Understanding subjective beliefs could be vital to tailoring more effective treatments for depression and ADHD

Taking into account whether people believe they are receiving a real treatment or a fake one (placebo) could provide better insights that could help improve interventions for conditions such as depression and ADHD.

A team of psychologists, led by Professor Roi Cohen Kadosh from the University of Surrey, analysed five independent studies that covered different types of neurostimulation treatments to understand the role of patients' subjective beliefs.

These patients included both clinical patients being treated for ADHD and depression, as well as healthy adults.

The study found that patients' beliefs about whether they were receiving real or placebo treatments explained the treatment outcomes in four of the five studies.

On some occasions, the subjects' beliefs explained the treatment's results better than the actual treatment itself.

Assumptions about the treatment intensity also played a significant role in the treatment.

Professor Roi Cohen Kadosh from the University of Surrey said that the results have provided a twist that scientists must consider in future research:

"The common wisdom is that the same medical treatment would produce similar results across patients, but our latest study suggests a fascinating twist. While you'd expect uniform improvements in a group of people with depression undergoing the same neurostimulation treatment, outcomes can vary widely.

"What's truly eye-opening is that this variability could be largely influenced by the participants' own beliefs about the treatment they're receiving. In essence, if an individual believes they're receiving an effective treatment -- even when given a placebo -- that belief alone might contribute to significant improvements in their condition."

In the first study analysed, 121 participants were treated with different forms of Transcranial Magnetic Stimulation (rTMS) for depression.

The results showed that participants' perceptions about receiving real or placebo treatment mattered more than the actual type of rTMS in reducing depression.

The second study involved 52 older people with late-life depression who received either a real or placebo of deep rTMS.

Surrey researchers found that the effect of treatment on reducing depression scores depended on the combination of the participants' perceptions about receiving real or placebo treatment and the actual treatment they received.

In the third dataset, researchers investigated the effects of home-based Transcranial Direct Current Stimulation (tDCS) treatment on 64 adults diagnosed with ADHD.

At the end of the study, participants' beliefs about the treatment they thought they had received were also collected.

This study differed from the first two as both the subjects' beliefs and the actual treatment had a dual effect on reducing inattention scores.

In the fourth study, 150 healthy participants got varying doses of tDCS for mind wandering.

Those who believed they got a more potent dose reported more mind wandering, even if the actual treatment wasn't a factor.

The fifth study analysed the impact of transcranial random noise stimulation on working memory.

Unlike previous studies, participants' beliefs didn't affect the results, highlighting the varying influence of beliefs in brain stimulation research.

Thus, Roi Cohen Kadosh and his team show how subjective beliefs can vary in their effect on research -- from fully explaining results beyond the actual treatment, to interacting with the treatment, to having no influence at all.

Dr Shachar Hochman, a co-author on this work from the University of Surrey, said:

"The concept that a placebo or sham treatment can mimic genuine treatment effects is well-established in science. While researchers have closely monitored this phenomenon, it has been typically catalogued separately from the in-depth analyses of the actual treatment outcomes. What sets our study apart is that we have brought together these two datasets -- subjective beliefs and objective treatment measures. This has the potential to reveal new insights into treatment efficacy."

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Diet plays key role in ADHD symptoms in children

 Here's a good reason for children with attention deficit hyperactivity disorder (ADHD) to eat their fruits and vegetables: It may help reduce inattention issues, a new study suggests.

As part of a larger study, researchers asked parents of 134 kids with ADHD symptoms to complete a detailed questionnaire about the typical foods the children ate, including portion sizes, over a 90-day period.

Another questionnaire asked parents to rate symptoms of inattention -- a hallmark of ADHD -- in their kids, such as having trouble staying focused, not following instructions, difficulty remembering things, and difficulty regulating emotions.

Results showed that kids who consumed more fruits and vegetables showed less severe symptoms of inattention, said Irene Hatsu, co-author of the study and associate professor of human nutrition at The Ohio State University.

"Eating a healthy diet, including fruits and vegetables, may be one way to reduce some of the symptoms of ADHD," Hatsu said.

The study was published online recently in the journal Nutritional Neuroscience.

The data for this research was collected as part of the Micronutrients for ADHD in Youth (MADDY) Study, which examined the efficacy of a 36-ingredient vitamin and mineral supplement to treat symptoms of ADHD and poor emotional control in the 134 kids aged 6 to 12.

The study that evaluated the effectiveness of the supplement showed that children who took the micronutrients were three times as likely to show significant improvement in their ADHD and emotional dysregulation symptoms than those who took a placebo. That study was published last year in the Journal of the American Academy of Child and Adolescent Psychiatry.

