Treatment of autism spectrum disorder: The potential role of repetitive transcranial magnetic stimulation

doi:10.3724/SP.J.1042.2025.0598

Abstract

Abstract:

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive brain modulation technique that has gained increasing attention in the field of autism spectrum disorder (ASD) intervention in recent years. This study systematically reviews the literature on rTMS interventions for ASD from 2014 to 2024, focusing on its mechanisms of action, target selection, and the relationship with core symptoms, as well as future optimization directions.

Regarding the mechanisms of action, (1) low-frequency rTMS modulates cortical GABAergic neurotransmission to restore the excitatory-inhibitory (E/I) balance, thereby significantly improving repetitive and stereotypical behaviors as well as executive function deficits in ASD; (2) high-frequency rTMS enhances synaptic long-term potentiation (LTP) and regulates neurotransmitter transmission to increase the excitability of target regions and associated neural networks, contributing to the alleviation of social interaction impairments in ASD.

From the perspective of target selection, studies indicate that low-frequency rTMS targeting the dorsolateral prefrontal cortex (DLPFC) has shown significant effects in improving repetitive and stereotypical behaviors and executive function in ASD. High-frequency rTMS targeting the temporo-parietal junction (TPJ, including pSTS and IPL) has been found to significantly enhance social behaviors and language abilities in ASD patients. Intervention cycles are generally set to 15-18 sessions, with stimulation intensity adjusted based on individual motor thresholds (80%-100%) to ensure a balance between efficacy and safety.

Although rTMS interventions have shown some positive results, existing studies still have several limitations. This review highlights the following issues: (1) random double-blind designs are not widely employed, with most studies lacking strict experimental controls, and only a few studies using sham stimulation as a control; (2) target localization is mainly based on standard electrode caps or the “5 cm rule,” which has limited precision, with only a few studies using individualized brain imaging for localization; (3) stimulation parameters (such as frequency, intensity, and duration) are not standardized and require optimization; (4) the critical period effect of rTMS interventions for ASD, particularly during the highly plastic period of early childhood (0-6 years), remains unclear and warrants further investigation.

To enhance the scientific rigor and clinical efficacy of rTMS interventions for ASD, future studies should focus on designing strict random double-blind trials, preferably using sham stimulation as a control to mitigate placebo effects. Additionally, multimodal techniques such as functional magnetic resonance imaging (fMRI), magnetic resonance spectroscopy (MRS), and electroencephalography (EEG) should be employed to elucidate the underlying neural mechanisms. Furthermore, the effects of rTMS at different age stages and its personalized therapeutic outcomes should be systematically evaluated. Lastly, exploring the optimization of stimulation parameters could improve the therapeutic effects and provide a basis for individualized treatments.

Key words: autism spectrum disorder, repetitive transcranial magnetic stimulation, dorsolateral prefrontal cortex, temporoparietal junction

CLC Number:

B845

TIAN Renxia, YANG Ping, GUO Yuanyuan, WU Xia. Treatment of autism spectrum disorder: The potential role of repetitive transcranial magnetic stimulation[J]. Advances in Psychological Science, 2025, 33(4): 598-610.

