Table 2.

Published Reports of Therapeutic Use of TMS in ASD

Paper	Diagnosis	Intellectual Disability	n (ASD)	Mean age (years)	Gender	Medication	Site	Coil	Frequency	Intensity	Duration
Sokhadze et al. [2009], Journal of   Autism and Developmental Disorders   (RCT with waitlist control)	Autism	None	13 (8rTMS,   5 waitlist)	17	M	–	L dlPFC (5cm anterior to   M1)	Fo8	0.5 Hz	90% RMT	10 min
Baruth et al. [2010], Journal of   Neurotherapy (RCT with waitlist control)	ASD	2	25 (16rTMS,   9 waitlist)	14	M/F	–	L & R dlPFC (5cm ante-   rior to M1)	Fo8	1 Hz	90% RMT	10 min
Sokhadze et al. [2010], Applied   Psychophysiology and Biofeedback   (Clinical trial with no control)	Autism	None	13	16	M/F	–	L dlPFC (5cm anterior to   M1)	Fo8	0.5 Hz	90% RMT	10 min
Enticott et al. [2011], Journal of ECT   (Single case study)	AS	None	1	20	F	None	Bilateral dmPFC (7cm   anterior to M1)	H-coil	5 Hz	100% RMT	15 min
Fecteau et al. [2011], European Journal   of Neuroscience (Crossover trial with   sham control)	AS	None	10	37	M/F	None	L & R pars opercularis, L   & R par triangularis   (MRIneuronaviga   tion), sham (central   lobe midline)	Fo8	1 Hz	70% of   stimulator   output	30 min
Casanova et al. [2012], Translational   Neuroscience (RCT with waitlist control)	ASD	None	45 (25 rTMS,   20 waitlist)	13	M/F	-	L & R dlPFC (5cm ante-   rior to M1)	Fo8	1 Hz	90% RMT	10 min
Enticott et al. [2012], Brain Stimulation   (Crossover trial with sham control)	ASD (6   HFA, 5 AS)	None	11	18	M/F	-	SMA (15%of nasion to   inion anterior to Cz),   L M1, Sham (M1)	Fo8	1 Hz	100% RMT	15 min
Niederhofer [2012], Clinical Neuropsychiatry   (Single case study with placebo)	Autism	Not reported	1	42	F	None	M1	–	1 Hz	–	1 hr
Sokhadze et al. [2012], Applied Psychophysiology   and Biofeedback (RCT with waitlist control)	ASD (36   HFA, 4 AS)	None	40 (20 rTMS,   20 waitlist)	14	M/F	–	L & R dlPFC (5cm ante-   rior to M1)	Fo8	1 Hz	90% RMT	10 min
Panerai et al. [2013], Autism ((i) Crossover trial   with sham; (ii) RCT with sham; (iii) crossover   trial with sham iv) RCT (TMS, EHI training,   TMS + EHI training))	Autism	Severe to   profound	(i) 9 (ii) 17 (iii) 4 (iv) 13	(i) 14 (ii) 13 (iii) 16 (iv) 13	M	–	(i) left and right PrMC   (2.5 cm anterior to   M1) (ii), (iii), iv) left PrMC	Fo8	(i) 8 Hz, 1 Hz (ii) 8 Hz, 1 Hz (iii), (iv) 8 Hz	90% RMT	8 Hz 30 min, 1 Hz 15 min;
Enticott et al. [2014], Brain Stimulation   (RCT with sham control)	ASD (4 HFA, 24 AS)	None	28 (15active,   13 sham)	33	M/F	Yes (39%)	dmPFC (7cm anterior to   M1)	H-coil	5 Hz	100% RMT	15 min
Cristancho et al. [2014], Journal of ECT   (Single case study)	Autism,   Depression	Not reported	1	15	M	olanzapine,   fluoxetine,   guanfacine,   clonazepam	(i) R DLPFC (6cm anterior to M1),   (ii) L DLPFC (6cm anterior to M1)	Fo8	1 Hz	0% RMT	Variable   (between   5 to 25 min)
Casanova et al. [2014], Frontiers in Human   Neuroscience (Proof of feasibility study,   no control)	ASD	None	18	13	M/F	–	L & R dlPFC (5cm ante-   rior to M1)	Fo8	5 Hz	90% RMT	10 min
Sokhadze et al. [2014a], Frontiers in   Systems Neuroscience (RCL with   waitlist control)	ASD	None	27	14.5	M/F	–	L & R dlPFC (5cm ante-   rior to M1)	Fo8	1 Hz	90% RMT	10 min
Sokhadze et al. [2014b], Appl Psychophysiol   Biofeedback (Clinical trial with waitlist   control)	ASD	None	42	14.5	M/F	–	L & R dlPFC (5cm ante-   rior to M1)	Fo8	1 Hz	90% RMT	10 min

Paper	Trains	Pulses Delivered	Sessions	Blinding	Measures	Assessment Times	Reported Effects	Side Effects