Another study involving the same children, published earlier this year in the journal Nutrients, showed that kids whose families had higher levels of food insecurity were more likely than others to show more severe symptoms of emotional dysregulation, such as chronic irritability, angry moods and outbursts of anger.

The three studies all paint a similar picture, Hatsu said: A healthy diet that provides all the nutrients that children require can help reduce the symptoms of ADHD in children.

"What clinicians usually do when kids with ADHD start having more severe symptoms is increase the dose of their treatment medication, if they are on one, or put them on medication," Hatsu said.

"Our studies suggest that it is worthwhile to check the children's access to food as well as the quality of their diet to see if it may be contributing to their symptom severity."

Children in the MADDY study, all of whom met the criteria for ADHD, were recruited from three sites: Columbus, Ohio; Portland, Oregon; and Lethbridge, Alberta, Canada. The study took place between 2018 and 2020. Participants were either not taking medication or stopped using it two weeks before the study began.

The studies on fruit and vegetable intake and the role of food insecurity were based on data collected when the children were first enrolled in the study, before they began taking the micronutrient supplement or placebo.

Why may diet be so important in ADHD?

Researchers believe that ADHD is related to low levels of some neurotransmitters in the brain -- and vitamins and minerals play a key role as cofactors in helping the body make those important neurochemicals and in overall brain function, Hatsu said.

Food insecurity may play an additional role.

"Everyone tends to get irritated when they're hungry and kids with ADHD are no exception. If they're not getting enough food, it could make their symptoms worse," she said.

Also, the stress of parents who are upset about not being able to provide enough food for their children can create family tension that could lead to more symptoms for children with ADHD.

The MADDY study is one of the first to look at the relationship between ADHD symptoms and diet quality among children in the United States and Canada, Hatsu said.

That's important because Western diets are more likely than many others, such as the Mediterranean diet, to fall short on fruit and vegetable intake, she said.

"We believe clinicians should assess the food security status of children with ADHD before creating or changing a treatment program," Hatsu said.

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ADHD linked to hoarding behavior

New research has found that people with Attention Deficit/Hyperactivity Disorder (ADHD) are significantly more likely to also exhibit hoarding behaviours, which can have a serious impact on their quality of life.

The study, published in the Journal of Psychiatric Research and funded by theBritish Academy and the Leverhulme Trust, found that almost one in five people with ADHD exhibited clinically significant levels of hoarding, indicating there could be a hidden population of adults struggling with hoarding and its consequences.

Hoarding Disorder is a recognised condition that involves excessive accumulation, difficulties discarding and excessive clutter. The disorder can lead to distress or difficulties in everyday life and can contribute to depression and anxiety.

Previous research into Hoarding Disorder has mainly focused on older females who self-identify as hoarders and have sought help later in life. This new study, led by Dr Sharon Morein of Anglia Ruskin University (ARU), recruited 88 participants from an adult ADHD clinic run by the Cambridge and Peterborough NHS Foundation Trust.

The study found that 19% of this ADHD group displayed clinically significant hoarding symptoms, were on average in their 30s, and there was an equal gender split. Amongst the remaining 81%, the researchers found greater hoarding severity, but not to a degree that significantly impaired their lives, compared to the study's control group.

The researchers asked the same questions, about ADHD symptoms and impulsivity, levels of hoarding and clutter, obsessive compulsive severity, perfectionism, depression and anxiety, and everyday function, on a closely-matched group of 90 adults from the general population, without an ADHD diagnosis, and found only 2% of this control group exhibited clinically significant hoarding symptoms.

They then replicated this with a larger online sample of 220 UK adults to see if similar patterns were found, and similarly only 3% of this group exhibited symptoms.

Dr Morein, Associate Professor in Psychology at Anglia Ruskin University (ARU), said: "Hoarding Disorder is much more than simply collecting too many possessions. People with diagnosed Hoarding Disorder have filled their living areas with so many items and clutter that it impacts their day-to-day functioning leading to a poorer quality of life, anxiety, and depression.

"Overall, we found that people who had been diagnosed with ADHD had a higher likelihood of also having hoarding symptoms. This is important because it demonstrates that hoarding doesn't just affect people later in life, who are typically the focus of much of the research so far into Hoarding Disorder.

"Our findings also indicate that Hoarding Disorder should be routinely assessed in individuals with ADHD, as they do not typically disclose associated difficulties despite these potentially impairing their everyday lives. Likewise, it is possible that many people who are currently being treated for Hoarding Disorder might also have undiagnosed ADHD.

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