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Cited by 164Transcranial Magnetic Stimulation StudiesAttention Deficit Hyperactivity DisorderNeural and Behavioral Psychology Studies

Transcranial Direct Current Stimulation Improves Executive Dysfunctions in ADHD: Implications for Inhibitory Control, Interference Control, Working Memory, and Cognitive Flexibility

Open access
Nejati, Vahid, Salehinejad, Mohammad Ali, Nitsche, Michael A., Najian, Asal, Javadi, Amir-Homayoun·2020·Journal of Attention Disorders
DOI 10.1177/1087054717730611
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Abstract

Objective: This study examined effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) on major executive functions (EFs), including response inhibition, executive control, working memory (WM), and cognitive flexibility/task switching in ADHD. Method: ADHD children received (a) left anodal/right cathodal DLPFC tDCS and (b) sham stimulation in Experiment 1 and (a) left anodal DLPFC/right cathodal OFC tDCS, (b) left cathodal DLPFC/right anodal OFC tDCS, and (c) sham stimulation in Experiment 2. The current intensity was 1 mA for 15 min with a 72-hr interval between sessions. Participants underwent Go/No-Go task, N-back test, Wisconsin Card Sorting Test (WCST), and Stroop task after each tDCS condition. Results: Anodal left DLPFC tDCS most clearly affected executive control functions (e.g., WM, interference inhibition), while cathodal left DLPFC tDCS improved inhibitory control. Cognitive flexibility/task switching benefited from combined DLPFC-OFC, but not DLPFC stimulation alone. Conclusion: Task-specific stimulation protocols can improve EFs in ADHD.

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Crossref · 10.1177/1087054717730611

Cites

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Claims the paper makes

0 of 59 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Cathodal tDCS over the left DLPFC improved inhibitory control in children with ADHD.

    “cathodal lDLPFC tDCS improved inhibitory control”
    • Also stated in: § 3. Results · plain
      “Fisher's least significant difference (LSD) post hoc test showed that cathodal lDLPFC / anodal rOFC tDCS (montage 2) resulted in a significant increase of No-Go accuracy compared to sham stimulation (p < 0.01; Mmontage2 = 24.2 vs. Msham = 20.7)”
    • Also stated in: § 4. Discussion · hedged
      “These findings support the second hypothesis of the study that cathodal lDLPFC tDCS would improve prepotent response inhibition”
    Quote in the paperSubstantial claim
  • Findingown data

    Anodal tDCS over the left DLPFC most clearly affected executive control functions such as working memory and interference inhibition in children with ADHD.

    “anodal lDLPFC tDCS most clearly affected executive control functions (e.g., WM, interference inhibition)”
    • Also stated in: § 3. Results · plain
      “Finally, the respective ANOVA showed a significant improving effect of anodal lDLPFC / cathodal rDLPFC tDCS on interference response inhibition measured by the Stroop task in terms of accuracy (F = 9.01, p < 0.01) and RT (F = 7.7, p < 0.02).”
    • Also stated in: § 3. Results · plain
      “However, RT was significantly reduced after anodal lDLPFC / cathodal rDLPFC tDCS compared to sham situation (F = 21.01,p < 0.01).”
    Quote in the paperSubstantial claim
  • Findingown data

    The number of correct responses on the working memory task was not significantly raised by anodal left DLPFC / cathodal right DLPFC tDCS.

    “For WM performance, the ANOVA results showed that anodal lDLPFC / cathodal rDLPFC tDCS did not significantly increase the number of accurate responses (F = 0.21, p = 0.65).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Only montage one (anodal lDLPFC / cathodal rOFC tDCS) significantly increased working memory accuracy and reaction time compared to sham.

