Therapeutic Potential of Low-Frequency Transcranial Magnetic Stimulation in Children with Autism Spectrum Disorder: Sensory and Behavioral Outcomes: A Randomized Trial

HAYFA Ali AL-GHABBAN^1,2*Fahad A. Bashiri³Shuliweeh Alenezi^4,5,6Afaf El-Ansary^7,8Asad Sabr⁹Laila Al-Ayadhi^10,8

• ¹College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
• ²Department of Anatomy and Physiology, Faculty of Medicine, College of Medicine, Imam Mohammed Ibn Saud Islamic University,, Riyadh, Saudi Arabia
• ³Division of Pediatric Neurology, Department of Pediatrics, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
• ⁴Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
• ⁵SABIC Psychological Health Research and Applications Chair (SPHRAC), Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
• ⁶General Administration of Mental and Social Health, Assistant Agency for Hospital Services, salenizi@ksu.edu.sa; ORCID: Ministry of Health,, Riyadh, Saudi Arabia
• ⁷Autism Center, Lotus Holistic Medical Center, Abu dhabi, United Arab Emirates
• ⁸Autism Research and Treatment Center, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
• ⁹Consultant psychiatrist, Medicare Specialized Clinics, Riyadh, Saudi Arabia
• ¹⁰Department of Physiology, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia

Background: Autism spectrum disorder (ASD) is one of the neurodevelopmental disorders, affecting individuals in various life domains. Despite this, its therapeutic options are scarce, with none having been officially approved for its treatment. One recently explored treatment modality is Transcranial Magnetic Stimulation (rTMS), a non-invasive neurostimulation intervention. This study examines the effectiveness of low-frequency rTMS in improving social, cognitive, and sensory function in individuals with ASD. Method: The study included 35 children aged between 5-11 years who had been diagnosed with ASD. Participants were randomly assigned into two groups: 17 children received rTMS treatment twice weekly (Active Group), while the remaining 18 served as a waitlist (WTL) control group. Outcome measures were collected at baseline (pre-intervention) and three weeks after the completion of the 9-week rTMS intervention (post-intervention). Results: Significant (p < 0.05) improvements in cognitive, social, and sensory functions were observed in the Active Group measures three weeks after the 9-week rTMS intervention (post-intervention). This was evidenced by their CARS, SRS, and SSP scores (27.47 ± 7.95, 71.59 ± 11.55, and 156.47 ± 20.17, respectively), with a highly significant reduction in sensory hypersensitivity (p = 0.001) compared to the WLT group, who presented more severe scores of CARS (35.89 ± 8.96), SRS (81.72 ± 7.68), and SSP (133.67 ± 11.65). Additionally, ROC curves were measured. CARS, SRS, and SSP recorded poor AUCs in the active pre-rTMS group (0.557, 0.565, and 0.574, respectively); all ROC curves recorded satisfactory higher AUCs in post-rTMS (0.775, 0.753, and 0.825, respectively). Conclusion: The findings of this study suggest that low-frequency rTMS may hold potential as an adjunctive intervention for specific ASD-related symptoms in social, cognitive, and sensory domains. However, further research is warranted to validate and expand these preliminary observations.