Sokhadze et al. [2009],   Journal of Autism and   Developmental   Disorders	15 × 10 sec,   20–30 sec ISI	150	6	None	EEG Gamma power Accuracy,   RT (Kanizsa), Abberant   Behavior Checklist (ABC),   Social Responsiveness   Scale (SRS) (Caregiver-   report), Repetitive Behavior Scale-   Revised (RBS-R)	Before and two   weeks after treat-   ment course	Decreased frontal EEG P3a amplitude   to non-targets following TMS Decreased centro-parietal latency   EEG P3b to nontarget and non-   Kanizsa following TMS Decrease in gamma power for non-   target and non-Kanizsa following   TMS Reduced repetitive behavior (RBS-R)   following TMS	–
Baruth et al. [2010],   Journal of   Neurotherapy	15 × 10 sec,   20–30 s ISI	150	12 (6 L, 6 R)	None	EEG Gamma power Accuracy,   RT (Kanizsa), Abberant   Behavior Checklist (ABC),   Social Responsiveness   Scale (SRS) (Caregiver-   report), Repetitive Behavior Scale-   Revised (RBS-R)	Before and two   weeks after treat-   ment course	Increased EEG gamma power to tar-   gets, decrease to nontargets Reduced repetitive behavior (RBS-R)   Reduced irritability (ABC)	Itching sensation at   nose (5) Mild headache (1)
Sokhadze et al. [2010],   Applied Psychophysi-   ology and   Biofeedback	15 × 10 sec,   20–30 sec ISI	150	6	None	EEG event-related potentials   (visual oddball) Accuracy,   RT (Kanizsa) Abberant   Behavior Checklist (ABC)   Social Responsiveness   Scale (SRS) (Caregiver-   report) Repetitive Behavior   Scale-Revised (RBS-R)	Before and two   weeks after treat-   ment course	Reduced error rate Increased frontal EEG P50 amplitude   to targets Increased frontal EEG P50 latency to   targets Decreased frontal EEG N200 latency   to novel distractors Decreased parieto-occipital EEG P50   to novel distractor Increased centro-parietal EEG P50 to   targets and decreased to standard   distractor Centro-parietal EEG P3b amplitude   increase to targets and decrease to   standard distractors Centro-parietal EEG P200 increased   latency to targets Reduced repetitive behaviors (RBS-   R)	–
Enticott et al. [2011],   Journal of ECT	30 × 10 sec,   20 sec ISI	1500	10	Double	IRI, AQ, RAADS	Before, after, and   one-month after   treatment course	Reduction on all measures Anecdotal   reports of improvement from   patient and relatives	None
Fecteau et al. [2011],   European Journal of   Neuroscience	1	1800	1 per site	Double	Response latency on Boston   Naming Test	Before and after TMS	Increased response latency after L   pars opercularis Decreased response latency after L   pars triangularis	Many reported,   including: Sleepy,   Trouble concen-   trating, Improved   mood, Headache,   Dizziness
Casanova et al. [2012],   Translational   Neuroscience	15 × 10 sec,   20–30 sec ISI	150	12 (6 L, 6 R)	None	EEG event-related potentials   (ERP) Accuracy, RT   (Kanizsa), Abberant   Behavior Checklist (ABC),   Social Responsiveness   Scale (SRS) (Caregiver-   report), Repetitive Behav-   ior Scale - Revised (RBS-   R)	Before and two   weeks after treat-   ment course	Reduced error rate Increased frontal   EEG N200 to targets Reduced frontal EEG N200 latency   Increased frontal RHEEG P300 to   targets Increased parietal EEG N200 to tar-   gets, Reduced repetitive behavior   (RBS) Reduced irritability (ABC)	–
Enticott et al. [2012],   Brain Stimulation	1	900	1 per site	Single	EEG movement-related corti-   cal potentials Motor   response time	Before and after TMS	SMA: increased early EEG component   PMC: increased EEG negative slope	–
Niederhofer [2012], Clin-   ical Neuropsychiatry	1	1200	5	Single	Abberant Behavior Checklist   (ABC)	Before and after   treatment course	ABC Irritability: Active 40 to 33,   Sham 39 to 35, ABC Sterotypy:   Active 18 to 12, Sham 16 to 15	–
Sokhadze et al. [2012],   Applied Psychophysi-   ology and   Biofeedback	15 × 10 sec,   20–30 sec ISI	150	12 (6 L, 6 R)	None	EEG event-related potentials   (ERPs) RT Accuracy (Kanizsa)	Before and after   treatment course	Reduced omission error rates   Increased EEG ERN amplitude   Reduced EEG ERN latency	–
