title: Repetitive Transcranial Magnetic Stimulation for the Treatment of Executive Function Deficits in Autism Spectrum Disorder: Clinical Trial Approach.
abstract: OBJECTIVE
  Executive function (EF) deficits in patients with autism spectrum disorder (ASD) are ubiquitous and understudied. Further, there are no effective, neuroscience-based treatments to address this impairing feature of ASD. Repetitive transcranial magnetic stimulation (rTMS) has demonstrated promise in addressing EF deficits in adult neuropsychiatric disorders. This article will outline the design of a novel randomized-controlled trial of bilateral, 20 Hz, rTMS applied to the dorsolateral prefrontal cortex (DLPFC) for treatment of EF deficits in ASD that is currently ongoing. We describe prior therapeutic rTMS research for ASD and prior rTMS trials targeting EFs in adult neuropsychiatric disorders. A neurophysiological rationale for rTMS treatment of EF deficits in ASD is presented.
  
  
  METHODS
  An ongoing protocol will enroll participants aged 16-35 with ASD and no intellectual disability. Psychotropic medications will be continued during the 4-week trial of active 20 Hz versus sham rTMS applied to the DLPFC. Twenty, active treatment sessions consisting of 25 stimulation trains at a 90% motor threshold will be administered. The primary outcome measure is the Cambridge Neuropsychological Test Automated Battery (CANTAB) spatial working memory task. At present, recruitment, enrollment, and treatment within the described clinical trial are ongoing.
  
  
  CONCLUSIONS
  EF deficits are common and impairing symptoms of ASD. There are no evidence-based treatments for EF deficits in ASD. The protocol described here will provide important preliminary data on the feasibility and efficacy of 20 Hz rTMS to DLPFC for EF deficits in ASD.
authors.affiliation: 1 Centre for Brain and Mental Health, The Hospital for Sick Children , Toronto, Canada .|2 The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto , Toronto, Canada .|3 Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Canada .
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Ameis
authors.affiliation: 3 Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Canada .|4 Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute , Centre for Addiction and Mental Health, Toronto, Ontario, Canada .
authors.forename: Zafiris J
authors.initials: ZJ
authors.lastname: Daskalakis
authors.affiliation: 3 Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Canada .|4 Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute , Centre for Addiction and Mental Health, Toronto, Ontario, Canada .
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Blumberger
authors.affiliation: 3 Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Canada .|4 Temerty Centre for Therapeutic Brain Intervention, Campbell Family Mental Health Research Institute , Centre for Addiction and Mental Health, Toronto, Ontario, Canada .
authors.forename: Pushpal
authors.initials: P
authors.lastname: Desarkar
authors.affiliation: 5 Genetics and Genome Biology and Autism Research Unit, The Centre for Applied Genomics, The Hospital for Sick Children , Toronto, Canada .
authors.forename: Irene
authors.initials: I
authors.lastname: Drmic
authors.affiliation: 6 Program in Neurosciences and Mental Health, Research Institute , The Hospital for Sick Children, Toronto, Canada .|7 Department of Psychology, Faculty of Graduate Studies, University of Toronto , Toronto, Canada .
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Mabbott
authors.affiliation: 1 Centre for Brain and Mental Health, The Hospital for Sick Children , Toronto, Canada .|2 The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto , Toronto, Canada .|3 Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Canada .
authors.forename: Meng-Chuan
authors.initials: MC
authors.lastname: Lai
authors.affiliation: 8 Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Croarkin
authors.affiliation: 1 Centre for Brain and Mental Health, The Hospital for Sick Children , Toronto, Canada .|2 The Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, The Centre for Addiction and Mental Health, University of Toronto , Toronto, Canada .|3 Department of Psychiatry, Faculty of Medicine, University of Toronto , Toronto, Canada .
authors.forename: Peter
authors.initials: P
authors.lastname: Szatmari
mesh_terms: D000293:Adolescent; D000328:Adult; D000067877:Autism Spectrum Disorder / Q000523:psychology / Q000628:therapy*; D056344:Executive Function; D006801:Humans; D008570:Memory, Short-Term / Q000502:physiology; D009483:Neuropsychological Tests; D012107:Research Design; D065852:Spatial Memory / Q000502:physiology; D050781:Transcranial Magnetic Stimulation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Asperger's disorder; autistic disorder; executive function deficits; repetitive transcranial magnetic stimulation; treatment