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right inferior frontal gyrus), HD-tDCS signicantly increased the average amplitude levels of P300 and N200in patients compared to sham stimulation, but no
signicant improvement was observed in working memory tasks, and there was no
signicant difference compared to traditional tDCS [63]. Breitling-Ziegler etal. further found that after 5days of HD-tDCS stimulation on the right inferior frontal
gyrus of 33 children and adolescents with ADHD, compared to sham stimulation,
0.25mA stimulation resulted in an increase in error rate in the nogo task, while
0.5mA showed a reduction in omission errors. The therapeutic effect of HD-tDCS
appears to be related to the current intensity [52]. Additionally, another study involving 56 adult ADHD patients found that while HD-tDCS targeting the right dorsolateral prefrontal cortex signicantly improved cognitive measures of attention
maintenance, it did not signicantly alleviate overall symptoms of hyperactivity
patients [53].
M. Gu et al.
8.3.2.2 Safety
The side effects of HD-tDCS are similar to traditional tDCS, typically including
scalp irritation, mild headache, and the like. However, due to its more focused current, local stimulation sensation may be slightly stronger than traditional tDCS, and
its side effects are mostly transient and mild.
8.3.2.3 Treatment Regimen
Existing studies indicate that current intensity affects treatment outcomes, with low
current potentially leading to impaired inhibitory behavior in ADHD patients. In
addition, the stimulation area is also related to treatment outcomes. However, due to
the limited number of studies and lack of evidence, specic stimulation parameters
and treatment durations require further exploration.
HD-tDCS is especially suitable for patients who require precise control of brain
regions, particularly individuals who show poor responsiveness to traditional tDCS
or other noninvasive neurostimulation methods.
8.3.2.4 Clinical Recommendations
HD-tDCS is especially suitable for patients who require precise control of brain
regions, particularly individuals who show poor responsiveness to traditional tDCS
or other noninvasive neurostimulation methods. As shown in Table8.2.
8.4 TMS vs. tDCS
8.4.1 Efficacy
Noninvasive brain stimulation (NIBS) is a potential tool to promote neuroplasticity
by altering the brain activity of specic cortical regions and their networks. Among
the NIBS techniques, the most commonly used are transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) [64]. Low-frequency
(<1 Hz) TMS usually have an inhibitory effect, high-frequency (>5 Hz) TMS
8 Attention Decit Hyperactivity Disorder
235
increase cortical excitability [42]. In contrast, tDCS regulates brain excitability by
applying a low-amplitude (0.2–0.5mA) current through electrodes on the scalp.
The short-term effects of tDCS are achieved by resting potential, while the longterm effects are attributed to NMDA-dependent mechanisms and synaptic plasticity
[65]. It is generally believed that anode tDCS can excite the function of the cortical
region, while cathode tDCS has an inhibitory effect.
In treating ADHD patients, tDCS and TMS have shown different therapeutic
effects in alleviating symptoms. The therapeutic effect of TMS is mainly reected
in the relief of symptoms such as inattention, while tDCS mainly improves the
executive function of patients. The effectiveness of tDCS is also different for different populations, and tDCS can treat inattention in adult patients [50]. Low-frequency
rTMS on the left DLPFC and high-frequency rTMS on the right DLPFC improved
inattention, hyperactivity, and impulsivity in the subjects [23]. Anode-left DLPFC
tDCS had the most signicant effect on executive control function, while cathodeleft DLPFC tDCS improved suppression control [66]. tDCS stimulation of the left
DLPFC may improve impulsive symptoms of ADHD, supporting the therapeutic
potential of tDCS in adults with ADHD.In addition to this, tDCS may also improve
language uency in children with ADHD [60]. Therefore, the two treatment methods can achieve complementary effects in the treatment of ADHD. In summary,
physical nerve stimulation can be used to treat ADHD, and the therapeutic effect is
promising.
8.4.2 Safety
Both TMS and tDCS are considered to be well-tolerated and have an acceptable
safety prole [67]. In terms of safety, TMS is a noninvasive, noninvasive brain stimulation technique. In the current study, the main adverse effects observed included
mild headache and localized scalp discomfort, and no serious adverse effects were
observed. Generally speaking [68], tDCS is also a safe technique because it works
with a low-amplitude current, which mainly causes tingling, burning, and discomfort on the scalp of the subject. But it is also mild and transient, within the tolerable
range [69]. In summary, the two brain stimulation techniques can be used to treat a
variety of mental disorders, including ADHD, and are reliable in safety.
8.5 Conclusion
The number of studies evaluating the efcacy of noninvasive brain stimulation
(especially TMS and tDCS) in the treatment of children with ADHD is still small,
and the study design is highly heterogeneous. Although the efcacy of TMS and
tDCS is mixed, they both hold promise as treatment options for people with
ADHD.Considering that the optimal indications, short-and long-term efcacy, and
the interaction between different brain stimulation techniques in the treatment of
ADHD children are still unclear, rigorous clinical studies are needed to conrm.
236
M. Gu et al.
Noninvasive brain stimulation technology has the advantages of good safety and
small adverse reactions, has shown certain efcacy in the treatment of ADHD children, and has great application prospects. It is expected that these approaches can
help enhance our understanding of the underlying pathological mechanisms and
treatments of ADHD, ultimately achieving effective outcomes.