    “The post hoc tests showed that only montage one (anodal lDLPFC / cathodal rOFC tDCS) resulted in a significant increase in accuracy and RT compared to sham stimulation (p < 0.04; Mmontage1 = 21 vs. Msham = 17.9; p < 0.01; Mmontage1 = 103.39 vs. Msham = 162.88).”
    Quote in the paperSubstantial claim
  • Findingown data

    In experiment one, there were no significant differences between tDCS conditions in Go/No-Go measures of accuracy Go, accuracy No-Go, and reaction time.

    “Results showed no significant differences between tDCS conditions in the Go-No/Go measures of accuracy Go (F = 0.19, p = 0.66), accuracy No-Go (F = 1.02, p = 0.32) and reaction time (F = 2.42, p = 0.14).”
    Quote in the paperSubstantial claim
  • May combine two claims. 32
  • The quote only partly states this claim. 2
  • Classified as probably not a substantial claim. 22

  • May combine two claims.

    Findingown data

    Cognitive flexibility and task switching benefited from combined DLPFC-OFC stimulation, but not from DLPFC stimulation alone.

    “Cognitive flexibility/task switching benefited from combined DLPFC-OFC, but not DLPFC stimulation alone.”
    • Also stated in: § 3. Results · plain
      “ANOVA results also showed no significant effect of anodal lDLPFC / cathodal rDLPFC tDCS on cognitive flexibility and task-switching measured by the WCST regarding perseverative errors, completed categories and total errors.”
    • Also stated in: § 3. Results · plain
      “The respective post hoc analyses further showed that montage one (anodal lDLPFC / cathodal rOFC tDCS) (p < 0.01; Mmontage1 = 7.8 vs. Msham = 14.8) and montage two (cathodal lDLPFC / anodal rOFC tDCS) (p < 0.04; Mmontage2 = 11.8 vs. Msham = 14.8) significantly reduced perseverative errors in ADHD children compared to sham stimulation”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In experiment two, there was a significant difference between stimulation conditions regarding working memory performance in both accuracy and reaction time.

    “Finally, the respective repeated measures ANOVAs showed a significant difference between stimulation conditions regarding WM performance in terms of both accuracy (F = 9.84, p < 0.01) and RT (F = 5.89, p < 0.01).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In experiment one, anodal lDLPFC / cathodal rDLPFC tDCS had a significant effect on Stroop task performance and N-back speed, but not on WCST and Go/No-Go tasks.

    “In sum, the results of experiment one indicated a significant effect of anodal lDLPFC / cathodal rDLPFC tDCS on performance of the Stroop task and N-back speed but not the WCST and Go-No/Go tasks.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    Montage one and montage two significantly increased categories completed compared to sham, with montage one significantly more effective than montage two.

    “Again the first montage was significantly more effective compared to second one (p < 0.01; M montage1 = 5.1 vs. M montage2 = 4.5 4.5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Left anodal / right cathodal DLPFC tDCS improved both accuracy and reaction time in the Stroop task.

    “We found that left anodal / right cathodal DLPFC tDCS improved both accuracy and RT in the Stroop task.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In experiment 2, both accuracy and reaction time on the N-back task were improved by stimulation.

    “in the second experiment both accuracy and RT were improved by stimulation”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Stimulation conditions in experiment two, which involved both DLPFC and OFC, significantly improved performance on cognitive flexibility, task switching, and attentional shifting compared to experiment one, which involved only the DLPFC.

    “The stimulation conditions in experiment two, which involved both, DLPFC and OFC, significantly improved performance on these EFs compared to the first experiment, that only involved the DLPFC.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Both tDCS montages (anodal left DLPFC / cathodal right OFC and cathodal left DLPFC / anodal right OFC) significantly improved WCST performance in ADHD children compared to sham stimulation.

    “both tDCS montages (i.e., anodal lDLPFC tDCS/ cathodal rOFC tDCS and cathodal lDLPFC tDCS / anodal rOFC tDCS) significantly improved performance on the WCST in ADHD children compared to sham stimulation”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    The DLPFC is the main area implicated in inhibition-based models, while the OFC is more strongly linked to motivational dysfunction models.

