Noninvasive Brain Stimulation in Pediatric Attention-Deficit Hyperactivity Disorder (ADHD)

Abstract

Attention-deficit hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental disorders in the pediatric population. The clinical management of ADHD is currently limited by a lack of reliable diagnostic biomarkers and inadequate therapy for a minority of patients that do not respond to standard pharmacotherapy. There is optimism that noninvasive brain stimulation may help to address these limitations. Transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) are two methods of noninvasive brain stimulation that modulate cortical excitability and brain network activity. TMS can be used diagnostically to probe cortical neurophysiology, while daily use of repetitive TMS or tDCS can induce long-lasting and potentially therapeutic changes in targeted networks. In this review we highlight research showing the potential diagnostic and therapeutic applications of TMS and tDCS in pediatric ADHD. We also discuss the safety and ethics of using these tools in the pediatric population.

Modulation of Brain Activity with Noninvasive Transcranial Direct Current Stimulation (tDCS): Clinical Applications and Safety Concerns

“…The exact pathophysiology of ADHD has been difficult to delineate because of complicating factors such as evolving diagnostic criteria, phenotypic heterogeneity, frequent comorbidities, and environmental variables that may exacerbate or mimic symptoms (Rubio et al, 2016). One of the most influential theories for the neural basis of ADHD has focused on deficient inhibitory control leading to executive dysfunction (Gilbert et al, 2011), which has been proved to be linked to frontostriatal circuits, specifically hypo-activity in the DLPFC, ventrolateral prefrontal cortex, and the anterior cingulate cortex (Konrad et al, 2006).…”

Neuroethics of neuromodulation: An update

“…Yet Johnco and Storch[40] note the lack of a standardized definition of “refractory” when considering DBS or other neurodevices, and that the use of invasive neuromodulation in pediatric populations is in need of more thorough clinical and ethical analysis. The articles discussing pediatric DBS note concerns about the scarcity of clinical studies and data with minors, including little information about long-term effects, concerns about safety and informed consent, potential effects on agency of developing minors, and the use of neuromodulation tools to attempt to enhance healthy children[40] [41] [42] [43] [44] [45] [46] [47] [48] [49]. …”

Applications of transcranial direct current stimulation in children and pediatrics

“…A complete review about studies of tDCS and other noninvasive brain stimulation techniques (with greater emphasis on transcranial magnetic stimulation) in childhood and adolescence can be found in Quintana (2005), Croarkin et al (2011), Vicario and Nitsche (2013a,b), and Rubio et al (2016). The effects of tDCS on learning and motor performance have been most frequently studied in healthy children (Ciechanski and Kirton, in press).…”