Challenges and perspectives of non-invasive brain stimulation in the management of Attention-Deficit/Hyperactivity Disorder: need for rethinking the efficacy

Abstract

Attention-deficit/hyperactivity disorder (ADHD) requires comprehensive and carefully tailored therapeutic approaches. Although pharmacotherapy is effective and considered the first-line treatment, it has notable limitations owing to its non-specific effects on the nervous system and the potential for adverse effects and drug tolerance. Non-invasive brain stimulation (NIBS), which selectively targets neural circuits, has emerged as a novel alternative intervention. Evidence suggests that repetitive transcranial magnetic stimulation (rTMS) is effective in improving the core symptoms of ADHD. By contrast, transcranial direct current stimulation (tDCS) primarily improves inhibitory control and reduces impulsive behaviours. However, the absence of a significant dose–response relationship, together with heterogeneity in study findings, indicates that these methods require more precise tailoring to patients’ clinical profiles. This article examines the mechanisms, targeting strategies, and challenges associated with the clinical application of NIBS in patients with ADHD.

Keywords: Attention-deficit/hyperactivity disorder, Noninvasive brain stimulation, Transcranial magnetic stimulation, Transcranial direct current stimulation, Nhibitory control, Neuroplasticity