Effects and Mechanisms of Transcranial Direct Current Stimulation Combined With Dialectical Behavior Therapy Skills Training in Adults With Attention-Deficit/Hyperactivity Disorder

April 27, 2026 updated by: Chun Wang, Nanjing Medical University

Effects and Mechanisms of Transcranial Direct Current Stimulation Combined with Dialectical Behavior Therapy Skills Training in Adults with Attention-Deficit/Hyperactivity Disorder

Abstract Adult attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder that frequently persists into adulthood and is associated with substantial impairments in academic, occupational, and social functioning. Although pharmacological treatment remains the primary intervention, some adults with ADHD show limited response to medication or experience adverse effects, highlighting the need for effective non-pharmacological or combined treatment approaches. Dialectical Behavior Therapy Skills Training (DBT-ST), which emphasizes emotion regulation, impulse control, mindfulness, and behavioral organization, has shown potential in the treatment of adult ADHD. However, its therapeutic efficacy may vary across individuals, and strategies to enhance treatment outcomes still require further investigation. In parallel, transcranial direct current stimulation (tDCS), a safe and non-invasive neuromodulation technique, has attracted increasing attention as an adjunctive intervention in psychiatric disorders. Existing studies suggest that combining tDCS with psychotherapy may optimize treatment effects by modulating neural networks related to cognitive control and emotional regulation. Nevertheless, evidence for such combined interventions in adult ADHD remains limited, particularly with respect to rigorous randomized controlled designs and mechanism-based neuroimaging validation.

The present study aims to investigate the efficacy and potential mechanisms of tDCS combined with DBT-ST in adults with ADHD. A randomized, double-blind, sham-controlled design will be adopted. Sixty eligible adult participants with ADHD will be randomly assigned to either an active tDCS group or a sham stimulation group, with both groups receiving weekly DBT-ST for ten consecutive weeks. tDCS will be administered over the bilateral dorsolateral prefrontal cortex (DLPFC) with 2 mA current for 20 minutes, prior to each group therapy session. Clinical symptoms, functional outcomes, and cognitive performance will be assessed at baseline, post-intervention, and one-month follow-up using standardized self-report measures and behavioral tasks. In addition, resting-state functional magnetic resonance imaging (rs-fMRI) will be conducted before and after the intervention to examine changes in functional connectivity within prefrontal regulatory networks.

This study is expected to clarify whether tDCS can enhance the therapeutic effects of DBT-ST on core ADHD symptoms and related functional outcomes, and whether such effects are associated with improvements in executive function, emotion regulation, and alterations in DLPFC-related resting-state functional connectivity. By integrating clinical, behavioral, and neuroimaging measures, the study seeks to provide preliminary evidence for a novel non-pharmacological combined intervention for adult ADHD and to further elucidate its underlying neural mechanisms.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Estimated)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • China
    • Jiangsu
      • Nanjing, Jiangsu, China, 210029
        • Recruiting
        • Nanjing Brain Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Meet the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Diagnosis confirmed using the Chinese version of the Diagnostic Interview for ADHD in Adults (DIVA-5).
  • Aged between 18 and 55 years.
  • Right-handed.
  • Voluntary participation with provision of written informed consent.

Exclusion Criteria:

  • Presence of neurological disorders or other psychiatric disorders.
  • Severe physical illness.
  • Receipt of electroconvulsive therapy (ECT) or other physical treatments within 6 months prior to enrollment.
  • Planned changes in ADHD-related medication before the final follow-up assessment.
  • Contraindications to tDCS (e.g., intracranial metal or electronic implants, skull plates, or other cranial implants).
  • Pregnancy or breastfeeding.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Active tDCS + DBT-ST
Participants receive active transcranial direct current stimulation (tDCS) over the bilateral dorsolateral prefrontal cortex combined with dialectical behavior therapy skills training (DBT-ST).
Device: Transcranial Direct Current Stimulation (tDCS)
Transcranial direct current stimulation (tDCS) is administered over the bilateral dorsolateral prefrontal cortex (DLPFC). In the active condition, a constant current of 2 mA is applied for 20 minutes per session, twice prior to each weekly therapy session, for 10 weeks. The anodal electrode is placed over the left DLPFC (F3) and the cathodal electrode over the right DLPFC (F4). In the sham condition, the current is ramped up and down briefly to mimic the sensation of stimulation without delivering an effective dose.
Other Names:
  • tDCS
Sham Comparator: Sham tDCS + DBT-ST
Participants receive sham transcranial direct current stimulation (tDCS) combined with dialectical behavior therapy skills training (DBT-ST).
Device: Transcranial Direct Current Stimulation (tDCS)
Transcranial direct current stimulation (tDCS) is administered over the bilateral dorsolateral prefrontal cortex (DLPFC). In the active condition, a constant current of 2 mA is applied for 20 minutes per session, twice prior to each weekly therapy session, for 10 weeks. The anodal electrode is placed over the left DLPFC (F3) and the cathodal electrode over the right DLPFC (F4). In the sham condition, the current is ramped up and down briefly to mimic the sensation of stimulation without delivering an effective dose.
Other Names:
  • tDCS

