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Noninvasive brain stimulation (NIBS) techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have recently emerged as alternative, nonpharmacological interventions for a variety of psychiatric, neurological, and neurodevelopmental conditions. NIBS is beginning to be applied in both research and clinical settings for the treatment of core and associated symptoms of autism spectrum disorder (ASD) including social communication deficits, restricted and repetitive behaviors, irritability, hyperactivity, depression and impairments in executive functioning and sensorimotor integration. Though there is much promise for these targeted device‐based interventions, in other disorders (including adult major depressive disorder (MDD) and obsessive compulsive disorder (OCD) where rTMS is FDA cleared), data on the safety and efficacy of these interventions in individuals with ASD is limited especially in younger children when neurodevelopmental interventions typically begin. Most studies are open‐label, small scale, and/or focused on a restricted subgroup of individuals with ASD. There is a need for larger, randomized controlled trials that incorporate neuroimaging in order to develop predictive biomarkers of treatment response and optimize treatment parameters. We contend that until such studies are conducted, we do not have adequate estimates of the safety and efficacy of NIBS interventions in children across the spectrum. Thus, broad off‐label use of these techniques in this population is not supported by currently available evidence. Here we discuss the existing data on the use of NIBS to treat symptoms related to ASD and discuss future directions for the field. Lay Summary: Noninvasive Brain Stimulation techniques are currently being studied in research centers and being offered in clinical settings to treat individuals with autism spectrum disorder. In this commentary, we discuss the evidence base for the use of these techniques. We also highlight the limitations and caution against broad expedited translation of these tools to the clinic without properly powered and controlled studies that provide sufficient data to inform their safety and efficacy in this population. [ABSTRACT FROM AUTHOR]

The clinical, social and financial burden of autism spectrum disorder (ASD) is staggering. We urgently need valid and reliable biomarkers for diagnosis and effective treatments targeting the often debilitating symptoms. Transcranial magnetic stimulation (TMS) is beginning to be used by a number of centers worldwide and may represent a novel technique with both diagnostic and therapeutic potential. Here we critically review the current scientific evidence for the use of TMS in ASD. Though preliminary data suggests promise, there is simply not enough evidence yet to conclusively support the clinical widespread use of TMS in ASD, neither diagnostically nor therapeutically. Carefully designed and properly controlled clinical trials are warranted to evaluate the true potential of TMS in ASD.

Spontaneous mimicry, including that of emotional facial expressions, is important for socio-emotional skills such as empathy and communication. Those skills are often impacted in autism spectrum disorders (ASD). Successful mimicry requires not only the activation of the response, but also its appropriate speed. Yet, previous studies examined ASD differences in only response magnitude. The current study investigated timing and magnitude of spontaneous and voluntary mimicry in ASD children and matched controls using facial electromyography (EMG). First, participants viewed and recognized happy, sad, fear, anger, disgust and neutral expressions presented at different durations. Later, participants voluntarily mimicked the expressions. There were no group differences on emotion recognition and amplitude of expression-appropriate EMG activity. However, ASD participants' spontaneous, but not voluntary, mimicry activity was delayed by about 160 ms. This delay occurred across different expressions and presentation durations. We relate these findings to the literature on mirroring and temporal dynamics of social interaction.

In an early description of the mu rhythm, Gastaut and Bert [Gastaut, H. J., & Bert, J. (1954). EEG changes during cinematographic presentation. "Clinical Neurophysiology", 6, 433-444] noted that it was blocked when an individual identified himself with an active person on the screen, suggesting that it may be modulated by the degree to which the individual can relate to the observed action. Additionally, multiple recent studies suggest that the mirror neurons system (MNS) is impaired in individuals with autism spectrum disorders (ASD), which may affect their ability to relate to others. The current study aimed to investigate MNS sensitivity by examining mu suppression to familiarity, i.e., the degree to which the observer is able to identify with the actor on the screen by using familiar versus unfamiliar actors. The participants viewed four 80 s videos that included: (1) stranger: an unfamiliar hand performing a grasping action; (2) familiar: the child's guardian or sibling's hand performing the same action; (3) own: the participant's own hand performing the same action; (4) bouncing balls: two balls moving vertically toward and away from each other. The study revealed that mu suppression was sensitive to degree of familiarity. Both typically developing participants and those with ASD showed greater suppression to familiar hands compared to those of strangers. These findings suggest that the MNS responds to observed actions in individuals with ASD, but only when individuals can identify in some personal way with the stimuli. (Contains 1 table and 3 figures.)

The mechanism by which humans perceive others differs greatly from how humans perceive inanimate objects. Unlike inanimate objects, humans have the distinct property of being "like me" in the eyes of the observer. This allows us to use the same systems that process knowledge about self-performed actions, self-conceived thoughts, and self-experienced emotions to understand actions, thoughts, and emotions in others. The authors propose that internal simulation mechanisms, such as the mirror neuron system, are necessary for normal development of recognition, imitation, theory of mind, empathy, and language. Additionally, the authors suggest that dysfunctional simulation mechanisms may underlie the social and communicative deficits seen in individuals with autism spectrum disorders.