Wednesday, August 2, 2023

Breakthrough ADHD treatment with random noise stimulation and cognitive training

Ornella, DK., Noam, M., Shachar, H. et al. Transcranial random noise stimulation combined with cognitive training for treating ADHD: a randomized, sham-controlled clinical trial. Transl Psychiatry 13, 271 (2023).


Non-invasive brain stimulation has been suggested as a potential treatment for improving symptomology and cognitive deficits in Attention-Deficit/Hyperactivity Disorder (ADHD), the most common childhood neurodevelopmental disorder. Here, we examined whether a novel form of stimulation, high-frequency transcranial random noise stimulation (tRNS), applied with cognitive training (CT), may impact symptoms and neural oscillations in children with ADHD. We conducted a randomized, double-blind, sham-controlled trial in 23 unmedicated children with ADHD, who received either tRNS over the right inferior frontal gyrus (rIFG) and left dorsolateral prefrontal cortex (lDLPFC) or sham stimulation for 2 weeks, combined with CT. tRNS + CT yielded significant clinical improvements (reduced parent-reported ADHD rating-scale scores) following treatment, compared to the control intervention. These improvements did not change significantly at a 3-week follow-up. Moreover, resting state (RS)-EEG periodic beta bandwidth of the extracted peaks was reduced in the experimental compared to control group immediately following treatment, with further reduction at follow-up. A lower aperiodic exponent, which reflects a higher cortical excitation/inhibition (E/I) balance and has been related to cognitive improvement, was seen in the experimental compared to control group. This replicates previous tRNS findings in adults without ADHD but was significant only when using a directional hypothesis. The experimental group further exhibited longer sleep onset latencies and more wake-up times following treatment compared to the control group. No significant group differences were seen in executive functions, nor in reported adverse events. We conclude that tRNS + CT has a lasting clinical effect on ADHD symptoms and on beta activity. These results provide a preliminary direction towards a novel intervention in pediatric ADHD.

Dakwar-Kawar O, Berger I, Barzilay S, Grossman ES, Cohen Kadosh R, Nahum M. Examining the Effect of Transcranial Electrical Stimulation and Cognitive Training on Processing Speed in Pediatric Attention Deficit Hyperactivity Disorder: A Pilot Study. Front Hum Neurosci. 2022 Jul 27;16:791478. doi: 10.3389/fnhum.2022.791478. PMID: 35966992; PMCID: PMC9363890.


Objective: Processing Speed (PS), the ability to perceive and react fast to stimuli in the environment, has been shown to be impaired in children with attention deficit hyperactivity disorder (ADHD). However, it is unclear whether PS can be improved following targeted treatments for ADHD. Here we examined potential changes in PS following application of transcranial electric stimulation (tES) combined with cognitive training (CT) in children with ADHD. Specifically, we examined changes in PS in the presence of different conditions of mental fatigue.

Methods: We used a randomized double-blind active-controlled crossover study of 19 unmedicated children with ADHD. Participants received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or transcranial random noise stimulation (tRNS), while completing CT, and the administration order was counterbalanced. PS was assessed before and after treatment using the MOXO-CPT, which measures PS in the presence of various conditions of mental fatigue and cognitive load.

Results: tRNS combined with CT yielded larger improvements in PS compared to tDCS combined with CT, mainly under condition of increased mental fatigue. Further improvements in PS were also seen in a 1-week follow up testing.

Conclusion: This study provides initial support for the efficacy of tRNS combined with CT in improving PS in the presence of mental fatigue in pediatric ADHD.

A breakthrough in treating attention-deficit/hyperactivity disorder could “significantly improve” the lives of children with the condition, experts said.

A new study found that brain stimulation combined with cognitive training can improve symptoms of ADHD.

“ADHD is one of the most common neurodevelopmental disorders affecting children across the world,” Ornella Dakwar-Kawar, a post-doctoral researcher at the Hebrew University of Jerusalem, said in a press release.

“Treating the condition with medication improves a child’s attention span and overall mood, however … there can be side effects including headache and a loss of appetite,” Dakwar-Kawar added.

“There is, therefore, a pressing need for developing and testing novel, non-pharmacological interventions for ADHD.”

ADHD symptoms include trouble paying attention, overactivity, and impulsive behaviors, according to the Centers for Disease Control and Prevention.

The CDC estimates that 6 million children in the US ages 3 to 17 have been diagnosed with ADHD.

The condition is usually treated with a combination of behavior therapy and medication.

Researchers at the University of Surrey and the Hebrew University conducted a clinical trial with 23 children ages 6 to 12 who were unmedicated.

The researchers administered a non-invasive brain stimulation with a mild electrical current running through two electrodes.

Cognitive treatment included problem-solving and reading comprehension.

After two weeks, 55% of the children showed significant clinical improvements in their ADHD symptoms, as reported by their parents, in comparison to 17% of children in the control group who received placebo brain stimulation.

The improvements were maintained at three weeks post-trial, with 64% reporting positive effects from the treatment compared to 33% in the control group.

After two weeks, 55% of the children showed significant clinical improvements in their ADHD symptoms, as reported by their parents, in comparison to 17% of children in the control group who received placebo brain stimulation.

The improvements were maintained at three weeks post-trial, with 64% reporting positive effects from the treatment compared to 33% in the control group.

The study, published in the journal Translational Psychiatry, also found that participants had changes in their brain electrical activity patterns, even three weeks after treatment.

“I believe that the scientific community is duty-bound to investigate and develop ever more effective and longer-lasting treatments for ADHD,” said Roi Cohen Kadosh, co-lead of the study and professor of cognitive neuroscience at the University of Surrey.

“The findings we demonstrate in our study suggest that a combination of transcranial direct current stimulation (tRNS), which is shown to be safe with minimal side effects, has the potential to transform the lives of children and their families,” Kadosh added.

“The results from this proof-of-concept study, together with previous results we received using tRNS, increase our confidence that in the future non-invasive brain stimulation may be able to provide an alternative to medication as a treatment pathway for children,” Kadosh continued.

“However, our important test will be the results from a multi-center clinical trial with a larger sample that we will start soon.”

Scientists noted that further research and trials would need to be done to make brain stimulation a practical therapy for children with ADHD.

“This is an important first step in offering new therapeutic options for ADHD. Future studies, with larger and more varied samples, should help establish this as a viable therapy for ADHD, and help us understand the underlying mechanisms of the disorder,” said Dr. Mor Nahum, co-lead of the study and head of the Computerized Neurotherapy Lab at the Hebrew University.

“If the results will be replicated in future larger studies we will be able to offer a novel, promising non-invasive, and safe treatment to large number of children and their families not only in the field of ADHD but in other neurodevelopmental disorders,” said professor Itai Berger, co-lead of the study.

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