ABSTRACT
Importance: Transcranial direct current stimulation (tDCS) may improve symptoms of inattention in adults with attention-deficit/hyperactivity disorder (ADHD). However, previous trials are characterized by small sample sizes, heterogeneous methodologies, and short treatment periods using clinic-based tDCS. Objective: To determine the efficacy and safety of home-based tDCS in treating inattention symptoms in adult patients with ADHD. Design, Setting, and Participants: Randomized, double-blind, parallel, sham-controlled clinical trial (tDCS for the Treatment of Inattention Symptoms in Adult Patients With ADHD [TUNED]), conducted from July 2019 through July 2021 in a single-center outpatient academic setting. Of 277 potential participants screened by phone, 150 were assessed for eligibility on site, and 64 were included. Participants were adults with ADHD, inattentive or combined subtype. Exclusion criteria included current stimulant drug treatment, current moderate to severe symptoms of depression or anxiety, diagnosis of bipolar disorder with a manic or depressive episode in the last year, diagnosis of schizophrenia or another psychotic disorder, and diagnosis of autism spectrum disorder; 55 of participants completed follow-up after 4 weeks. Interventions: Thirty-minute daily sessions of home-based tDCS for 4 weeks, 2 mA anodal-right and cathodal-left prefrontal stimulation with 35-cm2 carbon electrodes. Main Outcomes and Measures: Inattentive scores in the clinician-administered version of the Adult ADHD Self-report Scale version 1.1 (CASRS-I). Results: Included in this trial were 64 participants with ADHD (31 [48%] inattentive presentation and 33 [52%] combined presentation), with a mean (SD) age of 38.3 (9.6) years. Thirty participants (47%) were women and 34 (53%) were men. Fifty-five finished the trial. At week 4, the mean (SD) inattention score, as measured with CASRS-I, was 18.88 (5.79) in the active tDCS group and 23.63 (3.97) in the sham tDCS group. Linear mixed-effects models revealed a statistically significant treatment by time interaction for CASRS-I (ßinteraction = -3.18; 95% CI, -4.60 to -1.75; P < .001), showing decreased symptoms of inattention in the active tDCS group over the 3 assessments compared to the sham tDCS group. Mild adverse events were more frequent in the active tDCS group, particularly skin redness, headache, and scalp burn. Conclusions and Relevance: In this randomized clinical trial, daily treatment with a home-based tDCS device over 4 weeks improved attention in adult patients with ADHD who were not taking stimulant medication. Home-based tDCS could be a nonpharmacological alternative for patients with ADHD. Trial Registration: ClinicalTrials.gov Identifier: NCT04003740.
Subject(s)
Attention Deficit Disorder with Hyperactivity , Autism Spectrum Disorder , Bipolar Disorder , Transcranial Direct Current Stimulation , Adult , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Autism Spectrum Disorder/therapy , Bipolar Disorder/therapy , Double-Blind Method , Female , Humans , Male , Transcranial Direct Current Stimulation/methods , Treatment OutcomeABSTRACT
O objetivo deste estudo foi investigar a coparentalidade aos 24 meses da criança. Trata-se de pesquisa qualita-tiva, da qual participaram 10 famílias nucleares, com um único filho. A mãe e o pai responderam entrevista sobre sua experiência de maternidade e paternidade, res-pectivamente. Essas entrevistas foram examinadas por análise temática dedutiva, considerando os temas com-ponentes do modelo de coparentalidade de Feinberg: divisão de trabalho, acordo nos cuidados, apoio versusdepreciação coparental e gerenciamento das interações familiares. Os resultados revelaram que cuidados bási-cos e tarefas domésticas estavam sob responsabilidade predominantemente materna, enquanto o envolvimento paterno se dava sobretudo em atividades de lazer, tais como brincadeiras e passeios. Houve predomínio de relatos de satisfação quanto à divisão de trabalho. So-bre acordo nos cuidados, os participantes enfatizaram especialmente os desafios de negociar e estabelecer limites apropriados à criança aos 24 meses, visando à promoção das novas habilidades e da autorregulação infantil, bem como à prevenção de acidentes. Relatos de apoio e de depreciação coparental coexistiram nas famílias. Assim, evidenciou-se respeito de um genitor às contribuições do outro, admiração e manutenção da autoridade, embora também culpabilização, crítica e competição entre a mãe e o pai. Quanto ao gerencia-mento das interações familiares, houve predomínio de estratégias construtivas para resolução de confli-tos, com destaque às conversações entre os genitores. Discutem-se aspectos gratificantes e desafiadores da coparentalidade aos 24 meses da criança, com ênfase aos estressores normativos nessa etapa do desenvolvi-mento infantil e às potencialidades dos genitores para enfrentá-los colaborativamente.
El objetivo de este estudio fue investigar la coparentalidad a los 24 meses del niño. La investigación fue cualitativa y participaron 10 familias nucleares con un solo hijo. La madre y el padre respondieron una entrevista sobre su experiencia de maternidad y paternidad, respectivamente. Estas entrevistas fueron examinadas por análisis temático deductivo, considerando los te-mas componentes del modelo de coparentalidad de Feinberg: división del trabajo, acuerdo en el cuidado, apoyo vs.depreciación coparental y manejo de las interacciones familiares. Los resultados revelaron que los cuidados básicos y las tareas del hogar eran predo-minantemente responsabilidad materna, mientras que la participación paterna se producía principalmente en actividades de ocio como juegos y salidas. Hubo predominio de relatos de satisfacción con respecto a la división del trabajo. En cuanto a la concordancia en el cuidado, los participantes destacaron los desafíos de negociar y establecer límites adecuados para el niño a los 24 meses, con el objetivo de promover nuevas habilidades y la autorregulación del niño, así como la prevención de accidentes. Coexistieron relatos de apoyo y desvalorización. Así, se evidenció el respeto de uno de los padres por las contribuciones del otro, la admiración y el mantenimiento de la autoridad, aunque también reproches, críticas y competencia entre la madre y el padre. En el manejo de las interacciones familiares, hubo predominio de estrategias constructivas para la resolución de conflictos, con énfasis en conversaciones entre padres. Se discuten los aspectos gratificantes y desafiantes de la coparentalidad de una crianza a los 24 meses de edad, con énfasis en los factores estresantes normativos en esta etapa del desarrollo y el potencial de los padres para enfrentarlos en colaboración.
The current study aimed to investigate co-parenting in children of 24 months of age. It was a qualitative study in which the participants were 10 nuclear families, each with an only child. The mother and father attended an interview about their experience of maternity and pa-ternity, respectively. These interviews were examined using the deductive thematic analysis, considering the component themes of Feinberg's co-parenting model: division of labor, childrearing agreement, support versus undermining, and joint family management. The results revealed that essential childcare and household chores were predominantly under maternal responsibility, while paternal involvement was mainly in leisure activities such as play and strolls. Reports on satisfaction regard-ing the division of labor were predominant. Concerning the childrearing agreement, the participants particularly emphasized the challenges of negotiating and setting appropriate limits for the child at 24 months, aiming to promote new skills and self-regulation in the toddlers, as well as to prevent accidents. Reports of support and undermining coexisted in the families. Thus, respect of one parent for the contributions of the other, admiration and sustaining of authority, on the one hand, and blaming, criticism, and competition between mother and father, on the other, were evidenced. Regarding joint family management, there was a predominance of constructive strategies for conflict resolution with an emphasis on conversations between parents. Rewarding and chal-lenging aspects of co-parenting at 24 months of age are discussed, highlighting the normative stressors at this stage of child development and the potential of parents to cope with them cooperatively.
