Aggressive behavior is a huge problem in child psychiatry. In fact, some estimates say as many as 80% of children and adolescents referred for psychiatric care have some type of aggression, including oppositional defiant disorder or conduct disorder (Connor D, The Carlat Child Psychiatry Report 2010;1(1):4–5).
Almost all aggression needs to be treated with psychosocial interventions. When those don’t work well enough, many of us resort to medication. But what if a natural treatment with some evidence in other psychiatric disorders, such as ADHD, could help treat aggressive behavior in children as well?
A group of researchers in Australia set out to answer this question in a small, randomized, controlled study of fish oil as a treatment for aggressive behavior. Unfortunately, results were not in favor of fish oil. Supplementation with fish oil showed no benefit in improving scores on two standard ratings of aggressive behavior.
In this study, 21 children, mean age of 10.3, were randomized to either six weeks of fish oil capsules (4 g/day, containing 400 mg EPA and 2,000 mg DHA), followed by six weeks of placebo; or six weeks of placebo capsules, followed by six weeks of fish oil capsules (4 g/day).
More than half of participants met criteria for conduct disorder (52.4%) and 76% met criteria for ADHD. Children with developmental, psychotic, substance use, and bipolar disorders and those with PTSD were excluded.
Aggressive behavior was measured based on the Children’s Aggression Scale-Parent Version (CAS-parent) and the Modified Overt Aggression Scale (MOAS). Secondary outcomes, including general functioning, symptoms of ADHD, and cognitive function, were also measured.
As would be expected, supplementation with fish oil increased serum concentrations of EPA and total omega-3s and omega-6s in participants. But there were absolutely no improvements on any measures of aggression after supplementation with fish oil.
In fact, there was a small worsening of scores on a secondary measure rating conduct problems on the Strengths and Difficulties scale (SDQ) compared to placebo. However, fish oil showed a significant improvement in a different SDQ secondary measure rating hyperactivity (Dean AJ et al, J Child Adolesc Psychopharmacology 2014;24(3):140–148).
CCPR’s Take: Omega-3s and other fatty acids are regularly touted as treatments for psychiatric illnesses, but unfortunately this study, like many others, doesn’t show that to be the truth. So we won’t be recommending omega-3 fatty acids as a treatment for aggression.
But what about those children in the study whose aggression worsened with fish oil? Should we be discouraging parents of children with aggression from using omega-3s at all, even for their other purported benefits? The study’s several limitations and small size suggest waiting for more research before taking this step.
More on this topic:
Omega-3 fatty acids do treat depression, but not with the formulations that are commonly found on the shelves. Here we point you in the right direction, and give a winding origin story of these essential fatty acids. Listen to the podcast.
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