Gustafsson 2010

Methods	Parallel trial of omega‐3 PUFA versus placebo
Participants	Inclusion criteria: children aged between 7 and 12 years with a diagnosis of ADHD combined type meeting DSM IV criteria, inclusive of any neuropsychiatric comorbidity, and had been evaluated for pharmacological treatment Exclusion criteria: mental retardation (IQ < 70), autism, major depression, epileptic seizure during the preceding 2 years, other neurological or endocrine disorders, fish allergy, severely impaired hearing or vision, severe sleeping disorder, psychotic symptoms or ongoing psychoactive, anticonvulsant or stimulant medication. If the child had taken a PUFA, a washout period of 10 weeks was required. Age: 7 to 12 years, gender: not stated, loss to follow‐up: 17/109 Baseline parent‐rated Conners score: placebo 46.0; PUFA 51.0; teacher‐rated: placebo 43.5, PUFA 49.7 Setting: 8 Child and Adolescent Psychiatric and Paediatric clinics, Sweden
Interventions	Omega‐3 PUFA (PlusEPA®  Minami Nutrition, Belgium): 1 capsule daily containing 500 mg eicosapentaenoic acid (EPA), 2.7 mg docosahexaenoic acid (DHA), 10 mg vitamin E for 15 weeks. All took the supplement for at least 70 days. Placebo: 1 placebo capsule (rape seed oil and medium chain triglycerides) daily for 15 weeks
Outcomes	ADHD symptoms Parent and Teacher Conners Rating Scale total, inattentive and hyperactive‐impulsive subscales Behaviour Parent and Teacher Conners Rating Scale oppositionality subscales Side effects: nausea, diarrhoea, nose bleed All scales measured at 15 weeks
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Participants were assigned a study number and randomised in blocks of 4 according to a computer‐generated code
Allocation concealment (selection bias)	Unclear risk	Not stated
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Placebo and PUFA were in "identical" capsules
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Capsules "identical" and parent and teacher‐rated scales used
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	The authors reported that ITT analysis was done on 92 participants but this did not include "17 drop‐outs"
Selective reporting (reporting bias)	Low risk	All outcomes appear to have been reported
Other bias	Unclear risk	Minami Nutrition sponsored the study