Differential cognitive effects of DHA-enriched and standard phosphatidylserine formulations in children with ADHD: a randomized, placebo-controlled trial

OBJECTIVE: This randomized, placebo-controlled trial investigated the cognitive effects of three phosphatidylserine (PS) formulations, with or without docosahexaenoic acid (DHA), in children aged 10-14 years diagnosed with attention-deficit/hyperactivity disorder (ADHD) or presenting with clinically significant subthreshold ADHD symptoms. MATERIAL AND METHODS: Forty-five medication-naïve children meeting DSM-5 criteria for ADHD or exhibiting subthreshold symptoms confirmed by standardized parent-teacher rating scales (Turgay/Conners) and clinical evaluation were randomized in a 1:1:1:1 ratio to receive placebo, PS Capsule (100 mg PS + 17.78 mg DHA), PS Sachet (117.78 mg PS without DHA), or PS Plus Capsule (150 mg PS + 26.67 mg DHA) for eight weeks. Cognitive performance was assessed at baseline and post-intervention using the MOXO continuous performance test and the Stroop test. RESULTS: Significant between-group differences were observed across MOXO and Stroop outcomes. The PS Plus group showed the greatest improvements in attention, impulsivity, and hyperactivity, along with the largest reductions in reaction time. The placebo, Capsule, and Sachet groups demonstrated smaller and generally comparable changes. Stroop error rates and correction counts decreased significantly only in the PS Plus group, suggesting enhanced inhibitory control and cognitive flexibility. CONCLUSION: Higher-dose phosphatidylserine combined with DHA (PS Plus) yielded superior cognitive benefits compared with placebo and lower-dose formulations.