Figures/Tables 4

References 72

[1]	李梦青, 姜志梅, 李雪梅, 郭岚敏. (2018). rTMS结合脑电生物反馈对孤独症谱系障碍儿童刻板行为的疗效. 中国康复, 33(2), 114-117.
[2]	吴野, 李新剑, 金鑫, 杨忠秀, 李之林, 吴洁, 武改, 李杰. (2016). 高频经颅磁刺激背外侧前额叶联合康复训练对孤独症谱系障碍儿童的治疗作用. 中国医药导报, 13(27), 119-122.
[3]	Abbott, A. E., Linke, A. C., Nair, A., Jahedi, A., Alba, L. A., Keown, C. L., Fishman, I., & Müller, R. A. (2018). Repetitive behaviors in autism are linked to imbalance of corticostriatal connectivity: A functional connectivity MRI study. Social Cognitive and Affective Neuroscience, 13(1), 32-42. https://doi.org/10.1093/scan/nsx129 doi: 10.1093/scan/nsx129 URL pmid: 29177509
[4]	Abujadi, C., Croarkin, P. E., Bellini, B., Brentani, H., & Marcolin, M. (2018). Intermittent theta-burst transcranial magnetic stimulation for autism spectrum disorder: An open-label pilot study. Revista Brasileira de Psiquiatria, 40(3), 309-311. https://doi.org/10.1590/1516-4446-2017-2279 doi: S1516-44462018000300309 URL pmid: 29236921
[5]	Ahmad, N., Zorns, S., Chavarria, K., Brenya, J., Janowska, A., & Keenan, J. P. (2021). Are we right about the right tpj? A review of brain stimulation and social cognition in the right temporal parietal junction. Symmetry, 13(11), 2219. https://doi.org/10.3390/sym13112219
[6]	Ameis, S. H., Blumberger, D. M., Croarkin, P. E., Mabbott, D. J., Lai, M. C., Desarkar, P., Szatmari, P., & Daskalakis, Z. J. (2020). Treatment of executive function deficits in autism spectrum disorder with repetitive transcranial magnetic stimulation: A double-blind, sham-controlled, pilot trial. Brain Stimulation, 13(3), 539-547. https://doi.org/10.1016/j.brs.2020.01.007 doi: S1935-861X(20)30007-3 URL pmid: 32289673
[7]	Barahona-Corrêa, J. B., Velosa, A., Chainho, A., Lopes, R., & Oliveira-Maia, A. J. (2018). Repetitive transcranial magnetic stimulation for treatment of autism spectrum disorder: A systematic review and meta-analysis. Frontiers in Integrative Neuroscience, 12, 27. https://doi.org/10.3389/fnint.2018.00027
[8]	Baruth, J. M., Casanova, M. F., El-Baz, A., Horrell, T., Mathai, G., Sears, L., & Sokhadze, E. (2010). Low- frequency repetitive transcranial magnetic stimulation (rTMS) modulates evoked-gamma frequency oscillations in autism spectrum disorder. Journal of Neurotherapy, 14(3), 179-194. https://doi.org/10.1080/10874208.2010.501500
[9]	Casanova, M. F., Shaban, M., Ghazal, M., El-Baz, A. S., Casanova, E. L., Opris, I., & Sokhadze, E. M. (2020). Effects of transcranial magnetic stimulation therapy on evoked and induced gamma oscillations in children with autism spectrum disorder. Brain Sciences, 10(7), 423. https://doi.org/10.3390/brainsci10070423
[10]	Casanova, M. F., Sokhadze, E. M., Casanova, E. L., & Li, X. (2020). Transcranial magnetic stimulation in autism spectrum disorders: Neuropathological underpinnings and clinical correlations. Seminars in Pediatric Neurology, 35, 100832. https://doi.org/10.1016/j.spen.2020.100832
[11]	Cerliani, L., Mennes, M., Thomas, R. M., Di Martino, A., Thioux, M., & Keysers, C. (2015). Increased functional connectivity between subcortical and cortical resting-state networks in autism spectrum disorder. JAMA Psychiatry, 72(8), 767-777. https://doi.org/10.1001/jamapsychiatry.2015.0101 doi: 10.1001/jamapsychiatry.2015.0101 URL pmid: 26061743
[12]	Chervyakov, A. V., Chernyavsky, A. Y., Sinitsyn, D. O., & Piradov, M. A. (2015). Possible mechanisms underlying the therapeutic effects of transcranial magnetic stimulation. Frontiers in Human Neuroscience, 9, 303. https://doi.org/10.3389/fnhum.2015.00303
[13]	Cole, E. J., Enticott, P. G., Oberman, L. M., Gwynette, M. F., Casanova, M. F., Jackson, S. L. J., ... Puts, N. A. J. (2019). The potential of repetitive transcranial magnetic stimulation for autism spectrum disorder: A consensus statement. Biological Psychiatry, 85(4), e21-e22. https://doi.org/10.1016/j.biopsych.2018.06.003
[14]	Di Martino, A., Kelly, C., Grzadzinski, R., Zuo, X.-N., Mennes, M., Mairena, M. A., Lord, C., Castellanos, F. X., & Milham, M. P. (2011). Aberrant striatal functional connectivity in children with autism. Biological Psychiatry, 69(9), 847-856. https://doi.org/10.1016/j.biopsych.2010.10.029 doi: 10.1016/j.biopsych.2010.10.029 URL pmid: 21195388
