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Can Fish Oil Help Childhood ADHD?

Medically Reviewed by Smitha Bhandari, MD on May 27, 2022

You may have heard that fish oil can help improve some of the symptoms of ADHD in kids. It’s true that some research shows some benefits, but other research doesn't. Since these supplements aren’t FDA approved, you need to be careful. Here’s what you should know.

How Can Fish Oil Help Kids With ADHD?

It’s not really the fish oil that helps – it’s the omega-3 fatty acids that are found in fish oil. Known as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), they’re found in fish, seafood, and some algae, and they are essential to maintain a healthy brain, heart, and immune system. Some research has suggested that kids who have low levels of omega-3s have poorer reading and memory and more behavior problems.

There are a couple reasons why omega-3 fatty acids are thought to help:

  • Our brains use omega-3s in the hippocampus, the memory center of the brain. If you are low in omega-3 fatty acids, it may be harder to make new memories.
  • The symptoms of ADHD are thought to be due to brain cells having trouble sending and receiving neurotransmitters, brain chemicals that communicate information between cells. Since omega-3s are part of brain cell membranes, they may help neurotransmitters do their job.

In addition to fish oil, there’s another type of omega-3 fatty acid, alpha-linolenic acid (ALA), which is found in plant-based foods like flaxseed. While it gets converted into EPA and DHA in the brain, it’s not as efficient as if you actually ate fish or took a fish oil supplement.

A 2013 study published in the medical journal PLOS One found that kids given fish oil supplements rich in omega-3 fatty acids for 3 months showed significant improvements in behavior, reading, and spelling. But a follow-up study, published in 2018 also in the journal PLOS One, found that when researchers gave children who were struggling with reading 600 milligrams a day of DHA for 16 weeks, the fish oil supplements didn’t improve reading ability, working memory, or behaviors.

One reason may be that supplements don’t help unless a child already has low omega-3 levels. A 2019 study published in the journal Nature studied 92 children between 6 and 18 years old with ADHD. They measured their blood levels of EPA, then gave them either omega-3 fatty acid EPA or a placebo for 12 weeks. They found that kids who already had low EPA levels showed improvements in their ability to focus and pay attention. But it didn’t help the children who already had normal or high levels of EPA.

The National Institutes of Health says that despite a lot of research, it’s still unclear whether fish oil helps with ADHD. That’s why they shouldn’t be used as a substitute for ADHD medication or behavioral therapy. But they can be taken along with these treatments, as long as your child’s doctor is OK with it. Just keep in mind that any benefit will be pretty modest compared to prescription ADHD medication. It also takes about 3 months for you to see any effects.

Is Fish Oil Safe for Kids With ADHD?

Fish oil is generally considered safe. Side effects can include:

  • An unpleasant taste in your mouth
  • Bad breath
  • Heartburn
  • Nausea
  • Stomach pain
  • Diarrhea
  • Headache
  • Smelly sweat

You may think because fish oil is natural, it’s not a problem to give your child a supplement. But there are side effects, and there’s no set dosage for kids. That’s why it’s always important to talk to your pediatrician first.

That’s one reason why groups like the Academy of Nutrition and Dietetics recommend that parents try to give their kids omega-3 fats via food sources before they try supplements. Kid-friendly options include baked salmon in teriyaki or honey barbecue sauce, or use canned salmon to make salmon sliders or baked nuggets. Choose fish low in mercury, such as:

  • Salmon
  • Sardines
  • Canned light tuna
  • Freshwater trout
  • Herring
  • Oysters
  • Shrimp

The FDA recommends that your child eat about two servings of low-mercury fish high in omega-3s twice a week. It’s worth noting that research suggests that kids with ADHD eat fish and seafood less frequently than kids without ADHD. That’s why you may want to try going the fish route first.

What to Look for in a Supplement

When you shop for a supplement, make sure:

  • The supplement is mercury-free. Check the label to make sure it says either “mercury-free,” “refined to eliminate mercury,” or “USP.”
  • Use fish body oil, rather than fish liver oil, since liver oil has less omega-3 fats.
  • Avoid cod liver oil. While it is high in omega-3 fatty acids, it may contain high amounts of vitamin A and D.
  • Don’t use flaxseed oil. It contains high levels of ALA omega-3s, which isn’t the recommended form for kids with ADHD.
  • Consider enteric-coated fish oil supplements. These have a thicker coating, which makes them easier for your child to tolerate. You can also put them in the refrigerator or freezer, too. Liquid supplements may also be easier for your child to take.

Since supplements aren’t regulated by the FDA, there’s no way to know for sure what’s in an over-the-counter fish oil product. One study even found that over 70% of fish oil supplements didn’t contain the stated label amount of EPA or DHA. Only about 20% of those tested contained the amount of EPA they said they did, while only a quarter had enough DHA.

That’s why if you and your child’s doctor decide to have your child take a supplement, it may make sense to consider a prescription supplement. They’re regulated, which means they contain exactly what they say they do. The amount is generally anywhere from 700 to 1,600 milligrams, depending on your child’s age and weight. It’s not recommended to go over that because there have been reports of kids whose behavior deteriorated after they took 4,000 to 5,000 milligrams over several years.

Remember that fish oil – whether your child gets it from food or a supplement – is just one component of a healthy diet for a kid with ADHD. Research suggests that a traditional “Western” diet high in saturated fat, refined sugars, and sodium doubles the risk that a teen has ADHD, compared to a high-fiber, overall low-fat diet.

Show Sources

SOURCES:

PLOS One: “Low Blood Long Chain Omega-3 Fatty Acids in UK Children are Associated with Poor Cognitive Performance and Behavior: a Cross-sectional Analysis from the DOLAB study,” “Docosahexaenoic Acid for Reading, Cognition and Behavior in Children Aged 7-9 Years: A Randomized, Controlled Trial (The DOLABS Study),” “Docosahexaenoic Acid for Reading, Working Memory and Behavior in UK Children Aged 7-9: A Randomized Controlled Trial for Replication (the DOLAB II Study).”

CHADD: “Fishy or Not? Omega-3s and the ADHD Brain,” “Fish Oil Supplements and ADHD,” “What Should I Feed My Child with ADHD.”

Nutrients: “The Importance of Marine Omega-3s for Brain Development and the Prevention and Treatment of Behavior, Mood, and Other Brain Disorders.”

Nature: “High-Dose Eicosapentaenoic Acid (EPA) Improves Attention and Vigilance in Children and Adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and Low Endogenous EPA levels.”

National Center for Complementary and Integrative Health: “Attention-Deficit Hyperactivity Disorder At a Glance.”

Understood: “Can Fish Oil Help Kids with ADHD?”

National Institutes of Health: “Omega-3 Fatty Acids.”

Academy of Nutrition and Dietetics: “Do Kids Need Omega Fats.”

FDA: “Advice on Eating Fish.”

Brain Science: “Omega-3 Long-Chain Polyunsaturated Fatty Acids Intake in Children with Attention Deficit and Hyperactivity Disorder.”

Journal of Science and Agriculture: “A Comparison of Actual vs. Stated Label Amounts of EPA and DHA in Commercial Omega-3 Dietary Supplements in the United States.”

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