Transcranial Direct Current Stimulation in ADHD: A Systematic Review of Efficacy, Safety, and Protocol-induced Electrica
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REVIEW
Transcranial Direct Current Stimulation in ADHD: A Systematic Review of Efficacy, Safety, and Protocol-induced Electrical Field Modeling Results Mohammad Ali Salehinejad1,2,3 • Vahid Nejati4 • Mohsen Mosayebi-Samani1,5 Ali Mohammadi4 • Miles Wischnewski6 • Min-Fang Kuo1 • Alessio Avenanti7,8 • Carmelo M. Vicario9 • Michael A. Nitsche1,10
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Received: 4 November 2019 / Accepted: 4 February 2020 Ó Shanghai Institutes for Biological Sciences, CAS 2020
Abstract Transcranial direct current stimulation (tDCS) is a promising method for altering cortical excitability with clinical implications. It has been increasingly used in neurodevelopmental disorders, especially attention-deficit hyperactivity disorder (ADHD), but its efficacy (based on effect size calculations), safety, and stimulation parameters have not been systematically examined. In this systematic review, we aimed to (1) explore the effectiveness of tDCS on the clinical symptoms and neuropsychological deficits of ADHD patients, (2) evaluate the safety of tDCS application, especially in children with ADHD, (3) model the electrical field intensity in the target regions based on the commonly-applied and effective versus less-effective Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12264-020-00501-x) contains supplementary material, which is available to authorized users.
protocols, and (4) discuss and propose advanced tDCS parameters. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach, a literature search identified 14 empirical experiments investigating tDCS effects in ADHD. Partial improving effects of tDCS on cognitive deficits (response inhibition, working memory, attention, and cognitive flexibility) or clinical symptoms (e.g., impulsivity and inattention) are reported in 10 studies. No serious adverse effects are reported in 747 sessions of tDCS. The left and right dorsolateral prefrontal cortex are the regions most often targeted, and anodal tDCS the protocol most often applied. An intensity of 2 mA induced stronger electrical fields than 1 mA in adults with ADHD and was associated with significant behavioral changes. In ADHD children, however, the electrical field induced by 1 mA, which is likely larger than the electrical
& Mohammad Ali Salehinejad [email protected]
6
Donders Institute for Brain, Cognition and Behaviour, Radboud University, 6525 HR Nijmegen, The Netherlands
& Vahid Nejati [email protected]
7
Centro studi e ricerche in Neuroscienze Cognitive, Dipartimento di Psicologia, Alma Mater Studiorm, Universita` di Bologna, 47521 Cesena, Italy
8
Centro de Investigacio´n en Neuropsicologı´a y Neurociencias Cognitivas, Universidad Cato´lica del Maule, 3605 Talca, Chile
9
Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e degli studi culturali, Universita` di Messina, 98121 Messina, Italy
10
Department of Neurology, University Medical Hospital Bergmannsheil, 44789 Bochum, Germany
& Michael A. N
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