Probing the Neurodynamic Mechanisms of Cognitive Flexibility in Depressed Individuals with Autism Spectrum Disorder
Abstract
Introduction: Autism spectrum disorder (ASD) is characterized by deficits in social behavior and executive function (EF), particularly in cognitive flexibility. Whether transcranial magnetic stimulation (TMS) can improve cognitive outcomes in patients with ASD remains an open question. We examined the acute effects of prefrontal TMS on cortical excitability and fluid cognition in individuals with ASD who underwent TMS for refractory major depression. Methods: We analyzed data from an open-label pilot study involving nine participants with ASD and treatment-resistant depression who received 30 sessions of accelerated theta burst stimulation of the dorsolateral prefrontal cortex, either unilaterally or bilaterally. Electroencephalography data were collected at baseline and 1, 4, and 12-weeks posttreatment and analyzed using a mixed-effects linear model to assess changes in regional cortical excitability using three models of spectral parametrization. Fluid cognition was measured using the National Institutes of Health Toolbox Cognitive Battery. Results: Prefrontal TMS led to a decrease in prefrontal cortical excitability and an increase in right temporoparietal excitability, as measured using spectral exponent analysis. This was associated with a significant improvement in the NIH Toolbox Fluid Cognition Composite score and the Dimensional Change Card Sort subtest from baseline to 12 weeks posttreatment (t = 3.79, p = 0.005, n = 9). Improvement in depressive symptomatology was significant (HDRS-17, F (3, 21) = 28.49, p < 0.001) and there was a significant correlation between cognitive improvement at week 4 and improvement in depression at week 12 (r = 0.71, p = 0.05). Conclusion: These findings link reduced prefrontal excitability in patients with ASD and improvements in cognitive flexibility. The degree to which these mechanisms can be generalized to ASD populations without Major Depressive Disorder remains a compelling question for future research.
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Cites a retracted work: 10.1016/j.rasd.2011.01.025
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Cited work 10.1016/j.rasd.2011.01.025 · retracted 2016-01-01 · notice 10.1016/j.rasd.2015.10.007 · this paper published 2025-01-10
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- 10.2254/1/au.166733713.33443910/v1 · DOI
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- Authors
- Elmaghraby, R., Blank, E., Miyakoshi, M., Gilbert, D. L., Wu, S. W., Larsh, T., Westerkamp, G., Liu, Y., Horn, P. S., Erickson, C. A., & Pedapati, E. V.
- Affiliations
- Cincinnati Children's Hospital Medical Center (US)
- Corresponding author
- Elmaghraby, Rana
- ORCID
- Venue
- Journal of Child and Adolescent Psychopharmacology
- Publisher
- SAGE Publications
- Published
- 2025-01-10
- Volume
- 35
- Issue
- 4
- Pages
- 231-243
- ISSN
- 1044-5463 (ISSN-L)
- 1557-8992
- OpenAlex
- W4406270145
- Semantic Scholar
- 8c99e1b3f39e6ee0365ab22c3dea16f46e0d3e56
- Cited by
- 5
- References
- 80
- Citations by year
- 2026: 2 · 2025: 3
- FWCI
- 1.81
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Child and Adolescent Psychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Neuroscience › Neurology › Transcranial Magnetic Stimulation Studies
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- autism spectrum disorder, major depressive disorder, cognitive flexibility, transcranial magnetic stimulation, theta burst stimulation, dorsolateral prefrontal cortex, cortical excitability, fluid cognition, executive function, treatment-resistant depression, NIH Toolbox
- MeSH terms
- Autism Spectrum Disorder, Dorsolateral Prefrontal Cortex, Cognitive Flexibility, Adolescent, Adult, Cognition, Major Depressive Disorder, Depressive Disorder, Major, Electroencephalography, Female, Humans, Male, Pilot Projects, Prefrontal Cortex, Transcranial Magnetic Stimulation, Young Adult, Executive Function, Depressive Disorder, Treatment-Resistant
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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