June 13, 2019

Could a New Device Be the Right ADHD Treatment for Your Child?

The FDA just added another option to consider

ADHD brain stimulation treatment

Long division: It’s not so fascinating for most kids, but it’s especially hard for kids with attention deficit hyperactivity disorder. It’s hard for them to tear their attention away from something more captivating — like the squirrels playing outside the window — and focus on math.


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For many kids, ADHD treatment can make it easier for the brain to focus and concentrate. Until recently, medications and behavioral therapy were the only treatment options. But the Food and Drug Administration (FDA) has fast-tracked the approval of a device to treat ADHD.

Pediatric behavioral health specialist Michael Manos, PhD, Clinical Director of the ADHD Center for Evaluation and Treatment, describes the new device and who might benefit from it.

Q: What is the new ADHD device?

A: The new device is called the Monarch® eTNS® System, which stands for external trigeminal nerve stimulation. The child wears the device during sleep. It consists of a patch worn on the child’s forehead that is connected to a wire. The wire delivers mild electrical stimulation to the frontal cortex, which feels like a slight tingling sensation on the skin.

The frontal cortex is the part of the brain used when doing an effortful attention task, like schoolwork — when you have to force yourself to pay attention. Effortful tasks are more challenging for kids with ADHD.

Q: Electrical stimulation for ADHD? How does that work?

A: Researchers don’t understand exactly how eTNS works. In studies, patients who were treated with it showed increased activity in the frontal cortex compared with patients who received a placebo treatment. The mild electrical stimulation likely triggers that part of the brain to work better.


Q: How effective is the ADHD device?

A: The short story is it works, but not quite as well as meds.

Kids using eTNS saw their ADHD drop from 34.1 points to 23.4 points using the ADHD rating system. We typically look for the improvement number to be closer to 18, which we reach consistently with medications. So while eTNS affects ADHD, the improvement isn’t as pronounced as what we typically see from medicines.

Q: If it’s less effective, why would someone choose the eTNS device instead of medication?

A: Perhaps a child doesn’t tolerate ADHD medications well. Or parents may not be comfortable using medicines for a variety of reasons. If a child doesn’t have access to an ADHD drug for any reason, this is an alternative treatment.

Q: Are there side effects to the ADHD treatment device?

A: The side effects of eTNS include:

  • Drowsiness and fatigue.
  • Increase in appetite.
  • Trouble sleeping.
  • Teeth clenching.
  • Headache.

These side effects are similar to those that may accrue with medicine, but are not considered more significant than the side effects of ADHD medications, which include irritability, sleep delays and appetite suppression.


Q: How quickly will the ADHD device begin to take effect?

A: It takes a bit longer to see results with the device: up to four weeks. By comparison, medicines start working in 20 to 30 minutes. (It’s best to take the medication consistently just as using this device consistently is likely to be helpful.)

Q: So what’s your overall impression of the ADHD device?

A: It’s good to have options. This is an alternative to ADHD medication that shows effectiveness. While it doesn’t demonstrate as strong a response as medicine, there’s no reason not to use it if medication isn’t an option for your child. And the side effects are similar to those of medication, so there appears to be no danger in using eTNS for ADHD.

To hear more about ADHD from Dr. Manos, listen to the Health Essentials podcast episode “ADHD and Kids.” New episodes of the Health Essentials podcast publish every Wednesday.

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