{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:57:25Z","timestamp":1792173445022,"version":"4.4.0"},"reference-count":48,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by restricted and repetitive behaviors and disturbances in social communication and interaction. Currently, there is no fundamental treatment for ASD, with only a few medications available for use on a limited basis to manage concomitant neuropsychiatric symptoms. The primary therapeutic goal of such treatments is to alleviate symptoms while maximizing the functional independence and quality of life of affected individuals. Many complementary and alternative medicine therapies have been reported to have effects on ASD symptoms; however, evidence is insufficient to confirm their clinical effectiveness. Acupuncture has traditionally been used as a complementary intervention to manage various neurological and neuropsychiatric diseases, including ASD, in East Asia. However, how acupuncture stimulation modulates neural activity at the macroscale level in individuals with ASD remains largely unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to elucidate disease-related brain alterations and explore the acute neural mechanisms underlying acupuncture stimulation in patients with ASD and in typically developing (TD) individuals, using a multimodal neuroimaging approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study was designed as a randomized, sham-controlled trial. In this stratified 2\u00d72 design, 70 participants, including individuals with ASD (n=35) and TD controls (n=35), will each be randomly assigned to either the verum or sham acupuncture group, resulting in 4 groups. The verum acupuncture group will receive stimulation at specific acupoints clinically indicated for ASD, eliciting a deqi sensation. The sham acupuncture group will receive superficial needling at nonacupoints unrelated to ASD symptoms. Each group will undergo clinical assessments and multimodal neuroimaging measurements, including functional near-infrared spectroscopy and electroencephalography, before and after acupuncture stimulation. The primary outcome will be differences in resting state network metrics and relative band power in frontal areas by disease status. Secondary outcomes will include differences in these neural markers following acupuncture stimulation between the verum and sham groups, reflecting the group \u00d7 intervention interaction. Exploratory outcomes will focus on identifying neural markers that correlate with clinical indicators of ASD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Recruitment began in April 2025. To date, 23 individuals with ASD and 21 TD individuals have participated in this study. The recruitment process is expected to continue until December 2026.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ASD presents a significant socioeconomic burden, with no definitive treatment established to date. Although acupuncture is a widely applied intervention for various neurological conditions, including ASD, its large-scale neural mechanisms remain poorly understood. By using multimodal neuroimaging, the present study aims to investigate the immediate neural substrates underlying acupuncture stimulation in patients with ASD. These findings are expected to provide a robust neurobiological foundation for future longitudinal research and the development of evidence-based integrative strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/97910","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T11:40:06Z","timestamp":1788176406000},"page":"e97910-e97910","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the Neural Mechanisms of Acupuncture Stimulation in Autism Spectrum Disorder: Protocol for a Randomized, Sham-Controlled, Multimodal Neuroimaging Trial"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5088-290X","authenticated-orcid":false,"given":"Jaehee","family":"Sim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3059-0174","authenticated-orcid":false,"given":"Koung-soon","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1602-3138","authenticated-orcid":false,"given":"Dong Hyuk","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"Suppl 1","key":"R1","doi-asserted-by":"publisher","first-page":"S55","DOI":"10.21037\/tp.2019.09.09","article-title":"Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation","volume":"9","author":"Hodges","journal-title":"Transl