{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T12:15:06Z","timestamp":1767183306860,"version":"3.41.2"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,31]],"date-time":"2025-03-31T00:00:00Z","timestamp":1743379200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Autism spectrum disorders (ASD) are common neurodevelopmental disorders, mainly caused by disrupted excitation\/inhibition balance and synaptic plasticity. Intermittent theta burst stimulation (iTBS) is a variant of excitatory repetitive transcranial magnetic stimulation, inducing long-term potentiation-like plasticity. In recent years, there has been a growing interest in high-dose iTBS as a therapeutic tool for psychiatric disorders. We aim to preliminarily investigate the feasibility, safety, and efficacy of high-dose iTBS in children with autism spectrum disorder (ASD).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A randomized controlled pilot trial with a 4-week intervention will be conducted. Forty children with ASD will be randomized into either the intervention or control group. The intervention group will receive 5400-pulse iTBS per day, while the control group will receive sham iTBS. Feasibility will be evaluated through recruitment, intervention adherence, and assessment completion. Safety will be assessed by comparing the rates of drop-outs attributed to adverse events and the rates of serious adverse events The efficacy outcomes include the Autism Behavior Checklist, Social Responsiveness Scale, 2nd Edition, Childhood Autism Rating Scale, Autism Treatment Evaluation Checklist and Repetitive Behavior Scale-Revised. Resting-state electroencephalogram and functional near-infrared spectroscopy will be employed to quantify alterations in functional brain connectivity and cerebral haemodynamics. Salivary levels of oxytocin, growth hormone, insulin-like growth factor 1, and insulin-like growth factor binding protein 3 are measured to reflect the biochemical response to iTBS. These indicators will be assessed at baseline and at the end of the intervention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>This trial will evaluate the feasibility, safety, and efficacy of high-dose iTBS treatment in children with ASD. The proposed study will provide pilot data to inform the feasibility and design of larger sample-size trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical trial registration<\/jats:title><jats:p><jats:uri>http:\/\/www.chictr.org.cn<\/jats:uri>, identifier ChiCTR2400089757.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpsyt.2025.1549982","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T15:58:35Z","timestamp":1743523115000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Feasibility, safety, and efficacy of high-dose intermittent theta burst stimulation in children with autism spectrum disorder: study protocol for a pilot randomized sham-controlled trial"],"prefix":"10.3389","volume":"16","author":[{"given":"Junzi","family":"Long","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maoyuan","family":"Niu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingxing","family":"Liao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaiyue","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiarou","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenlong","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xianna","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianjun","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yan","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1071181","article-title":"The global prevalence of autism spectrum disorder: A three-level meta-analysis","volume":"14","author":"Talantseva","year":"2023","journal-title":"Front Psychiatry"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2011.11071024","article-title":"Autism in DSM-5","volume":"168","author":"Tanguay","year":"2011","journal-title":"Am J Psychiatry"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-019-0138-4","article-title":"Autism spectrum disorder","volume":"6","author":"Lord","year":"2020","journal-title":"Nat Rev Dis Primers."},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1017\/S003329172300212X","article-title":"Randomised controlled trials of antipsychotics for people with autism spectrum disorder: a systematic review and a meta-analysis","volume":"53","author":"Deb","year":"2023","journal-title":"Psychol Med"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1007\/s11065-022-09564-1","article-title":"Treatment response of transcranial magnetic stimulation in intellectually capable youth and young adults with autism spectrum disorder: A systematic review and meta-analysis","volume":"33","author":"Smith","year":"2023","journal-title":"Neuropsychol Rev"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fnint.2018.00027","article-title":"Repetitive transcranial magnetic stimulation for treatment of autism spectrum disorder: A systematic review and meta-analysis","volume":"12","author":"Barahona-Corr\u00eaa","year":"2018","journal-title":"Front Integr Neurosci"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1016\/0006-8993(92)91715-q","article-title":"Theta burst stimulation is optimal for induction of LTP at both apical and basal dendritic synapses on hippocampal CA1 neurons","volume":"591","author":"Capocchi","year":"1992","journal-title":"Brain Res"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2004.12.033","article-title":"Theta burst stimulation of the human motor cortex","volume":"45","author":"Huang","year":"2005","journal-title":"Neuron."