We currently use the following medically approved neuromodulation devices: tDCS, CES, taVNS, TPS (outside of Alzheimer’s therapy, TPS is always an off-label individual therapeutic attempt).
I have already written an article about TPS as an individual therapeutic attempt in autism.
“Individual therapeutic attempt” because there is not yet any official approval for it, although studies at Evidence Level 1b already exist. This means that this application of TPS has not yet been incorporated into official treatment guidelines.
tDCS as an option for autism
In this article, the main focus is on the second neuromodulation strategy known as “transcranial direct current stimulation.”
“The current level of evidence for the use of tDCS in autism is in the range of Level 2a, with several high-quality Level 1b studies available.”
tDCS in autism – does it really work?
In this article, I would like to provide you – just as I do in daily clinical practice – a clear, easy-to-understand overview, which I did not simply put together spontaneously, but researched on a scientific, study-based basis:
Yes, tDCS works in autism, and in a measurable, verifiable way. The studies so far are still small and not perfect, but the trend is clearly positive.
One important point I would like to emphasize here
Most studies to date have almost always worked with ONE standard montage and only over short periods of time. Studies are studies – they must establish a scientific basis and be comparable. They therefore use limited treatment durations and a limited number of stimulation sessions, always with the same montage.
In real clinical practice, however, we combine individualized, case-adapted montages, tailor the targets to the child, and treat over significantly longer periods of time.
Our own results therefore often show stronger effects than the studies would suggest.
For example, today the secretary came to me in the afternoon and told me: “… the exhausting autistic child with ADHD who was only difficult and perseverated for hours (repeating the same things over and over) was completely transformed after the TPS / tDCS application. He actually had a normal conversation with his mother without acting out in an extreme way.”
What exactly is tDCS?
tDCS stands for “transcranial direct current stimulation”.
It is a gentle form of brain stimulation using very weak electrical current (1–2 mA) that stimulates or calms specific brain areas. The method is non-invasive, painless, scientifically well-studied, and is used worldwide in developmental disorders.
In short
tDCS promotes brain network maturation, improves signal processing, and supports learning, behavior, and attention.
How well does tDCS really work in autism?
The answer from research is: noticeable, but moderate – and very different from child to child.
Summary
tDCS improves in a proportion of children
- social interaction
- behavior / hyperactivity
- attention and executive functions
- in some cases, language and daily living skills
It is not a miracle cure, but a neuroplastic enhancer that often makes therapies such as speech therapy, behavioral training, school, and cognitive exercises much easier and more effective – which is exactly what our feedback from clinical practice confirms.
What does the current research show?
Overview of existing studies
So far, there are approximately 15–20 studies, including 8–10 randomized, double-blind trials – in other words, solid scientific work.
What has been stimulated so far?
In most studies, the executive centers – where “the boss at home” sits – were activated. This is a central area for
– social cognition
– emotion regulation
– attention
– verbal working memory
What were the results?
The studies found consistent improvements, especially in:
- social interaction and communication
- behavior (impulsivity, hyperactivity)
- ATEC overall symptom score
- executive functions
- emotional perception
Summary
The effects are statistically significant, clearly measurable – but still not huge leaps, because the protocols are short and only minimally individualized.
What do the best randomized studies show?
Child studies from Thailand (Auvichayapat, Amatachaya)
5–20 sessions
– significant reduction in overall autism symptomatology
– improvements in behavior and attention
– EEG shows normalization of pathological rhythms
This means
tDCS measurably alters brain activity and leads to functional improvements.
“Long-term” study 2023: 5 vs. 20 sessions
One of the most important papers (Dev Med Child Neurol 2023):
- 5 sessions were already effective
- 20 sessions had a stronger effect
- Effects lasted up to 12 months
This means
tDCS can induce long-term changes in brain networks.
Adolescents and young adults (Han 2023)
– over 100 participants
– combination of stimulation + cognitive training
– significant improvements in social function vs. sham
This means
tDCS works particularly well when combined with training – exactly as we apply it in clinical practice.
