The Effect of Optimized Electrode Placement Protocols for Transcranial Direct Current Stimulation on the Cold and Hot Executive Functions of Children with Attention Deficit Hyperactivity Disorder: A Scoping Review

Document Type : Review Articles

Authors
Mohadeseh Erfaninasab 1
Salar Faramarzi 2
1 MSc, Department of Psychology and Education of People with Special Needs, School of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
2 Professor, Department of Psychology and Education of People with Special Needs, School of Educational Sciences and Psychology, University of Isfahan, Isfahan, Iran
10.48305/jrrs.2026.42721.1092
Abstract
Introduction: Attention deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder characterized by complex and heterogeneous clinical manifestations, including disruptive and inappropriate levels of inattention, hyperactivity, and impulsivity, which cause significant dysfunctions in the mechanisms related to hot and cold executive functions. This disorder directly affects processes such as working memory, attention, response inhibition, emotional self-regulation, planning, cognitive flexibility, reaction time manipulation, preference for immediate rewards, and decision-making. Given the significance of executive functions in essential daily living skills and their prominent role in neurodevelopmental disorders, many studies have examined the effectiveness of various approaches, such as neuromodulation strategies, in improving these functions. Therefore, the present review was conducted to investigate the effect of transcranial direct current stimulation (tDCS) on cold and hot executive functions of children with ADHD.
Materials and Methods: This study was conducted as a scoping review. To identify relevant studies, a comprehensive search was performed across several international databases, including Web of Science, ScienceDirect, Scopus, PubMed, and Google Scholar, using English keywords such as ‘Transcranial Direct Current Stimulation’, ‘tDCS’, ‘Hot and Cold Executive Functions’, ‘Attention-Deficit/Hyperactivity Disorder’, ‘ADHD’, and ‘Brain Neuromodulation’. Additionally, the Persian Scientific Information Database (SID) was searched using equivalent Persian keywords to identify relevant local studies. Ultimately, 15 studies met the inclusion criteria and underwent full-text analysis.
Results: tDCS generally demonstrates significant potential for improving executive functions in children with ADHD. Numerous studies suggest that this method works by modulating the excitability of brain regions associated with executive functions, particularly the prefrontal cortex (PFC). tDCS appears to enhance aspects of cold executive functions, such as working memory and cognitive flexibility, by increasing activity or altering the excitation/inhibition balance in these areas. Regarding hot executive functions, evidence also supports the impact of tDCS on emotional regulation and impulse control. However, results in this area may be more variable due to differences in electrode placement protocols and targeted regions. Some research emphasizes the importance of precise tDCS protocol selection, including current intensity, stimulation duration, and electrode placement (especially on prefrontal areas), for achieving optimal efficacy.
Conclusion: Utilizing appropriate protocols for electrode placement across a variety of brain neuromodulation methods, including tDCS, can be a promising treatment for improving symptoms in children with ADHD.
Keywords
Transcranial direct current stimulation
Cold executive functions
Hot executive functions
Children
Attention deficit-hyperactivity disorder
Subjects
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