A non-invasive neurostimulation intervention may improve social communication impairment in children with autism spectrum disorder

1. Five days of accelerated continuous theta burst stimulation (a-cTBS) targeting the left primary motor cortex improved social communication impairment in children with autism spectrum disorder.

Evidence Rating Level: 1 (Excellent)

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neurostimulation technique that has shown efficacy in treating various neuropsychiatric conditions. Research on the application of rTMS to autism spectrum disorder (ASD), particularly among young children and people with comorbid intellectual disability, has been limited and inconclusive. This study thus examined the efficacy and safety of an accelerated continuous theta burst stimulation (a-cTBS) protocol of rTMS in improving social communication impairment in children with ASD and those with co-occurring intellectual disability. This multicentre randomised controlled trial was conducted at three hospitals in China, between July 2023 and October 2024 and included children aged 4-10 years with ASD with a full-scale intelligence quotient ≥50. Participants were randomised 1:1 to receive active a-cTBS or sham treatment (10 sessions/day for five consecutive days) targeting the left primary motor cortex. The primary outcomes were changes in social communication impairment from baseline to post-intervention and from baseline to one-month follow-up, assessed using the Social Responsiveness Scale, second edition (SRS-2). Secondary outcomes included language improvements assessed from baseline to one-month follow-up, measured by the Multilingual Assessment Instrument for Narratives. In total, 198 were included in the modified intention-to-treat analysis (99 in each group), and 193 completed the full intervention. Compared with the sham group, participants who received a-cTBS had greater reductions in SRS-2 scores post-intervention (mean difference, −6.25; 95% CI, −8.69 to −3.81; Cohen’s d, −0.92) and at one-month follow-up (mean difference, −6.17; 95% CI, −8.65 to −3.70; Cohen’s d, −0.90). The a-cTBS group also showed greater improvements in language abilities (Cohen’s d 0.12 to 0.47; all P < 0.02). Adverse events were mild to moderate and resolved without intervention. Overall, this study found that a five-day a-cTBS protocol targeting the left primary motor cortex improved social communication impairment in children with ASD, highlighting its potential as a viable therapeutic option for this population.

Click here to read the study in the BMJ

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