADHD. Due to the recent increase in waiting times, it is advised that you contact your GP to arrange an appointment as soon as possible if you suspect you have the condition.

During an ADHD assessment, patients are usually asked to provide details of their symptoms and the duration, as well as how this has impacted their life. An assessment will typically include a physical examination to rule out other conditions which can cause similar symptoms.

Treatments

For patients who require medication there are many pharmacological options. Methylphenidate is one of the most popular medications, and is a stimulant which acts to increase brain activity enabling patients to have improved attentiveness and focus. Non-stimulant medications are a less controlled slower acting alternative and act by increasing levels of norepinephrine, a chemical which functions as both a hormone and neurotransmitter, able to elevate focus and decrease impulsivity symptoms, an example of which is atomoxetine. Due to the risk of possible side effects, such as insomnia, many people seek to adopt a more holistic approach with respect to their ADHD treatment.

Other more socially focussed therapies which are frequently recommended include counselling, coaching and cognitive behavioural therapy (CBT). It is important to remember to practise a lifestyle as soon as possible with the appropriate amount of sleep, nutritious diets and exercise to support your brain to minimise ADHD symptoms.

Omega 3

Omega-3 fatty acids are a group of polyunsaturated fatty acids (PUFA), known for a variety of health benefits. There are 3 types of omega-3: α-linolenic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).⁶ ALA fatty acids are found in high quantities in terrestrial sources including walnuts, pumpkin seeds and flaxseeds while microalgae and oily fish such as mackerel, salmon and krill provide rich sources of EPA and DHA.

An interest in the health benefits of omega-3 arose as early as the 1940s when Scottish doctor Hugh McDonald Sinclair observed low incidences of coronary heart disease in the Inuit population of Greenland whose the local diet consisted of high quantities of fish but low consumption fresh fruit and vegetables.⁷ Similar observations were made with respect to heart attacks, in which populations with fish rich diets had a lowered risk leading to an interest in the health benefits of fish and omega-3. 

The link between ADHD and Omega-3

Research has revealed that ADHD patients tend to have lower levels of omega-3 in their blood compared with patients who do not have ADHD. Approximately 50-60% of the brain's weight is composed of lipids and 35% of these are omega-3 PUFAs, providing an insight into just how valuable omega-3 is for brain health.⁸ Omega-3 has been demonstrated to increase the levels of oxygen saturation in haemoglobin which suggests improved blood circulation in the brain and could be linked to the following health benefits:

• Improved memory
• Improved learning
• Better cognitive wellbeing

Omega-3 fatty acids are an important component of neuronal cell membranes critical for brain development and play roles in nerve functions and cell growth. DHA is associated with increased neuronal responses. which is achieved by boosting cell membrane flexibility.⁹ DHA is also known to play a key role in dopamine transmission pathways in the brain, which places it at the forefront in having a role in ADHD.

Studies have revealed DHAs can reduce stress levels in students as well as associated aggression, hostility, child depression and anti-social behaviours which suggests they may also have a role in emotional regulation which could benefit ADHD patients.¹⁰

It is important to note that connections between other deficiencies and ADHD have been documented, with zinc being one example. Zinc is actually involved in the synthesis of highly unsaturated fatty acids which once more implicates the role of omega-3 in the ADHD brain.¹¹

How to take omega-3

By incorporating more oily fish such as mackerel, sardines and salmon into your diet you can naturally increase your consumptions of omega-3. The NHS recommends having a minimum of two portions of fish weekly, with one of these being oily, which should provide a sufficient quantity of omega-3 to reap the health benefits. You can also find omega-3 in leafy green vegetables, walnuts, pumpkin seeds, chia seeds, soya, pumpkin and algal oil. It is widely recommended that you feature omega-3 rich foods in your diet compared to taking supplements, however if doing this is not possible consult your GP or medical practitioner for advice on available supplements and recommended dosages.

Summary

ADHD is a neurodevelopmental disorder which can cause difficult symptoms for those living with it. There are a number of medications currently available which are known to be effective in improving cognitive function, however these do have their side effects and there is currently a movement to find more holistic treatments. Omega-3 PUFAs have been noted for their positive effect on health for years, including great benefits to cardiovascular and brain health. Omega-3 has been found to be implicated in ADHD as it can alter the neurological pathways which transmit the neurotransmitter dopamine, a mood modulator believed to be involved in the causal mechanisms of the condition. Although there remains a lack of concrete data regarding the impact omega-3 has on ADHD, given how closely linked omega-3 is to brain health you would likely be encouraged to tuck into those fish dishes.