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Noninvasive brain stimulation (NIBS) techniques may offer targeted therapeutic benefits for individuals with attention-deficit/hyperactivity disorder (ADHD), according to results published in the Journal of the American Academy of Child & Adolescent Psychiatry.
Although pharmacologic treatment remains the first-line option for patients with ADHD, concerns around long-term tolerability, side effects, and risk of misuse have spurred interest in nonpharmacologic approaches. NIBS, which modulates neural circuits through externally applied currents or magnetic fields, has demonstrated promise in psychiatric conditions by targeting specific brain regions associated with symptom regulation.
To evaluate the therapeutic efficacy of NIBS for the management of patients with ADHD, researchers conducted a systematic search of PubMed, Web of Science, and Embase for studies published through July 5, 2024. Additional studies were identified through manual review of previous meta-analyses and systematic reviews. Eligible studies included those in which patients were diagnosed with ADHD using clinical or validated rating scale criteria, as well as those where researchers employed any form of NIBS. Only randomized controlled trials (RCTs) were included in the quantitative meta-analysis.
The researchers identified 59 studies with a total of 1657 participants with ADHD (mean age, 17.08 years; 70% men) to be included in the systematic review. They also identified 6 NIBS modalities, including repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation (tDCS), external trigeminal nerve stimulation, transcranial random noise stimulation, transcranial alternating current stimulation, and transcranial pulse stimulation. The final meta-analysis included 33 RCTs (n=7 rTMS; n=26 tDCS) with 1049 participants.
Meta-analysis results showed that rTMS was associated with significant reductions in inattention (Hedges’s g =-1.44; P =.002) and hyperactivity/impulsivity (Hedges’s g =-0.95; P =.005) symptoms, as well as improvements in attention-related function (Hedges’s g =0.53; P =.023). In contrast, tDCS was associated with modest improvements in hyperactivity/impulsivity (Hedges’s g =-0.28; P =.024) and inhibitory control (Hedges’s g = 0.39; P =.028), but had no significant effects on inattention, working memory, attention, or processing speed.
Subgroup analysis by stimulation site indicated that tDCS targeting the left dorsolateral prefrontal cortex (anodal) and right orbitofrontal cortex (cathodal) significantly improved inhibitory control. Age-stratified analyses showed that rTMS was more effective in reducing hyperactivity/impulsivity in children, while tDCS reduced inattention symptoms in adults. No dose-response relationship was identified for either modality.
Overall, NIBS interventions were well tolerated, with most adverse events described as mild and transient. Common side effects included scalp tingling, local discomfort, and mild headache. Serious adverse events were rare.
Study limitations include high variability in study designs, stimulation protocols, and diagnostic criteria, as well as differences in outcome measures and limited long-term follow-up data.
“Moving forward, future research should focus on optimizing NIBS protocols and investigating the comparative advantages of different NIBS technologies to establish their relative efficacy in addressing both clinical symptoms and cognitive deficits, ultimately advancing the practical therapeutic application of NIBS for ADHD management,” the study authors concluded.
Disclosures: This research was supported by the National Natural Science Foundation of China, the National Institute of Mental Health, the China Association for Science and Technology, and the China Scholarships Council. One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
This article originally appeared on Psychiatry Advisor