    “The dorsoloateral PFC (DLPFC) is the primary region involved in inhibition-based models whereas the orbitofrontal cortex (OFC) is more closely implicated in motivational dysfunction models (Seidman et al., 2005;Sonuga-Barke, 2005).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Seidman et al., 2005

      Not checked in the free run.

    • cites Sonuga-Barke, 2005

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  • May combine two claims.

    Premisecitation

    Impaired executive functions are among the most pervasive deficits in ADHD, and ADHD has been labelled an executive dysfunction disorder whose symptoms are based on a primary EF deficit.

    “Impaired EF are among the most pervasive deficits in ADHD, such that ADHD was labelled as an executive dysfunction disorder, whose symptoms are based on a primary deficit in EF (Barkley, 1997;Castellanos & Tannock, 2002;Willcutt, Doyle, Nigg, Faraone, & Pennington, 2005).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Barkley, 1997

      Not checked in the free run.

    • cites Castellanos & Tannock, 2002

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    • cites Willcutt et al., 2005

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Impaired inhibitory processes are the core deficit in ADHD that disrupts other executive function domains.

    “Similarly, other studies proposed impaired inhibitory processes as the core deficit in ADHD that disrupts other EF domains (Barkley, 1997;Nigg, 2001).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Barkley, 1997

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    • cites Nigg, 2001

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Cool executive functions are closely associated with DLPFC functions, whereas hot executive functions are assumed to be closely related, but not limited to, OFC activity.

    “The former is thought to be closely associated with DLPFC functions, whereas the latter is assumed to be closely related, but not limited to OFC activity (Rubia, 2011).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Rubia, 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Only a subgroup of children with ADHD may have executive deficits.

    “Specifically, it is suggested that only a subgroup of ADHD children may have executive deficits implicating that more consideration should be given to the probability that only a subset of behaviorally defined children will have a deficit in a given neurocognitive mechanism which can contribute to the disorder (Nigg et al., 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Nigg et al., 2005

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Structural imaging studies found smaller prefrontal volumes in ADHD in either the right or left hemisphere.

    “Structural imaging studies found smaller prefrontal volumes in ADHD either in the right or left hemisphere (Bush, Valera, & Seidman, 2005)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Bush et al., 2005

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    tDCS has been documented as feasible and safe for use in children.

    “Feasibility and safety of tDCS application in children has been documented in previous studies (Andrade et al., 2013;Krishnan, Santos, Peterson, & Ehinger, 2015).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Andrade et al., 2013

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    • cites Krishnan et al., 2015

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  • May combine two claims.

    Premisecitation

    tDCS has been shown to improve impaired components of executive function in ADHD, in other disorders with impaired EF such as depression and OCD, and in healthy populations, depending on the targeted cortical area.

    “tDCS has been shown to improve impaired components of EF not only in ADHD (Soltaninejad, Nejati, & Ekhtiari, 2015a) but also in other disorders accompanied by impaired EF such as depression (Salehinejad et al., 2017) and OCD (Brem, Grünblatt, Drechsler, Riederer, & Walitza, 2014) as well as in healthy populations (Salehinejad, Nejati, & Derakhshan, 2016) depending on the targeted cortical area.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Soltaninejad et al., 2015a

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    • cites Salehinejad et al., 2017

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    • cites Brem et al., 2014

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  • May combine two claims.

    Premisecitation

    The DLPFC and VLPFC support vigilance, selective and divided attention, attention shifting, planning, executive control, and working memory, while the OFC relates to social disinhibition and impulsivity.

    “DLPFC and VLPFC are involved in vigilance, selective and divided attention, attention shifting, planning, executive control, and working memory (Duncan & Owen, 2000;Elliott, 2003) and the OFC is associated with social disinhibition and impulsivity (Rolls, 2004).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Duncan & Owen, 2000

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    • cites Elliott, 2003

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    • cites Rolls, 2004

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Anodal tDCS increases cortical excitability while cathodal tDCS decreases it at the macroscopic level.

