The Science of Nutrition, Affect, & Cognition in Kids (SNACK) Lab is part of the Center for Mental Health Innovation in the Department of Psychiatry at Oregon Health & Science University.  We study complementary and integrative treatments for a variety of mental health conditions including attention deficit hyperactivity disorder (ADHD), emotional dysregulation, Below is a summary of our recent work with links to the published papers.  

From 2018-2021, we conducted the Micronutrients for ADHD in Youth (MADDY) study, an international study of a micronutrient supplement for children with ADHD and emotional dysregulation. Children were randomized to receive the micronutrients or a placebo. We found children who received the micronutrients were 3x more likely to have an improvement in symptoms compared to children who received placebo. After the randomized portion of the study, all the participants were given the opportunity to take the micronutrients (the “open-label” portion of the study), and children experienced continued symptom improvement. Overall, the children in the micronutrient group did not experience any more negative side effects than the children in placebo group.  

In MADDY study participants, we also found that lower fruit and vegetable intake was associated with more severe symptoms of inattention, but that children who received the micronutrients improved regardless of their diet quality or baseline mineral status. Children who came from households with food insecurity, however, had higher baseline symptoms of emotional dysregulation. Children with higher baseline urinary histamine levels did not have more severe symptoms of ADHD and emotional dysregulation symptoms, or different intake of high-histamine foods, however. In a subset of participants, we found that children who took micronutrients compared to placebo and responded to the micronutrient treatment had changes in their gut microbiome.  

Parents of MADDY participants reported their priorities and preferences for their child’s treatment, noting the desire to find the right treatment in this qualitative study. When parents nominated their child’s biggest problem and reported on its frequency, duration and impairment level, we found that inattention and internalizing symptoms (e.g anxiety, depression) improved in more children who received the micronutrients, compared to those who received placebo.  

We are currently investigating moderators of treatment response as well as the micronutrients’ biological mechanisms (how they effect change in the body). We also have manuscripts in progress on changes in antioxidant levels, catecholamine and kynurenine neurotransmitters, steroid hormones, hair cortisol, herbicides, and more.  

We have published multiple systematic reviews and meta-analysis:  

• The effectiveness of micronutrients for pediatric mental health, including ASD, ADHD, and emotional dysregulation 

• Non-pharmacological interventions for children with ADHD 

• Neutrophil/lymphocyte ratio (NLR) in ADHD, a measure of inflammation, NLR appears to be increased in children with ADHD 

• White and pink noise in ADHD - children with ADHD benefit from background white/pink noise when completing tasks of attention 

• Interoception in ADHD - interoception (body awareness) is reduced in individuals with ADHD and lower interoceptive abilities are associated with more severe ADHD symptoms  

• Phosphatidylserine in ADHD - supplementation improved inattention in children with ADHD 

We have examined sensory processing, chronic pain, and pain sensitivity.  

• We conducted a systematic review on the association between chronic pain, interoception, and alexithymia in children with chronic pain, finding decreased interoception and increased alexithymia in this population (under review).  

• In the MADDY study, we found that baseline pain sensitivity was associated with more severe emotional dysregulation symptoms.  

Lastly, we have studied suicidal thoughts and behavior (suicidality) in children and adolescents. In a systematic review on the clinical use of ketamine for depression, anxiety, bipolar disorder, and suicidality in youth, we found that ketamine appeared to be effective and safe in this population, with few side effects. We are also in the process of investigating the role of inflammation in suicidality for children in the MADDY study (in progress).  

In 2022-2023 we conducted a study of a powdered form of the micronutrients (manuscript in progress). The lab is currently supported on a K23 grant from the National Center for Complementary and Integrative Health to Dr. Johnstone to study the micronutrients in broad population, including remote collection of biological samples.