The use of noninvasive brain stimulation techniques in autism spectrum disorder

Abstract

Noninvasive brain stimulation (NIBS) techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have recently emerged as alternative, nonpharmacological interventions for a variety of psychiatric, neurological, and neurodevelopmental conditions. NIBS is beginning to be applied in both research and clinical settings for the treatment of core and associated symptoms of autism spectrum disorder (ASD) including social communication deficits, restricted and repetitive behaviors, irritability, hyperactivity, depression and impairments in executive functioning and sensorimotor integration. Though there is much promise for these targeted device‐based interventions, in other disorders (including adult major depressive disorder (MDD) and obsessive compulsive disorder (OCD) where rTMS is FDA cleared), data on the safety and efficacy of these interventions in individuals with ASD is limited especially in younger children when neurodevelopmental interventions typically begin. Most studies are open‐label, small scale, and/or focused on a restricted subgroup of individuals with ASD. There is a need for larger, randomized controlled trials that incorporate neuroimaging in order to develop predictive biomarkers of treatment response and optimize treatment parameters. We contend that until such studies are conducted, we do not have adequate estimates of the safety and efficacy of NIBS interventions in children across the spectrum. Thus, broad off‐label use of these techniques in this population is not supported by currently available evidence. Here we discuss the existing data on the use of NIBS to treat symptoms related to ASD and discuss future directions for the field.

Is there evidence for the use of noninvasive brain stimulation techniques for children and adolescents with mental illness?

“…The possibility of short‐ and long‐term side‐effects when using rTMS in children and adolescents with mental illness requires more empirical studies, although rTMS is relatively safe. 3 , 6 , 7 …”

“…The neurodevelopmental processes ongoing in children and adolescents, compounded by the pathophysiological processes affecting those with neuropsychiatric and neurodevelopmental disorders, warrant careful consideration. 7 Currently available evidence does not support the broad off‐label use of rTMS in children and adolescents; thus, the broad expedited translation of rTMS to clinics requires caution. 7 Recent systematic reviews supported the efficacy of rTMS treatment for adolescents with major depressive disorder 8 or the safety of rTMS treatment in children and adolescents within the currently applied protocols.…”

“… 7 Currently available evidence does not support the broad off‐label use of rTMS in children and adolescents; thus, the broad expedited translation of rTMS to clinics requires caution. 7 Recent systematic reviews supported the efficacy of rTMS treatment for adolescents with major depressive disorder 8 or the safety of rTMS treatment in children and adolescents within the currently applied protocols. 9 Herein, our mini‐review endorses the validity of the revised practical guide for the appropriate use of rTMS for treatment‐resistant depression by the JSPN.…”

“…The possibility of short-and long-term side-effects when using rTMS in children and adolescents with mental illness requires more empirical studies, although rTMS is relatively safe. 3,6,7 Evidence regarding the efficacy of rTMS for children and adolescents with mental illness is currently lacking, although rTMS does show promise. The neurodevelopmental processes ongoing in children and adolescents, compounded by the pathophysiological processes affecting those with neuropsychiatric and neurodevelopmental disorders, warrant careful consideration.…”