Transcranial Direct Current Stimulation Improves Attention for ADHD

Douglas Teixeira Leffa, MD, PhD

Transcranial direct current stimulation (tDCS) can be a beneficial non-pharmacological options for patients with attention deficit/hyperactivity disorder (ADHD).

A team, led by Douglas Teixeira Leffa, MD, PhD, ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, determined the efficacy and safety of home-based tDCS in treating the inattention symptoms of adult patients with ADHD.

Unknown Efficacy

While tDCS has shown promise in improving the symptoms of ADHD, previous research mainly involved smaller sample sizes, heterogenous methodologies, and short treatment periods using clinic-based tDCS.

In the randomized, double-blind, parallel, sham-controlled clinical trial called tDCS for the Treatment of Inattention Symptoms in Adult Patients With ADHD (TUNED), the investigators examined patients between July 2019 and July 2021 at a single-center outpatient academic setting.

The team screened 277 potential participants by phone and assessed 150 for eligibility on site. Of this group, 64 patients with ADHD, inattentive or combined subtype were included in the final analysis. In addition, 55 participants completed follow-up after 4 weeks.

Of the 64 patients with ADHD, 48% (n = 31) had inattentive presentation and 52% (n = 33) had combined presentation. The mean age of the patient population was 38.3 years.

Patients excluded from the trial included those with current stimulant drug treatment, current moderate to severe symptoms of depression or anxiety, diagnosis of bipolar disorder with a manic or depressive episode in the last year, diagnosis of schizophrenia or another psychotic disorder, and diagnosis of autism spectrum disorder.

The Program

The program included 30 minute daily sessions of home-based tDCS for 4 weeks, 2 mA anodal-right and cathodal-left prefrontal stimulation with 35-cm² carbon electrodes.

The investigators sought main outcomes of inattentive scores in the clinician-administered version of the Adult ADHD Self-report Scale version 1.1 (CASRS-I).

There was a mean inattention score of 18.88 (5.79) in the active tDCS group at week 4, compared to 23.63 (3.97) in the sham tDCS group.

The investigators also observed more frequent mild adverse events in the active tDCS group, especially skin redness, headache, and scalp burn.

“In this randomized clinical trial, daily treatment with a home-based tDCS device over 4 weeks improved attention in adult patients with ADHD who were not taking stimulant medication,” the authors wrote. “Home-based tDCS could be a nonpharmacological alternative for patients with ADHD.”

Alternative Therapies

Finding alternative therapeutics in psychiatry has been a priority in recent years.

Investigational digital therapeutic AKL-T03 provided significant improvement to the sustained attention and overall cognition of patients with major depression.

In new findings assessing the clinically-used digital video game software as a therapeutic for attention and related attentional control processes, a team of US-based investigators found the novel intervention may be beneficial, safe and more accessible for patients struggling to resolve depression-associated cognitive dysfunction.

Investigators observed no serious adverse events among treated patients with depression; 2 (5.5%) patients in the AKL-T03 group reported intervention-related headaches.

The study, “Transcranial Direct Current Stimulation vs Sham for the Treatment of Inattention in Adults With Attention-Deficit/Hyperactivity Disorder,” was published online in JAMA Psychiatry.