[15]	Di Martino, A., Yan, C.-G., Li, Q., Denio, E., Castellanos, F. X., Alaerts, K., ... Milham, M. P. (2014). The autism brain imaging data exchange: Towards a large-scale evaluation of the intrinsic brain architecture in autism. Molecular Psychiatry, 19(6), 659-667. https://doi.org/10.1038/mp.2013.78 doi: 10.1038/mp.2013.78 URL pmid: 23774715
[16]	Dickinson, A., Jones, M., & Milne, E. (2016). Measuring neural excitation and inhibition in autism: Different approaches, different findings and different interpretations. Brain Research, 1648, 277-289. https://doi.org/10.1016/j.brainres.2016.07.011 doi: S0006-8993(16)30484-X URL pmid: 27421181
[17]	Enticott, P. G., Fitzgibbon, B. M., Kennedy, H. A., Arnold, S. L., Elliot, D., Peachey, A., Zangen, A., & Fitzgerald, P. B. (2014). A double-blind, randomized trial of deep repetitive transcranial magnetic stimulation (rTMS) for autism spectrum disorder. Brain Stimulation, 7(2), 206-211. https://doi.org/10.1016/j.brs.2013.10.004 doi: 10.1016/j.brs.2013.10.004 URL pmid: 24280031
[18]	Estes, A., Munson, J., Rogers, S. J., Greenson, J., Winter, J., & Dawson, G. (2015). Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 54(7), 580-587. https://doi.org/10.1016/j.jaac.2015.04.005 doi: 10.1016/j.jaac.2015.04.005 URL pmid: 26088663
[19]	Estes, A., Shaw, D. W. W., Sparks, B. F., Friedman, S., Giedd, J. N., Dawson, G., Bryan, M., & Dager, S. R. (2011). Basal ganglia morphometry and repetitive behavior in young children with autism spectrum disorder. Autism Research, 4(3), 212-220. https://doi.org/10.1002/aur.193 doi: 10.1002/aur.193 URL pmid: 21480545
[20]	First, M. B. (2013). Diagnostic and statistical manual of mental disorders, 5th edition, and clinical utility. The Journal of Nervous and Mental Disease, 201(9), 727-729. https://doi.org/10.1097/NMD.0b013e3182a2168a
[21]	Fox, M. D., Halko, M. A., Eldaief, M. C., & Pascual-Leone, A. (2012). Measuring and manipulating brain connectivity with resting state functional connectivity magnetic resonance imaging (fcMRI) and transcranial magnetic stimulation (TMS). NeuroImage, 62(4), 2232-2243. https://doi.org/10.1016/j.neuroimage.2012.03.035 doi: 10.1016/j.neuroimage.2012.03.035 URL pmid: 22465297
[22]	Frye, R. E., Casanova, M. F., Fatemi, S. H., Folsom, T. D., Reutiman, T. J., Brown, G. L., ... Adams, J. B. (2016). Neuropathological mechanisms of seizures in autism spectrum disorder. Frontiers in Neuroscience, 10, 192. https://doi.org/10.3389/fnins.2016.00192
[23]	Gao, L., Wang, C., Song, X. R., Tian, L., Qu, Z. Y., Han, Y., & Zhang, X. (2022). The sensory abnormality mediated partially the efficacy of repetitive transcranial magnetic stimulation on treating comorbid sleep disorder in autism spectrum disorder children. Frontiers in Psychiatry, 12, 820598. https://doi.org/10.3389/fpsyt.2021.820598
[24]	Gliga, T., Jones, E. J. H., Bedford, R., Charman, T., & Johnson, M. H. (2014). From early markers to neuro- developmental mechanisms of autism. Developmental Review, 34(3), 189-207. https://doi.org/10.1016/j.dr.2014.05.003 URL pmid: 25187673
[25]	Gómez, L., Vidal, B., Maragoto, C., Morales, L. M., Berrillo, S., Cuesta, H. V., … Robinson M. (2017). Non-invasive brain stimulation for children with autism spectrum disorders: A short-term outcome study. Behavioral Sciences, 7(3), 1-12. https://doi.org/10.3390/bs7030063
[26]	Grothe, B., & Klump, G. M. (2000). Temporal processing in sensory systems. Current Opinion in Neurobiology, 10(4), 467-473. https://doi.org/10.1016/s0959-4388(00)00115-x URL pmid: 10981615
[27]	Hazlett, H. C., Gu, H., Munsell, B. C., Kim, S. H., Styner, M., Wolff, J. J., ... Piven, J. (2017). Early brain development in infants at high risk for autism spectrum disorder. Nature, 542(7641), 348-351. https://doi.org/10.1038/nature21369
[28]	Hill, E. L. (2004). Executive dysfunction in autism. Trends in Cognitive Sciences, 8(1), 26-32. https://doi.org/10.1016/j.tics.2003.11.003 doi: 10.1016/j.tics.2003.11.003 URL pmid: 14697400
[29]	Hull, J. V., Dokovna, L. B., Jacokes, Z. J., Torgerson, C. M., Irimia, A., & Van Horn, J. D. (2017). Resting-state functional connectivity in autism spectrum disorders: A review. Frontiers in Psychiatry, 7, 205. https://doi.org/10.3389/fpsyt.2016.00205
[30]	Hyman, S. L., Levy, S. E., & Myers, S. M. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1), e20193447. https://doi.org/10.1542/peds.2019-3447
