Neurophysiological and behavioral effects of multisession prefrontal tDCS and concurrent cognitive remediation training in patients with autism spectrum disorder (ASD): A double-blind, randomized controlled fNIRS study

Yvonne M Y Han; Melody M Y Chan; Caroline K S Shea; Oscar Long-Hin Lai; Karthikeyan Krishnamurthy; Mei-Chun Cheung; Agnes S Chan

doi:10.1016/j.brs.2022.02.004

Neurophysiological and behavioral effects of multisession prefrontal tDCS and concurrent cognitive remediation training in patients with autism spectrum disorder (ASD): A double-blind, randomized controlled fNIRS study

Brain Stimul. 2022 Mar-Apr;15(2):414-425. doi: 10.1016/j.brs.2022.02.004. Epub 2022 Feb 15.

Authors

Yvonne M Y Han¹, Melody M Y Chan², Caroline K S Shea³, Oscar Long-Hin Lai², Karthikeyan Krishnamurthy², Mei-Chun Cheung⁴, Agnes S Chan⁵

Affiliations

¹ Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China; University Research Facility in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong SAR, China. Electronic address: yvonne.han@polyu.edu.hk.
² Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
³ Alice Ho Miu Ling Nethersole Hospital, Hospital Authority, Hong Kong SAR, China; Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁴ Department of Social Work, The Chinese University of Hong Kong, Hong Kong SAR, China.
⁵ Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China.

PMID: 35181532
DOI: 10.1016/j.brs.2022.02.004

Abstract

Background: The clinical effects and neurophysiological mechanisms of prefrontal tDCS and concurrent cognitive remediation training in individuals with autism spectrum disorder (ASD) remain unclear.

Objective: This two-armed, double-blind, randomized, sham-controlled trial aimed to investigate the beneficial effects of tDCS combined with concurrent cognitive remediation training on adolescents and young adults with ASD.

Methods: Participants were randomly assigned to either active or sham tDCS groups and received 1.5 mA prefrontal tDCS with left dorsolateral prefrontal cortex (dlPFC) cathode placement and right supraorbital region anode placement for 20 minutes over two consecutive weeks. tDCS was delivered concurrently with a computerized cognitive remediation training program. Social functioning and its underlying cognitive processes, as well as prefrontal resting-state functional connectivity (rsFC), were measured.

Results: The results from 41 participants indicated that multisession prefrontal tDCS, compared to sham tDCS, significantly enhanced the social functioning of ASD individuals [F(1,39) = 4.75, p = .035, η_p² = 0.11]. This improvement was associated with enhanced emotion recognition [F(1,39) = 8.34, p = .006, η_p² = 0.18] and cognitive flexibility [F(1,39) = 4.91, p = .033, η_p² = 0.11]. Specifically, this tDCS protocol optimized information processing efficiency [F(1,39) = 4.43, p = .042, η_p² = 0.10], and the optimization showed a trend to be associated with enhanced rsFC in the right medial prefrontal cortex (ρ = 0.339, pFDR = .083).

Conclusion: Multisession tDCS with left dlPFC cathode placement and right supraorbital region anode placement paired with concurrent cognitive remediation training promoted social functioning in individuals with ASD. This appeared to be associated with the enhancement of the functional connectivity of the right medial PFC, a major hub for flexible social information processing, allowing these individuals to process information more efficiently in response to different social situations.

Trial registration: ClinicalTrials.gov (ID: NCT03814083).

Keywords: Autism; Cognitive; RCT; Social; fNIRS; tDCS.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Autism Spectrum Disorder* / therapy
Cognitive Remediation*
Double-Blind Method
Humans
Prefrontal Cortex / physiology
Transcranial Direct Current Stimulation* / methods
Young Adult

Associated data

ClinicalTrials.gov/NCT03814083