Interesting study. The Oxford-Durham Study: A Randomized, Controlled Trial of Dietary Supplementation With Fatty Acids in Children With Developmental Coordination Disorder Alexandra J. Richardson and Paul Montgomery Pediatrics 2005;115;1360-1366 The following excerpts from: http://pediatrics.aappublications.org/cgi/content/full/115/5/1360 "ABSTRACT. Background. Developmental coordination disorder (Developmental Coordination Disorder (DCD)) affects 5% of school-aged children. In addition to the core deficits in motor function, this condition is associated commonly with difficulties in learning, behavior, and psychosocial adjustment that persist into adulthood. Mounting evidence suggests that a relative lack of certain polyunsaturated fatty acids may contribute to related neurodevelopmental and psychiatric disorders such as dyslexia and attention-deficit/hyperactivity disorder. Given the current lack of effective, evidence-based treatment options for Developmental Coordination Disorder (DCD), the use of fatty acid supplements merits investigation.... DISCUSSION To our knowledge, this is the first randomized, controlled trial of this kind among children with Developmental Coordination Disorder (DCD). Our hypothesis was that treatment for 3 months with a fatty acid supplement would lead to significant improvements over placebo, as assessed with changes in motor skills, reading and spelling ages, and teacher ratings of behavioral and learning difficulties usually associated with ADHD. Results showed no effect of treatment on motor skills but significant improvements in reading, spelling, and behavior for active treatment versus placebo during 3 months of treatment in parallel groups. After a 1-way treatment crossover (placebo to active), similar changes were seen in the placebo crossover group, whereas children continuing with active treatment maintained or improved their progress. This study involved 117 children, between 5 and 12 years of age, from mainstream schools in 1 United Kingdom county, all of whom met Developmental Coordination Disorder (DCD) criteria but were otherwise normal and not receiving any other treatment for their specific learning difficulties. Although it seems unlikely that these children would differ significantly from general population samples in other developed countries, generalizability to other age groups and cultures cannot be assumed. The low rate of dropout and high rate of compliance with treatment indicated that the researchers and teaching staff members provided very strong motivation, which might not be the case in other circumstances. No adverse events were reported, and the high compliance rate also suggests good acceptability of fatty acid supplements. The improvements in literacy skills and behavior found here are consistent with other reports of benefits from fatty acid supplementation among children selected for dyslexia or ADHD,5,6 but it is noteworthy that no group effect of treatment on motor skills was apparent. The similarity in the effect sizes for ADHD-related symptoms between this Developmental Coordination Disorder (DCD) sample and one selected with standard criteria for dyslexia5 suggests that these results may be more widely generalizable. Although the focus of this investigation was Developmental Coordination Disorder (DCD), the high level of comorbidity typically found between these conditions and the heterogeneity within each of them suggest that a symptom-based approach may be more fruitful than an exclusive focus on current diagnostic categories. In this kind of population, delays in literacy development usually increase over time, indicating the value of early intervention. Children in the placebo group fell even more behind with spelling during the 0- to 3-month parallel-group phase, although they did show average progress in reading. In contrast, children receiving active treatment made 3 times the expected normal gain in reading age and twice the normal gain in spelling age, bringing their average scores toward normative values. In the follow-up phase, they continued to make improvements above what would be expected for chronologic age. With global measures of teacher-rated behavior, children receiving active treatment improved by 0.5 SD in the 0- to 3-month parallel-group phase, with some additional improvements in the follow-up phase. In the placebo group, no changes were observed until the children crossed over to active treatment. The first-line treatment for ADHD symptoms in most developed countries is methylphenidate, for which a recent meta-analysis21 found an overall effect size of 0.78 with the Conners index but little or no evidence of durability beyond 4 weeks of treatment. By comparison, in this study the effect sizes with this measure were 0.55 for the first 3 months and 0.70 over 6 months for children receiving fatty acid treatment throughout. The problems faced by this kind of population are enduring. Follow-up studies indicate that, without specific intervention, children with Developmental Coordination Disorder (DCD) and ADHD at 7 years of age have unusually poor academic, social, and health outcomes in adolescence and young adulthood.13,22,23 Studies with older populations are therefore required, in addition to replication of the current findings. Although our data suggest that continuing treatment from 3 to 6 months may produce additional benefits, issues of both durability and maintenance of treatment effects also require attention in future studies. The optimal dosage and combination of fatty acids are at present unknown. An -3/-6 ratio of 4:1 was selected for this study on the basis of previous work indicating benefits in dyslexia and ADHD,5,6 although in this case the marine oil contained a higher eicosapentaenoic acid/docosahexaenoic acid ratio. Additional studies are needed to establish both the optimal composition of fatty acid treatments and dose-response relationships. This study was a pragmatic one designed to investigate the efficacy of fatty acid treatment and can therefore shed no light on the possible mechanisms at work. The findings do suggest, however, that fatty acid supplements of this type may be a safe, tolerable, effective treatment for improving academic progress and behavior among children with Developmental Coordination Disorder (DCD)."