A novel cholinergic activating agent, ABT-418, was used to treat 29 adults with ADHD, in a double-blind, placebo-controlled, randomized, crossover trial at the Pediatric Psychopharmacology Clinic, Massachusetts General Hospital, Boston. A significantly higher proportion of patients was benefited by ABT-418 in a transdermal patch (75 mg/day) compared to placebo (40% versus 13%). ADHD symptom checklist scores were also significantly reduced (28% versus 15%). Attentiveness scores and patients with less severe ADHD responded most frequently. Dizziness, skin irritation, nausea, and headaches were the most common adverse effects, and necessitated dose reduction in 6 patients and withdrawal in 1. [1]

COMMENT. ABT-418, a nicotinic analog, may be a useful new agent in the treatment of ADHD, and especially in patients with the inattentiveness subtype (ADD) and those with less severe symptoms. The results of this trial provide further evidence of a link between nicotinic-cholinergic agents, catecholamine function, and improvement in ADHD.

EEG operant conditioning (neurotherapy) to treat ADHD is reviewed by Nash JK [2]. Studies suggest that clinical improvement in ADHD is related to measurable improvements in the EEG, with a decline in theta/beta ratios over the frontal/central cortex and/or reduced theta/alpha band amplitudes.