{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:38:46Z","timestamp":1789688326069,"version":"4.0.1"},"reference-count":71,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ"],"accepted":{"date-parts":[[2026,3,24]]},"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n To investigate the efficacy and safety of a five day accelerated continuous theta burst stimulation (a-cTBS) protocol in improving social communication impairment in children with autism spectrum disorder.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n \n Multicentre randomised sham controlled trial.\n \n <\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Three academic hospitals across three provinces in China, conducted from July 2023 to October 2024.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n 200 children aged 4-10 years with autism spectrum disorder (167 boys and 33 girls) all with a full scale intelligence quotient \u226550.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Participants were randomised 1:1 to receive active a-cTBS (n=100) or sham (n=100) treatment stratified by full scale intelligence quotient (\u226570 or <70) and study site. Participants received 10 sessions each day for five consecutive days, targeting the left primary motor cortex. Participants and evaluators were masked to interventions.<\/jats:p>\n <\/jats:sec>\n \n Main outcome measures<\/jats:title>\n Two primary outcomes were assessed using the Social Responsiveness Scale, second edition (SRS-2): changes in social communication impairment from baseline to post-intervention and from baseline to one month follow-up. Primary analyses were conducted on a modified intention-to-treat population, including participants who received at least one stimulation session. Secondary outcomes included language improvements assessed from baseline to one month follow-up and changes in SRS-2 subscales.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of the 200 participants, 198 were included in the modified intention-to-treat analysis (99 in each group) and 193 completed the full intervention. Compared with the sham group, the a-cTBS group showed significantly greater reductions in SRS-2 scores post-intervention (\u22126.25, 95% confidence interval \u22128.69 to \u22123.81; Cohen\u2019s d \u22120.92; P<0.001) and at one month follow-up (\u22126.17, \u22128.65 to \u22123.70; \u22120.90; P<0.001). Secondary outcomes also favoured a-cTBS, with significant improvements observed in language abilities (Cohen\u2019s d 0.12-0.47; all P<0.02; measured by Multilingual Assessment Instrument for Narratives). Reported adverse events were all mild to moderate and resolved without intervention.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n A five day a-cTBS protocol targeting the left primary motor cortex significantly improved social communication in children with autism spectrum disorder and showed a favourable safety profile. These findings support a-cTBS as a viable and scalable therapeutic option for children with autism spectrum disorder.<\/jats:p>\n <\/jats:sec>\n \n Trial registration<\/jats:title>\n \n ClinicalTrials.gov\n NCT05927792<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1136\/bmj-2025-086295","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:00:16Z","timestamp":1777507216000},"page":"e086295","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":7,"title":["Accelerated continuous theta burst stimulation targeting left primary motor cortex for children with autism spectrum disorder: multicentre randomised sham controlled trial"],"prefix":"10.1136","volume":"393","clinical-trial-number":[{"clinical-trial-number":"nct05927792","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct05927792","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Hangyu","family":"Tan","sequence":"first","affiliation":[{"name":"Department of Developmental and Behavioural Paediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory of Children\u2019s Environmental Health, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tai","family":"Ren","sequence":"additional","affiliation":[{"name":"Department of Developmental and Behavioural Paediatric and Child Primary Care & Ministry of Education, Shanghai Key Laboratory of Children\u2019s Environmental Health, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 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