团体认知训练叠加重复经颅磁刺激对高功能孤独症谱系障碍共病注意缺陷多动障碍的增效作用及脑电机制

doi:10.3969/j.issn.1006-9771.2025.08.015

Abstract

Abstract:

Objective To examine the effect and electrophysiological mechanism of repetitive transcranial magnetic stimulation (rTMS) augmentated to group cognitive training (GCT) on children with high-functioning autism spectrum disorder (ASD) comorbided with attention-deficit/hyperactivity disorder (ADHD).

Methods From March to December, 2023, 70 children diagnosed with ASD+ADHD were recruited from the Affiliated Xuzhou Children's Hospital of Xuzhou Medical University and partnering special education centers. They were randomly divided into control group (n = 35) and experimental group (n = 35). Both groups received standardized GCT, twice a week, for ten weeks. During the same period, the control group received sham stimulation, while the experimental group additionally received 1 Hz rTMS over the right temporoparietal junction at 80% of resting motor threshold, five times a week, for ten weeks. Core symptoms were assessed before and after treatment with the Social Responsiveness Scale-2 (SRS-2), Repetitive Behavior Scale-Revised (RBS-R) and Conners Parent Rating Scale-3 (CPRS-3) attention-deficit and hyperactivity/impulsivity subscales. Resting-state EEG was simultaneously recorded to obtain θ and β power spectral density (PSD) and the θ/β ratio at Fz, Cz and Pz.

Results Two cases in the control group and one in the experimental group dropped down. After treatment, SRS-2 scores (|Z| > 4.876, P < 0.001) and RBS-R scores (|Z| > 4.329, P< 0.001) decreased in both groups. CPRS-3 attention-deficit scores (|Z| > 4.940, P < 0.001) and hyperactivity/impulsivity scores (|t| > 16.273, P < 0.001) decreased in both groups, and they were lower in the experimental group (Z = 4.732, P < 0.001; t = -3.169, P < 0.01). In the experimental group, Fz θ-PSD decreased significantly (Z = -4.830, P < 0.001), and it was lower than that in the control group (Z = -2.609, P = 0.009); and the θ/β ratio likewise fell (t = 4.754, P < 0.001), and it was lower than that in the control group (t = -2.256, P = 0.027).

Conclusion Adding rTMS to GCT can further alleviate attention deficits and hyperactive-impulsive symptoms in children with ASD comorbided with ADHD, which may associate with the inhibit of power of θ wave in profrontal contex.

Key words: repetitive transcranial magnetic stimulation, group cognitive training, autism spectrum disorder, attention deficit/hyperactivity disorder

CLC Number:

R749.93

QIU Aizhen, WANG Min, WANG Qiushuang, WU Ye, BAO Kexiu. Effect of repetitive transcranial magnetic stimulation augmentation on group cognitive training for high-functioning autism spectrum disorder comorbided with attention-deficit/hyperactivity disorder, and electrophysiological mechanisms[J]. Chinese Journal of Rehabilitation Theory and Practice, 2025, 31(8): 979-986.

Figures/Tables 7

Table 1

Table 2

Table 3

Table 4

Table 5

Table 6

Comparison of hyperactivity/impulsivity dimension raw scores in CPRS-3 scores between two groups pre- and post-treatment"

组别	n	测试	$x - ± s$	t值	P值
对照组	33	前测	24.79±4.23	16.273	< 0.001
		后测	22.58±3.98
试验组	34	前测	23.65±3.85	22.331	< 0.001
		后测	19.65±3.58
治疗前两组比较				-1.155	0.703
治疗后两组比较				-3.169	0.002

Table 6

Table 7

Comparison of θ-PSD、β-PSD and θ/β ratio at Fz electrode between two groups pre- and post-treatment"

