A lack of efficacy of continuous theta burst stimulation over the left dorsolateral prefrontal cortex in autism: A double blind randomized sham-controlled trial.
cTBS over the left front brain adds no extra help for autism, so spend your hours on proven ABA and social-skills plans.
01Research in Context
What this study did
Researchers tested a brain-zap method called cTBS on sixty kids, teens, and adults with autism.
The coil sat over the left front of the brain for a few minutes each visit.
Half got real zaps, half got fake zaps. No one knew which was which.
What they found
After eight and twelve weeks, both groups looked the same on social, language, and behavior scores.
Real cTBS did no better than pretend cTBS.
How this fits with other research
Two other teams tried mild brain stimulation on autistic youth and saw gains. Aydin et al. (2025) used tDCS and saw better social talk, but they had no control group. Han et al. (2023) added tDCS plus computer games and saw social growth in a real RCT.
Those positive results clash with this null finding. The gap is mostly about method: tDCS gives a steady low current, cTBS gives quick bursts, and the two positive studies used extra training or bigger samples.
Strydom et al. (2020) also ran a tight RCT and found no benefit from a behavior program for autistic adults, showing that solid trials sometimes just say “no.”
Why it matters
You can skip cTBS for now. If you want to try brain stimulation, pick tDCS paired with social-cognitive drills and track data carefully. Keep funding and time focused on ABA and evidence-based social skills packages until clearer dose and coil answers arrive.
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02At a glance
03Original abstract
Although previous open-label trials suggest the therapeutic potential of inhibitory repetitive transcranial magnetic stimulation (rTMS) over the dorsolateral prefrontal cortex (DLPFC) in autism spectrum disorder (ASD), methodological caveats exist. We conducted an 8-week randomized, double-blind sham-controlled trial to investigate the efficacy of inhibitory continuous theta burst stimulation (cTBS, a variant of rTMS) over the left DLPFC in individuals with ASD. Sixty children, adolescents and young adults (aged 8-30 years) with ASD without co-occurring intellectual disabilities were randomized to a 16-session 8-week cTBS versus sham stimulation course, with a follow-up 4 weeks after the trial. The Active group was not superior to the Sham group in any clinical or neuropsychological metrics at Week 8 or Week 12. Time effects of 8-week cTBS on symptoms and executive function were remarkable in both Active and Sham groups, with comparable response rates and effect sizes of changes in symptoms/cognition between groups. Our results from a sufficiently powered sample do not endorse the superior efficacy of cTBS over the left DLPFC to the shamed stimulation for children, adolescents and adults with ASD. These findings suggest that earlier positive open-label trial findings may be generalized by generalized/placebo effects. This highlights the urgent need for more rTMS/TBS studies with rigorous trial designs in ASD.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1002/aur.2954