[31]	Iwabuchi, S. J., Raschke, F., Auer, D. P., Liddle, P. F., Lankappa, S. T., & Palaniyappan, L. (2017). Targeted transcranial theta-burst stimulation alters fronto-insular network and prefrontal GABA. NeuroImage, 146, 395-403. https://doi.org/10.1016/j.neuroimage.2016.09.043 doi: S1053-8119(16)30520-1 URL pmid: 27651067
[32]	Jiang, L., He, R., Li, Y., Yi, C., Peng, Y., Yao, D., Wang, Y., Li, F., Xu, P., & Yang, Y. (2022). Predicting the long-term after-effects of rTMS in autism spectrum disorder using temporal variability analysis of scalp EEG. Journal of Neural Engineering, 19(5). https://doi.org/10.1088/1741-2552/ac999d
[33]	Kana, R. K., Libero, L. E., & Moore, M. S. (2011). Disrupted cortical connectivity theory as an explanatory model for autism spectrum disorders. Physics of Life Reviews, 8(4), 410-437. https://doi.org/10.1016/j.plrev.2011.10.001 doi: 10.1016/j.plrev.2011.10.001 URL pmid: 22018722
[34]	Kang, J. N., Song, J. J., Casanova, M. F., Sokhadze, E. M., & Li, X. L. (2019). Effects of repetitive transcranial magnetic stimulation on children with low-function autism. CNS Neuroscience and Therapeutics, 25(11), 1254-1261. https://doi.org/10.1111/cns.13150
[35]	Keil, A., Gruber, T., & Müller, M. M. (2001). Functional correlates of macroscopic high-frequency brain activity in the human visual system. Neuroscience and Biobehavioral Reviews, 25(6), 527-534. https://doi.org/10.1016/s0149-7634(01)00031-8 URL pmid: 11595272
[36]	Kennedy, D. P., & Courchesne, E. (2008). The intrinsic functional organization of the brain is altered in autism. NeuroImage, 39(4), 1877-1885. https://doi.org/10.1016/j.neuroimage.2007.10.052 doi: 10.1016/j.neuroimage.2007.10.052 URL pmid: 18083565
[37]	Keown, C. L., Shih, P., Nair, A., Peterson, N., Mulvey, M. E., & Müller, R.-A. (2013). Local functional overconnectivity in posterior brain regions is associated with symptom severity in autism spectrum disorders. Cell Reports, 5(3), 567-572. https://doi.org/10.1016/j.celrep.2013.10.003 doi: 10.1016/j.celrep.2013.10.003 URL pmid: 24210815
[38]	Kirkovski, M., Enticott, P. G., Hughes, M. E., Rossell, S. L., & Fitzgerald, P. B. (2016). Atypical neural activity in males but not females with autism spectrum disorder. Journal of Autism and Developmental Disorders, 46(3), 954-963. https://doi.org/10.1007/s10803-015-2639-7 doi: 10.1007/s10803-015-2639-7 URL pmid: 26520145
[39]	Klausberger, T., & Somogyi, P. (2008). Neuronal diversity and temporal dynamics: The unity of hippocampal circuit operations. Science, 321(5885), 53-57. https://doi.org/10.1126/science.1149381 doi: 10.1126/science.1149381 URL pmid: 18599766
[40]	Klin, A., Shultz, S., & Jones, W. (2015). Social visual engagement in infants and toddlers with autism: Early developmental transitions and a model of pathogenesis. Neuroscience and Biobehavioral Reviews, 50, 189-203. https://doi.org/10.1016/j.neubiorev.2014.10.006 doi: 10.1016/j.neubiorev.2014.10.006 URL pmid: 25445180
[41]	Liu, P., Xiao, G., He, K., Zhang, L., Wu, X., Li, D., ... Wang, K. (2020). Increased accuracy of emotion recognition in individuals with autism-like traits after five days of magnetic stimulations. Neural Plasticity, 2020, 9857987. https://doi.org/10.1155/2020/9857987
[42]	Lombardo, M. V., Chakrabarti, B., Bullmore, E. T., & Baron- Cohen, S. (2011). Specialization of right temporo-parietal junction for mentalizing and its relation to social impairments in autism. NeuroImage, 56(3), 1832-1838. https://doi.org/10.1016/j.neuroimage.2011.02.067 doi: 10.1016/j.neuroimage.2011.02.067 URL pmid: 21356316
[43]	Long, D., Yang, T., Chen, J., Dai, Y., Chen, L., Jia, F., ... Li, T. (2022). Age of diagnosis and demographic factors associated with autism spectrum disorders in chinese children: A multi-center survey. Neuropsychiatric Disease and Treatment, 18, 3055-3065. https://doi.org/10.2147/NDT.S374840 doi: 10.2147/NDT.S374840 URL pmid: 36606184
[44]	Maenner, M. J., Shaw, K. A., Baio, J., Washington, A., Patrick, M., DiRienzo, M., ... Dietz, P. M. (2020). Prevalence of autism spectrum disorder among children aged 8 years -- Autism and developmental disabilities monitoring network, 11 sites, United States, 2016. Morbidity and Mortality Weekly Report. Surveillance Summaries, 69(4), 1-12. https://doi.org/10.15585/mmwr.ss6904a1
