In the last decade, the number of children, particularly pre-schoolers, with hyperactivity and problems concentrating has been increasing. Clinical trials and popular programmes like Jamie’s Dinners have highlighted a link between poor diet and behavioural problems in children.

In County Durham, we carried out some groundbreaking research in this field. Firstly, with the Primary Schools Trial involving 120 pupils aged between six and 12 and, later, a secondary school trial. Both trials looked at the effect of an essential fatty acid supplement on behaviour. The trials showed that the supplement significantly reduced hyperactivity as well as improving memory, and reading and spelling skills (some children made four years’ progress in reading during the six-month trial). We felt that it was therefore important to find out about the effects of fatty acid supplements on the developing skills of pre-school children.

Rationale for the trial

Many studies have shown that the fatty acids omega 3 and omega 6 are important for normal brain development. These fatty acids are present in breast milk and many studies have been carried out that compare the effects of breast milk versus formula milk on the abilities of children:
Professor Alan Lucas of the University of Cambridge reported in 1992 that children (seven-and-a-half to eight years) fed breast milk showed significant IQ advantages when compared with children fed formula milk.

Makrides et al2 suggested that the differences in ability were due to the presence of a derivative of omega 3.

Research by Peter Willats and colleagues at the University of Dundee3,4 compared the effects of combinations of omega 3 and omega 6 in formula milk. The ratio of these fatty acids appeared directly to affect the learning outcomes in young children.

Peterlee Sure Start initiative

The Sure Start initiative is a government programme in the UK that aims to “achieve better outcomes for children, parents and communities”. As part of this, Sure Start Peterlee in County Durham supplemented the diets of a number of pre-school children aged 18 months to three years with fatty acids. We selected the same formulas of fatty acids for this trial as in our previous studies. However, given the age of the children, we used a fruit-flavoured emulsion that can be easily swallowed from its sachet.

Children from the primary schools in this area featured in Jamie’s Dinners. Many of those involved were unable to name quite common vegetables and fruits. We assessed 65 children at baseline (the start of the study) and five months after starting the fatty acid supplementation.

Results of the trial

Assessments included parental ratings of children’s behaviour and concentration – measured on a five-point scale of “very good” through to “very poor” – as well as developmental profiles, which included assessment of their spoken language and comprehension skills:
47 children (72 per cent) completed the treatment period.
15 children (23 per cent) withdrew early from the trial.
3 (5 per cent) had missing data.

Behaviour and concentration

Of the parents whose children completed the treatment period:
22 (47 per cent) rated their children’s behaviour as either “poor” or “very poor”.
27 (36 per cent) rated it as “moderate”.
8 (17 per cent) rated it as “good” or “very good”.

When rating their children’s ability to concentrate:
29 parents (65 per cent) chose “poor” or “very poor”.
13 (29 per cent) selected “moderate”.
Only 3 parents (7 per cent) said their children were “good” or “very good” at concentrating.

After five months of supplementation, parental ratings of behaviour were as follows:
32 (67 per cent) said their child was “good” or “very good”.
Only 2 (4 per cent) parents still considered their child’s behaviour to be “poor” or “very poor”.

Consistent with this improvement in behaviour were improved ratings of concentration:
37 of the parents (78 per cent) said their children were “good” or “very good” after supplementation.

This compared with 65 per cent who rated their children as “poor” or “very poor” at concentrating at baseline (see above) – none gave this rating after five months (Figures 1 and 2).

Language development

All children taking part in Sure Start complete developmental assessments at 18, 24, 30 and 36 months. This enabled us to compare children who were taking the fatty acid supplement with those who were not (the ‘control’ group), by matching the former group by age and date of assessment, with the control group of children.

Both groups had the same opportunities to access support from the Sure Start programme, which included training for parents, nursery or playgroup experiences and specialist language support. c
We compared the language skills of 47 pre-school children (average age: 25 months) who completed supplementation with 47 controls (average age: 26 months) and measured expressive and receptive language ability.

At baseline, there were no significant differences between the treatment and control groups in expressive language (18.1 versus 19.4 months) and receptive language (19.5 versus 20.5 months). After the five-month period, the supplemented group showed an 8.8 months’ improvement in expressive language ability and 7.1 months’ improvement in receptive language – above expected developmental gains. In contrast, the control group made an average gain in expressive language of 5.1 months and of 4.1 months in receptive language.

Conclusions

We found that the fatty acid supplement reduced excitability and improved concentration in the children – as measured by their parents. It meant that parents and children spent quality time together at home. Parents were more able to engage their children in activities such as role play, inset puzzles and, most importantly, sitting with them to read books.

I believe that it is the improvement in the child-parent bond in these crucial early years that helped produce the remarkable changes in the development of the children’s language skills. Parents had attended training on developing language skills and they received regular support from family workers. Parents reported that the improvements in their children’s concentration enabled their children to use newly learnt skills.

The eight months’ improvement in expressive language in the five-month period of the study is a considerable leap, particularly as these children were between 18 months and two-and-a-half years at the time of assessment. Although the five-month gain in the control group was significantly less than the group that received the supplement, this was still impressive as the children were behind their chronological age at baseline. This suggests that the support from Sure Start workers was also positive.

Our ongoing research programme in Durham is helping to raise awareness of the effects of a poor diet on children’s concentration and subsequent behaviour and learning. In children from disadvantaged areas, the likelihood of a poor diet having a more profound effect on their behaviour and learning is greater. Indeed, the evidence suggests that in the Peterlee group of pre-school children, unlike other studies we have completed, almost two-thirds of the children involved are responding positively.

Acknowledgements

The study was facilitated by Brian Brown, Sure Start Manager, Peterlee, and all of his team. Particular thanks go to all of the children who took part and their parents.

References

1. Lucas A. Breast milk and subsequent intelligence quotient in children born prematurely. Lancet 1992; 339: 261–264.
2. Makrides M. Neumann, MA, Gibson RA. Effect of maternal docosahexaenoic acid (DHA) supplementation on breast milk composition. European Journal of Clinical Nutrition 1996; 50: 352–357.
3. Willats P. The effects of long-chain polyunsaturated fatty acids on visual and cognitive development in young children. Nutrition in Developmental Disorders Conference, Oxford, 2001.
4. Willats P, Forsyth J, DiModugno M. Effect of long-chain polyunsaturated fatty acids in infant formula on problem solving at 10 months of age. Lancet 1998; 352: 688–691.