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Omega-3 (ω-3) and social skills interventions for reactive aggression and childhood externalizing behavior problems: a randomized, stratified, double-blind, placebo-controlled, factorial trial

Published online by Cambridge University Press:  10 May 2018

Adrian Raine ,
Rebecca P. Ang ,
Olivia Choy ,
Joseph R. Hibbeln ,
Ringo M-H. Ho ,
Choon Guan Lim ,
Nikki S. J. Lim-Ashworth ,
Shichun Ling ,
Jean C. J. Liu  and
Yoon Phaik Ooi
...Show all authors
Adrian Raine*
Affiliation:
Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, PA, USA
Rebecca P. Ang
Affiliation:
National Institute of Education, Nanyang Technological University, Singapore
Olivia Choy
Affiliation:
Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore
Joseph R. Hibbeln
Affiliation:
Section on Nutritional Neuroscience, National Institute on Alcohol Abuse and Alcoholism, Rockville, MD, USA
Ringo M-H. Ho
Affiliation:
Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore
Choon Guan Lim
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore
Nikki S. J. Lim-Ashworth
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore
Shichun Ling
Affiliation:
Department of Criminology, University of Pennsylvania, Philadelphia, PA, USA
Jean C. J. Liu
Affiliation:
Division of Social Sciences, Yale–NUS College, Singapore
Yoon Phaik Ooi
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
Yi Ren Tan
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore
Daniel S. S. Fung
Affiliation:
Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore
*
Author for correspondence: Adrian Raine, E-mail: [email protected]
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Abstract

Background

While studies suggest that nutritional supplementation may reduce aggressive behavior in children, few have examined their effects on specific forms of aggression. This study tests the primary hypothesis that omega-3 (ω-3), both alone and in conjunction with social skills training, will have particular post-treatment efficacy for reducing childhood reactive aggression relative to baseline.

Methods

In this randomized, double-blind, stratified, placebo-controlled, factorial trial, a clinical sample of 282 children with externalizing behavior aged 7–16 years was randomized into ω-3 only, social skills only, ω-3 + social skills, and placebo control groups. Treatment duration was 6 months. The primary outcome measure was reactive aggression collected at 0, 3, 6, 9, and 12 months, with antisocial behavior as a secondary outcome.

Results

Children in the ω-3-only group showed a short-term reduction (at 3 and 6 months) in self-report reactive aggression, and also a short-term reduction in overall antisocial behavior. Sensitivity analyses and a robustness check replicated significant interaction effects. Effect sizes (d) were small, ranging from 0.17 to 0.31.

Conclusions

Findings provide some initial support for the efficacy of ω-3 in reducing reactive aggression over and above standard care (medication and parent training), but yield only preliminary and limited support for the efficacy of ω-3 in reducing overall externalizing behavior in children. Future studies could test further whether ω-3 shows promise in reducing more reactive, impulsive forms of aggression.

Keywords

Antisocialexternalizingnutritionω-3reactive aggressionsocial skills
Type
Original Articles
Information
Psychological Medicine , Volume 49 , Issue 2 , January 2019 , pp. 335 - 344
Copyright
Copyright © Cambridge University Press 2018 

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Footnotes

Clinical Trial registration: ‘Supplements and Social Skills Intervention Study (SASSI)’. ClinicalTrials.gov Identifier: NCT00819429 https://clinicaltrials.gov/ct2/show/NCT00819429?term=daniel+fung&rank=4

