Trigeminal nerve stimulation (TNS) does not appear to improve the cognitive performance of children with attention-deficit/hyperactivity disorder (ADHD), according to a
report in
The American Journal of Psychiatry.
Why It’s Relevant
ADHD is the most common neurodevelopmental disorder, affecting 5% to 8% of children. While stimulant medications are first-line treatments, many people with ADHD and/or their parents prefer nonpharmacological treatments. The Monarch eTNS device (which is
cleared by the Food and Drug Administration) is one alternative option, but the evidence for its effectiveness on ADHD symptoms is mixed and has lacked cognitive and physiological measures. The current study was undertaken to address these shortcomings.
By the Numbers
- Researchers assigned 150 youth with ADHD (ages 8 to 18) to four weeks of nightly active or sham TNS. The active TNS protocol involved four hours of 120-Hz stimulation on a cycle of 30 seconds on and 30 seconds off.
- There were no differential treatment effects of active versus sham TNS on any cognitive outcomes—assessed with a comprehensive battery of executive function and attention tasks—at either four weeks posttreatment or a six-month follow-up assessment.
- In addition, no significant differences between groups were observed for physiological outcomes such as heart rate or skin conductance.
- A medium-sized difference in resting-state head motion was observed at posttreatment, but this was due to increased head motion in the sham TNS group rather than improvements in the active TNS group.
What’s More
A subgroup analysis of the 91 participants who were not taking medication for their ADHD also identified no group differences for any cognitive measures at posttreatment or the six-month follow-up.
The Other Side
The researchers noted that they used a sophisticated sham protocol that included a few minutes of active stimulation each night (though at lower frequency), which may have led to a stronger placebo effect. Additionally, the wrist-worn sensors may have yielded imprecise measures of electrodermal activity.
Takeaway Message
“Although our results do not support physiological or cognitive effects of TNS in children with ADHD, they do not preclude the possibility that other protocols might be more effective,” the researchers wrote. They added that the optimal parameters for TNS such as frequency, intensity, and timing remain poorly characterized and should be systematically tested in future studies.
Related Information
Source
Irem Ece Eraydin, et. al. Effects of external trigeminal nerve stimulation on neurocognitive functioning in children and adolescents with ADHD: a phase 2b multicenter randomized controlled trial. The American Journal of Psychiatry. Published October 28, 2026. doi:10.1176/appi.ajp.20260002
(Image: Getty Images/iStock/Jitendra Jadhav)