Personalized optimization of pediatric HD-tDCS for dose consistency and target engagement

Abstract

High-definition transcranial direct current stimulation (HD-tDCS) dosing in children remains largely empirical, relying on one-size-fits-all protocols despite rapid developmental changes in head anatomy and tissue properties that strongly modulate how currents reach the developing brain. Using 70 pediatric head models and commonly used cortical targets, our forward simulations find that standard montages produce marked age-dependent reductions in target electric-field intensity and systematic sex differences linked to tissue-volume covariation, underscoring the profound limitations of conventional uniform montages. To overcome these limitations, we introduce a developmentally informed, dual-objective optimization framework designed to generate personalized Pareto fronts summarizing the trade-off between electric-field intensity and focality. From these optimized solutions, we derive two practical dosing prescriptions: a dose-consistency strategy that, for the first time, enforces fixed target intensity across individuals to implicitly mitigate demographic effects, and a target-engagement strategy that maximizes target intensity under safety limits. Both strategies remain robust to large conductivity variations, and we further show that dense HD-tDCS solutions admit sparse equivalents without performance loss under the target-engagement strategy. We also find that tissue conductivity sensitivity is depth-dependent, with Pareto-front distributions for superficial cortical targets most influenced by gray matter, scalp, and bone conductivities, and those for a deep target predominantly shaped by gray and white matter conductivities. Together, these results establish a principled framework for pediatric HD-tDCS planning that explicitly accounts for developmental anatomy and physiological uncertainty, enabling reliable and individualized neuromodulation dosing in pediatric populations.