rTMS and tDCS in Neurodevelopmental Conditions: New Ways to Enhance Neuroplasticity

Neuropsychologist Astrid Ortega presents scientific evidence on rTMS and tDCS for ADHD and ASD. 

Mechanisms of noninvasive brain stimulation in neurodevelopmental disorders

Neurostimulation encompasses cutting-edge, noninvasive therapeutic techniques designed to modulate brain activity. These techniques must be adapted to the neurobiological characteristics of each stage of life. This ability to personalize treatment is even more important when addressing neurodevelopmental conditions. 

Neurodevelopmental disorders (NDDs), in turn, comprise a diverse group of conditions characterized by difficulties with cognitive, behavioral, emotional, and social processes that emerge in the early stages of development and persist, to varying degrees, into adulthood. 

Growing knowledge about the neurobiology of NDDs, especially attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), along with evidence of alterations in inhibitory control, motivation, and socioemotional processing systems, has supported the inclusion of noninvasive brain stimulation (NIBS) techniques as a possible complementary therapeutic intervention alongside pharmacological, cognitive, and psychological interventions for children and adolescents. 

Repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS) stand out for their ability to safely modulate cortical excitability and synaptic plasticity without medication, with the potential to improve executive functioning and reduce clinical symptoms (Idiazabal, et al., 2026). 

Scientific evidence shows that neurostimulation techniques can induce lasting neuroplastic changes and improve functional domains such as attention, inhibitory control, working memory, and emotional regulation (Idiazabal, et al., 2026). 

These findings have paved the way for exploring the applicability and effectiveness of these techniques in pediatric populations, where alterations in connectivity and cortical maturation are central to the pathophysiology of NDDs. 

Clinical criterion	Transcranial direct current stimulation (tDCS)	Repetitive transcranial magnetic stimulation (rTMS)
Primary mechanism	Modulation of cortical excitability and reactivation of altered circuits.	Induction of lasting neuroplastic changes and functional connectivity.
Therapeutic targets	Left DLPFC and ventromedial prefrontal cortex (vmPFC).	DLPFC (bilateral/left) and cerebro-cerebellar circuits.
Suggested protocol	Anodal tDCS combined with cognitive or language training, applied simultaneously.	Low-frequency stimulation over a longer course of treatment.
Effects in ADHD	Increased attention/concentration and reduced impulsivity.	Improved processing speed and sustained attention.
Effects in ASD	Improvements in social competence and cognition, and reduced stereotypies.	Modulation of cortical inhibition and improvement in core symptoms.
Population and safety	Approved for pediatric populations; side effects are mild and transient.	An excellent option for ADHD that is resistant to medication or when adverse effects occur.

Scientific evidence for noninvasive brain stimulation in neurodevelopmental conditions

Clinical use of rTMS and tDCS in ADHD treatment

Attention-deficit disorder, with or without hyperactivity (ADD/ADHD), is described as a disorder characterized by inattention, psychomotor restlessness, and difficulty controlling impulses, which together form the symptom triad of distractibility (Soler, et al., 2014). 

Biologically, it is associated with structural and functional alterations in prefrontal regions, the striatum, and the cerebellum, as well as hypoactivation of bilateral attentional networks, particularly the dorsolateral prefrontal cortex (DLPFC). This region plays a key role in working memory, sustained attention, inhibitory control, and interference control. These functions are especially affected in ADHD, making the DLPFC a priority therapeutic target (Idiazábal, 2026). 

ADHD is also associated with altered cortical maturation, imbalances in functional connectivity, and dysfunction in excitatory and inhibitory neurotransmission systems, particularly glutamatergic and GABAergic systems, which affect networks such as the frontoparietal and executive control networks, as well as frontostriatal circuits (Rubia, 2018). 

ADHD treatment is multimodal, combining medication, cognitive behavioral intervention, and psychoeducation; this combination is the most effective. However, medication may cause adverse effects or be ineffective for some patients, and cognitive training alone often has limited efficacy. 

In this context, noninvasive brain stimulation techniques are emerging as a promising strategy for modulating the neural networks involved and promoting synaptic plasticity. rTMS and tDCS, primarily targeting the DLPFC, have different effects on symptoms, supporting individualized selection of the modality based on clinical profile and therapeutic goals (Chen, et. al., 2025). 

The mechanisms by which tDCS improves ADHD symptoms and cognitive functioning are related to the reactivation of altered neural circuits. tDCS is safe and can effectively improve attention and concentration, as well as reduce symptoms of impulsivity (Antal, et al., 2022). 

Studies suggest positive results from using transcranial magnetic stimulation (TMS) to treat ADHD in children and young adults, including improvements in attention at school and in hyperactivity/impulsivity at home. These treatments are also an excellent option when there are few alternatives for treating medication-resistant ADHD in adolescents, as well as for patients who experience intolerable medication-related adverse effects and need to discontinue treatment (Memon, 2021).

Although brain stimulation treatments have been reported to improve cognitive functions and attention associated with various psychiatric and neurodevelopmental disorders, evidence supporting the therapeutic effect of repetitive transcranial magnetic stimulation (rTMS) on attentional performance remains limited. Significant improvements in sustained attention and processing speed, but not in memory or executive functions, have been observed in patients with ADHD treated with rTMS compared with control groups (Chen et al., 2023).

Nevertheless, the strength of the evidence obtained in the studies mentioned needs to be further examined in future clinical research and compared with traditional neuropsychological treatments.

Efficacy of rTMS and tDCS in ASD treatment

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by persistent deficits in communication and social interaction, as well as restricted and repetitive patterns of behavior, interests, or activities, with symptoms present from childhood that affect daily functioning (Gollo, et, al., 2025). 