Acknowledgments None.
Disclosure/Conicts of Interest The authors declare no conicts of interest in conducting this
study or preparing the manuscript.
Financial Support None.
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M. Gu et al.
Autism Spectrum Disorder
Shi-BinWang, LinyanFu, JinmingLiu, MinDong,
andFanYang
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social communication decits, repetitive behaviors, and restricted interests (RRBI). Currently, there is no single medication that alleviates the core
symptoms of ASD, but noninvasive brain stimulation alternatives have been
explored and developed. The evidence to date supports the efcacy of noninvasive neuromodulation techniques, including transcranial magnetic stimulation
(TMS), theta burst stimulation (TBS), magnetic seizure therapy (MST), and transcranial direct current stimulation (tDCS), which will be discussed in this chapter.
Keywords
9
rTMS · dTMS · TBS · MST · tDCS
S.-B. Wang · L. Fu · M. Dong · F. Yang (*)
Guangdong Mental Health Center, Guangdong Provincial People’s Hospital
(Guangdong Academy of Medical Sciences), Southern Medical University,
Guangzhou, Guangdong Province, China
e-mail: yangfan@gdph.org.cn
J. Liu
Department of Maternal and Child Health, School of Public Health,
Sun Yat-sen University, Guangzhou, Guangdong Province, China
© The Author(s), under exclusive license to Springer Nature Singapore Pte
Ltd. 2025
W. Zheng, Y. Ning (eds.), TMS and tDCS for Psychiatric Disorders,
https://doi.org/10.1007/978-981-96-8504-2_9
241
242
Abbreviations
ABA applied behavior analysis
ABC autism behavior checklist
ADHD attention-decit hyperactivity disorder
ALT autism-like traits
APOE apolipoprotein E
AQ autism-spectrum quotient
ASD autism spectrum disorder
ATEC autism treatment evaluation checklist
BDNF brain-derived neurotrophic factor
CARS childhood autism rating scale
cTBS the continuous theta-burst stimulation
DAN the dorsal attention network
DLPFC dorsolateral prefrontal cortex
DMN default mode network
ECT electroconvulsive therapy
FXS fragile X syndrome
HD-tDCS high-denition tDCS
HF high frequency
iTBS intermittent TBS
LF low-frequency
LTP long-term potentiation
M1 motor cortex
MEPs motor-evoked potentials
MST magnetic seizure therapy
mPFC medial prefrontal cortex
NIBS noninvasive brain stimulation
OCD obsessive-compulsive disorder
pSTS posterior superior temporal sulcus
RCTs randomized controlled trials
RpSTS the right posterior superior temporal sulcus
RRBI repetitive and restricted behaviors and interests
rTMS repetitive transcranial magnetic stimulation
rTPJ the right temporoparietal junction
SRS-2 social responsiveness scale-2
SSRIs selective serotonin reuptake inhibitors
sTMS synchronized TMS
SMN sensorimotor network
TBS theta burst stimulation
TDC typically developing children
tDCS transcranial direct current stimulation
S.-B. Wang et al.
9 Autism Spectrum Disorder
243
TEACCH the treatment and education of autistic and communication-related
handicapped children
tES transcranial electrical stimulation
TMS transcranial magnetic stimulation
VLPFC the ventrolateral prefrontal cortex
VmPFC the ventromedial prefrontal cortex
WHO The World Health Organization (WHO)
9.1 Introduction
Autism spectrum disorder (ASD) is characterized by core impairments in social
communication, repetitive and restricted behaviors and interests (RRBI). It is a neurodevelopmental disorder that emerges in early childhood, although the symptoms
may not be immediately apparent.
Despite the inuence of various factors, including the investigation period,
research program, and tools, the prevalence of ASD has generally increased globally over the past 20–30years. The World Health Organization (WHO) has suggested that the average prevalence of ASD is 1%. This disorder is widely considered
a chronic disease with a poor long-term prognosis. Early diagnosis and intervention
are crucial for improving the prognosis.
Pharmacotherapies are frequently utilized in individuals with ASD, yet these
medications do not target the core decits of the condition. The majority of evidence supporting the treatment of RRBI or comorbid disorders points to risperidone, aripiprazole, methylphenidate, and selective serotonin reuptake inhibitors
(SSRIs). The adverse effects of medications used in ASD treatment should be systematically monitored. Education and behavioral intervention training are the most
prevalent rehabilitation strategies in ASD treatment. Applied behavior analysis
(ABA) and the treatment and education of autistic and communication-related
handicapped children (TEACCH) are the most recognized and evidence-based therapies for ASD.It is crucial to bolster family support and empower parents to foster
their child’s development within the family unit. This can encompass techniques to
encourage communication, manage behavior, and promote social interaction. With
comprehensive guidance, parents can collaborate with teachers and doctors to
implement these treatments.
Noninvasive brain stimulation (NIBS) techniques, such as transcranial magnetic
stimulation (TMS) and transcranial direct current stimulation (tDCS), have recently
been used to investigate the pathophysiology of various neuropsychiatric disorders,
including ASD.These techniques are also being explored for the treatment of core
and associated symptoms of ASD.This chapter will describe the effectiveness and
safety of these NIBS treatments for ASD.