References

Abraha, I and Montedori, A (2010) Modified intention to treat reporting in randomised controlled trials: systematic review. British Medical Journal 340, c2697.Google Scholar
Achenbach, TM and Rescorla, L (2001) Manual for the ASEBA: School-age Forms & Profiles. Burlington: University of Vermont, Research Center for Children, Youth, and Families.Google Scholar
Baker, LA, et al. (2008) Differential genetic and environmental influences on reactive and proactive aggression in children. Journal of Abnormal Child Psychology 36, 1265–1278.Google Scholar
Buss, AH and Perry, M (1992) The aggression questionnaire. Journal of Personality and Social Psychology 63, 452–459.Google Scholar
Conners, CK (1997) Conners’ Rating Scales – Revised: Technical Manual. North Tonawanda, NY: Multi-Health Systems.Google Scholar
De Los Reyes, A, et al. (2013) Principles underlying the use of multiple informants’ reports. Annual Review of Clinical Psychology 9, 123–149.Google Scholar
DeMar, JC, et al. (2006) One generation of n-3 polyunsaturated fatty acid deprivation increases depression and aggression test scores in rats. Journal of Lipid Research 47, 172–180.Google Scholar
Fossati, A, et al. (2009) A cross-cultural study of the psychometric properties of the reactive-proactive aggression questionnaire among Italian nonclinical adolescents. Psychological Assessment 21, 131–135.Google Scholar
Frick, PJ, Bodin, SD and Barry, CT (2000) Psychopathic traits and conduct problems in community and clinic-referred samples of children: further development of the psychopathy screening device. Psychological Assessment 12, 382–393.Google Scholar
Gajos, JM and Beaver, KM (2016) The effect of omega-3 fatty acids on aggression: a meta-analysis. Neuroscience and Biobehavioral Reviews 69, 147–158.Google Scholar
Gesch, CB, et al. (2002) Influence of supplementary vitamins, minerals and essential fatty acids on the antisocial behaviour of young adult prisoners: randomised, placebo-controlled trial. British Journal of Psychiatry 181, 22–28.Google Scholar
Hibbeln, JR (2001) Homicide mortality rates and seafood consumption: a cross-national analysis. World Review of Human Nutrition 88, 41–46.Google Scholar
Hochberg, Y (1988) A sharper Bonferroni procedure for multiple tests of significance. Biometrika 75, 800–802.Google Scholar
Jacka, FN (2017) Nutritional psychiatry: where to next? EBioMedicine 17, 24–29.Google Scholar
Kahan, BC, et al. (2014) The risks and rewards of covariate adjustment in randomized trials: an assessment of 12 outcomes from 8 studies. Trials 15. http://www.trialsjournal.com/content/15/1/139.Google Scholar
Lin, YH, et al. (2012) Fast transmethylation of serum lipids using microwave irradiation. Lipids 47, 1109–1117.Google Scholar
Liu, JCJ, et al. (2015) An analysis of blinding success in a randomised controlled trial of fish oil omega-3 fatty acids. Annals Academy of Medicine Singapore 44, 85–91.Google Scholar
Liu, JH, et al. (2004) Malnutrition at age 3 years and externalizing behavior problems at ages 8, 11 and 17 years. American Journal of Psychiatry 161, 2005–2013.Google Scholar
McNamara, RK, et al. (2010) Docosahexaenoic acid supplementation increases prefrontal cortex activation during sustained attention in healthy boys: a placebo-controlled, dose-ranging, functional magnetic resonance imaging study. American Journal of Clinical Nutrition 91, 1060–1067.Google Scholar
Moher, D (2010) CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. British Medical Journal 343, c869.Google Scholar
Molenberghs, S and Verbeke, G (2005) Models for Discrete Longitudinal Data. New York: Springer.Google Scholar
Neugebauer, R, Hoek, HW and Susser, E (1999) Prenatal exposure to wartime famine and development of antisocial personality disorder in early adulthood. JAMA: Journal of the American Medical Association 282, 455–462.Google Scholar
Ooi, YP, Ang, RP and Lim-Ashworth, N (2015) Effective Anger Management for Children and Youth: The Manual. Singapore: World Scientific.Google Scholar
Ooi, YP, et al. (2007) Effects of CBT on children with disruptive behavior disorders: findings from a Singapore study. ASEAN Journal of Psychiatry 8, 71–81.Google Scholar
Raine, A (2013) The Anatomy of Violence: The Biological Roots of Crime. New York: Pantheon Books.Google Scholar
Raine, A, et al. (1998) Reduced prefrontal and increased subcortical brain functioning assessed using positron emission tomography in predatory and affective murderers. Behavioral Sciences & the Law 16, 319–332.Google Scholar
Raine, A, et al. (2001) Early educational and health enrichment at age 3–5 years is associated with increased autonomic and central nervous system arousal and orienting at age 11 years: evidence from the Mauritius child health project. Psychophysiology 38, 254–266.Google Scholar
Raine, A, et al. (2003) Effects of environmental enrichment at ages 3–5 years on schizotypal personality and antisocial behavior at ages 17 and 23 years. American Journal of Psychiatry 160, 1627–1635.Google Scholar
Raine, A, et al. (2006) The reactive-proactive aggression questionnaire: differential correlates of reactive and proactive aggression in adolescent boys. Aggressive Behavior 32, 159–171.Google Scholar
Raine, A, et al. (2015) Reduction in behavior problems with omega-3 supplementation in children aged 8–16 years: a randomized, double-blind, placebo-controlled, stratified, parallel-group trial. Journal of Child Psychology and Psychiatry 56, 509–520.Google Scholar
Raine, A, et al. (2016) Nutritional supplementation to reduce child aggression: a randomized, stratified, single-blind, factorial trial. Journal of Child Psychology and Psychiatry 57, 1038–1046.Google Scholar
Scarpa, A, Haden, SC and Tanaka, A (2010) Being hot-tempered: autonomic, emotional, and behavioral distinctions between childhood reactive and proactive aggression. Biological Psychology 84, 488–496.Google Scholar
Sonuga-Barke, EJ (2015) Editorial: diet and children's behaviour problems – disentangling urban myth from clinical reality. Journal of Child Psychology and Psychiatry 56, 497–499.Google Scholar
Wechsler, D (2003) Wechsler Intelligence Scale for Children – Fourth Edition, 4th edn., San Antonio, TX: Harcourt Assessment.Google Scholar
White, I, Horton, NJ and Pocock, SJ (2011) Strategy for intention to treat analysis in randomised trials with missing outcome data. British Medical Journal 342, d40.Google Scholar
Zaalberg, A, et al. (2010) Effects of nutritional supplements on aggression, rule-breaking, and psychopathology among young adult prisoners. Aggressive Behavior 36, 117–126.Google Scholar
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