Abstract
Attention deficit hyperactivity disorder (ADHD) is a disorder most frequently diagnosed in children and adolescents. Although ADHD can be effectively treated with psychostimulants, a significant proportion of patients discontinue treatment because of adverse events or insufficient improvement of symptoms. In addition, cognitive abilities that are frequently impaired in ADHD are not directly targeted by medication. Therefore, additional treatment options, especially to improve cognitive abilities, are needed. Because of its relatively easy application, well-established safety, and low cost, transcranial direct current stimulation (tDCS) is a promising additional treatment option. Further research is needed to establish efficacy and to integrate this treatment into the clinical routine. In particular, limited evidence regarding the use of tDCS in children, lack of clear translational guidelines, and general challenges in conducting research with vulnerable populations pose a number of practical and ethical challenges to tDCS intervention studies. In this paper, we identify and discuss ethical issues related to research on tDCS and its potential therapeutic use for ADHD in children and adolescents. Relevant ethical issues in the tDCS research for pediatric ADHD center on safety, risk/benefit ratio, information and consent, labeling problems, and nonmedical use. Following an analysis of these issues, we developed a list of recommendations that can guide clinicians and researchers in conducting ethically sound research on tDCS in pediatric ADHD.
Highlights
Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder characterized by developmentally inappropriate levels of hyperactivity, impulsivity, and inattention [1]
Keywords were derived from the areas of “ethics,” “social,” “pediatric research,” “ADHD,” “neuropsychiatric disorders,” “brain stimulation,” and “transcranial direct current stimulation (tDCS).” Papers of all types were included in the analysis, ranging from articles providing a purely theoretical reflection to reports of empirical studies of ethical aspects, to policy proposals
Our focus is on research with children with ADHD, as there are both an ethical imperative to address needs in this population that have not been met and a tension of “great needs matching great uncertainty” [68]
Summary
Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric disorder characterized by developmentally inappropriate levels of hyperactivity, impulsivity, and inattention [1]. While the treatment with stimulants is characterized by high effect sizes (>1), it comes with a number of adverse events [6]. In some children and adolescents, the medication shows an insufficient improvement of symptoms, especially of cognitive and motor inhibition or inattention symptoms [8] Alternative treatment options such as behavioral therapy, neurofeedback, cognitive training, as well as dietary interventions have been studied [9]. These are characterized by small effect sizes and are time consuming, requiring high motivation and compliance of patients and their families [5]. Based on the results of this analysis, we present preliminary guidelines to enable high ethical standards for future tDCS studies in children and adolescents
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call