Comparative efficacy of neurofeedback, tDCS, and TMS: The future of therapy for adults with ADHD. A systematic review and meta-analysis.

BACKGROUND

ADHD is a prevalent neurodevelopmental condition worldwide. While therapeutic approaches continue to evolve, clinical considerations for adult patients remain underexplored. Recent approaches such as neurofeedback, tDCS, or rTMS, have emerged, requiring clarification of therapeutic protocols need to assess their relevance and efficacy.

METHODS

a systematic search of PubMed, Web of Science, Cochrane Library, Ovid and ScienceDirect databases was performed. A total of 1747 articles were extracted and inclusion and exclusion criteria were applied to screen satisfactorily. Eighteen articles were selected for detailed analysis.

RESULTS

tDCS and rTMS showed the most robust methodological designs among the studies analyzed. TDCS seems to be effective with anode at F3 and cathode at F4 at 2 mA. RTMS seems to be effective on unilateral DLPFC at high frequency, with optimal results using deep coil. Medication appeared to have little to no effect in the studies reviewed. However, meta-analysis did not reach significance for any of the techniques studied.

CONCLUSIONS

Future research should focus on enlarging the sample sizes for tDCS and TMS, and investigating the effect of comorbidities. Neurofeedback lacks significant study quality. It could still be a viable option, particularly for population reluctant to undergo neuromodulation technics. Combination of tDCS and other therapies may hold significant therapeutic potential.