Transcranial magnetic stimulation is a promising therapy for autism spectrum disorder.
The Centers for Disease Control and Prevention (CDC) estimates that 1 in 54 children in the United States have autism spectrum disorder (ASD), a developmental disability that can affect communication, social relationships, behavior, and emotion regulation.1 Because autism exists on a spectrum, high variation exists in symptom type and severity among each autistic person; some experience significant impairment in one or more life domain, and others experience very little. In most cases, a physician can use a child’s behavioral and developmental history to diagnose autism by the time a child is two years old.2
Currently, the exact causes of autism are unknown and remain of great interest to physicians, neuroscientists, and behavioral health specialists. Experts do know that autism is likely caused by a complex interaction of genetic and environmental factors that can affect the developing fetal brain, leading to predictable changes in structure and function. Because many autistic people share several of these structural brain features, neuroscientists believe that effective treatments for autism should target and modulate these affected regions of the brain.3
An innovative technology called transcranial magnetic stimulation (TMS) has emerged as a promising therapy to improve autism symptoms that have not responded to other treatments. The therapy regulates brain function by stimulating neurons in specific areas of the brain that may malfunction in people with certain psychiatric or neurodevelopmental disorders. TMS has already received FDA approval as a therapy for major depressive disorder and obsessive-compulsive disorder. A large body of clinical evidence demonstrates that TMS effectively treats these mental health conditions by encouraging healthy neural activation in brain regions that are responsible for regulating psychological, emotional, and behavioral health.4,5
Given the exceptional success of this TMS for these mental health conditions, scientists have used the unique neural features of autism to adapt the therapy as a treatment for this developmental disorder. Neuroscientists have discovered that the social and sensory deficits associated with autism may be in part caused by over-activation of neurons in the prefrontal cortex of the brain.6 Additionally, many brains with autism show dysfunctional processing of a molecule called GABA, a chemical messenger that helps to reduce and regulate neuronal activity.7 TMS can improve autism symptoms by directly modifying these malfunctioning neural activation processes.
During a treatment session with TMS, a small wire coil is positioned directly above the recipient’s prefrontal cortex, an area of the brain that has been implicated in autism. The coil generates a magnetic field that produces electrical activity in the brain, creating a more balanced activation pattern in the targeted neurons. The treatment is painless, and the recipient remains awake during the entire session.
Because TMS for autism has yet to receive FDA approval, treatment protocols vary by clinic. Some have opted to deliver sparse long-term treatment (once or twice weekly for nine weeks),8 while others have delivered dense short-term treatment (five times weekly for two weeks).9 A typical treatment session lasts 20 to 40 minutes in total, including 15 to 20 minutes of active TMS stimulation. To optimize a TMS protocol for autism, health care providers must consider that autistic children may struggle to complete lengthy or high-volume TMS sessions due to sensory issues, inability to sit still, and distress caused by disruptions to daily routine.
Clinical studies have found that patients who receive TMS (either alone or in combination with behavioral therapy) show significant improvements in their autism symptoms compared to those who receive no treatment or only standard behavioral therapy. One study of 28 autistic adults found that those who received TMS showed improvement in social relationships and were better able to manage their anxiety during difficult emotional and social situations.9 Another study of 32 autistic children found that a full course of TMS reduced their behavioral problems as measured by the Autism Behavior Checklist.8 Larger reviews of recent literature on TMS for autism report that TMS is most effective in treating the social deficits associated with autism, and about half of existing studies report that the improvements were sustained for up to six months.10
Importantly, TMS offers the only biomedical treatment option for autism. Although some side effects of autism (such as hyperactivity) can be treated with medications, at this time behavioral intervention remains the only targeted treatment for autism. One of the most common behavioral therapies for autism, applied behavioral analysis (ABA), has sparked controversy among autism advocates for harshly discouraging certain behaviors (such as stimming, which can relieve anxiety and energy), not to reduce harm to the autistic person but to conform them to the expectations of a neurotypical society.11 ABA is also highly time-intensive, typically requiring 20 to 40 hours of therapy per week for years.12 TMS, on the other hand, makes no value judgment on autism behaviors nor attempts to discourage them. Furthermore, a standard TMS protocol for autism requires only about total 20 hours total spread over a span of weeks, expanding accessibility for families who may be unable to participate in an intensive, years-long course of ABA.
For children and adults on the autism spectrum, TMS may offer hope for reduced symptom burden and higher quality of life, particularly in social domains. FDA clearance of TMS for autism is expected to follow as new data continue to demonstrate the effectiveness and safety of this treatment. In consideration of the large evidence base, TMS Program is proud to offer this cutting-edge therapy for our autistic patients.
1 Autism Spectrum Disorder (ASD). Centers for Disease Control and Prevention. (2020). Retrieved from https://www.cdc.gov/ncbddd/autism/index.html
2 Autism Spectrum Disorder. National Institute of Mental Health. (2020). Retrieved from https://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd/index.shtml
3 Oberman LM, Rotenberg A, & Pascual-Leone A. (2016). Use of transcranial magnetic stimulation in autism spectrum disorders. Journal of Autism and Developmental Disorders, 45(2):524-536.
4 Perera T, George MS, Grammer G, et al. (2016). The Clinical TMS Society consensus review and treatment recommendations for TMS therapy for major depressive disorder. Brain Stimulation, 9:336-346.
5 Carmi L, Tendler A, Bystritsky A, et al. (2019). Efficacy and safety of deep transcranial magnetic stimulation for obsessive-compulsive disorder: A prospective multicenter randomized double-blind placebo-controlled trial. American Journal of Psychiatry.
6 Rubenstein JL, & Merzenich MM. (2003). Model of autism: Increased ratio of excitation/inhibition in key neural systems. Genes, Brain, and Behavior, 2(5):255-267.
7 Fatemi SH, Folsom TD, Reutiman TJ, & Thuras PD. (2009). Expression of GABA(B) receptors altered in brains of subjects with autism. Cerebellum, 8(1):64-69.
8 Kang JN, Song JJ, Casanova MF, et al. (2019). Effects of repetitive transcranial magnetic stimulation on children with low-function autism. CNS Neuroscience and Therapeutics, 25(11):1254-1261.
9 Enticott PG, Fitzgibbon BM, Kennedy HA, et al. (2014). A double-blind, randomized trial of deep repetitive transcranial magnetic stimulation (rTMS) for autism spectrum disorder. Brain Stimulation, 7:206-211.
10 Barahona-Corrêa JB, Velosa A, Chainho A, et al. (2018). Repetitive transcranial magnetic stimulation for treatment of autism spectrum disorder: A systematic review and meta-analysis. Frontiers in Integrative Neuroscience, 12:27.
11 Sandoval-Norton AH & Shkedy G. (2019). How much compliance is too much compliance: Is long-term ABA therapy abuse? Cogent Psychology, 6:1.
12 Linstead E, Dixon DR, Hong E, et al. (2017). An evaluation of the effects of intensity and duration on outcomes across treatment domains for children with autism spectrum disorder. Translational Psychiatry, 7(9):e1234.