[45]	McPartland, J. C., Bernier, R. A., Jeste, S. S., Dawson, G., Nelson, C. A., Chawarska, K., ... Webb, S. J. (2020). The autism biomarkers consortium for clinical trials (ABC-CT): Scientific context, study design, and progress toward biomarker qualification. Frontiers in Integrative Neuroscience, 14, 16. https://doi.org/10.3389/fnint.2020.00016
[46]	Monk, C. S., Peltier, S. J., Wiggins, J. L., Weng, S.-J., Carrasco, M., Risi, S., & Lord, C. (2009). Abnormalities of intrinsic functional connectivity in autism spectrum disorders. NeuroImage, 47(2), 764-772. https://doi.org/10.1016/j.neuroimage.2009.04.069 doi: 10.1016/j.neuroimage.2009.04.069 URL pmid: 19409498
[47]	Ni, H. C., Chen, Y. L., Chao, Y. P., Wu, C. T., Chen, R. S., Chou, T. L., Gau, S. S. F., & Lin, H. Y. (2023). A lack of efficacy of continuous theta burst stimulation over the left dorsolateral prefrontal cortex in autism: A double blind randomized sham-controlled trial. Autism Research, 16(6), 1247-1262. https://doi.org/10.1002/aur.2954
[48]	Ni, H. C., Chen, Y. L., Chao, Y. P., Wu, C. T., Wu, Y. Y., Liang, S. H. Y., ... Lin, H. Y. (2021). Intermittent theta burst stimulation over the posterior superior temporal sulcus for children with autism spectrum disorder: A 4-week randomized blinded controlled trial followed by another 4-week open-label intervention. Autism, 25(5), 1279-1294. https://doi.org/10.1177/1362361321990534
[49]	Oblak, A. L., Gibbs, T. T., & Blatt, G. J. (2010). Decreased GABA (B) receptors in the cingulate cortex and fusiform gyrus in autism. Journal of Neurochemistry, 114(5), 1414-1423. https://doi.org/10.1111/j.1471-4159.2010.06858.x
[50]	Patriquin, M. A., DeRamus, T., Libero, L. E., Laird, A., & Kana, R. K. (2016). Neuroanatomical and neurofunctional markers of social cognition in autism spectrum disorder. Human Brain Mapping, 37(11), 3957-3978. https://doi.org/10.1002/hbm.23288 doi: 10.1002/hbm.23288 URL pmid: 27329401
[51]	Philip, R. C. M., Dauvermann, M. R., Whalley, H. C., Baynham, K., Lawrie, S. M., & Stanfield, A. C. (2012). A systematic review and meta-analysis of the fMRI investigation of autism spectrum disorders. Neuroscience and Biobehavioral Reviews, 36(2), 901-942. https://doi.org/10.1016/j.neubiorev.2011.10.008 doi: 10.1016/j.neubiorev.2011.10.008 URL pmid: 22101112
[52]	Saxe, R., & Kanwisher, N. (2003). People thinking about thinking people. The role of the temporo-parietal junction in “theory of mind”. NeuroImage, 19(4), 1835-1842. https://doi.org/10.1016/s1053-8119(03)00230-1 doi: 10.1016/s1053-8119(03)00230-1 URL pmid: 12948738
[53]	Sheldrick, R. C., Maye, M. P., & Carter, A. S. (2017). Age at first identification of autism spectrum disorder: An analysis of two US surveys. Journal of the American Academy of Child and Adolescent Psychiatry, 56(4), 313-320. https://doi.org/10.1016/j.jaac.2017.01.012
[54]	Sokhadze, E., Baruth, J., Tasman, A., Mansoor, M., Ramaswamy, R., Sears, L., Mathai, G., El-Baz, A., & Casanova, M. F. (2010). Low-frequency repetitive transcranial magnetic stimulation (rTMS) affects event- related potential measures of novelty processing in autism. Applied Psychophysiology Biofeedback, 35(2), 147-161. https://doi.org/10.1007/s10484-009-9121-2
[55]	Sokhadze, E. M., El-Baz, A., Baruth, J., Mathai, G., Sears, L., & Casanova, M. F. (2009). Effects of low frequency repetitive transcranial magnetic stimulation (rTMS) on gamma frequency oscillations and event-related potentials during processing of illusory figures in autism. Journal of Autism and Developmental Disorders, 39(4), 619-634. https://doi.org/10.1007/s10803-008-0662-7 doi: 10.1007/s10803-008-0662-7 URL pmid: 19030976
[56]	Sokhadze, E. M., Lamina, E. V., Casanova, E. L., Kelly, D. P., Opris, I., Tasman, A., & Casanova, M. F. (2018). Exploratory study of rTMS neuromodulation effects on electrocortical functional measures of performance in an oddball test and behavioral symptoms in autism. Frontiers in Systems Neuroscience, 12, 20. https://doi.org/10.3389/fnsys.2018.00020
[57]	Sokhadze, G. E., Casanova, M. F., Kelly, D. P., Casanova, E. L., Russell, B., & Sokhadze, E. M. (2017). Neuromodulation based on rTMS affects behavioral measures and autonomic nervous system activity in children with autism. NeuroRegulation, 4(2), 65-78. https://doi.org/10.15540/nr.4.2.65
