TY - JOUR
T1 - Transcranial direct current stimulation (tDCS) combined with cognitive training in adolescent boys with ADHD
T2 - A double-blind, randomised, sham-controlled trial
AU - Westwood, Samuel J.
AU - Criaud, Marion
AU - Lam, Sheut Ling
AU - Lukito, Steve
AU - Wallace-Hanlon, Sophie
AU - Kowalczyk, Olivia S.
AU - Kostara, Afroditi
AU - Mathew, Joseph
AU - Agbedjro, Deborah
AU - Wexler, Bruce E.
AU - Cohen Kadosh, Roi
AU - Asherson, Philip
AU - Rubia, Katya
N1 - Publisher Copyright:
Copyright © The Author(s), 2021. Published by Cambridge University Press.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background Transcranial direct current stimulation (tDCS) could be a side-effect-free alternative to psychostimulants in attention-deficit/hyperactivity disorder (ADHD). Although there is limited evidence for clinical and cognitive effects, most studies were small, single-session and stimulated left dorsolateral prefrontal cortex (dlPFC). No sham-controlled study has stimulated the right inferior frontal cortex (rIFC), which is the most consistently under-functioning region in ADHD, with multiple anodal-TDCS sessions combined with cognitive training (CT) to enhance effects. Thus, we investigated the clinical and cognitive effects of multi-session anodal-TDCS over rIFC combined with CT in double-blind, randomised, sham-controlled trial (RCT, ISRCTN48265228). Methods Fifty boys with ADHD (10-18 years) received 15 weekday sessions of anodal-or sham-TDCS over rIFC combined with CT (20 min, 1 mA). ANCOVA, adjusting for baseline measures, age and medication status, tested group differences in clinical and ADHD-relevant executive functions at posttreatment and after 6 months. Results ADHD-Rating Scale, Conners ADHD Index and adverse effects were significantly lower at post-Treatment after sham relative to anodal tDCS. No other effects were significant. Conclusions This rigorous and largest RCT of tDCS in adolescent boys with ADHD found no evidence of improved ADHD symptoms or cognitive performance following multi-session anodal tDCS over rIFC combined with CT. These findings extend limited meta-Analytic evidence of cognitive and clinical effects in ADHD after 1-5 tDCS sessions over mainly left dlPFC. Given that tDCS is commercially and clinically available, the findings are important as they suggest that rIFC stimulation may not be indicated as a neurotherapy for cognitive or clinical remediation for ADHD.
AB - Background Transcranial direct current stimulation (tDCS) could be a side-effect-free alternative to psychostimulants in attention-deficit/hyperactivity disorder (ADHD). Although there is limited evidence for clinical and cognitive effects, most studies were small, single-session and stimulated left dorsolateral prefrontal cortex (dlPFC). No sham-controlled study has stimulated the right inferior frontal cortex (rIFC), which is the most consistently under-functioning region in ADHD, with multiple anodal-TDCS sessions combined with cognitive training (CT) to enhance effects. Thus, we investigated the clinical and cognitive effects of multi-session anodal-TDCS over rIFC combined with CT in double-blind, randomised, sham-controlled trial (RCT, ISRCTN48265228). Methods Fifty boys with ADHD (10-18 years) received 15 weekday sessions of anodal-or sham-TDCS over rIFC combined with CT (20 min, 1 mA). ANCOVA, adjusting for baseline measures, age and medication status, tested group differences in clinical and ADHD-relevant executive functions at posttreatment and after 6 months. Results ADHD-Rating Scale, Conners ADHD Index and adverse effects were significantly lower at post-Treatment after sham relative to anodal tDCS. No other effects were significant. Conclusions This rigorous and largest RCT of tDCS in adolescent boys with ADHD found no evidence of improved ADHD symptoms or cognitive performance following multi-session anodal tDCS over rIFC combined with CT. These findings extend limited meta-Analytic evidence of cognitive and clinical effects in ADHD after 1-5 tDCS sessions over mainly left dlPFC. Given that tDCS is commercially and clinically available, the findings are important as they suggest that rIFC stimulation may not be indicated as a neurotherapy for cognitive or clinical remediation for ADHD.
KW - ADHD
KW - randomised controlled trial
KW - tDCS
KW - treatment
UR - http://www.scopus.com/inward/record.url?scp=85109302263&partnerID=8YFLogxK
U2 - 10.1017/S0033291721001859
DO - 10.1017/S0033291721001859
M3 - Article
AN - SCOPUS:85109302263
SN - 0033-2917
JO - Psychological Medicine
JF - Psychological Medicine
ER -