Evaluating the effect of repetitive transcranial magnetic stimulation on sleep difficulties in children with autism spectrum disorder: a randomized controlled trial

Uchenna Ezedinma ^1,2,3, Scott Burgess ⁴, Evan Jones ^1,2,5

⁰School of Health and Behavioral Science, University of the Sunshine Coast, 90 Sippy Downs Dr, Sippy Downs, QLD, 4556, Australia.

Sleep Advances : a Journal of the Sleep Research Society +

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December 25, 2025

View abstract on PubMed

Summary

Alpha rhythm-guided repetitive transcranial magnetic stimulation (α-rTMS) improved sleep difficulties in children with autism spectrum disorder (ASD). These benefits, including better sleep duration and reduced resistance to bedtime, were observed for up to four months.

Area Of Science

Neuroscience
Developmental Pediatrics
Sleep Medicine

Background

Sleep difficulties are prevalent in children with autism spectrum disorder (ASD), significantly impacting their quality of life and development.
Current interventions for sleep problems in ASD have limitations, necessitating exploration of novel therapeutic approaches.
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive neuromodulation technique with potential therapeutic applications.

Purpose Of The Study

To evaluate the efficacy and safety of alpha rhythm-guided repetitive transcranial magnetic stimulation (α-rTMS) in ameliorating sleep difficulties among children diagnosed with ASD.
To assess the durability of treatment effects on sleep parameters in children with ASD following α-rTMS intervention.

Main Methods

A randomized controlled trial involving 20 children (6-12 years) with ASD (Level 2) assigned to either an α-rTMS treatment group or a waitlist control group.
The treatment group received ten α-rTMS sessions over two weeks, followed by a crossover for the control group.
Sleep difficulties were objectively and subjectively assessed using the Children's Sleep Habit Questionnaire (CSHQ), actigraphy, and polysomnography (PSG) at baseline, post-intervention, and at one and four-month follow-ups.

Main Results

The α-rTMS treatment group demonstrated significant improvements in total CSHQ scores and specific subdomains, including bedtime resistance, sleep onset delay, and sleep duration, compared to the waitlist control group.
Following α-rTMS, the waitlist group showed improvements in sleep-disordered breathing, parasomnia, and sleep duration, alongside enhanced PSG measures of Waking After Sleep Onset (WASO) and sleep efficiency.
Subjective improvements in CSHQ scores persisted up to four months post-intervention, with actigraphy confirming sustained improvements in WASO. Reported side effects of α-rTMS were mild and transient.

Conclusions

This randomized controlled trial provides preliminary evidence supporting the effectiveness and safety of α-rTMS for improving subjective sleep difficulties in children with ASD.
The observed improvements in sleep parameters suggest α-rTMS as a promising non-invasive neuromodulation strategy for managing sleep disturbances in this population.
Further research with larger sample sizes and sham-controlled designs is recommended to confirm these findings and establish optimal treatment protocols.

Keywords:

alpha rhythm autism spectrum disorder children polysomnography repetitive transcranial magnetic stimulation sleep difficulties