Panerai et al. [2013],   Autism	8 Hz 30 × 3.6 sec, 56.4 sec ISI	900	i) 3; ii) 10; iii) 5 active, 5 sham, 5 active, 5 sham; iv) 10	Double	(i), (ii), (iii), (iv) Psycho-   educational Profile-   Revised (PEP-R) eye-hand   coordination;	Before and after   treatment course	(i), (ii), (iii) improved eye-hand   coordination score following lPrMC   HF TMS iv) Improved eye-hand   coordination score following com-   bined TMS + EHI training compared   to each technique alone	–
Enticott et al. [2014],   Brain Stimulation	30 × 10 sec,   20 sec ISI	1500	10	Double	Interpersonal Reactivity Index (IRI) Autism Spectrum Quotient   (AQ) Ritvo Autism-Aspergers Diag-   nostic Scale (RAADS) Reading the Mind in the   Eyes Test (RMET)   Mentalizing Animations Task	Before, after, and   one-month after   treatment course	Reduced social relatedness (RAADS)   Reduced personal distress (IRI)	1. “light-   headedness” 2. facial discomfort   during rTMS
Cristancho et al. [2014],   Journal of ECT	(i) 15 × 10 sec,   10–30 sec ISI (week 1), 30 ×   10 sec, 10–30 sec   ISI (week 2),   (ii) 30–60 × 10 sec,   10–15 sec ISI	(i) 150–300, (ii) 300–600	(i) 10, (ii) 26	None	Mental status examination	Before and after   treatment course	Anecdotal reports of improve mood,   eye contact, interpersonal commu-   nication, verbal expression, focus,   activity	Mild headaches, jaw   twiching, tran-   sient dizziness
Casanova et al. [2014],   Frontiers in Human   Neuroscience	8 × 10 sec,   20 sec ISI	160	18	None	Aberrant Behavior Checklist,   restricted Behavior Pat-   tern, Time- domain meas-   ures of HRV (R-R interval,   SDNN, RMSSD, pNN50),   Frequency –domain meas-   ures of HRV (LV and HF of   HRV, LF/HF ratio index),   SCL	Before and 2 weeks   after treatment	Increase in R-R interval, SDNN, and   HF power. Significant decrease in   the LF/HF ratio and SCL. Signifi-   cant improvements in RBS-R and   ABC rating scores.	None
Sokhadze et al. [2014a],   Frontiers in Systems   Neuroscience	9 × 20 sec,   20–30 sec ISI	180	18	None	Aberrant Behavior Checklist   (ABC), Repetitive Behav-   ior Scale (RBS-R), EEG   event related potentials   (ERPs), RT and post-error   RT	Before and after	Decreased irritability and hyperactiv-   ity on the Aberrant Behavior   Checklist (ABC), and decreased   stereotypic behaviors on the   Repetitive Behavior Scale (RBS-R).   Decreased amplitude and pro-   longed latency in the frontal and   fronto-central N100, N200, and   P300 (P3a) ERPs to non-targets.   Increased amplitude of P2d (P2a   to targets minus P2a to non-tar-   gets) and centro-parietal P100   and P300 (P3b) to targets.   Decrease in latency and increase   in negativity of ERN during com-   mission errors.	None
Sokhadze et al. [2014b],   Appl Psychophysiol   Biofeedback	9 × 20 sec,   20–30 sec ISI	180	18	None	Aberrant Behavior Checklist,   Repetitive Behavior Scale-   Revised, EEG Gamma   power, Theta/Beta ratio,   RT and Accuracy, Post-   error RT, EEG event   related potentials (ERPs)	Before and after	Integrated TMS-NFB treatment   enhanced the process of target   recognition. Significant improve-   ments in RBS-R and ABC rating   scores. Improvement in both early   and later stage ERP indices.	None

ASD, Autism Spectrum Disorder; HFA, High Functioning Autism; AS, Asperger’s Syndrome; M1, Primary Motor Cortex; dlPFC, Dorsolateral Prefrontal Cortex; dmPFC, Dorsomedial Prefrontal Cortex; Fo8, Figure of 8 coil; ISI, Interstimulus Interval; rTMS, Repetitive Transcranial Magnetic Stimulation; RMT, Resting Motor Threshold.