[58]	Solomon, M., Ozonoff, S. J., Cummings, N., & Carter, C. S. (2008). Cognitive control in autism spectrum disorders. International Journal of Developmental Neuroscience, 26(2), 239-247. https://doi.org/10.1016/j.ijdevneu.2007.11.001 doi: 10.1016/j.ijdevneu.2007.11.001 URL pmid: 18093787
[59]	Sperduti, M., Guionnet, S., Fossati, P., & Nadel, J. (2014). Mirror neuron system and mentalizing system connect during online social interaction. Cognitive Processing, 15(3), 307-316. https://doi.org/10.1007/s10339-014-0600-x doi: 10.1007/s10339-014-0600-x URL pmid: 24414614
[60]	Sun, X., Allison, C., Wei, L., Matthews, F. E., Auyeung, B., Wu, Y. Y., ... Brayne, C. (2019). Autism prevalence in China is comparable to western prevalence. Molecular Autism, 10, 7. https://doi.org/10.1186/s13229-018-0246-0
[61]	Tan, T., Wang, W., Xu, H., Huang, Z., Wang, Y. T., & Dong, Z. (2018). Low-frequency rTMS ameliorates autistic-like behaviors in rats induced by neonatal isolation through regulating the synaptic GABA transmission. Frontiers in Cellular Neuroscience, 12, 46. https://doi.org/10.3389/fncel.2018.00046
[62]	Towle, P. O., Patrick, P. A., Ridgard, T., Pham, S., & Marrus, J. (2020). Is earlier better? The relationship between age when starting early intervention and outcomes for children with autism spectrum disorder: A selective review. Autism Research and Treatment, 2020, 7605876. https://doi.org/10.1155/2020/7605876
[63]	Uddin, L. Q., Supekar, K., Lynch, C. J., Khouzam, A., Phillips, J., Feinstein, C., Ryali, S., & Menon, V. (2013). Salience network-based classification and prediction of symptom severity in children with autism. JAMA Psychiatry, 70(8), 869-879. https://doi.org/10.1001/jamapsychiatry.2013.104 doi: 10.1001/jamapsychiatry.2013.104 URL pmid: 23803651
[64]	Uddin, L. Q., Supekar, K., & Menon, V. (2010). Typical and atypical development of functional human brain networks: Insights from resting-state FMRI. Frontiers in Systems Neuroscience, 4, 21. https://doi.org/10.3389/fnsys.2010.00021
[65]	Vivanti, G., Prior, M., Williams, K., & Dissanayake, C. (2014). Predictors of outcomes in autism early intervention: Why don’t we know more. Frontiers in Pediatrics, 2, 58. https://doi.org/10.3389/fped.2014.00058
[66]	Wang, W., Liu, J., Shi, S., Liu, T., Ma, L., Ma, X., Tian, J., Gong, Q., & Wang, M. (2018). Altered resting-state functional activity in patients with autism spectrum disorder: A quantitative meta-analysis. Frontiers in Neurology, 9, 556. https://doi.org/10.3389/fneur.2018.00556
[67]	Wang, Y., Hensley, M. K., Tasman, A., Sears, L., Casanova, M. F., & Sokhadze, E. M. (2016). Heart rate variability and skin conductance during repetitive TMS course in children with autism. Applied Psychophysiology Biofeedback, 41(1), 47-60. https://doi.org/10.1007/s10484-015-9311-z
[68]	Yang, Y., Jiang, L., He, R., Song, P., Xu, P., Wang, Y., & Li, F. (2023). Repetitive transcranial magnetic stimulation modulates long-range functional connectivity in autism spectrum disorder. Journal of Psychiatric Research, 160, 187-194. https://doi.org/10.1016/j.jpsychires.2023.02.021 doi: 10.1016/j.jpsychires.2023.02.021 URL pmid: 36841084
[69]	Yang, Y., Wang, H., Xue, Q., Huang, Z., & Wang, Y. (2019). High-frequency repetitive transcranial magnetic stimulation applied to the parietal cortex for low- functioning children with autism spectrum disorder: A case series. Frontiers in Psychiatry, 10, 293. https://doi.org/10.3389/fpsyt.2019.00293
[70]	Yuan, L. X., Wang, X. K., Yang, C., Zhang, Q. R., Ma, S. Z., Zang, Y. F., & Dong, W. Q. (2024). A systematic review of transcranial magnetic stimulation treatment for autism spectrum disorder. Heliyon, 10(11), e32251. https://doi.org/10.1016/j.heliyon.2024.e32251
[71]	Zapparrata, N. M., Brooks, P. J., & Ober, T. M. (2023). Slower processing speed in autism spectrum disorder: A meta-analytic investigation of time-based tasks. Journal of Autism and Developmental Disorders, 53(12), 4618-4640. https://doi.org/10.1007/s10803-022-05736-3
[72]	Zewdie, E., Ciechanski, P., Kuo, H. C., Giuffre, A., Kahl, C., King, R., ... Kirton, A. (2020). Safety and tolerability of transcranial magnetic and direct current stimulation in children: Prospective single center evidence from 3.5 million stimulations. Brain Stimulation, 13(3), 565-575. https://doi.org/10.1016/j.brs.2019.12.025 doi: S1935-861X(19)30496-6 URL pmid: 32289678

