ADHD With Working Memory Deficits
Conditions
Brief summary
Working memory (WM) is the foundational cognitive control process of holding information 'in mind' to execute goal-directed behaviors. WM deficits are an established component of ADHD. Despite being one of the strongest predictors of poor clinical and functional outcomes in pediatric mental health, there remains a dearth of available treatments for WM deficits. Non-invasive brain stimulation hold tremendous promise in transforming psychiatry, as it takes a brain-first approach to treatment. The dorsolateral prefrontal cortex (DLPFC) is the known structural foundation of WM, and the interaction between slow and fast brain waves (i.e., theta-gamma coupling \[TGC\]) is a neural, functional foundation of WM. Thus, the DLPFC and TGC are potential brain-based targets for the modulation of WM with brain stimulation. Intermittent theta burst stimulation (iTBS) is a novel paradigm that applies a three-minute dose of stimulation to the DLPFC at an intensity that directly mimics TGC dynamics. The objective of this study is to test whether iTBS can enhance dysfunctional brain activity that causes working memory deficits. iTBS will be tested compared to standard or traditional transcranial magnetic stimulation (TMS), called 10 Hz TMS. It will also be compared to sham or fake TMS. Each participant receives a single session of each of these types of TMS. EEG will record neural activity during a working memory test immediately before and after each TMS session. If this study shows TMS can enhance dysfunctional brain activity, the next step will be to conduct a clinical trial to test if TMS can lead to a sustained, positive effect on working memory deficits.
Interventions
DEVICEMagstim Super Rapid2 stimulator, 10 Hz condition
10 Hz (2,000 pulses) at left DLPFC
DEVICEMagstim Super Rapid2 stimulator, Sham condition
sham
DEVICEMagstim Super Rapid2 stimulator, iTBS condition
50 Hz, iTBS (600 pulses) at left DLPFC
Sponsors
Thrasher Research Fund
Rhode Island Foundation
Bradley Hospital
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
13 Years to 17 Years
Healthy volunteers
No
Inclusion criteria
1. Ability to provide assent and have parent provide parental permission 2. English fluency 3. 13-17 years 4. List Sorting Test (NIH Toolbox) performance: Greater than 1.0 standard deviation (SD) below normative mean 5. Parent rating on BRIEF-2 Working Memory: Greater than 1.0 SD above normative mean 6. IQ \> 80 7. Clinical diagnosis of attention deficit hyperactivity disorder (ADHD): predominantly inattentive type, predominantly hyperactive/impulsive type, combined type, or unspecified type. Diagnostic criteria will be confirmed with NICHQ Vanderbilt Assessment Scales-Parent.
Exclusion criteria
Participants will be screened to exclude individuals with neurological or medical conditions that might confound the results, as well as to exclude participants in whom rTMS might result in increased risk of side effects or complications. Common TMS contraindications include metallic hardware in the body, cardiac pacemaker, patients with an implanted medication pumps or an intracardiac line, or prescription of medications known to lower seizure threshold. This accounts for the majority of the
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Compared to sham and 10 Hz, iTBS will enhance theta-gamma coupling during working memory demands | Within 24 hours |
Secondary
| Measure | Time frame |
|---|---|
| Compared to sham and 10 Hz, iTBS will improve working memory test performance | Within 24 hours |
Countries
United States
Outcome results
None listed