Transdermal Electrical Neuromodulation for Anxiety and Sleep Problems in High-Functioning Autism Spectrum Disorder: Feasibility and Preliminary Findings

Abstract

Background: Autism spectrum disorder (ASD) is associated with anxiety and sleep problems. We investigated transdermal electrical neuromodulation (TEN) of the cervical nerves in the neck as a safe, effective, comfortable and non-pharmacological therapy for decreasing anxiety and enhancing sleep quality in ASD. Methods: In this blinded, sham-controlled study, seven adolescents and young adults with high-functioning ASD underwent five consecutive treatment days, one day of the sham followed by four days of subthreshold TEN for 20 min. Anxiety-provoking cognitive tasks were performed after the sham/TEN. Measures of autonomic nervous system activity, including saliva α-amylase and cortisol, electrodermal activity, and heart rate variability, were collected from six participants. Results: Self-rated and caretaker-rated measures of anxiety were significantly improved with TEN treatment as compared to the sham, with effect sizes ranging from medium to large depending on the rating scale. Sleep scores from caretaker questionnaires also improved, but not significantly. Performance on two of the three anxiety-provoking cognitive tasks and heart rate variability significantly improved with TEN stimulation as compared to the sham. Four of the seven (57%) participants were responders, defined as a ≥ 30% improvement in self-reported anxiety. Salivary α-amylase decreased with more TEN sessions and decreased from the beginning to the end of the session on TEN days for responders. TEN was well-tolerated without significant adverse events. Conclusions: This study provides preliminary evidence that TEN is well-tolerated in individuals with ASD and can improve anxiety.

A Personalized Multidisciplinary Approach to Evaluating and Treating Autism Spectrum Disorder

“…The ABC irritability scale is the standard assessment that defines this symptom [ 32 ]. Anxiety is a key symptom that impedes social interactions, which affects a significant portion of the ASD population [ 41 ]. The Parent-Rated Anxiety Scale for ASD [ 42 ] is a recently developed parent-rated questionnaire while the Screen for Child Anxiety Related Disorders (SCARED) has both child- and parent-rated questionnaires [ 41 ].…”

“…Anxiety is a key symptom that impedes social interactions, which affects a significant portion of the ASD population [ 41 ]. The Parent-Rated Anxiety Scale for ASD [ 42 ] is a recently developed parent-rated questionnaire while the Screen for Child Anxiety Related Disorders (SCARED) has both child- and parent-rated questionnaires [ 41 ]. Attention Deficit Hyperactivity Disorder is highly comorbid with ASD and is known to modulate social responsiveness and competency [ 43 ] and can be assessed by the widely used standard no cost Vanderbilt questionnaire [ 44 ].…”

“…Standard treatments with selective serotonin reuptake inhibitors result in variable outcomes and may do more harm than good [ 100 ], while cognitive behavioral therapy appears to be superior to standard treatments [ 101 ]. Other promising safe medications such as propranolol [ 102 ] and novel methodologies such as transdermal electrical neuromodulation [ 41 ] have also shown some promising outcomes for anxiety. Treatment of attention deficit hyperactivity disorder is complicated as there is a greater adverse effect burden with standard stimulant medication in children with ASD so alpha-adrenergic medications may be a better choice [ 103 ].…”

A Personalized Approach to Evaluating and Treating Autism Spectrum Disorder

“…Transdermal Electrical Neuromodulation (TEN) is an approved safe non-invasive treatment for several disorders including attention-deficit hyperactivity disorder and migraines. In the first study using TEN to treat individuals with ASD, researchers at the Barrow Neurologic Institute at Phoenix Children's Hospital demonstrate the feasibility and potential effectiveness of TEN treatment for anxiety as well as demonstrate how autonomic system biomarkers may be used to predict response to TEN treatment [20].…”

“…Is ASD itself a result of abnormal mitochondria, with effects on neurons and/or leukocytes-essentially a "Bad Trio" of mitochondrial dysfunction, oxidative stress and redox regulation, and immune system dysfunction [3]? Is there a room for a primary role in pathogenesis for other pathways, including synapses [6][7][8], methylation [8,18], autonomic nervous function [9,20], ion channels [6], hypermobility [9], and microbiome [14], at least in some cases? Or, perhaps, do these concepts work within the mitochondrial hypothesis?…”