The Cotswold Community School is where children come when everything else has been tried.
It is a residential school for some of the UK's most damaged boys. Here 62 staff try to help up to 25 children aged from seven to 17 who have severe behavioural problems using a panoply of treatments at a cost of about £100,000 per boy per year. The most recent treatment has been a course of fish oils.
On a damp autumn morning, the scale of the boys' problems is indicated by a series of noises off: the sound of shattering glass on the floor below as a stone is lobbed through a window; the violent rattling of a locked door; a small figure running full pelt round a corner yelling angrily; another child, a pencil moustache inked on his top lip, fleeing a classroom to disappear up a tree.
Many of the boys are on the child protection register and most have already been in care for some time. They are frequently aggressive both verbally and physically. As a last resort, each boy has to be restrained on average two to three times a week because they are a danger to themselves, to other people or to the fabric of the school.
Nobody is pretending that a few fish oils alone are the answer to their problems, but the head of the school, Andrew Thomas, had read about the role of omega-3 fatty acid deficiency in aggression and depression. He introduced a healthy food policy some time ago, but fish is not popular with the boys. So he approached the supplement company Efamol to see if improving the boys' nutritional status with supplements might help them. The boys have just come to the end of 20 weeks taking Efalex, a fish oil supplement that is high in the omega-3s DHA and EPA and contains a small amount of arachidonic acid. A nutritionist, Dr Jackie Stordy, was asked to look at the effect, if any, on behaviour.
By the end of the 20 weeks, the school logs show that the number of times staff needed to restrain the boys had dropped by 46%. The length of time it took the boys to calm down when restrained had also fallen by 42%. The boys are also marked routinely using standard tests for cognitive problems, impulsiveness and hyperactivity. The boys' marks changed significantly after the treatment, their scores improving by 20% for impulsiveness and hyperactivity.
Stordy, who has previously worked as a consultant to Efamol but did this work for the school pro bono, is clear that you cannot call the treatment a proper "trial". The numbers involved were tiny, only 19, with one boy refusing to take the fish oil and another declined permission by his social worker. There was no placebo or control.
With all these caveats, she adds: "It obviously had an impact on the school; it seemed to ease the children's lives."
For nearly all the children there was a small but significant improvement, with the exception of the boys who did not take part, who showed no improvement. For three boys taking the fish oil, the improvement was dramatic. "Their scores moved into the normal population range, which is remarkable," Stordy says. One, who had extreme symptoms of Attention Deficit and Hyperactivity Disorder, scored close to normal by the end.
The head of care at the home, Stuart Harragan, explains what that meant to their lives. "John [not his real name] for example was very aggressive. He'd strip off completely to stop adults going near him to restrain him. He'd abscond for long periods. Any physical restraint would go on for a very long time before you could calm him down. The change in him was very marked. He was even able to go away for a bit with his brother and father, which just hadn't been possible before."
Thomas says he is used to measuring progress among the boys "in coffee spoons" and finds the results fascinating. "These are boys who have lost their childhood. It could be a terrific help."
