Intermittent theta burst stimulation for attention deficit hyperactivity disorder

Objective: Attention deficit hyperactivity disorder (ADHD) is the most diagnosed psychiatric disorder in childhood and often causes lifelong symptom burden. Transcranial magnetic stimulation (TMS) has been investigated in adult ADHD with encouraging findings, although work in pediatric samples remains limited and no ADHD studies have examined the utility of intermittent theta burst stimulation (iTBS). Methods: Twenty-nine adolescents with ADHD and working memory (WM) symptoms were randomized into a sham-controlled, counter-balanced, double-blind, crossover clinical trial of iTBS for adolescent ADHD. Participants completed ten active iTBS sessions (600 pulses per session) and ten sham iTBS sessions to the left dorsolateral prefrontal cortex (DLPFC) at 80% resting motor threshold. Primary outcome variables included safety, feasibility, and change in parent-reported ADHD and WM symptoms. Secondary outcomes consisted of parent and participant-reported affective symptom changes. Results: The protocol was feasible (82% completed all scheduled sessions) and safe (zero serious adverse events). A statistically significant improvement was seen in active versus sham iTBS in parent-reported overall ADHD symptoms, hyperactivity/impulsivity, working memory, anger, depressive symptoms, and anxiety symptoms. Conclusions: iTBS holds promise as a potential future treatment for ADHD, and effects achieved when targeting the left DLPFC may be most robust for transdiagnostic cognitive and affective symptoms. Increasing the number of iTBS sessions per day with accelerated protocols may maximize efficacy and feasibility for teens with ADHD and their parents. Clinicaltrials.gov Identifier: NCT05102864