For children with autism spectrum disorder and with an intellectual disability, the options for improving communication and social skills are limited.
Talking therapies and behavioural programmes can help some children develop these skills, but they depend on specialists who are in short supply – even in wealthy countries.
Around 30-35% of autistic children have an intellectual disability, according to research from the US. They are less likely to get treatment than those without one (in part because doctors lack confidence managing their needs and insurance coverage for intellectual disability is patchy) despite having greater needs and placing heavier demands on their families. It is a group that researchers often overlook.
That gap motivated us to test a different kind of intervention: using brief, targeted magnetic pulses to stimulate specific parts of the brain. The technique, known as non-invasive brain stimulation or neuromodulation, involves no surgery, no anaesthetic and no drugs.
A device held close to the scalp generates a rapidly changing magnetic field that passes harmlessly through the skull and stimulates the activity of neurons underneath. It has been used for years to treat depression, and researchers have increasingly been exploring whether it might also help with the social and communication difficulties that are a key symptom of autism.
The version we tested uses a technique called theta-burst stimulation, which delivers pulses in rapid clusters rather than one at a time. This makes each session much shorter than conventional approaches, which is a significant practical advantage when you are asking young children to sit still and cooperate.
In our study, published in the BMJ, each session lasted only a few minutes, and the full course ran over just five days. One group of children received real stimulation, another received a sham version. In the sham treatment, the equipment was applied in the same way and delivered vibrations, but no active pulses were delivered. That way, we could compare results without either group knowing what they’d received, which helps keep the findings reliable.
One hundred and ninety-four children took part, with an average age of around six and a half years. Roughly half had IQ scores below 70, which is typically described as the low-functioning range, though all scored above 50 – the minimum needed to ensure a reliable diagnosis and meaningful participation in the study.
Parents filled in a questionnaire about their child’s social communication, before the treatment, right after, and again a month later.
The improvements seen after five days were still there after a month, and the size of the effect was large by the standards of clinical research. Children also showed gains in language ability.
No serious side-effects were reported and all minor side-effects resolved without treatment.
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Early days
Children were recruited from multiple sites by advertisements posted in outpatients clinics and through local clinical registries. All legal guardians gave written consent.
Children with intellectual disability are so often left out of trials of this kind that the evidence for treating them has remained seriously lacking. That this trial included them at all – and in significant numbers – is itself noteworthy. But it is only a first step.
It is still unclear how long the benefits last beyond a month, how many sessions would be needed to maintain them, or how the approach would work when moved from a research setting into an ordinary clinic.
Brain stimulation is not a replacement for behavioural support, and the equipment needed is not cheap or universally available. But conventional approaches – where they exist at all – often require daily sessions over several weeks with a professional, which carries its own costs in time, money and specialist input.
A five-day course is a different proposition. For families who are already stretched, even modest and durable gains in a child’s ability to communicate could matter enormously to them and their families and greatly improve their wellbeing and quality of life.
Barbara Jacquelyn Sahakian receives funding from the Wellcome Trust. Her research work is conducted within the NIHR Cambridge Biomedical Research Centre (BRC) Mental Health and Neurodegeneration Themes. She receives Royalties from Cambridge University Press for Brain Boost: Healthy Habits for a Happier Life.
Christelle Langley is funded by the Wellcome Trust. Her research work is conducted within the NIHR Cambridge Biomedical Research Centre (BRC) Mental Health and Neurodegeneration Themes. She receives Royalties from Cambridge University Press for Brain Boost: Healthy Habits for a Happier Life.
Fei Li receives funding from the National Natural Science Foundation of China. She is affiliated with Department of Developmental and behavioral pediatrics, Society of Pediatrics, Chinese Medical Association.
Qiang Luo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