    “Anodal stimulation increases cortical excitability while cathodal stimulation decreases it at the macroscopic level (Nitsche et al., 2009).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Nitsche et al., 2009

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  • Classified as probably not a substantial claim.

    Study design and conductown data

    Each participant was randomly allocated to every stimulation condition.

    “Participants were randomly assigned to each stimulation condition.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The sham stimulation method used has been shown to be reliable.

    “This method of sham stimulation has been shown to be reliable (Gandiga, Hummel, & Cohen, 2006).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Gandiga et al., 2006

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data

    The results back the second hypothesis-that cathodal left DLPFC tDCS would enhance prepotent response inhibition-and agree with earlier work linking reduced right lateral prefrontal cortex activity to poor inhibitory control.

    “These findings support the second hypothesis of the study that cathodal lDLPFC tDCS would improve prepotent response inhibition and are in accordance with findings of previous studies showing that decreased activity in the rLPFC is responsible for poor inhibitory control (Aron & Poldrack, 2005;Depue et al., 2010).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Aron & Poldrack, 2005

      Not checked in the free run.

    • cites Depue et al., 2010

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Mauchly's test was used to evaluate sphericity before repeated measures ANOVA, and Greenhouse-Geisser correction was applied when sphericity was violated.

    “Mauchly's test was used to evaluate the sphericity of the data before performing the repeated measures ANOVA for each dependent variable.”
    • Also stated in: § 2.5. Statistical Analysis · plain
      “In case that the assumption of sphericity was violated, the degrees of freedom were corrected using Greenhouse-Geisser estimates of sphericity.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Due to smaller head circumference in children, the stimulation might also have affected the right DLPFC, which is close to the right OFC.

    “Moreover, due to smaller head circumference in children, this might also have affected the rDLPFC which is close to the rOFC.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All statistical comparisons used an alpha of .05, and Fisher's LSD test was applied for post hoc analysis.

    “A significance level of p < .05 was used for all statistical comparisons and Fisher's least significant difference (LSD) post hoc test was used for post hoc analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    This tDCS montage should lead to decreased activity of the right DLPFC as a result of cathodal rDLPFC tDCS and anodal lDLPFC tDCS, the latter likely reducing activity of the contralateral region through inhibitory transcallosal connections.

    “This tDCS montage should lead to decreased activity of rDLPFC as a result of cathodal rDLPFC tDCS as well as anodal lDLPFC tDCS, the latter likely reducing activity of the contralateral region through inhibitory transcallosal connections (Mishra, Nizamie, Das, & Praharaj, 2010).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Mishra et al., 2010

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  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The experimenters and the data collectors did not know the study hypothesis.

    “Both experimenters and data collectors were blind to the study hypothesis.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Stimulation of the pre-supplementary motor area with anodal tDCS enhanced inhibitory control, whereas cathodal tDCS reduced it.

    “Hsu et al (2011) showed that anodal tDCS over the pre-supplementary motor area (Pre-SMA) improved inhibitory control, while cathodal tDCS impaired it.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Hsu et al., 2011

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    Premisecitation

    In a prior study by the authors, cathodal tDCS over the left DLPFC improved inhibitory control in prepotent response inhibition as measured by a Go/No-Go task, while anodal tDCS over the same area impaired it.

    “In a recently published study, we found that cathodal tDCS over the lDLPFC improved inhibitory control in prepotent response inhibition explored by a Go/No-Go task, while anodal tDCS over the same area impaired it (Soltaninejad et al., 2015a).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Soltaninejad et al., 2015a

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  • May combine two claims. The quote only partly states this claim.

    Study design and conductown data

    The study was a randomized, double-blinded, sham-controlled crossover trial.