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in ADHD symptoms as measured by the Adult ADHD Self-Report Scale (ASRS)
Time Frame: Baseline to 10 weeks (post-intervention)
ADHD symptom severity will be assessed using the Adult ADHD Self-Report Scale (ASRS). The ASRS is a self-administered questionnaire consisting of 18 items. The total score ranges from 0 to 72, with higher scores indicating more severe ADHD symptoms. The primary outcome is the change in ASRS total score from baseline to post-intervention (10 weeks).
Baseline to 10 weeks (post-intervention)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in executive function performance as measured by the Stop-Signal Task (SST)
Time Frame: Baseline to 10 weeks
Executive function will be assessed using the Stop-Signal Task (SST). The outcome measure is the stop-signal reaction time (SSRT), reported in milliseconds. The change in SSRT from baseline to post-intervention will be analyzed.
Baseline to 10 weeks
Change in emotion regulation ability as measured by the Difficulties in Emotion Regulation Scale (DERS)
Time Frame: Baseline to 10 weeks (post-intervention)
Emotion regulation will be assessed using the Difficulties in Emotion Regulation Scale (DERS). The DERS is a 36-item self-report questionnaire. The total score ranges from 36 to 180, with higher scores indicating greater difficulties in emotion regulation. The change in DERS total score from baseline to post-intervention will be evaluated.
Baseline to 10 weeks (post-intervention)
Change in anxiety symptoms as measured by the Generalized Anxiety Disorder-7 (GAD-7)
Time Frame: Baseline to 10 weeks (post-intervention)
Anxiety symptoms will be assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale. The GAD-7 is a 7-item self-report questionnaire. The total score ranges from 0 to 21, with higher scores indicating more severe anxiety. The change in GAD-7 total score from baseline to post-intervention will be evaluated.
Baseline to 10 weeks (post-intervention)
Change in resting-state functional connectivity within prefrontal regulatory networks
Time Frame: Baseline to 10 weeks (post-intervention)
Resting-state functional connectivity will be assessed using resting-state functional magnetic resonance imaging (rs-fMRI). The outcome measure is the strength of functional connectivity within prefrontal regulatory networks, focusing on the dorsolateral prefrontal cortex (DLPFC), and is expressed as Fisher's Z-transformed correlation coefficient. The change in connectivity from baseline to post-intervention will be analyzed.
Baseline to 10 weeks (post-intervention)
Maintenance of treatment effects at 1-month follow-up
Time Frame: 1-month follow-up
Maintenance of treatment effects will be evaluated by reassessing the following clinical and cognitive outcomes at 1-month follow-up and comparing them with baseline values: ASRS total score (range 0-72, higher = worse), SST stop-signal reaction time (milliseconds), N-back d-prime (unitless), DERS total score (36-180, higher = worse), GAD-7 total score (0-21, higher = worse), PHQ-9 total score (0-27, higher = worse), and rs-fMRI DLPFC functional connectivity (Fisher's Z). Each of these measurements will be analyzed as a separate maintenance endpoint, using the same units of measure as defined in the respective outcomes above.
1-month follow-up
Change in depressive symptoms as measured by the Patient Health Questionnaire-9 (PHQ-9)
Time Frame: Baseline to 10 weeks (post-intervention)
Depressive symptoms will be assessed using the Patient Health Questionnaire-9 (PHQ-9). The PHQ-9 is a 9-item self-report questionnaire. The total score ranges from 0 to 27, with higher scores indicating more severe depression. The change in PHQ-9 total score from baseline to post-intervention will be evaluated.
Baseline to 10 weeks (post-intervention)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Nanjing Medical University

Investigators

  • Principal Investigator: Chun Wang, PhD, Nanjing Brain Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Estimated)

April 1, 2026

Primary Completion (Estimated)

June 21, 2028

Study Completion (Estimated)

September 1, 2028

Study Registration Dates

First Submitted

April 15, 2026

First Submitted That Met QC Criteria

April 27, 2026

First Posted (Actual)

May 4, 2026

Study Record Updates

Last Update Posted (Actual)

May 4, 2026

Last Update Submitted That Met QC Criteria

April 27, 2026

Last Verified

April 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • 2026-KY022-01

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

UNDECIDED

IPD Plan Description

Data sharing plans are currently undecided. Data may be made available upon reasonable request and subject to institutional approval and participant confidentiality considerations.

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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