Transcranial direct current stimulation in attention-deficit hyperactivity disorder: A meta-analysis of neuropsychological deficits

Mohammad Ali Salehinejad, Miles Wischnewski, Vahid Nejati, Carmelo M Vicario, Michael A Nitsche, Mohammad Ali Salehinejad, Miles Wischnewski, Vahid Nejati, Carmelo M Vicario, Michael A Nitsche

Abstract

Transcranial direct current stimulation (tDCS) is a promising method for altering cortical excitability with clinical implications in neuropsychiatric diseases. Its application in neurodevelopmental disorders especially attention-deficit hyperactivity disorder (ADHD), is in early stage and promising but its effectiveness has not been systematically examined yet. We conducted a meta-analysis on the effectiveness of tDCS on the most studied neuropsychological symptoms of ADHD, which is the first reported meta-analysis of tDCS studies on ADHD. Data from 10 randomized controlled studies (including 11 separate experiments) targeting inhibitory control, and/or working memory (WM) in ADHD were included. Results show that overall tDCS significantly improved inhibitory control. Sub-analyses further show that dorsolateral prefrontal cortex (dlPFC) (but not right inferior frontal gyrus) tDCS and anodal (but not cathodal) tDCS significantly improved inhibitory control with a small effect size. Anodal dlPFC-tDCS had the largest significant effect on inhibitory control with a small-to-medium effect size. Additionally, a significant improving effect of tDCS on inhibitory control accuracy (but not response time) and WM speed (but not accuracy) were found. Overall, this meta-analysis supports a beneficial effect of tDCS on inhibitory control and WM in ADHD with a small-to-medium effect size. TDCS seems to be a promising method for improving neuropsychological and cognitive deficits in ADHD. However, there might be a dissociation between neuropsychological deficits and clinical symptoms of ADHD and therefore, the significance of this meta-analysis for clinical purposes is limited. Future studies should systematically evaluate the role of inter-individual factors (i.e., ADHD subtype, types of the deficit) and stimulation parameters (i.e., site, polarity, intensity, duration, repetition rate) on tDCS efficacy in ADHD population and examine whether benefits are long-term.

Conflict of interest statement

MAN is a member of the Scientific Advisory Board of Neuroelectrics. All other authors declare no competing interests. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1
(A) Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of selection of studies, (B) Bias assessment in individual studies. tDCS = Transcranial Direct Current Stimulation; ADHD = attention-deficit hyperactivity disorder; IC = Inhibitory Control; WM = Working Memory.
Fig 2
Fig 2
Meta-analysis and forest plot results including Hedges’ g and 95% confidence interval and Cumulative effect size of tDCS on inhibitory control (top) and working memory (down).

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