Different brain regions
Studies show:
- DLPFC, rTPJ, Cerebellum, Motor cortex ….. different brain regions improve children’s behavior in different ways
This means
Autism is a network problem – and tDCS can target different nodes of this network.
How large is the effect?
Meta-analyses generally report small to moderate effect sizes (Cohen’s d 0.4–0.6).
What this means in practice
Parents notice improvements, but no miracles – similar to what is seen with successful occupational therapy or a good medication.
Safety: How well do children tolerate tDCS?
The most important point
According to more than 35 studies in children, tDCS is considered safe and very well tolerated.
In more than 6,500 sessions, no serious side effects have been reported.
Typical effects are limited to:
- mild tingling
- itching
- redness under the electrodes
- short-term fatigue or minimal headaches
No long-term side effects have been observed to date.
What does all of this mean for clinical practice?
In summary
- tDCS works – but moderately and with individual variability
- Improvements are mainly seen in
– social interaction
– behavior
– attention
– executive functions
– emotional perception - Language sometimes improves, but less consistently
- The protocols are not yet standardized
What is missing in current studies?
- treatment durations that are too short
- no individualization
- hardly any combination protocols
- small patient numbers
This is exactly where SOZO-trained physicians intervene in clinical practice
Why individualized montages are significantly more effective
From daily clinical practice, we see:
Every autistic child is different – three children, three different networks, three different montages.
In addition, we train the parents in HOME THERAPY so that they can carry it out independently on a daily or several-times-weekly basis. During regular check-ups, we observe the response and can adjust accordingly.
Conclusion: What can realistically be expected?
tDCS can improve the following areas in autism
- social interaction
- eye contact
- emotional perception
- hyperactive / impulsive behavior
- executive functions
- learning ability
tDCS is not a “cure”, but
A neuroplastic enhancement therapy that makes other therapies visibly more successful.
The effects are
- real
- consistent
- moderate
- safe
- highly individual
Evidence Level of tDCS in autism
The current state of scientific evidence for tDCS in autism lies overall between Level 1b and Level 2a, with a realistic, conservative overall assessment of:
Evidence Level 2a (systematic reviews of RCTs, but with methodological limitations and heterogeneous protocols)
With a trend in several high-quality individual studies already toward Level 1b
Classification according to the classical evidence hierarchy
- Level 1a
Systematic reviews and meta-analyses of multiple large, high-quality randomized controlled trials (RCTs) with high homogeneity
→ For autism + tDCS: not yet fully achieved - Level 1b
Individual well-conducted RCTs with clear significance and robust design
→ For autism + tDCS: several studies meet this criterion - Level 2a
Systematic reviews of RCTs with heterogeneity, small sample sizes, or methodological differences
→ Currently the best overall label for the entire field of tDCS + autism - Level 2b–4
Cohort studies, case-control studies, case series
→ Also numerous and consistently positive
In summary
The most scientifically accurate overall classification at present is Evidence Level 2a, with multiple Level 1b studies as the main supporting pillars of the evidence.
Why no Level 1a yet?
Not because tDCS “works poorly”, but due to structural limitations in the current body of research:
-
- small sample sizes
- different montages
- different endpoints
- different age groups
- short intervention periods
- hardly any individualized protocols
- few large multi-center studies
These factors currently prevent a formal classification as Level 1a, even though the results are strong in substantive terms.
