Dual-target iTBS for Youth With ADHD

Inclusion criteria

• ADHD Diagnosis: Meets the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5);
• Inadequate Response to Medication: After a full course of pharmacological treatment, the SNAP-IV Parent Rating Scale (first 18 items, assessing inattention/hyperactivity-impulsivity) score \>1, and the Clinical Global Impression-Severity Scale (CGI-S) score \>2;
• Age and Gender: 10-18 years old; males or females;
• Intellectual Functioning: Full-scale intelligence quotient (IQ) \>70 on the China-Wechsler Intelligence Scale for Children (C-WISC) (excluding participants with intellectual disability);
• Symptom Severity: A score of ≥1.6 on either the Inattention or Hyperactivity/Impulsivity subscale of the SNAP-IV Parent Rating Scale;
• Medication Requirements:
• \) Medication-naïve or currently off medication; 2) If currently on medication, must be on a stable medication regimen for at least 4 weeks prior to the baseline visit and throughout the study duration; 3) Prohibited medications: Psychostimulants; 7. Right-handed.

Exclusion criteria

• Contraindications for TMS therapy include epilepsy, cardiac pacemakers, cochlear implants, and metal implants.
• Contraindications for MRI include metal implants in the body, claustrophobia, and tattoos.
• Significant medical history: history of epilepsy, organic brain disorders, traumatic brain injury (TBI), or severe physical illnesses.
• Behavioral risks: history of violent or suicidal behavior.
• Comorbid neurodevelopmental disorders, such as autism spectrum disorder (ASD), tic disorders, etc.
• Comorbid psychiatric disorders: any other primary psychiatric disorders, except conduct disorder/oppositional defiant disorder, mild anxiety, or depression.
• Substance abuse.
• Currently receiving any non-medical treatments, such as cognitive behavioral therapy (CBT), neurofeedback, etc.
• Female participants must not be pregnant or breastfeeding.