P 48 tDCS in the daily routine – Experiences on feasibility and integrability of home-based tDCS for children and adolescents suffering from ADHD

Abstract

Although tDCS is receiving more and more attention in research, there are still few studies addressing a home-based setting of tDCS sessions. In our clinical trial we are investigating not only the potential beneficial effects of anodal multi-channel tDCS over bilateral dlPFC applied to children and adolescents suffering from ADHD on related behavioral symptoms as well as on relevant neuropsychological and neurophysiological measures, but also, we are examining whether home-based tDCS is a feasible and safe tool for the participants and their caregivers. The study is conducted within the framework of the Horizon2020 project “Stimulation in Pediatrics”. The home-based use of tDCS takes advantage of several features such as the device being easily portable and the well reported safety record. Furthermore, there is strong empirical evidence that tDCS should be applied in multiple sessions in order to increase its effects. Consequently, the ability to perform tDCS independently at home also saves resources on the part of the clinic, as well as frequent trips to the clinic for the participants. The resulting reduced time effort, in addition to the low side effects, may have a beneficial effect on patient compliance. Based on the empirical evidence and guidelines for the implementation of tDCS as home treatment we conceptualized and currently perform home-based tDCS for children and adolescents with ADHD. This includes several procedures such as the selection of an appropriate patient sample in terms of resources and potential compliance, detailed theoretical instruction as well as practical training in the application of the device, safety questions before each session, real-time remote monitoring incl. on-call services, and recording of possible side effects after each session. In addition, on the technical side, it is ensured that no misuse of the device can take place, e.g. by allowing sessions to be (un-)blocked by the responsible investigator. Besides a good quality of stimulation parameters is achieved through individual MRI-based electrode montages and a user-friendly software incl. instructions and integrated impedance checks. Furthermore the training of parents and children in the use of the device will be evaluated. We also ask about their concerns, expectations, satisfaction and the usability regarding home-based tDCS before and after its application. We would like to share our experiences (clinician’s and participant’s view) with the home-based use of tDCS in the context of the study presented above. The focus is to give recommendations for a safe, user-friendly and optimized home-based application of tDCS and to discuss its feasibility. The results of the study are contributing to a possible integration of tDCS as an innovative, safe and cost-effective treatment approach in the daily routine of children and adolescents with ADHD.