项目	组别	n	测试	M(Q_L, Q_U)/( $x - ± s$ )	Z/t值	P值
Fz-θ/μV²	对照组	33	前测	17.24(15.34, 22.65)	-0.241	0.809
	对照组	33	后测	16.69(11.23, 22.76)	-0.241	0.809
	试验组	34	前测	16.97(14.24, 18.68)	-4.830	< 0.001
	试验组	34	后测	13.89(8.89, 15.94)	-4.830	< 0.001
	治疗前两组比较				-0.608	0.543
	治疗后两组比较				-2.609	0.009
Fz-β/μV²	对照组	33	前测	3.06(2.38, 5.11)	-0.785	0.432
	对照组	33	后测	3.08(2.38, 5.11)	-0.785	0.432
	试验组	34	前测	3.29(2.22, 4.16)	-0.812	0.417
	试验组	34	后测	3.29(2.23, 4.24)	-0.812	0.417
	治疗前两组比较				-0.314	0.754
	治疗后两组比较				-0.326	0.744
Fz-θ/β	对照组	33	前测	5.25±1.43	1.682	0.102
	对照组	33	后测	5.10±1.32	1.682	0.102
	试验组	34	前测	5.45±1.46	4.754	< 0.001
	试验组	34	后测	4.37±1.32	4.754	< 0.001
	治疗前两组比较				0.548	0.586
	治疗后两组比较				-2.256	0.027

Table 7

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组别	n	性别(男/女)/n	年龄/岁	ADOS-2	WISC-IV	ADHD-RS
对照组	33	20/13	8.96±1.56	6.00(6.00, 7.00)	92.91±10.09	41.67±6.65
试验组	34	21/13	9.04±1.33	6.50(6.00, 8.00)	92.00±8.44	41.65±6.01
χ²/t/Z值		0.013	-0.228	-1.247	-0.401	-0.013
P值		0.910	0.821	0.213	0.690	0.990

模块	内容
社交思维	用眼睛“倾听”(解析肢体语言；捕捉微表情；追踪目光落点；与环境互动)
	以耳“观”心(解析语音韵律：语气/重音/语调/语速；辨识隐喻暗示；捕捉潜在情感)
	破译无声信号(解析肢体语言；识别情绪变化；追踪环境互动)
	站在他人视角(模拟对方立场；预判互动反应；化解沟通冲突)
	解构复杂场景(拆解逻辑链条；预判潜在信息；构建因果模型)
执行功能	三思而后行(暂停-评估-执行三步骤；情绪冲动管理；多场景预演)
	走神应对方案(注意力召回信号；抗干扰策略；任务锚定技术)
	时间管理框架(任务切片化；时间计划表；记忆清单)
	逆境响应机制(合理提要求，找原因继续沟通，合理接受拒绝)
	灵活且有规则(“交通信号灯”系统、坚守核心原则、思维灵活性)

Effect of repetitive transcranial magnetic stimulation augmentation on group cognitive training for high-functioning autism spectrum disorder comorbided with attention-deficit/hyperactivity disorder, and electrophysiological mechanisms

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组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	33	前测	85.00(75.00, 109.50)	-4.876	< 0.001
		后测	82.00(72.00, 104.50)
试验组	34	前测	94.00(83.50, 116.25)	-5.019	< 0.001
		后测	84.50(77.50, 113.00)
治疗前两组比较				-1.556	0.120
治疗后两组比较				-1.205	0.228

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	33	前测	71.00(62.00,78.00)	-4.329	< 0.001
		后测	60.00(49.00, 72.50)
试验组	34	前测	71.00(61.50, 78.00)	-4.516	< 0.001
		后测	65.50(56.00, 74.00)
治疗前两组比较				1.157^a	0.165
治疗后两组比较				-1.783^b	0.075

组别	n	测试	M(Q_L, Q_U)	Z值	P值
对照组	33	前测	20.00(18.50, 21.00)	-5.143	< 0.001
		后测	18.00(16.00, 19.00)
试验组	34	前测	19.00(18.00, 20.00)	-4.940	< 0.001
		后测	12.00(10.00, 15.25)
治疗前两组比较				1.501	0.133
治疗后两组比较				4.732	< 0.001

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