Supplements and Social Skills Intervention Study (SASSI)

• Computerised Diagnostic Interview Schedule for Children - Version IV (C-DISC) [ Time Frame: 48 weeks ] [ Designated as safety issue: No ]
• Clinical Global Assessment Scale [ Time Frame: 48 weeks ] [ Designated as safety issue: Yes ]
  Assessment of the participants's level of general functioning using the Children's Global Assessment Scale

This is a 36-week, randomised, double-blind, placebo-controlled trial. The overarching aim of this study is to assess whether a nutritional intervention (Omega-3 supplement), when combined with a more traditional treatment approach to conduct disorder and Attention Deficit Hyperactivity Disorder (ADHD), is more effective than either approach alone in treating these conditions in children and adolescents. The research questions cannot be answered through alternative means because disruptive behaviour disorders are primarily childhood disorders.

• Conduct Disorder
• Attention Deficit Hyperactivity Disorder
• Oppositional Defiant Disorder

• Dietary Supplement: Omega-3
  1000mg of Omega-3 supplement will be given twice a day for a duration of 6 months. All supplements (including placebo) will be administered as two 500mg softgels twice daily, to be taken during breakfast and during the evening meal.
• Behavioral: Social Skills Training
  1 hourly sessions over 12 weeks duration and 4 booster sessions at 3 weeks intervals. During these 16 sessions, children are taught empathy, pro-social skills, and a variety of positive coping techniques for problem-solving, emotional regulation, conflict resolution, and anger management via the use of practical strategies, materials, activities, role-play and games.
• Other: Standard Treatment (or TAU in Child Guidance Clinic)
  Standard treatment is administered on a monthly basis to the parents of the child participants by the clinicians. Parents will be provided Parent Management Training where they will be taught behaviour and parenting techniques and may be referred to a parent support group. There is clinical pathway for the management of ADHD in our department which will be adhered to (i.e., Clinical Pathway for ADHD).

• Experimental: 1

  Omega-3 + Standard treatment

  Children in this group will be given 400 mg of DHA and 600 mg of EPA. Caregivers will be instructed to give two 500mg Omega-3 capsules twice a day, at breakfast and at the evening meal for 6 months. Parents will be seen by the attending on a monthly basis for standard treatment procedure.

  Interventions:

  • Dietary Supplement: Omega-3
  • Other: Standard Treatment (or TAU in Child Guidance Clinic)
• Experimental: 2

  Social skills + Omega-3 placebo + Standard treatment

  Children in this group will be given two placebo capsules twice daily; at breakfast and at the evening meal for a total period of 6 months. They will also undergo a manualised group social problem solving skills training protocol of 12 weekly 1-hour sessions (Ang & Ooi, 2003a, 2003b). There will be booster sessions scheduled at 3-week intervals after the initial treatment period of 12 weeks, for a total of 4 booster sessions.

  Interventions:

  • Behavioral: Social Skills Training
  • Other: Standard Treatment (or TAU in Child Guidance Clinic)
• Experimental: 3

  Omega-3 + Social skills + Standard treatment

  Children in this group will receive omega-3 supplement and social skills training on top of standard treatment. Procedures for administration of Omega-3 supplement are similar to those stated in (1) and (2).

  Interventions:

  • Dietary Supplement: Omega-3
  • Behavioral: Social Skills Training
  • Other: Standard Treatment (or TAU in Child Guidance Clinic)
• Placebo Comparator: 4

  Omega-3 placebo + Standard treatment.

  Children in this group will receive placebo as well as a course of the standard treatment. Procedure for administering the placebo capsules is similar to that outlined in (2).

  Intervention: Other: Standard Treatment (or TAU in Child Guidance Clinic)

Inclusion Criteria:

• Subjects between ages 7 and 16 years
• Subjects who fulfils all criteria for a DSM-IV diagnosis of ADHD, conduct disorder, or oppositional defiant disorder
• Subjects with willingness to participate in a randomized, double-blind controlled trial,
• Subjects with complete with written, informed parental consent and assent
• Subjects with IQ of 70 or more

Exclusion Criteria:

• Subjects who have IQ in the below 70
• Subjects who are younger than 7 years old
• Those without written parental consent will not be allowed to participate in the study
• Those with brain pathology such as serious head injury, epilepsy will be excluded

• Nanchang University
• University of Pennsylvania
• National University, Singapore
• Duke-NUS Graduate Medical School
• Alexandra Hospital, Singapore
• Singapore Institute for Clinical Studies