    “We conducted a randomized, double-blinded sham-controlled trial.”
    • Also stated in: § 2.2. Experimental Protocol · plain
      “The design was a crossover study in which subjects were randomly assigned to a sequence of tDCS treatment.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Every patient was unaware of which tDCS type was given in each session.

    “All patients were blind to the type of tDCS delivered in each session.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The data met the ANOVA linear assumptions, and Levene's test was used to examine homogeneity of variances.

    “Our data met the ANOVA linear assumptions and the Leven's test was used to examine homogeneity of variances.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Stimulation with cathodal left DLPFC and anodal right OFC enhanced No-Go accuracy, probably through indirect activation of the right DLPFC by reduced transcallosal inhibition.

    “Our second experiment showed that cathodal lDLPFC / anodal rOFC tDCS significantly improved accuracy of No-Go responses, likely by indirectly activating the rDLPFC via reduction of transcallosal inhibition.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Both experiments had a relatively low number of participants.

    “both experiments had a relatively low number of participants”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Study design and conductreasoning

    The total sample size was adequate considering that small sample size has been the case in many studies on ADHD children.

    “although the total sample size was adequate considering that small sample size has been the case in many studies on ADHD children.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Interpretationcitation

    This study is an initial step towards developing clinical treatment of ADHD, especially regarding impaired executive functions, by electrically stimulating the DLPFC or OFC.

    “This study is also an initial step towards developing clinical treatment of ADHD, especially regarding impaired EFs, by electrically stimulating the DLPFC or OFC.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Improved inhibitory control, which was observed only in the second experiment, could explain why working memory was more robustly improved in experiment two.

    “improved inhibitory control, which was only observed in the second experiment, could explain why participants' WM was more robustly improved in experiment two.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    The relevance of interhemispheric balance for task performance is task- or domain-specific, because an impact of suggested alterations of interhemispheric balance was observed only for response inhibition and not for other executive function domains.

    “Moreover, it also suggests that the relevance of the interhemispheric balance for task performance is also task-or domain-specific, since an impact of suggested alterations of interhemispheric balance on performance was only observed for response inhibition, but not other EF domains.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductnone given

    Despite sham control, a group of healthy controls can add to data interpretation in terms of effectiveness of tDCS.

    “a group of healthy control can add to data interpretation in terms of effectiveness of tDCS”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The effects of activation of PFC regions, especially the DLPFC, are task-specific and domain-specific, benefiting some but not all executive function domains in a lateralized way.

    “our findings suggest that the effects of activation of PFC regions, especially the DLPFC, are taskspecific and domain-specific, benefiting some but not all the EFs domains in a lateralized way”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

    Study design and conductreasoning

    Assessment of task performance before and after tDCS provides a better evaluation of tDCS effectiveness.

    “assessment of task performance before and after tDCS provides a better evaluation of tDCS effectiveness.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The design involved only post-stimulation assessment.

    “our design involved only post-stimulation assessment”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Low focality of tDCS limits interpretability of the stimulation effects regarding specific areas.

    “low focality of tDCS limits interpretability of the stimulation effects regarding specific areas.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Deficits in ADHD are not limited to executive dysfunctions controlled by the DLPFC and are related to DLPFC-OFC interaction rather than imbalanced DLPFC activity marked in other disorders with frontal abnormalities.

    “This also implies that deficits in ADHD are not limited to executive dysfunctions controlled by the DLPFC and are related to DLPFC-OFC interaction rather than imbalanced DLPFC activity marked in other disorders with frontal abnormalities.”
    Quote in the paperSubstantial claim
    • The authors state this as an assumption: A DLPFC-OFC interaction underlies WCST performance.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    tDCS can enhance cerebral plasticity and could be used as a tool to increase the developmental potential of children, especially in neurodevelopmental disorders such as ADHD.

    “tDCS, as a clinical intervention and neuromodulation technique (Brunoni et al., 2012) can enhance cerebral plasticity and could then be used as a tool to increase the developmental potential of children (Holt & Mikati, 2011) especially in neurodevelopmental disorders such as ADHD.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Brunoni et al., 2012

      Not checked in the free run.

