MONTREAL—Children with speech apraxia, a neurological problem that can persist into adulthood, appear to benefit from daily supplementation with omega-3 fatty acids, reported Robert Katz, PhD, at the biannual meeting of the International Society for the Study of Fatty Acids and Lipids.
Recent headlines touting the benefits of fish oils and omega-3 fatty acids have claimed improvements in neurological and behavioral disorders ranging from depression and bipolar disorder to schizophrenia and dyslexia. One of the long chain omega-3 fatty acids, docosahexaenoic acid (DHA), preferentially accumulates in certain neurological tissues. It is also an active constituent of cell membranes. Thus, is not far-fetched to consider diverse ways in which omega-3 fatty acids, particularly DHA, may affect brain activity and neurological development.
New findings from children with disorders of speech motor control may extend the therapeutic repertoire of these fatty acids which have long been recognized for their cardiovascular benefits.
Apraxia of speech (AOS) is a motor speech disorder characterized by the inability to organize and produce purposeful speech sounds and sequences. It may be detected in infancy and persist into adulthood. Its occurrence is sometimes associated with other disorders such as autism, hypotonia, sensory integration disorder, and attention deficit hyperactivity disorder, to name a few. Although there are no reliable figures for the prevalence of AOS, it has generally been considered relatively rare. That perception is changing.
Children with AOS struggle to put together the movement patterns and sequences needed to produce sounds, syllables, or words. In addition, they usually have poor organizational, attention, and concentration skills. “These children rely on nonverbal communication and may make only single sounds,” said Dr. Katz, President of the Omega-3 Research Institute, Bethesda, MD.
AOS has only recently been recognized as a discrete neurogenic condition whose origin is unknown. “It could be neurodevelopmental or genetic in origin,” commented Dr. Katz. With intensive speech therapy, sometimes augmented with occupational and physical therapy, these children may develop some degree of language skill. No other more definitive treatments are known.
Dr. Katz conducted a pilot study on the effect of low dose omega-3 fatty acid supplementation in 19 children with AOS, who were also receiving intensive speech therapy. Severity of AOS among subjects varied from mild to severe. The children ranged from 27 months to 8 years of age, and included 16 males and 3 females. They were given ProEFA, an essential fatty acid mixture containing approximately 250 mg of EPA and DHA, the principal long chain marine omega-3 fatty acids, and 40 mg gamma linolenic acid from borage oil per capsule. Seventeen children received one capsule and two received two capsules daily. Duration of supplementation ranged from 3 to 21 weeks. ProEFA is manufactured by Nordic Naturals, a Scandinavian company with US offices in Watsonville, CA (Nordic Naturals, Tel. 1-831-724-6200, www.nordicnaturals.com).
Information about the children’s performance before and after supplementation was obtained by questionnaire distributed to subjects’ individual speech therapists. A detailed questionnaire was designed by Dr. Katz, Dr. Marilyn C. Agin, Medical Director of the New York City Early Intervention Program, and Ms. Lisa Geng, founder of the CHERAB Foundation, Gillette, NJ. Therapists were asked to score speech, affect, muscle tone, muscle control, behavior, social skills, attention, eye contact, and academic ability after supplementation. Baseline data on and social skills were collected from the therapists prior to supplementation.
Speech therapists reported moderate to significant improvements in speech in eight subjects, subtle improvements in nine, and no improvements in two. Interestingly, five children with severe AOS, including one with autism, showed moderate to significant improvements. While the data do not permit definitive conclusions, the investigators observed significant improvements in behavioral and social skills, such as attention span, eye contact, and calmness.
When compared with the children showing little or no improvement, responders showed increases in higher orders of communication, such as single words, multiple words, sentences, and singing. More primitive forms of communication, such as gesturing, grunting, and single sounds decreased. “It was striking how quickly these children responded,” noted Dr. Katz.
The children who responded to the fatty acids also showed improvements in certain behavior and social skills. Speech therapists noted that they became more vocal, used simple phrases or sentences, and were more articulate. “These results are particularly encouraging,” said Dr. Katz, “because until now, there has been no clinical intervention correlated with any improvement. Our results warrant further study in a controlled clinical trial.”
In a separate case study, Lori Roth, a speech pathologist in Morris Plains, NJ, followed four children with verbal apraxia who were given a single capsule of ProEFA daily, in addition to their usual speech therapy. Children were evaluated initially for language, oral motor coordination, and verbal/sound production. As early as two weeks after supplementation, they began demonstrating improved attention to task, sustained eye contact, and calmness in their participatory behavior. Verbal expression also improved rapidly. One child progressed from nonverbal communication to two-word utterance within two months. All four showed modest to significant changes in standardized language assessment after 2 to 3 months on ProEFA. The author said these results are characteristic of what would be achieved in 9 to 12 months of intensive speech therapy.
While the observational findings from both Katz and Roth are preliminary, they suggest a link between AOS and developmental deficits in the prenatal period. It is now well known that certain neurological tissues such as cerebral grey matter and retina accumulate DHA during fetal development and infancy. Tissue availability of essential fatty acids, particularly DHA, has been linked to visual acuity and other developmental assessments in infants.
The apparent involvement of long chain omega-3 and omega-6 fatty acids in speech development in children with AOS suggests these fatty acids may be involved in the development of speech centers in the brain. The promising observations from these studies could yield significant insights into the development and treatment of AOS in children while further extending the clinical utility of omega-3 fatty acids. They also raise the question of potential applications of omega-3 fatty acids in adults with motor speech disorders. Stay tuned.