People with ASD may have sensory differences, executive function difficulties, and a high prevalence of sleep disorders, and the condition may be associated with emotional difficulties. 

From a neurobiological perspective, ASD is associated with an imbalance between cortical excitation and inhibition, linked to alterations in the GABAergic system. This imbalance manifests as cortical hyperexcitability, alterations in gamma oscillations, and changes in evoked potentials related to attention and the processing of relevant stimuli (Martínez-Morga et al., 2019). 

These important findings support the use of noninvasive brain stimulation (NIBS) techniques as a strategy for modulating cortical inhibition and restoring the excitation-inhibition balance, as well as improving both core ASD symptoms and associated sleep disorders. NIBS techniques not only act directly on the stimulated region but also influence functionally connected areas, strengthening functional connectivity within the neural network. 

The dorsolateral prefrontal cortex (DLPFC) is involved in motor planning, inhibitory control, and organizational skills, and maintains functional connections with regions such as the orbitofrontal cortex, thalamus, and basal ganglia. This network of interactions links the DLPFC to behavioral features characteristic of ASD, such as restricted and repetitive behaviors and hypersensitivity. For this reason, it is considered a key brain target for this population (Mora-Rosales et al., 2025). 

From a complementary perspective, some studies have applied noninvasive brain stimulation (NIBS) techniques to the cerebellum to modulate cerebro-cerebellar circuits involved in emotional regulation, attention, and sensory integration. Side effects associated with NIBS are mild and transient. Most rTMS studies in ASD use low-frequency stimulation over the DLPFC, which has been associated with improvements in cognitive performance and social difficulties. Low-frequency rTMS over the left DLPFC is the most commonly used approach for improving core symptoms of ASD, with better results observed after longer courses of treatment than after shorter interventions (Auer, et al., 2025). 

tDCS is permitted for pediatric patients, including children and adolescents, and adds to the wide range of behavioral, neuropsychological, and pharmacological treatments for autism spectrum disorder (ASD). In addition, several studies have applied tDCS in infants with ASD. The results provide evidence of tDCS-induced brain plasticity, showing that tDCS can reconfigure the brain networks of infants with ASD, which may help establish effective tDCS modulation strategies for these cases (Sánchez Savigñón et al., 2023). 

Improvements in social interaction, a reduction in stereotyped behaviors, and better executive functioning have been observed. Based on the available evidence, anodal tDCS applied over the left dorsolateral prefrontal cortex appears to be more clinically effective than cathodal tDCS. 

Other brain regions involved in ASD, such as the ventromedial prefrontal cortex (vmPFC), have also been identified. Anodal tDCS applied over the vmPFC and DLPFC in ASD has been associated with improvements in social competence and social cognition. 

Similarly, combining tDCS treatment with cognitive, language, or emotion-recognition tasks enhances its therapeutic effects. 

The future of neurostimulation for neurodevelopmental conditions

Neurostimulation techniques hold promise for helping children with neurodevelopmental conditions, but more research is needed to determine whether they are truly safe and effective through studies involving more controlled populations and different settings. 

That research will help establish a stronger evidence base for the frequency and intensity with which these techniques are used in children and adolescents with ADHD or ASD. It will also help clarify the extent to which techniques such as TMS and tDCS can complement traditional neuropsychological rehabilitation.

These techniques are promising, but the field may still seem new. More rigorous research is therefore needed before they can be used with confidence in everyday clinical practice. 

References

• Antal, A., Luber, B., Brem, A.-K., Bikson, M., Brunoni, A. R., Cohen Kadosh, R., Dubljević, V., Fecteau, S., Ferreri, F., Flöel, A., Hallett, M., Hamilton, R. H., Herrmann, C. S., Lavidor, M., Loo, C., Lustenberger, C., Machado, S., Miniussi, C., Moliadze, V., … Paulus, W. (2022). Non-invasive brain stimulation and neuroenhancement. Clinical Neurophysiology Practice, 7, 146–165. https://doi.org/10.1016/j.cnp.2022.05.002
• Auer, G., Pruewasser, L., Scharinger, C., Laczkovics, C., Zesch, E., Plener, P., Antal, U., Koenig, J., & Konicar, L. (2025). Neurotherapy for children and adolescents with psychiatric disorders: A state-of-the-art review of selected clinical methodologies. Neuroscience & Biobehavioral Reviews, 176, 106258. https://doi.org/10.1016/j.neubiorev.2025.106258
• Chen, Q., Fang, P. N., Iargo, Y., Kun-Qin, K., Sangchooli, A., Cao, Y., Singh, M. K., Chen, Y., & Gong, Q. (2026). Noninvasive brain stimulation in attention deficit/hyperactivity disorder: A systematic review and meta-analysis of treatment efficacy and targeting strategies. Journal of the American Academy of Child & Adolescent Psychiatry, 65(3), 369–391. https://doi.org/10.1016/j.jaac.2025.07.009
• Mora-Rosales, J. C., Díaz-Alulema, V. M., Echeverría-Almeida, J. P., & Cerda-Andi, M. L. (2025). Funciones ejecutivas y trastorno del espectro autista en la infancia: Una revisión sistemática. Kiria, 1(1). https://doi.org/10.53877/6ewjhw60
• Rubia, K. (2018). Cognitive neuroscience of attention deficit hyperactivity disorder (ADHD) and its clinical translation [Neurociencia cognitiva del trastorno por déficit de atención e hiperactividad (TDAH) y su traducción clínica]. Frontiers in Human Neuroscience, 12, 100. https://doi.org/10.3389/fnhum.2018.00100

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