1000 Section - Therapeutic Effects of Repetitive Transcranial Magnetic Stimulation on Children with Attention Deficit Hyperactivity Disorder: A Systematic Review

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by inattention, hyperactivity and impulsivity with prevalence of 8,09% among Indonesian children. Standard management involves pharmacotherapy combined with cognitive behavioural therapy and behavioural parent training. Recently, non-invasive neuromodulation such as repetitive transcranial magnetic stimulation (rTMS) has gained attention for its potential to modulate cortical excitability and improve executive functions. This review aimed to assess the therapeutic effects of rTMS on children with ADHD.

Design:

This systematic review adhered PRISMA guidelines conducted in PubMed, EBSCOhost, and Scopus up to August 2025. Eligible studies were English-language trials focusing on pediatric ADHD populations, assessing outcomes related to symptom severity, executive function, neurocognition, and safety.

Results:

Seven studies met inclusion criteria. rTMS targeting the dorsolateral prefrontal cortex showed improvements in hyperactivity and impulsivity. Some studies reported enhanced attention and Go/No-Go accuracy (72.76% to 90.12%, p< 0.05). Low-frequency rTMS (1 Hz) improved behavioural outcomes and neurophysiological markers, while high-frequency (10 Hz) benefited executive function, though results for inattention were inconsistent. No serious adverse events occurred. Limitations encompassed heterogeneity, inadequate sample sizes, and a scarcity of randomized controlled trials.

Conclusion:

rTMS is safe, promising non-invasive treatment for ADHD, particularly in reducing hyperactivity and impulsivity, with possible benefits for attention. However, further large-scale studies are needed to confirm long-term efficacy, refine stimulation protocols, and establish clinical applicability.