Maud Rothärmel1, Virginie Moulier2,3, Marianne Vasse2, Clémence Isaac3, Mathieu Faerber4, Bilal Bendib2, Iris Mirea-Grivel2, Gaëlle Opolczynski2, Antoine Rosier4, Olivier Guillin2,4,5,6. 1. University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France, maud.rotharmel@ch-lerouvray.fr. 2. University Department of Psychiatry, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France. 3. EPS Ville Evrard, Unité de Recherche Clinique, Neuilly-sur-Marne, France. 4. Centre Ressource Autisme Normandie Seine Eure, Centre Hospitalier du Rouvray, Sotteville-lès-Rouen, France. 5. CHU de Rouen, Rouen, France. 6. Faculté de Médecine, Normandy University, Rouen, France.
Abstract
BACKGROUND:Executive functions (EF) are often impaired in autism spectrum disorder (ASD). Such dysfunctions are associated with anxiety, depression, and a lack of autonomy. Transcranial direct current stimulation (tDCS) has been shown to enhance EF in healthy adults and clinical populations and to improve working memory - a component of the EF - in adults with high-functioning ASD (HF-ASD). We hypothesized that tDCS could improve the EF of HF-ASD patients. Such enhancement could improve their adaptive behaviors. METHOD:Eight patients with HF-ASD received 10 consecutive cathodaltDCS sessions (2 mA) over the left dorsolateral prefrontal cortex (F3) for 15 min each in an open trial. EF (with the Stroop test, Trail Making Test [TMT] A and B, Modified Wisconsin Card Sorting Test [mWCST], and Verbal Fluency Test) and behavioral dysexecutive syndrome (with the Behavioral Dysexecutive Syndrome Inventory and the Repetitive and Restricted Behaviour scale) were assessed before and 10 days after treatment. RESULTS: This study showed significant improvement in initiation (TMT-A time: p = 0.018) and cognitive flexibility (TMT-B time: p = 0.009; letter Verbal Fluency Test: p = 0.017; mWCST total errors: p = 0.028) after tDCS. Regarding behavior, the hypoactivity of the patients improved, as well as their repetitive and restrictive behaviors. In addition, this noninvasive neurostimulation technique was well tolerated. CONCLUSIONS: Flexibility and initiation are the most impaired EF in autism. These are promising results which justify a randomized and placebo-controlled study in a wider population. If these results were confirmed by a randomized controlled trial, tDCS could be an easy and well-tolerated adjunctive treatment aiming to improve the quality of life and the autonomy of ASD patients.
RCT Entities:
BACKGROUND: Executive functions (EF) are often impaired in autism spectrum disorder (ASD). Such dysfunctions are associated with anxiety, depression, and a lack of autonomy. Transcranial direct current stimulation (tDCS) has been shown to enhance EF in healthy adults and clinical populations and to improve working memory - a component of the EF - in adults with high-functioning ASD (HF-ASD). We hypothesized that tDCS could improve the EF of HF-ASDpatients. Such enhancement could improve their adaptive behaviors. METHOD: Eight patients with HF-ASD received 10 consecutive cathodal tDCS sessions (2 mA) over the left dorsolateral prefrontal cortex (F3) for 15 min each in an open trial. EF (with the Stroop test, Trail Making Test [TMT] A and B, Modified Wisconsin Card Sorting Test [mWCST], and Verbal Fluency Test) and behavioral dysexecutive syndrome (with the Behavioral Dysexecutive Syndrome Inventory and the Repetitive and Restricted Behaviour scale) were assessed before and 10 days after treatment. RESULTS: This study showed significant improvement in initiation (TMT-A time: p = 0.018) and cognitive flexibility (TMT-B time: p = 0.009; letter Verbal Fluency Test: p = 0.017; mWCST total errors: p = 0.028) after tDCS. Regarding behavior, the hypoactivity of the patients improved, as well as their repetitive and restrictive behaviors. In addition, this noninvasive neurostimulation technique was well tolerated. CONCLUSIONS: Flexibility and initiation are the most impaired EF in autism. These are promising results which justify a randomized and placebo-controlled study in a wider population. If these results were confirmed by a randomized controlled trial, tDCS could be an easy and well-tolerated adjunctive treatment aiming to improve the quality of life and the autonomy of ASDpatients.
Authors: Christina Luckhardt; Magdalena Schütz; Andreas Mühlherr; Hannah Mössinger; Sara Boxhoorn; Astrid Dempfle; Ricardo Salvador; Giulio Ruffini; Helena C Pereira; Miguel Castelo-Branco; Marianne Latinus; Frédérique Bonnet-Brilhault; Julia Siemann; Michael Siniatchkin; Christine Ecker; Christine M Freitag Journal: Trials Date: 2021-04-06 Impact factor: 2.279