},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2018.06.003","article-title":"The potential of repetitive transcranial magnetic stimulation for autism spectrum disorder: A consensus statement","volume":"85","author":"Cole","year":"2019","journal-title":"Biol Psychiatry"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.989905","article-title":"Effects of non-invasive neurostimulation on autism spectrum disorder: A systematic review","volume":"13","author":"Zhang","year":"2022","journal-title":"Front Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(23)00026-3","article-title":"Effects of repetitive transcranial magnetic stimulation of the left dorsolateral prefrontal cortex on symptom domains in neuropsychiatric disorders: a systematic review and cross-diagnostic meta-analysis","volume":"10","author":"Kan","year":"2023","journal-title":"Lancet Psychiatry"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.3389\/fnint.2020.00035","article-title":"Assessing the effects of continuous theta burst stimulation over the dorsolateral prefrontal cortex on human cognition: A systematic review","volume":"14","author":"Ngetich","year":"2020","journal-title":"Front Integr Neurosci"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/aur.2954","article-title":"A lack of efficacy of continuous theta burst stimulation over the left dorsolateral prefrontal cortex in autism: A double blind randomized sham-controlled trial","volume":"16","author":"Ni","year":"2023","journal-title":"Autism Res"},{"key":"B14","doi-asserted-by":"publisher","first-page":"794","DOI":"10.1007\/s11682-024-00874-x","article-title":"Lack of effects of eight-week left dorsolateral prefrontal theta burst stimulation on white matter macro\/microstructure and connection in autism","volume":"18","author":"Yeh","year":"2024","journal-title":"Brain Imaging Behav"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3390\/jpm13010145","article-title":"A case series of intermittent theta burst stimulation treatment for depressive symptoms in individuals with autistic spectrum disorder: real world TMS study in the tokyo metropolitan area","volume":"13","author":"Noda","year":"2023","journal-title":"J Pers Med"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2021.711542","article-title":"Modulation of dorsolateral prefrontal cortex glutamate\/glutamine levels following repetitive transcranial magnetic stimulation in young adults with autism","volume":"15","author":"Moxon-Emre","year":"2021","journal-title":"Front Neurosci"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.1093\/brain\/awx379","article-title":"High-dose spaced theta-burst TMS as a rapid-acting antidepressant in highly refractory depression","volume":"141","author":"Williams","year":"2018","journal-title":"Brain."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awu109","article-title":"Efficacy of prefrontal theta-burst stimulation in refractory depression: a randomized sham-controlled study","volume":"137","author":"Li","year":"2014","journal-title":"Brain."},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1093\/cercor\/bhae106","article-title":"Effects of accelerated intermittent theta-burst stimulation in modulating brain of Alzheimer\u2019s disease","volume":"34","author":"Lin","year":"2024","journal-title":"Cereb Cortex."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.124.046597","article-title":"Efficacy and safety of high-dose TBS on poststroke upper extremity motor impairment: A randomized controlled trial","volume":"55","author":"Tang","year":"2024","journal-title":"Stroke."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2025.02.009","article-title":"Efficacy and safety of high-dose and personalized TBS on post-stroke cognitive impairment: A randomized controlled trial","volume":"18","author":"Ren","year":"2025","journal-title":"Brain Stimul."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1590\/1516-4446-2017-2279","article-title":"Intermittent theta-burst transcranial magnetic stimulation for autism spectrum disorder: an open-label pilot study","volume":"40","author":"Abujadi","year":"2018","journal-title":"Braz J Psychiatry"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1155\/2020\/9857987","article-title":"Increased accuracy of emotion recognition in individuals with autism-like traits after five days of magnetic stimulations","volume":"2020","author":"Liu","year":"2020","journal-title":"Neural Plast"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1016\/j.nicl.2023.103324","article-title":"Lack of effects of four-week theta burst stimulation on white matter macro\/microstructure in children and adolescents with autism","volume":"37","author":"Ni","year":"2023","journal-title":"NeuroImage Clin"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1002\/aur.2266","article-title":"Treatment of adults with autism and major depressive disorder using transcranial magnetic stimulation: an open label pilot study","volume":"3313","author":"Gwynette","year":"2020","journal-title":"Autism Res"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2023","article-title":"Repetitive transcranial magnetic stimulation can improve the fixation of eyes rather than the fixation preference in children with autism spectrum disorder","volume":"17","author":"Tian","year":"2023","journal-title":"Front Neurosci"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1017\/S0033291724001387","article-title":"Improving social cognition following theta burst stimulation over the right inferior frontal gyrus in autism spectrum: an 8-week double-blind sham-controlled trial","volume":"6","author":"Ni","year":"2024","journal-title":"Psychol Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1016\/j.brs.2020.01.007","article-title":"Treatment of Executive Function Deficits in autism spectrum disorder with repetitive transcranial magnetic stimulation: A double-blind, sham-controlled, pilot trial","volume":"13","author":"Ameis","year":"2020","journal-title":"Brain Stimul."