Autism spectrum disorder (ASD) refers to a broad range of several dozen behavioral symptoms, which researchers sometimes categorize in different ways. However, two of the main symptoms are difficulties in social interaction, including both verbal and nonverbal communication, and repetitive behaviors, again both verbal and nonverbal. Many of those with ASD, along with their families, spend considerable time and energy seeking and trying out ways of alleviating the symptoms. Most of the currently available interventions for those with ASD involve either drugs for symptoms like anxiety, depression, inattentiveness, sleeplessness, and others, or classes that teach social skills, daily living skills, adaptive coping, and problem solving. For many, these approaches lead to real gains. But few of those with autism, or their families, are fully satisfied with the results.
Some neuroscientists are now exploring the use of TMS to address two of the core challenges associated with ASD: difficulties in social interaction and repetitive behaviors. This research has moved through its earliest stages, and now is beginning to expand. By the start of 2016, the results of clinical studies in which TMS had been used with therapeutic intent for a total of more than 100 individuals with ASD have been published in professional scientific journals. In the United States, much of this published work has been carried out by researchers at Harvard University/Beth Israel Deaconess Medical Center/Boston Children’s Hospital and at the University of Louisville.
A number of individuals in these pilot studies have shown improved social skills and other executive functioning. Among the benefits experienced by some of those receiving TMS therapy were significant and prolonged improvement in social functioning, both in an ability to read nonverbal cues and to interact in conventional ways, and a reduction in rigidity and OCD-type behaviors as a result. They became more “clearly present” to themselves, more able to project conventional demeanor, and more able to manage the unspoken expectations and nuances of human interactions.
The accumulating evidence concerning the potential of TMS for ASD includes some compelling anecdotes. The founder of the Clearly Present Foundation, Kim Hollingsworth Taylor, observed her son Nick before and after TMS. In his case, the effects were not long-lasting and faded after several months. She noted: :“We could have gotten him social skills classes for the rest of his life and he wouldn’t have been able to do what he could do after 40 seconds of TMS.”
One prominent public example of the potential for TMS therapy John Elder Robison, author of several best-selling books including Look Me in the Eye (2007), Be Different (2011), and Raising Cubby (2013). His most recent book Switched On: A Memoir of Brain Change and Emotional Awakening (2016), specifically focuses on how his TMS treatment changed his life. Robison has autism, but found his ability to navigate what he called the “social disabilities” of his condition to be dramatically improved after a series of TMS treatments by the Harvard-based researchers. In John’s words:
“The difference is striking. The range in my voice, the life in my face, my animation and engagement . . . it’s remarkable.” “What TMS gave me is the same ability the other 99% of humanity takes for granted – the ability to read ordinary nonverbal cues from people. That’s the grease that makes social interaction work.”
John gives an overview of his experiences with TMS in a post originally published on his blog back in 2012 at http://jerobison.blogspot.com/p/use-of-tms-transcranial-magnetic.html. Or for a vivid demonstration of the potential of TMS treatments for autism, watch some footage of John in conversation recorded before his TMS treatments and after.
Clearly, the definitive scientific case for TMS as a treatment for some core symptoms of ASD is still under construction. Anecdotes can offer a powerful pointer, but as scientists sometimes say, “The plural of anecdotes is not data.” At this point, the published clinical studies involve a relatively small number of patients. In addition, the studies have used a range of treatment protocols: for example, some studies use 600 bursts of stimulation over 40 seconds, while others use one burst of stimulation per second over 30 minutes or more. Studies also differ in other aspects of the stimulation patterns, like the specific location of the brain that is stimulated, the number of days of treatments in a session, or what tests are used to monitor and measure the effects of the treatment. In addition, the research focus to date has mostly been on patients with high-functioning autism. In some cases the results of a multi-week session of TMS treatments on the symptoms of autism barely apparent at all; in other cases they were apparent only for days or weeks; and in still other cases for months or even longer. This finding is part of a broader agenda of brain scientists and psychologist, who are studying how the brain can change and adapt through a process known as “neuroplasticity.” Further research is needed, in particular to expand the number of subjects and to develop a set of TMS protocols that are most likely to be effective.
While the research on TMS for certain key symptoms of autism is admittedly in its early stages, a growing body of empirical evidence clearly supports the case that it is an area of study worth pursuing.