Treating autism with neuromodulation is part of the SOZO training program. You can find a qualified physician via the SOZOBRAINCENTER website
Referenzes
systematic reviews and Meta-Analysis (focussed on Autism / NIBS)
- García-González, S., Lugo-Marín, J., Setien-Ramos, I., Gisbert-Gustemps, L., Arteaga-Henríquez, G., Díez-Villoria, E. and Ramos-Quiroga, J.A. (2021) ‘Transcranial direct current stimulation in Autism Spectrum Disorder: A systematic review and meta-analysis’, European Neuropsychopharmacology, 48, pp. 89–109. doi:10.1016/j.euroneuro.2021.02.017. (PubMed)
- Osório, A.A.C. and Brunoni, A.R. (2019) ‘Transcranial direct current stimulation in children with autism spectrum disorder: A systematic scoping review’, Developmental Medicine & Child Neurology, 61(3), pp. 298–304. doi:10.1111/dmcn.14104. (SpringerLink)
- Chen, Y.C.B. et al. (2024) ‘A network meta-analysis of non-invasive brain stimulation interventions for autism spectrum disorder: Evidence from randomized controlled trials’, Neuroscience and Biobehavioral Reviews, 164, p. 105807. doi:10.1016/j.neubiorev.2024.105807. (ScienceDirect)
- Zhang, J. and Zhang, H. (2022) ‘Effects of non-invasive neurostimulation on autism spectrum disorder: A systematic review’, Autism, 26(8), pp. 1905–1923. doi:10.1177/13623613211042848. (ERIC)
randomized Studies and Pilotstudies for kids with Autism
- Amatachaya, A., Auvichayapat, N., Patjanasoontorn, N., Sathornsumetee, S., Ngernyam, N. and Auvichayapat, P. (2014) ‘Effect of anodal transcranial direct current stimulation on autism: a randomized double-blind crossover trial’, Behavioural Neurology, 2014, p. 173073. doi:10.1155/2014/173073. (PubMed)
- Amatachaya, A., Jensen, M.P., Patjanasoontorn, N., Auvichayapat, N., Suphakunpinyo, C., Janjarasjitt, S. and Auvichayapat, P. (2015) ‘The short-term effects of transcranial direct current stimulation on electroencephalography in children with autism: A randomized crossover controlled trial’, Behavioural Neurology, 2015, p. 928631. doi:10.1155/2015/928631. (Brieflands)
- Auvichayapat, P., Intayot, K., Udomchat, C., Suphakunpinyo, C., Patjanasoontorn, N., Keeratitanont, K. et al. (2023) ‘Long-term effects of transcranial direct current stimulation in the treatment of autism spectrum disorder: A randomized controlled trial’, Developmental Medicine & Child Neurology, 65(6), pp. 811–820. doi:10.1111/dmcn.15457. (SpringerLink)
- Hadoush, H., Nazzal, M., Almasri, N.A., Khalil, H. and Alafeef, M. (2020) ‘Therapeutic effects of bilateral anodal transcranial direct current stimulation on prefrontal and motor cortical areas in children with autism spectrum disorders: A pilot study’, Autism Research, 13(5), pp. 828–836. doi:10.1002/aur.2290. (SpringerLink)
- Qiu, J., Kong, X., Li, J., Yang, J., Huang, Y., Huang, M. et al. (2021) ‘Transcranial direct current stimulation (tDCS) over the left dorsal lateral prefrontal cortex in children with autism spectrum disorder (ASD)’, Neural Plasticity, 2021, p. 6627507. doi:10.1155/2021/6627507. (TinyEYE Online Speech Therapy for Kids)
- Zemestani, M., Hoseinpanahi, O. and Salehinejad, M.A. (2022) ‘The impact of prefrontal transcranial direct current stimulation (tDCS) on theory of mind, emotion regulation and emotional–behavioural functions in children with autism disorder: A randomized, sham-controlled, and parallel-group study’, Autism Research, 15(10), pp. 1985–2003. doi:10.1002/aur.2803. (Wiley Online Library)
