Alternatives for ADHD grounded in neurotech
For so long the standard of care for Attention Deficit Hyperactivity Disorder (ADHD) has been oral medications, but they are plagued by side effects and dosing challenges. Today, there is a growing pool of scientific and clinical evidence to support neurotechnology devices as an alternative to medications. Some devices are emerging from technical laboratories and others are further along the development spectrum to have regulatory approval or clearance. These technologies may be overlooked under the large umbrella of the pharmaceutical giants. Here, we shine a light on these technology alternatives.
The American Psychiatric Association estimates that 9.5 percent of children and 4.4 percent of adults in the U.S. have been diagnosed with ADHD. The worldwide prevalence is slightly higher at 7 to 12 percent. For children ages 4 to 17 in the U.S. approximately 11 percent have the condition, which equates to about 6.4 million children. The condition can be diagnosed in a wide age range including adolescents and adults. It is highly prevalent among males. According to the ADHD Institute, symptoms can be impulsiveness or inattention, the condition often arises alongside other psychiatric conditions such as anxiety disorders or depression.
For decades, Attention Deficit and Hyperactivity Disorder were considered two separate conditions. In 1994, the conditions were combined to become ADHD, but it led to confusing among the public. For instance, a person may be diagnosed with Attention Deficit but never elicit symptoms of hyperactivity. Still, clinically the diagnosis of ADHD can be along a spectrum of symptoms from mild to moderate to severe. Since the disorder is highly prevalent and diagnosed more frequently in children, many of the consequences of the condition are focused around education. Long term, there can be occupation impacts, such as higher rates of unemployment, more prevalence of unskilled jobs when employed and even lower wages compared to the general population.
ADHD has been studied under the auspices of neuroscience and more specifically brain health. Let’s take a look at alternative technologies for treatment of the condition.
What are some alternatives?
Trigeminal Nerve Stimulation: In 2017, results from a study lead by James McGough of Semel Institute for Neuroscience and Human Behavior and David Geffen School of Medicine at UCLA demonstrated that external trigeminal nerve stimulation may be effective for treating pediatric ADHD. A total of 62 children were enrolled in the trial and used the eTNS therapy each night, at home, for four weeks. The trial’s primary endpoint assessment, the ADHD-RS scale, showed that study participants who were randomized to active treatment had a statistically significant improvement in their ADHD symptoms compared with the sham (control) group. The scientific basis for this double-blind trial was established by an earlier open label trial conducted at UCLA, with funding and eTNS systems provided by NeuroSigma. In that trial, McGough and his team found significant improvements in the symptoms of ADHD and cognition in children treated with eTNS. The findings were published in the journal Brain Stimulation. Later in 2019, the Monarch eTNS device from NeuroSigma was cleared by the FDA for the treatment of ADHD. The device is currently approved in Canada and Europe.
Brain Training: In a study led by Sandeep Vaishnavi, a neuropsychiatrist at Duke University’s Department of Psychiatry and Behavioral Sciences used technology developed by NeuroPlus showed that children with attention deficit/hyperactivity disorder demonstrated greater focus and decreased hyperactivity and impulsivity after training on the NeuroPlus video game system. More recently in 2020, a landmark study published in Lancet demonstrated that an at-home based treatment may be used to improve treatment of inattention. The study used the AKL-T01 system, an investigational digital therapeutic, designed to target attention and cognitive control delivered through a video game-like interface via at-home play. The study protocol called for 25 minutes per day, 5 days per week for 4 weeks. This study aimed to assess whether the system developed by Akili Interactive Labs improved attention performance in pediatric patients with ADHD. Among the 348 participants, those in the treatment group reported significant improvemets in control and attention. (2)
Diagnosis and Monitoring: The potential for overdiagnosis and under-diagnosis is an important point of concern. One brain analysis system has been developed by NEBA Health, which has the first biomarker cleared by FDA to assist a clinician with ADHD evaluation. Of particular note, the study showed that this brainwave-based test, NEBA, can reduce overdiagnosis by identifying children whose ADHD- like symptoms may be better explained by another condition. The study compared a multidisciplinary team’s evaluation to that of an individual clinician. The study’s multidisciplinary team was comprised of a pediatrician, psychologist, and psychiatrist. The study examined the clinician’s outcome with or without NEBA. Results support that NEBA can help the clinician to identify children more likely to have conditions known to mimic ADHD such as head injury, auditory processing disorder, and substance abuse. PEER Analytics is another tool in the field of psychology to assist with the choice of clinical treatment options. The system uses individualized brain patterns to search a mental health dataset to find the best matched therapy for a specific person.
EEG devices are also emerging with evidence to not only help with diagnosis but also monitor activities to help drive personalized treatments. As a clinical assessment tool, ANT provides an EEG brain monitoring system to allow for a more objective diagnosis. B-Alert from Advanced Brain Monitoring also provides an EEG system for clinical assessment of ADHD. There is also an at-home option. Wearing a traditional EEG headset around in public may not be attractive and more than likely difficult to gain compliance from a child. A neurotech company, Neuroservo, has developed a fashionable way to have both. They have developed an EEG monitoring baseball-style cap for children. Miniaturized EEGs are concealed within the cap to measure brainwaves for diagnosis in real-world settings plus it can monitor attention in realtime.
Promising technologies under development
NeuroAudit, from Israel, is developing a non-invasive technology based on neuromodulation to treat mental and neurodegenerative disorders, particularly Alzheimer’s disease and ADHD. Their system, which is under investigation, is a closed-loop AI powered monitoring-stimulation system designed to target the specific user; tracking and adapting throughout the treatment course.
Another promising technology is the Atentivmynd system, an at-home gaming treatment for children living with ADHD. The system consists of a connected headset and tablet that provides an integrated behavior and care system. In a large scale randomized clinical study of 172 children with ADHD, the treatment group had significant improvements and sustained control after 24 sessions. The treatment consisted of eight hours of training over eight weeks. The company is currently working with Children’s Specialized Hospital’s Center for Discovery, Innovation and Development in a collaborative arrangement to gain FDA clearance and bring the technology into clinical practice.
Another treatment modality that is under investigation in several areas around the world, including Israel, Brazil, China and many sites in the United States, is transcranial direct current stimulation. tDCS is a non-invasive device modality that uses mild, low current stimulation to the brain. It is still under development but clinical researchers are investigating the impact on attention, inhibition decision making as well as working memory.
These are just a few of the neurotech modalities under investigation to either monitor or treat ADHD.
Resources
To learn more about both available and emerging neurotechnologies for Attention Deficit Hyperactivity Disorder, visit our resource directory. You will find a listing of some of the devices mentioned here and more.
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The source of references include the World Health Organization, National Institutes of Mental Health, CHADD and clinicaltrials.gov.
Other references include:
- Kuriyan AB, Pelham WE Jr, Molina BS, Waschbusch DA, Gnagy EM, Sibley MH, Babinski DE, Walther C, Cheong J, Yu J, Kent KM. Young adult educational and vocational outcomes of children diagnosed with ADHD. J Abnorm Child Psychol. 2013 Jan;41(1):27–41. doi: 10.1007/s10802–012–9658-z. PMID
- Kollins, SH, DeLoss, DJ, Canadas, E, et al. A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomized controlled trial Lancet Digital Health 2020; 2(4): PE168-E178 doi: https://doi.org/10.1016/S2859-7500(20)30017-0
