A recent study has uncovered promising results in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), a condition that affects millions of children worldwide. Researchers conducted a trial involving unmedicated children diagnosed with ADHD and found that a combination of brain stimulation and cognitive training significantly reduced ADHD symptoms. This breakthrough could potentially offer a non-pharmaceutical approach to managing the condition.
The study was published by the journal Translational Psychiatry.
ADHD is a common neurodevelopmental disorder that affects both children and adults. Its hallmark symptoms include inattention, hyperactivity, and impulsivity, which can impact a person’s daily life, school performance, and relationships. While medication has traditionally been the primary treatment for ADHD, it may not work for everyone, and some individuals prefer non-drug options due to concerns about side effects or other reasons.
This study aimed to explore an alternative approach to managing ADHD symptoms. Researchers were interested in investigating whether a combination of two interventions — a non-invasive brain stimulation technique known as transcranial Random Noise Stimulation and cognitive training — could lead to improvements in ADHD symptoms.
“Around 4% of children and 3% of adults worldwide have ADHD. The impairments associated with ADHD include school dropout, divorce/separation, unemployment, criminality, and a reduced life expectancy of ~13 years,” said study author Roi Cohen Kadosh, the head of the School of Psychology at the University of Surrey and a professor of cognitive neuroscience.
“The most prescribed treatment is using drugs, but it seems to not be effective for some, yielding side effects, and creates dependency. We have found that tRNS in health adults has led to long lasting effects on brain functions and behaviour, so it seems like a logical direction to examine its effects in ADHD.”
The research team conducted a randomized, double-blind trial involving children newly diagnosed with ADHD. They recruited children between the ages of 6 and 12 who had been diagnosed with ADHD and had not previously taken medication for the condition. The participants were randomly assigned to one of two groups: the first group received tRNS combined with cognitive training, while the second group received sham (placebo) stimulation along with cognitive training.
The cognitive training program used was derived from the ACTIVATE™ suite and aimed to improve executive functioning. It consisted of four exercises targeting various cognitive functions, including sustained attention, response inhibition, spatial working memory, cognitive flexibility, and switching. Each training session comprised four exercises, and each exercise was played for 5 minutes, resulting in a total of 20 minutes of gameplay per session.
Both groups underwent their designated treatment for two weeks, with sessions conducted on weekdays. This totaled ten treatment sessions. The researchers assessed the children’s ADHD symptom severity using a widely accepted diagnostic questionnaire. They also measured global functioning, memory performance, executive functions, and sleep quality.
The study included electroencephalography (EEG) recordings to examine brain activity. The researchers analyzed the EEG data for changes in specific frequency bands and aperiodic activity, which relates to the balance between excitatory and inhibitory brain activity.
Children who received both tRNS and cognitive training showed a significant reduction in ADHD symptoms compared to those in the placebo group. Of those who received both tRNS and cognitive training, 55% of the children exhibited substantial enhancements in their ADHD symptoms. In contrast, only 17% of the control group, which received sham (placebo) brain stimulation alongside cognitive training, showed similar improvements.
“I believe that the scientific community is duty-bound to investigate and develop evermore effective and longer-lasting treatments for ADHD,” Kadosh said in a news release. “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.
“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. However, our important test will be the results from a multi-centre clinical trial with a larger sample that we will start soon. If successful, this approach will be approved as a medical device for ADHD by the United States Food and Drug Administration.”
While the study explored various secondary outcomes, such as memory performance and executive functions, none of these measures showed significant differences between the treatment and placebo groups. Kadosh told PsyPost he was surprised that “we did not find an effect on working memory,” noting that his research team had observed improvements in a previous study.
Interestingly, the children who received active treatment experienced some changes in sleep quality, including longer times to fall asleep and more wake-ups during the night. However, these effects did not persist beyond the treatment period.
EEG data analysis indicated that the active treatment group had narrower beta bandwidth in their brain activity after treatment. This change suggested altered brain activity patterns associated with ADHD. The active treatment also appeared to influence the balance between excitatory and inhibitory brain activity, as indicated by changes in the aperiodic activity in specific brain regions.
Despite its promising results, the study has some limitations. The sample size was relatively small, which could affect the generalizability of the findings. Additionally, the study focused on children with mild to moderate ADHD symptoms, so its effectiveness for individuals with more severe symptoms remains uncertain. Future research with larger and more diverse samples is needed to confirm these findings.
Mor Nahum, co-lead of the study and Head of the Computerized Neurotherapy Lab at the Hebrew University where the study took place added: “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.”
More research is also need to better understand “how can we personalise tRNS, that includes a stimulation protocol with multiple parameters, to allow more optimal treatment to each individual,” Kadosh said.
The study, “Transcranial random noise stimulation combined with cognitive training for treating ADHD: a randomized, sham-controlled clinical trial“, was authored by Ornella Dakwar-Kawar, Noam Mairon, Shachar Hochman, Itai Berger, Roi Cohen Kadosh, and Mor Nahum.