来源	ASD人口学资料			rTMS干预参数					结果评估
来源	样本/男	岁数	智力	靶点	频率	强度	脉冲	刺激疗程	量表	得分	随访
Gómez et al., 2017	24/-	12.2	-	左侧dlPFC (F3)	1 Hz	90%RMT	1500	1次/天, 共20次	ADI-R	下降^***	6月效果持续
									ABC	下降^***
									ATEC	下降^***
吴野等, 2016	48/36	4.1	-	左侧dlPFC (F3)	10 Hz	100%AMT	-	1次/天, 共60次	ABC	101.88 to 89.64^***	-
									CARS	38.16 to 30.96^**
									DQ	59.04 to 65.8^**
Sokhadze et al., 2017	27/21	12.5	>80	双侧dlPFC (F3、F4)	0.5 Hz	90% RMT	160	1次/周, 共18周	ABC	下降^*	-
									RBS-R	下降^*
									SRS-2	下降^***
Kang et al., 2019	16/13	7.8	-	双侧dlPFC (5 cm)	1Hz	90%MT	180	2次/周, 共18次	ABC	下降^**	-
Kang et al., 2019	16/13	7.8	-	双侧dlPFC (5 cm)	1Hz	90%MT	180	2次/周, 共18次	ABC-社交	下降^**	-
Casanova, Shaban, et al., 2020	19/14	14.4	>80	双侧dlPFC (5 cm)	1 Hz	90%MT	180	1次/周, 共18周	RBS-R	23.74 to 5.21^*	-
									RBS-刻板	5.53 to 3.26^*
									RBS-强迫	3.95 to 2^*
									ABC-易怒	11.74 to 6.63^*
									ABC-多动	17.47 to 8.79^*
									ABC-社交	7.89 to 5.89^ns
Sokhadze et al., 2018	106/87	13.1	>80	双侧dlPFC (5 cm)	1 Hz	90%MT	180	1次/周, 共6/12/18周	RBS-R	26.5 to 14.6^*	-
									RBS-仪式	9.61 to 5.55^*
									RBS-刻板	5.71 to 2.73^*
									ABC-社交	11.5 to 6.42^*
									ABC-易怒	12.39 to 6.38^*
									ABC-多动	18.09 to 10.75^*
Abujadi et al., 2018	10/-	13	≥50	右侧dlPFC (T1)	iTBS	100%MT	900	5次/周, 共3周	RBS-R	27.4 to 13.3^ to 12.2^	5月效果持续
									YBOCS	11.8 to 8.5^* to 6.6^*
									WCST	0.30 to 0.23^* to 0.15^*
									Stroop	97.3 to 17.33^** to 78.67
李梦青等, 2018	60	5	≥70	双侧dlPFC	1 Hz	90%MT	400	5次/周, 共12周	RBS-R	8.40 to 6.87^*	-
李梦青等, 2018	60	5	≥70	双侧dlPFC	1 Hz	90%MT	400	5次/周, 共12周	ABC	53 to 43.2^*	-
Ni et al., 2021	73	8~17	>70	双侧pSTS	iTBS	80%AMT	600	2次/周, 4/8/12周	RBS-R	32.2 to 24.3^***	-
Ni et al., 2021	73	8~17	>70	双侧pSTS	iTBS	80%AMT	600	2次/周, 4/8/12周	SRS	107.3 to 97.2^***	-
Yang et al., 2023 Jiang et al., 2022	24/3	8.04	-	左侧IPL (P3)	15 Hz	50%机器强度	375	5次/周, 共3周	RBS-R	25.63 to 19.71^* to 20.96^*	4周效果持续
									SRS	107.8 to 100.6^* to 102.29^*
									ATEC-社交	20.88 to 16.92^* to 17.79^*
									ATEC-语言	12.13 to 10.29^* to 11.58
Yang et al., 2019	11/7	3~12	<70	左侧IPL (P3)	20 Hz	50%机器强度	500	5次/周, 共3周	ATEC-社交	19.8 to 13.6 to 12.2^*	6周持续
Yang et al., 2019	11/7	3~12	<70	左侧IPL (P3)	20 Hz	50%机器强度	500	5次/周, 共3周	ATEC-语言	16.1 to 12.1 to 9.8^*	6周持续