Pediatr"},{"issue":"10146","key":"R2","doi-asserted-by":"publisher","first-page":"508","DOI":"10.1016\/S0140-6736(18)31129-2","article-title":"Autism spectrum disorder","volume":"392","author":"Lord","journal-title":"Lancet"},{"issue":"1","key":"R3","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-17794-1","article-title":"Elevated rates of autism, other neurodevelopmental and psychiatric diagnoses, and autistic traits in transgender and gender-diverse individuals","volume":"11","author":"Warrier","journal-title":"Nat Commun"},{"issue":"3","key":"R4","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1017\/S003329171400172X","article-title":"The epidemiology and global burden of autism spectrum disorders","volume":"45","author":"Baxter","journal-title":"Psychol Med"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1681565","article-title":"Global burden, inequality, and frontier gaps of autism spectrum disorder disability in adolescents and young adults, 1990-2021: a systematic analysis of the GBD 2021 study","volume":"13","author":"Lin","journal-title":"Front Public Health"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","first-page":"248","DOI":"10.1007\/s13311-022-01183-1","article-title":"An update on psychopharmacological treatment of autism spectrum disorder","volume":"19","author":"Aishworiya","journal-title":"Neurotherapeutics"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1136\/bmjebm-2021-111804","article-title":"Risperidone and aripiprazole for autism spectrum disorder in children: an overview of systematic reviews","volume":"28","author":"Fieiras","journal-title":"BMJ Evid Based Med"},{"issue":"1","key":"R8","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1352\/2009.114:23;nd41","article-title":"Systematic review of early intensive behavioral interventions for children with autism","volume":"114","author":"Howlin","journal-title":"Am J Intellect Dev Disabil"},{"issue":"4","key":"R9","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1016\/j.cpr.2010.01.008","article-title":"Applied behavior analytic intervention for autism in early childhood: meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes","volume":"30","author":"Viru\u00e9s-Ortega","journal-title":"Clin Psychol Rev"},{"issue":"5","key":"R10","doi-asserted-by":"publisher","first-page":"432","DOI":"10.30773\/pi.2019.0229","article-title":"Efficacy of interventions based on applied behavior analysis for autism spectrum disorder: a meta-analysis","volume":"17","author":"Yu","journal-title":"Psychiatry Investig"},{"issue":"8","key":"R11","doi-asserted-by":"publisher","first-page":"940","DOI":"10.1016\/j.cpr.2013.07.005","article-title":"The TEACCH program for children and adults with autism: a meta-analysis of intervention studies","volume":"33","author":"Virues-Ortega","journal-title":"Clin Psychol Rev"},{"issue":"7","key":"R12","doi-asserted-by":"publisher","first-page":"901","DOI":"10.1007\/s10803-006-0131-0","article-title":"Patterns of complementary and alternative medical therapy use in children diagnosed with autism spectrum disorders","volume":"36","author":"Wong","journal-title":"J Autism Dev Disord"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.1016\/j.rasd.2015.05.002","article-title":"Prevalence and predictors of complementary and alternative medicine use in a large insured sample of children with autism spectrum disorders","volume":"17","author":"Owen-Smith","journal-title":"Res Autism Spectr Disord"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/1057539","article-title":"The efficacy and safety of acupuncture for the treatment of children with autism spectrum disorder: a systematic review and meta-analysis","volume":"2018","author":"Lee","journal-title":"Evid Based Complement Alternat Med"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-025-03637-4","article-title":"Electroacupuncture ameliorates autism spectrum disorder via modulating the gut-brain axis depending on the integrity of vagus nerve","volume":"15","author":"Chen","journal-title":"Transl Psychiatry"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.2147\/NDT.S398321","article-title":"Acupuncture ameliorated behavioral abnormalities in the autism rat model via pathways for hippocampal serotonin","volume":"19","author":"Chen","journal-title":"Neuropsychiatr Dis Treat"},{"issue":"2","key":"R17","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000046851","article-title":"BDNF and miRNAs in acupuncture-regulated neuroplasticity: emerging mechanisms and therapeutic strategies","volume":"105","author":"Li","journal-title":"Medicine (Baltimore)"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1186\/s13020-018-0189-6","article-title":"The therapeutic effect of scalp acupuncture on natal autism and regressive autism","volume":"13","author":"Yau","journal-title":"Chin Med"},{"issue":"2","key":"R19","first-page":"136","volume":"15","author":"Wong","journal-title":"Altern Med Rev"},{"issue":"11","key":"R20","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1016\/S1474-4422(15)00050-2","article-title":"Neuroimaging in autism spectrum disorder: brain structure and function across the lifespan","volume":"14","author":"Ecker","journal-title":"Lancet Neurol"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.52965\/001c.123439","article-title":"Neuroimaging insights into autism spectrum disorder: structural and functional brain","volume":"12","author":"Patil","journal-title":"Health Psychol Res"},{"issue":"2","key":"R22","doi-asserted-by":"publisher","first-page":"73","DOI":"10.17691\/stm2025.17.2.07","article-title":"The potential of near-infrared spectroscopy as a therapeutic tool following a stroke (review)","volume":"17","author":"Mokienko","journal-title":"Sovrem Tekhnologii Med"},{"key":"R23","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuroimage.2013.11.033","article-title":"Twenty years of functional near-infrared spectroscopy: introduction for the special issue","volume":"85 Pt 1","author":"Boas","journal-title":"Neuroimage"},{"issue":"2","key":"R24","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1016\/j.brs.2023.02.009","article-title":"TMS combined with EEG: recommendations and open issues for data collection and analysis","volume":"16","author":"Hernandez-Pavon","journal-title":"Brain Stimul"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijpsycho.2019.01.003","article-title":"Exploring brain functions in autism spectrum disorder: a systematic review on functional near-infrared spectroscopy (fNIRS) studies","volume":"137","author":"Zhang","journal-title":"Int J Psychophysiol"},{"issue":"4","key":"R26","doi-asserted-by":"publisher","first-page":"1262","DOI":"10.1364\/BOE.5.001262","article-title":"Reduced interhemispheric functional connectivity of children with autism spectrum disorder: evidence from functional near infrared spectroscopy studies","volume":"5","author":"Zhu","journal-title":"Biomed Opt Express"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.3389\/fnhum.2021.643410","article-title":"Narrowband resting-state fNIRS functional connectivity in autism spectrum disorder","volume":"15","author":"Sun","journal-title":"Front Hum Neurosci"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","DOI":"10.1186\/s13229-022-00500-x","article-title":"Resting state EEG power spectrum and functional connectivity in autism: a cross-sectional analysis","volume":"13","author":"Garc\u00e9s","journal-title":"Mol Autism"},{"key":"R29","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2024.116040","article-title":"Alterations in resting-state gamma-activity in adults with autism spectrum disorder: a high-density EEG study","volume":"339","author":"Kakuszi","journal-title":"Psychiatry Res"},{"issue":"1","key":"R30","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-023-02681-2","article-title":"Resting-state EEG power differences in autism spectrum disorder: a systematic review and meta-analysis","volume":"13","author":"Neo","journal-title":"Transl Psychiatry"},{"key":"R31","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.e7586","article-title":"SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials","volume":"346","author":"Chan","journal-title":"BMJ"},{"issue":"10","key":"R32","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1111\/pcn.12540","article-title":"Re-adjusting the cut-off score of the Korean version of the Childhood Autism Rating Scale for high-functioning individuals with autism spectrum disorder","volume":"71","author":"Kwon","journal-title":"Psychiatry Clin Neurosci"},{"issue":"9","key":"R33","doi-asserted-by":"publisher","first-page":"831","DOI":"10.30773\/pi.2021.0182","article-title":"Validation of Social Responsiveness Scale for Korean preschool children with autism","volume":"18","author":"Chun","journal-title":"Psychiatry Investig"},{"issue":"11","key":"R34","doi-asserted-by":"publisher","first-page":"4068","DOI":"10.1007\/s10803-024-06487-z","article-title":"Performance of the Social Responsiveness Scale-2 for the assessment of autistic behaviors in a sample of Canadian