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



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.


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.


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.


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.

Original Articles
Copyright © Cambridge University Press 2018 

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Clinical Trial registration: ‘Supplements and Social Skills Intervention Study (SASSI)’. Identifier: NCT00819429


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