来源	ASD人口学资料			rTMS干预参数					结果评估
来源	样本/男	岁数	智力	靶点	频率	强度	脉冲	刺激疗程	量表	得分	随访
Gómez et al., 2017	24/-	12.2	-	左侧dlPFC (F3)	1 Hz	90%RMT	1500	1次/天, 共20次	ADI-R	下降^***	6月效果持续
									ABC	下降^***
									ATEC	下降^***
吴野等, 2016	48/36	4.1	-	左侧dlPFC (F3)	10 Hz	100%AMT	-	1次/天, 共60次	ABC	101.88 to 89.64^***	-
									CARS	38.16 to 30.96^**
									DQ	59.04 to 65.8^**
Sokhadze et al., 2017	27/21	12.5	>80	双侧dlPFC (F3、F4)	0.5 Hz	90% RMT	160	1次/周, 共18周	ABC	下降^*	-
									RBS-R	下降^*
									SRS-2	下降^***
Kang et al., 2019	16/13	7.8	-	双侧dlPFC (5 cm)	1Hz	90%MT	180	2次/周, 共18次	ABC	下降^**	-
Kang et al., 2019	16/13	7.8	-	双侧dlPFC (5 cm)	1Hz	90%MT	180	2次/周, 共18次	ABC-社交	下降^**	-
Casanova, Shaban, et al., 2020	19/14	14.4	>80	双侧dlPFC (5 cm)	1 Hz	90%MT	180	1次/周, 共18周	RBS-R	23.74 to 5.21^*	-
									RBS-刻板	5.53 to 3.26^*
									RBS-强迫	3.95 to 2^*
									ABC-易怒	11.74 to 6.63^*
									ABC-多动	17.47 to 8.79^*
									ABC-社交	7.89 to 5.89^ns
Sokhadze et al., 2018	106/87	13.1	>80	双侧dlPFC (5 cm)	1 Hz	90%MT	180	1次/周, 共6/12/18周	RBS-R	26.5 to 14.6^*	-
									RBS-仪式	9.61 to 5.55^*
									RBS-刻板	5.71 to 2.73^*
									ABC-社交	11.5 to 6.42^*
									ABC-易怒	12.39 to 6.38^*
									ABC-多动	18.09 to 10.75^*
Abujadi et al., 2018	10/-	13	≥50	右侧dlPFC (T1)	iTBS	100%MT	900	5次/周, 共3周	RBS-R	27.4 to 13.3^ to 12.2^	5月效果持续
									YBOCS	11.8 to 8.5^* to 6.6^*
									WCST	0.30 to 0.23^* to 0.15^*
									Stroop	97.3 to 17.33^** to 78.67
李梦青等, 2018	60	5	≥70	双侧dlPFC	1 Hz	90%MT	400	5次/周, 共12周	RBS-R	8.40 to 6.87^*	-
李梦青等, 2018	60	5	≥70	双侧dlPFC	1 Hz	90%MT	400	5次/周, 共12周	ABC	53 to 43.2^*	-
Ni et al., 2021	73	8~17	>70	双侧pSTS	iTBS	80%AMT	600	2次/周, 4/8/12周	RBS-R	32.2 to 24.3^***	-
Ni et al., 2021	73	8~17	>70	双侧pSTS	iTBS	80%AMT	600	2次/周, 4/8/12周	SRS	107.3 to 97.2^***	-
Yang et al., 2023 Jiang et al., 2022	24/3	8.04	-	左侧IPL (P3)	15 Hz	50%机器强度	375	5次/周, 共3周	RBS-R	25.63 to 19.71^* to 20.96^*	4周效果持续
									SRS	107.8 to 100.6^* to 102.29^*
									ATEC-社交	20.88 to 16.92^* to 17.79^*
									ATEC-语言	12.13 to 10.29^* to 11.58
Yang et al., 2019	11/7	3~12	<70	左侧IPL (P3)	20 Hz	50%机器强度	500	5次/周, 共3周	ATEC-社交	19.8 to 13.6 to 12.2^*	6周持续
Yang et al., 2019	11/7	3~12	<70	左侧IPL (P3)	20 Hz	50%机器强度	500	5次/周, 共3周	ATEC-语言	16.1 to 12.1 to 9.8^*	6周持续