},{"key":"B29","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1111\/ner.13455","article-title":"A systematic review of the safety and tolerability of theta burst stimulation in children and adolescents","volume":"25","author":"Elmaghraby","year":"2022","journal-title":"Neuromodulation."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2022.875591","article-title":"Prevalence of adverse effects associated with transcranial magnetic stimulation for autism spectrum disorder: A systematic review and meta-analysis","volume":"13","author":"Huashuang","year":"2022","journal-title":"Front Psychiatry"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1089\/cap.2015.0217","article-title":"Magnetic resonance imaging-guided, open-label, high-frequency repetitive transcranial magnetic stimulation for adolescents with major depressive disorder","volume":"26","author":"Wall","year":"2016","journal-title":"J Child Adolesc Psychopharmacol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.11m07003","article-title":"Adjunctive use of repetitive transcranial magnetic stimulation in depressed adolescents: a prospective, open pilot study","volume":"72","author":"Wall","year":"2011","journal-title":"J Clin Psychiatry"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.4103\/aian.AIAN_102_18","article-title":"Increasing number of therapy sessions of repetitive transcranial magnetic stimulation improves motor development by reducing muscle spasticity in cerebral palsy children","volume":"22","author":"Rajak","year":"2019","journal-title":"Ann Indian Acad Neurol"},{"key":"B34","doi-asserted-by":"publisher","first-page":"056044","DOI":"10.1088\/1741-2552\/ac999d","article-title":"Predicting the long-term after-effects of rTMS in autism spectrum disorder using temporal variability analysis of scalp EEG","volume":"19","author":"Jiang","year":"2022","journal-title":"J Neural Eng."},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-022-02693-y","article-title":"Impact of repetitive transcranial magnetic stimulation on the directed connectivity of autism EEG signals: a pilot study","volume":"60","author":"Kang","year":"2022","journal-title":"Med Biol Eng Comput"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-022-02693-y","article-title":"Effect of transcranial magnetic stimulation on neural activity during expression recognition in children with autism spectrum disorder","volume":"33","author":"Ke","year":"2019","journal-title":"Chin Ment Health J"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2008.05.008","article-title":"The impact of one HF-rTMS session on mood and salivary cortisol in treatment resistant unipolar melancholic depressed patients","volume":"113","author":"Baeken C","year":"2009","journal-title":"J Affect Disord"},{"key":"B38","doi-asserted-by":"publisher","first-page":"e12494","DOI":"10.1002\/npr2.12494","article-title":"Effects of repetitive transcranial magnetic stimulation therapy on weight and lipid metabolism in patients with treatment-resistant depression: A preliminary single-center retrospective cohort study","volume":"45","author":"Nakazawa","year":"2025","journal-title":"Neuropsychopharmacol Rep"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1177\/13623613211034375","article-title":"Oxytocin levels tend to be lower in autistic children: A meta-analysis of 31 studies","volume":"25","author":"John","year":"2021","journal-title":"Autism."},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1016\/j.peptides.2024.171217","article-title":"Negative association between basal oxytocin and oxytocin changes after repetitive transcranial magnetic stimulation in patients with treatment-resistant depression","volume":"177","author":"Kojima","year":"2024","journal-title":"Peptides."},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1530\/EC-18-0099","article-title":"The growth hormone-insulin-like growth factor-I axis in the diagnosis and treatment of growth disorders","volume":"7","author":"Blum","year":"2018","journal-title":"Endocr Connect."},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2007.02868.x","article-title":"Elevated levels of growth-related hormones in autism and autism spectrum disorder","volume":"67","author":"Mills","year":"2007","journal-title":"Clin Endocrinol"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1186\/2040-2392-2-16","article-title":"Investigation of the serum levels of anterior pituitary hormones in male children with autism","volume":"2","author":"Iwata","year":"2011","journal-title":"Mol Autism."