TMS for the Neurodivergent

At Framework, we welcome Autism Spectrum Disorder/ Neurodivergent folks and have

had great success in advocating for them to receive TMS services through their

commercial insurer.

We’ve seen it time and time again, an individual with ASD reports being in a Major

Depressive Episode but when they complete the validated screenings needed to get

Prior Authorizations approved through insurance, their screenings show only “mild

depression!” The patient knows. We know. It’s not mild but the usual screening tools are

inaccurate. It should be acknowledged that adults with ASD are at elevated risk for

mood disorders. Autistic adults actually experience anxiety and depression at rates

higher than the general population. And, unfortunately, there are no specific tools

developed for this population (although researcher J Rodgers is developing a specific

tool for evaluation of anxiety in this treatment population). In one study, researchers

found weak evidence to support the use of the Beck Depression Inventory and it should

be mentioned that nobody has evaluated the other tools for reliability and validity in the

Autistic population.

Even more scary is the vulnerability and risk Neurodivergent folks experience. Non-

suicidal gestures are fairly common in the ASD population, but it is less well known that

Neurodivergent folks have much higher rates of suicide than the general population.

And they’re less likely to get help.

Lack of support for autistic adults has been associated with increased risk of depression

and suicidality (Cassidy, et al, 2018; Hedley et al, 2017). Autistic adults also report a

significantly higher number of unmet support needs than the general population

(Cassidy et al, 2018); autistic adults and children struggle to obtain appropriate support

post diagnosis (Crane et al, 2016; Jones et al, 2014; and autistic young adults face

challenges in accessing appropriate treatment for mental health problems (Crane et al,

2018). Hence, despite autistic people being at significantly increased risk of mental

health problems and suicidality than the general population, they appear to be less likely

to be able to access support and treatment for these difficulties.

We want to work to change that.

Gwynette, M.F., et al. (2020) in their research “Treatment of Adults with Autism and

Major Depressive Disorder Using Transcranial Magnetic Stimulation: An Open Label

Pilot Study” reported this: “After treatment, 70% of participants had a decrease in

depressive symptoms, and 40% experienced remission. No changes were seen in self-

reported autism symptoms. However, people who knew the participants detected

decreases in repetitive behaviors, hyperactivity and irritability.”

We’ve treated dozens of Neurodivergent folks here at Framework. Things we have

noticed (that don’t come from an academic paper):

 Patients are more organized and motivated

 Patients have decreased irritability

 Patients are better able to attend to self-care, like grooming

 Patients are more adaptable with improved impulse control

 Patients have enhanced decision-making

 Patients are more emotionally aware and have decreased reactivity

If you’re a Neurodivergent person interested in TMS, but had a bad experience or lack

of success with medications or you just didn’t get much out of talk therapy, we might be

able to help advocate for you. Reach out: 503.908.1625

Citations:

Cassidy S, Bradley L, Shaw R, Baron-Cohen S. Risk markers for suicidality in autistic adults. Mol Autism.

2018 Jul 31;9:42. doi: 10.1186/s13229-018-0226-4. PMID: 30083306; PMCID: PMC6069847.

Crane L, Chester JW, Goddard L, Henry LA, Hill E. Experiences of autism diagnosis: A survey of over

1000 parents in the United Kingdom. Autism. 2016 Feb;20(2):153-62. doi: 10.1177/1362361315573636.

Epub 2015 Mar 25.

Gwynette MF, Lowe DW, Henneberry EA, Sahlem GL, Wiley MG, Alsarraf H, Russo SB, Joseph JE,

Summers PM, Lohnes L, George MS. Treatment of Adults with Autism and Major Depressive Disorder

Using Transcranial Magnetic Stimulation: An Open Label Pilot Study. Autism Res. 2020 Mar;13(3):346-

351. doi: 10.1002/aur.2266. Epub 2020 Jan 15.

Hedley D, Uljarević M, Wilmot M, Richdale A, Dissanayake C. Brief Report: Social Support, Depression

and Suicidal Ideation in Adults with Autism Spectrum Disorder. J Autism Dev Disord. 2017

Nov;47(11):3669-3677. doi: 10.1007/s10803-017-3274-2.

Jones L, Goddard L, Hill EL, Henry LA, Crane L. Experiences of receiving a diagnosis of autism spectrum

disorder: a survey of adults in the United kingdom. J Autism Dev Disord. 2014 Dec;44(12):3033-44. doi:

10.1007/s10803-014-2161-3.

Rodgers J, Farquhar K, Mason D, Brice S, Wigham S, Ingham B, Freeston M, Parr JR. Development and

Initial Evaluation of the Anxiety Scale for Autism-Adults. Autism Adulthood. 2020 Mar 1;2(1):24-33. doi:

10.1089/aut.2019.0044. Epub 2020 Mar 11.