preschool-aged children","volume":"55","author":"Carty","journal-title":"J Autism Dev Disord"},{"issue":"3","key":"R35","doi-asserted-by":"publisher","first-page":"279","DOI":"10.5535\/arm.2019.43.3.279","article-title":"Effects of therapeutic horseback riding on cognition and language in children with autism spectrum disorder or intellectual disability: a preliminary study","volume":"43","author":"Kwon","journal-title":"Ann Rehabil Med"},{"issue":"2","key":"R36","doi-asserted-by":"publisher","DOI":"10.1002\/hbm.26619","article-title":"Wearable functional near-infrared spectroscopy for measuring dissociable activation dynamics of prefrontal cortex subregions during working memory","volume":"45","author":"Shin","journal-title":"Hum Brain Mapp"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.3389\/fnagi.2024.1468246","article-title":"An exploration of distinguishing subjective cognitive decline and mild cognitive impairment based on resting-state prefrontal functional connectivity assessed by functional near-infrared spectroscopy","volume":"16","author":"Pu","journal-title":"Front Aging Neurosci"},{"key":"R38","doi-asserted-by":"publisher","DOI":"10.1155\/2011\/130714","article-title":"EEGLAB, SIFT, NFT, BCILAB, and ERICA: new tools for advanced EEG processing","volume":"2011","author":"Delorme","journal-title":"Comput Intell Neurosci"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.942069","article-title":"Research status and prospects of acupuncture for autism spectrum disorders","volume":"14","author":"Li","journal-title":"Front Psychiatry"},{"issue":"6","key":"R40","doi-asserted-by":"publisher","first-page":"333","DOI":"10.51507\/j.jams.2022.15.6.333","article-title":"Sham acupuncture is not just a placebo","volume":"15","author":"Kim","journal-title":"J Acupunct Meridian Stud"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2024.1327206","article-title":"Effects of acupuncture for Bell\u2019s palsy patients in the acute phase and its impact on facial nerve edema: a study protocol for a randomized, controlled trial","volume":"15","author":"Wang","journal-title":"Front Neurol"},{"issue":"46","key":"R42","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000035275","article-title":"Effects of sham acupuncture for chronic musculoskeletal pain syndrome: a systematic review and network meta-analysis of randomized controlled trials","volume":"102","author":"Yu","journal-title":"Medicine (Baltimore)"},{"key":"R43","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m697","article-title":"Manual acupuncture versus sham acupuncture and usual care for prophylaxis of episodic migraine without aura: multicentre, randomised clinical trial","volume":"368","author":"Xu","journal-title":"BMJ"},{"key":"R44","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctim.2010.12.002","article-title":"Non-penetrating sham needle, is it an adequate sham control in acupuncture research?","volume":"19 Suppl 1","author":"Lee","journal-title":"Complement Ther Med"},{"issue":"1","key":"R45","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","journal-title":"J R Stat Soc Series B Stat Methodol"},{"issue":"4","key":"R46","doi-asserted-by":"publisher","first-page":"1292","DOI":"10.1016\/j.neubiorev.2012.02.007","article-title":"Autism as a neural systems disorder: a theory of frontal-posterior underconnectivity","volume":"36","author":"Just","journal-title":"Neurosci Biobehav Rev"},{"issue":"3","key":"R47","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.biopsych.2012.12.013","article-title":"Default mode network in childhood autism: posteromedial cortex heterogeneity and relationship with social deficits","volume":"74","author":"Lynch","journal-title":"Biol Psychiatry"},{"issue":"4","key":"R48","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1002\/aur.2082","article-title":"Frontal lobe dysfunction underlies the differential word retrieval impairment in adolescents with high-functioning autism","volume":"12","author":"Yeung","journal-title":"Autism Res"}],"container-title":["JMIR Research Protocols"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T17:41:16Z","timestamp":1792172476000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.researchprotocols.org\/2026\/1\/e97910"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":48,"URL":"https:\/\/doi.org\/10.2196\/97910","relation":{},"ISSN":["1929-0748"],"issn-type":[{"value":"1929-0748","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"article-number":"v15iSuppl 1e97910"}}