ADHD-children and Healthy Subjects

Forty ADHD-children classified according to the DSM-IV criteria were studied after obtaining the written information consent from his parents (31 males and 9 females, mean age 11 ? 4 years). Twenty healthy children (14 male and 6 female, mean age 12 ? 2 years) participated in the study as the Healthy Reference (HR). Four clinical specialists evaluated the children suspected as ADHD-subjects. The first evaluation consisted on a psychological interview where the following tests were applied: Wechsler Intelligence Scale for Children-Revised (WISC-R), Bender Visual Motor Gestalt Test, Harris Test, Wepman Evaluation (Auditory Discrimination), Write and Lecture Examination, Auditive Perception Evaluation and Family Paint Test. A neurologist performed the second evaluation consisting on a physical evaluation and an Electroencephalogram (EEG). These criteria allowed us to exclude any child with neurological compromise. The next step was the psychiatric examination in order to evaluate the child?s mental status. The biochemical, pharmacology and neurospectroscopy team, who validated the three previous criteria, carried out the forty interviews.

Magnetic Resonance Imaging (MRI)

Sagittal T1 weighted, Coronal T2 weighted, Axial T2 weighted and T2 Fluid Attenuated Inversion Recovery (FLAIR) images were performed on ADHD and HR subjects and carried out on a 1.5 Tesla system (Magnetom Sonata, Siemens Medical Systems®, Erlangen, Germany) equipped with a standard CP Head coil.

Magnetic Resonance Spectroscopy (MRS)

MRS was performed on each patient before and after the 6-month study. Single voxel proton MR spectra (1.8 cm x 1.8 cm x 1.8 cm = 5.83 cm3) of each one of both Basal Ganglia in sagittal, axial and coronal images was carried out on a 1.5 Tesla system (Magnetom Sonata, Siemens Medical Systems®, Erlangen, Germany) (Figure 1). MRS data sets were acquired with a Spin-Echo sequence (TR= 1500 msec, TE= 30 msec, 192 averaged acquisitions). N-Acetylaspartate (NAA), Choline (Cho) and Creatine (Cre) intensity signals were detected and NAA/Cho+Cre, Cho/Cre, NAA/Cho and NAA/Cre ratios were calculated, separately, at the right and left Basal Ganglia on ADHD and HR subjects. The results were analyzed with repeated measured Analysis of Variance (ANOVA). Tukey test was applied for multiple comparisons among ratio means with Bonferroni correction for small samples. Spearman rank correlation coefficients were calculated for Write and Lecture scores and measured metabolite ratios. After the first MRS study was performed, the children started a 6-month supplement consisting on a total daily dose of 50 mg/Kg Choline Bitartrate-Inositol (2000 mg maximum) + Fish Oils 720 mg Eicosapentaenoic Acid (EPA) + 480 mg Docosahexanoic Acid (DHA) (3000 mg maximum).