},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnpbp.2022.110667","article-title":"Can a single session of noninvasive brain stimulation applied over the prefrontal cortex prevent stress-induced cortisol release","volume":"121","author":"Vignaud","year":"2023","journal-title":"Prog Neuropsychopharmacol Biol Psychiatry"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1176\/appi.neuropsych.16010013","article-title":"Effects of transcranial magnetic stimulation on the hypothalamic-pituitary axis in depression: results of a pilot study","volume":"29","author":"Meille","year":"2017","journal-title":"J Neuropsychiatry Clin Neurosci"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1002\/ddr.21808","article-title":"Effect of non-invasive brain stimulation on behavior and serum brain-derived neurotrophic factor and insulin-like growth factor-1 levels in autistic patients","volume":"82","author":"Robinson-Agramonte","year":"2021","journal-title":"Drug Dev Res"},{"key":"B47","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","year":"2013","journal-title":"BMJ."},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1016\/0013-4694(87)90206-9","article-title":"Cerebral location of international 10-20 system electrode placement","volume":"66","author":"Homan","year":"1987","journal-title":"Electroencephalogr Clin Neurophysiol"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1097\/YCT.0000000000000537","article-title":"Comparison of site localization techniques for brain stimulation","volume":"35","author":"Nikolin","year":"2019","journal-title":"J ECT."},{"key":"B50","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci10070423","article-title":"Effects of transcranial magnetic stimulation therapy on evoked and induced gamma oscillations in children with autism spectrum disorder","volume":"10","author":"Casanova","year":"2020","journal-title":"Brain Sci"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuron.2005.01.008","article-title":"Toward establishing a therapeutic window for rTMS by theta burst stimulation","volume":"45","author":"Paulus","year":"2005","journal-title":"Neuron."},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.3389\/fnins.2020.00576","article-title":"The after-effect of accelerated intermittent theta burst stimulation at different session intervals","volume":"14","author":"Yu","year":"2020","journal-title":"Front Neurosci"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinph.2021.12.018","article-title":"Dose-response of intermittent theta burst stimulation of the prefrontal cortex: A TMS-EEG study","volume":"136","author":"Desforges","year":"2022","journal-title":"Clin Neurophysiol"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-10-1","article-title":"A tutorial on pilot studies: the what, why and how","volume":"10","author":"Thabane","year":"2010","journal-title":"BMC Med Res Methodol"},{"key":"B55","doi-asserted-by":"publisher","DOI":"10.1002\/nur.20247","article-title":"Considerations in determining sample size for pilot studies","volume":"31","author":"Hertzog","year":"2008","journal-title":"Res Nurs Health"},{"key":"B56","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7610.1980.tb01797.x","article-title":"Behavior checklist for identifying severely handicapped individuals with high levels of autistic behavior","volume":"21","author":"Krug","year":"1980","journal-title":"J Child Psychol Psychiatry"},{"key":"B57","doi-asserted-by":"publisher","DOI":"10.18502\/ijps.v15i1.2438","article-title":"The reliability of the social responsiveness scale-2 in an Iranian typically developing group of children","volume":"15","author":"Shahrivar","year":"2020","journal-title":"Iran J Psychiatry"},{"key":"B58","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1007\/BF02408436","article-title":"Toward objective classification of childhood autism: Childhood Autism Rating Scale (CARS)","volume":"10","author":"Schopler","year":"1980","journal-title":"J Autism Dev Disord"},{"key":"B59","doi-asserted-by":"publisher","DOI":"10.1080\/19315864.2012.681340","article-title":"A comparison of the autism treatment evaluation checklist (ATEC) and the childhood autism rating scale (CARS) for the quantitative evaluation of autism","volume":"6","author":"Geier","year":"2013","journal-title":"J Ment Health Res Intellect Disabil."},{"key":"B60","doi-asserted-by":"publisher","DOI":"10.1023\/a:1005596502855","article-title":"Varieties of repetitive behavior in autism: comparisons to mental retardation","volume":"30","author":"Bodfish","year":"2000","journal-title":"J Autism Dev Disord"},{"key":"B61","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-022-01719-z","article-title":"Advances in human oxytocin measurement: challenges and proposed solutions","volume":"28","author":"Tabak","year":"2023","journal-title":"Mol Psychiatry"},{"key":"B62","doi-asserted-by":"publisher","first-page":"e17553","DOI":"10.7759\/cureus.17553","article-title":"Sex differences in salivary free insulin-like growth factor-1 levels in elderly outpatients","volume":"13","author":"Yasuda","year":"2021","journal-title":"Cureus."},{"key":"B63","doi-asserted-by":"publisher","DOI":"10.3390\/children9091301","article-title":"Association between chronological age and IGF-1, IGFBP-3, and CTX levels in saliva of children through younger adult population with varying periodontal status","volume":"9","author":"Almalki","year":"2022","journal-title":"Children."}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1549982\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T15:58:37Z","timestamp":1743523117000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2025.1549982\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,31]]},"references-count":63,"alternative-id":["10.3389\/fpsyt.2025.1549982"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2025.1549982","relation":{},"ISSN":["1664-0640"],"issn-type":[{"type":"electronic","value":"1664-0640"}],"subject":[],"published":{"date-parts":[[2025,3,31]]},"article-number":"1549982"}}