    • cites Holt & Mikati, 2011

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  • May combine two claims.

    Interpretationreasoning

    The ability to disengage from the current task and engage in novel ones is required to apply new rules in the WCST and might explain why the second montage also improved WCST performance.

    “This is one of the abilities required to apply new rules in the WCST and might explain why the second montage also improved WCST performance.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: When the rule changes in the WCST, participants need to inhibit the now irrelevant response, which requires inhibition, and apply a new rule, which requires disinhibition.
    • The authors state this as an assumption: A DLPFC-OFC interaction underlies WCST performance.

  • May combine two claims.

    Interpretationcitation

    Reduced DLPFC activity affecting sustained and transient attentional control in ADHD was increased by anodal tDCS, leading to regulation of top-down attentional control, which is one mechanism of improved WCST performance.

    “In other words, reduced DLPFC activity that affects both sustained and transient aspects of attentional control in ADHD (Banich et al., 2009) was increased by anodal tDCS, which would lead to regulation of top-down attentional control which is one of the underlying mechanisms of improved scores of performance on the WCST.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Banich et al., 2009

      Not checked in the free run.

    • Rests on an assumption: When the rule changes in the WCST, participants need to inhibit the now irrelevant response, which requires inhibition, and apply a new rule, which requires disinhibition.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The first experiment sample size only included male ADHD children.

    “the first experiment sample size only included male ADHD children.”
    Quote in the paperNot a substantial claim
47 of 47

  • The paper relies on this without support.

    There is a lack of evidence about the effectiveness of brain stimulation on impaired executive function domains in ADHD other than inhibitory processes.

    “While most of the available brain stimulation studies have focused on inhibitory processes in ADHD, there is lack of evidence about the effectiveness of brain stimulation with regard to other impaired EF domains in ADHD.”

  • The paper relies on this without support.

    The way different prefrontal cortex regions contribute to different executive function domains in ADHD is still incompletely understood.

    “and the way different PFC regions contribute to different EF domains in ADHD is still incompletely understood.”

  • The paper relies on this without support.

    When the rule changes in the WCST, participants need to inhibit the now irrelevant response, which requires inhibition, and apply a new rule, which requires disinhibition.

    “However, when the rule changes, participants need to inhibit the now irrelevant response, which requires inhibition, and to apply a new rule which requires disinhibition.”

  • The authors state this as an assumption.

    A DLPFC-OFC interaction underlies WCST performance.

    “Regarding the presumed DLPFC-OFC interaction in WCST performance”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The WISC-IV indices might not examine specific aspects of cognition in ADHD.

    “Third, the WISC-IV indices might not examine specific aspects of cognition in ADHD and cognitive profile of ADHD subtypes needs to be explored with more specific cognitive measures of executive functions, such as cold vs hot executive functions [63].”

    From ADHD subtype-specific cognitive correlates and association with self-esteem: a quantitative difference (2020) · cites this paper as [63]

    The Cognitive Assessment section describes tasks that measure distinct executive functions, and the Introduction distinguishes cold from hot executive functions. Those passages support the sentence’s call for more specific measures, but our copy does not assess whether WISC-IV indices miss specific aspects of cognition in ADHD (searched: WISC-IV, Wechsler). (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Different regional tDCS stimulation protocols benefitted different cognitive tasks in children with ADHD.

    “As is to be expected, they found that different regional stimulation protocols benefitted different cognitive tasks.”

    From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Nejati et al., 2017

  • Anodal tDCS of left DLPFC most clearly affected executive control functions (e.g., WM, interference inhibition in the Stroop task), while cathodal left DLPFC/anodal right OFC tDCS improved inhibitory control in a Go/no-go task.

    “Anodal tDCS of left DLPFC most clearly affected executive control functions (e.g., WM, interference inhibition in the Stroop task), while cathodal left DLPFC/anodal right OFC tDCS improved inhibitory control in a Go/no-go task.”