- D’Urso, G., Toscano, E., Sanges, V., Sauvaget, A., Sheffer, C.E., Riccio, M.P. et al. (2022) ‘Cerebellar transcranial direct current stimulation in children with autism spectrum disorder: A pilot study on efficacy, feasibility, safety, and unexpected outcomes in tic disorder and epilepsy’, Journal of Clinical Medicine, 11(1), p. 143. doi:10.3390/jcm11010143. (SpringerLink)
- Han, Y.M.Y., Chan, M.M.Y., Shea, C.K.S., Li, X., Yuan, T.F., Cheung, E.F.C. and Chua, S.E. (2023) ‘Effects of prefrontal transcranial direct current stimulation on social functioning in individuals with autism spectrum disorder: A randomized controlled trial’, Autism. doi:10.1177/13623613231169547. (SAGE Journals)
- Chan, M.M.Y., Han, Y.M.Y., Shea, C.K.S., Li, X., Cheung, E.F.C., Chua, S.E. and Yuan, T.F. (2023) ‘Cathodal prefrontal transcranial direct current stimulation with concurrent cognitive remediation training for autism spectrum disorder: A randomized, double-blind, sham-controlled clinical trial’, Brain Stimulation. doi:10.1016/j.brs.2023.04.018. (PubMed)
- Nazari, M.A., Nami, M., Sangi, M., Sahraei, H. and Zoghi, M. (2023) ‘Prefrontal transcranial direct current stimulation improves facial emotion recognition and reduces autism symptoms in children with autism spectrum disorder: A randomized, sham-controlled study’, Iranian Journal of Psychiatry and Behavioral Sciences, 17(1), e124681. doi:10.5812/ijpbs-124681. (Semantic Scholar)
- Wilson, J.E., Quinn, D.K., Wilson, J.K., Garcia, C.M. and Tesche, C.D. (2018) ‘Transcranial direct current stimulation to the right temporoparietal junction for social functioning in autism spectrum disorder: A case report’, Journal of ECT, 34(1), pp. e10–e13. doi:10.1097/YCT.0000000000000445. (SpringerLink)
Reviews for tDCS in children and adolescence and security
- Gallop, L., Westwood, S.J., Lewis, Y.D., Campbell, I.C. and Schmidt, U. (2024) ‘Effects of transcranial direct current stimulation in children and young people with psychiatric disorders: A systematic review’, European Child & Adolescent Psychiatry, 33, pp. 3003–3023. doi:10.1007/s00787-023-02157-0. (SpringerLink)
- Salehinejad, M.A., Ghanavati, E., Glinski, B. and Azarkolah, A. (2022) ‘Efficacy and safety of transcranial direct current stimulation in children and adolescents with neurodevelopmental disorders: A systematic review of randomized controlled trials’, Brain and Behavior, 12(4), e2724. doi:10.1002/brb3.2724. (SSRN)
- Buchanan, D.M., Bogdanowicz, T., Khanna, N., Lockman-Dufour, G. and Robaey, P. (2021) ‘Systematic review on the safety and tolerability of transcranial direct current stimulation in children and adolescents’, Brain Sciences, 11(2), 212. doi:10.3390/brainsci11020212. (PubMed)
- Zewdie, E., Ciechanski, P., Kuo, H.-C., Giuffre, A., Kahl, C., King, R. et al. (2020) ‘Safety and tolerability of transcranial magnetic and direct current stimulation in children: Prospective single centre evidence from 3.5 million stimulations’, Brain Stimulation, 13(3), pp. 565–575. doi:10.1016/j.brs.2020.01.001. (MDPI)
- Bikson, M., Grossman, P., Thomas, C., Zannou, A.L., Jiang, J., Adnan, T. et al. (2016) ‘Safety of transcranial direct current stimulation: Evidence based update 2016’, Brain Stimulation, 9(5), pp. 641–661. doi:10.1016/j.brs.2016.06.004. (SpringerLink)
general Guidelines / Evidenceclassification tDCS
- Fregni, F., El-Hagrassy, M.M., Pacheco-Barrios, K., Carvalho, S., Leite, J., Simis, M. et al. (2021) ‘Evidence-based guidelines and secondary meta-analysis for the use of transcranial direct current stimulation in neurological and psychiatric disorders’, International Journal of Neuropsychopharmacology, 24(4), pp. 256–313. doi:10.1093/ijnp/pyaa051. (SpringerLink)
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