The impact of prefrontal transcranial direct current stimulation (tDCS) on theory of mind, emotion regulation and emotional-behavioral functions in children with autism disorder: A randomized, sham-controlled, and parallel-group study.
Ten brief tDCS sessions over both sides of the forehead lifted communication, theory-of-mind, and emotion control in 7- to 12-year-old autistic children.
01Research in Context
What this study did
Zemestani et al. (2022) tested ten short sessions of gentle brain stimulation called tDCS. Kids wore a small sponge clip on the left and right forehead while they played or rested.
The team worked with autistic children aged 7 to 12. Half got real stimulation, half got fake. Everyone kept taking turns talking, feeling, and playing games before and after.
What they found
Children who got real tDCS talked more clearly, understood others' thoughts better, and stayed calmer when upset.
These gains stayed strong one month later. The sham group did not show the same jump.
How this fits with other research
Samadi et al. (2021) saw a similar lift in theory-of-mind after only one session aimed at a nearby spot. Both studies show prefrontal tDCS can nudge social thinking in autistic kids.
Hsing-Liu et al. (2025) tried daily magnetic bursts in youth who also have intellectual disability. They proved the method is safe, but saw no skill gain. The milder tDCS sample in Mehdi et al. had clearer benefits, hinting that age and ability level shape results.
Fisher et al. (2005) taught theory-of-mind with stories and questions years earlier. Their lessons worked, yet the new zap-plus-play approach may save staff time while giving a similar boost.
Why it matters
You now have a low-cost, ten-session add-on that can speed up communication and self-control in elementary-aged autistic clients. Pair brief tDCS with your usual social-skills program, track mood and language each day, and watch for carry-over at home.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Ask your medical partner to map bilateral DLPFC spots and add five minutes of tDCS before peer-chat practice.
02At a glance
03Original abstract
Advances in our knowledge about the neuropsychological mechanisms underlying core deficits in autism spectrum disorder (ASD) have produced several novel treatment modalities. One of these approaches is modulation of activity of the brain regions involved in ASD symptoms. This study examined the effects of transcranial direct current stimulation (tDCS) over the dorsolateral prefrontal cortex (DLPFC) on autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functions in children with ASD. Thirty-two children (Mage = 10.16, SD = 1.93, range 7-12 years) diagnosed with ASD were randomly assigned to active (N = 17) or sham stimulation (N = 15) groups in a randomized, sham-controlled, parallel-group design. Participants underwent 10 sessions of active (1.5 mA, 15 min, bilateral left anodal/right cathodal DLPFC, 2 sessions per week) or sham tDCS. Autism symptom severity, theory of mind, emotion regulation strategies, and emotional-behavioral functioning of the patients were assessed at baseline, immediately after the intervention, and 1 month after the intervention. A significant improvement of autism symptom severity (i.e., communication), theory of mind (i.e., ToM 3), and emotion regulation strategies was observed for the active as compared to the sham stimulation group at the end of the intervention, and these effects were maintained at the one-month follow-up. The results suggest that repeated tDCS with anodal stimulation of left and cathodal stimulation of right DLPFC improves autism symptom severity as well as social cognition and emotion regulation in ASD. LAY SUMMARY: Previous research has suggested that targeting core mechanisms underlying cognitive-emotional and behavioral deficits of autistic children might improve symptoms of ASD. Deficient social and behavioral functioning, impaired theory of mind, and emotional regulation deficits have been identified as core treatment targets for this group. Specific subregions of the prefrontal cortex are involved in these deficits, including hypoactivity of the dorsolateral prefrontal cortex (DLPFC). Upregulation of this area with non-invasive brain stimulation, namely anodal transcranial direct current stimulation (tDCS), results in improved social and behavioral functioning in children with ASD. Very few studies have however examined the effects of this intervention on theory of mind, emotional regulation, and emotional-behavioral problems. We examined the effects of anodal tDCS over the left DLPFC (F3), combined with cathodal tDCS over the right DLPFC (F4) on autism symptom severity as well as theory of mind, emotional regulation, and emotional-behavioral problems of children with ASD. This intervention improved autism symptom severity, specific domains of theory of mind, and emotion regulation. These findings have clinical implications for the treatment of ASD and suggest that targeting core mechanisms underlying socio-cognitive-emotional deficits of autistic children using tDCS might improve symptoms of ASD.
Autism research : official journal of the International Society for Autism Research, 2022 · doi:10.1002/aur.2803