    From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Nejati et al., 2017

  • Cognitive flexibility benefitted from both anodal left DLPFC/cathodal right OFC and cathodal left DLPFC/anodal right OFC combinations, but not from left anodal DLPFC/cathodal right DLPFC stimulation.

    “Cognitive flexibility benefitted from both anodal left DLPFC/cathodal right OFC and cathodal left DLPFC/anodal right OFC combinations, but not from left anodal DLPFC/cathodal right DLPFC stimulation (Nejati et al., 2017).”

    From Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation (2018) · cites this paper as Nejati et al., 2017

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Significant WCST time effect omitted from the experiment-one conclusion

    Minor

    The summary says experiment one had no significant effect on the WCST, but Table 3 reports a significant effect on WCST time (p = 0.01).

  • Stroop reaction-time F statistic differs between prose and table

    Minor

    The results text reports F = 7.7 for Stroop reaction time, while Table 3 gives F = 7.07. The table value would round to 7.1, not 7.7.

  • Statistical methods misidentify an experiment-one condition

    Minor

    The statistical-analysis section lists cathodal stimulation as an experiment-one condition. The experimental protocol instead says its two conditions were anodal and sham.

  • Experiment-one montage is described as cathodal over the wrong side

    Minor

    The discussion invokes cathodal stimulation of the left DLPFC in experiment one, whereas the stated active montage placed the anode on the left and the cathode on the right.

  • N-back reaction time is called an increase despite decreasing

    Minor

    The reported montage-one N-back reaction time is 103.39, versus 162.88 for sham. That is a decrease, not the stated increase; the improvement interpretation itself is consistent with a decrease.

5 of 5

Cites

Flagged first, then by citations

Research works printed but not linked: 4

  1. Hasher L., 2006, Lifespan cognition: Mechanisms of change, 162
  2. Schneider W., 2002, E-Prime: User’s guide
  3. Swanson J., 1992, The SNAP-IV Rating Scale
  4. Swanson J. M., 2012, The International journal of educational and psychological assessment, 10, 51

Cited by

Sorted by citations

Related

Authors
Nejati, V., Salehinejad, M. A., Nitsche, M. A., Najian, A., & Javadi, A.-H.
Affiliations
  • Shahid Beheshti University (IR)
  • Leibniz Research Centre for Working Environment and Human Factors (DE)
  • BG University Hospital Bergmannsheil Bochum (DE)
  • University of Kent (GB)
Corresponding author
Nejati, Vahid
ORCID
Venue
Journal of Attention Disorders
Publisher
SAGE Publications
Published
2017-09-22
Volume
24
Issue
13
Pages
1928-1943
ISSN
  • 1087-0547 (ISSN-L)
  • 1557-1246
DOI
10.1177/1087054717730611
OpenAlex
W2759792736
Cited by
163
References
94
Citations by year
2026: 7 · 2025: 25 · 2024: 29 · 2023: 27 · 2022: 11 · 2021: 22 · 2020: 26 · 2019: 7 · 2018: 7 · 2017: 2
FWCI
5.66
Type
journal article
Language
en
Open access
Licence
journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations
  • Journal of Attention Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • Kent Academic Repository (University of Kent) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
Topics
  • Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
Keywords
transcranial direct current stimulation, attention deficit hyperactivity disorder, executive function, dorsolateral prefrontal cortex, orbitofrontal cortex, inhibitory control, interference control, working memory, cognitive flexibility, task switching, children, go/no-go task, n-back task, Wisconsin Card Sorting Test, Stroop task
MeSH terms
Attention Deficit Disorder with Hyperactivity, Child, Cognition, Humans, Memory, Short-Term, Prefrontal Cortex, Transcranial Direct Current Stimulation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-05.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-05.

Statistics and arithmetic are recomputed, not judged.

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