Li T, Han L, Feng SB, Li ZL, Zhang G. Effects of repetitive transcranial magnetic stimulation plus sandplay therapy on children with autism spectrum disorder. World J Psychiatry 2026; 16(10): 119983 [DOI: 10.5498/wjp.119983]
Corresponding Author of This Article
Gang Zhang, Associate Chief Physician, Department of Neurosurgery, Children’s Hospital Affiliated to Xi’an Jiaotong University, No. 69 Xijuyuan Lane, Lianhu District, Xi’an 710003, Shaanxi Province, China. zhanggang2509@163.com
Research Domain of This Article
Psychology
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Li T, Han L, Feng SB, Li ZL, Zhang G. Effects of repetitive transcranial magnetic stimulation plus sandplay therapy on children with autism spectrum disorder. World J Psychiatry 2026; 16(10): 119983 [DOI: 10.5498/wjp.119983]
World J Psychiatry. Oct 19, 2026; 16(10): 119983 Published online Oct 19, 2026. doi: 10.5498/wjp.119983
Effects of repetitive transcranial magnetic stimulation plus sandplay therapy on children with autism spectrum disorder
Tao Li, Liang Han, Shu-Bin Feng, Ze-Lin Li, Gang Zhang
Tao Li, Shu-Bin Feng, Ze-Lin Li, Department of Neurosurgery, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, Zhengzhou 450018, Henan Province, China
Liang Han, Department of Rehabilitation Medicine, Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, Zhengzhou 450018, Henan Province, China
Gang Zhang, Department of Neurosurgery, Children’s Hospital Affiliated to Xi’an Jiaotong University, Xi’an 710003, Shaanxi Province, China
Author contributions: Li T designed the research and wrote the first manuscript; Li T, Han L, Feng SB, Li ZL and Zhang G contributed to conceiving the research and analyzing data; Li T conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.
AI contribution statement: The authors declare that no AI tools were used in the development or writing of this manuscript and take full responsibility for its integrity, accuracy, and originality.
Supported by Henan Province Medical Science and Technology Research Plan Joint Construction Project, No. LHGJ20240559.
Institutional review board statement: This study was approved by the Ethic Committee of Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital Zhengzhou Children’s Hospital, No. 2026-IITGC-020-001.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
Data sharing statement: No additional data are available.
Corresponding author: Gang Zhang, Associate Chief Physician, Department of Neurosurgery, Children’s Hospital Affiliated to Xi’an Jiaotong University, No. 69 Xijuyuan Lane, Lianhu District, Xi’an 710003, Shaanxi Province, China. zhanggang2509@163.com
Received: April 17, 2026 Revised: June 15, 2026 Accepted: June 30, 2026 Published online: October 19, 2026 Processing time: 175 Days and 23.9 Hours
Abstract
BACKGROUND
Current interventions demonstrate limited efficacy in children with autism spectrum disorder (ASD), highlighting the need to explore more effective therapeutic approaches.
AIM
To investigate the effects of repetitive transcranial magnetic stimulation (rTMS) plus sandplay therapy on developmental levels and autism severity in children with ASD.
METHODS
A retrospective analysis was conducted in 109 children with ASD enrolled between November 2023 and November 2025. The control group comprised 53 children who received sandplay therapy alone, whereas the observation group included 56 children who received rTMS in addition to sandplay therapy. Developmental levels were assessed using the Psychoeducational Profile-Third Edition (PEP-3), autism severity using the Childhood Autism Rating Scale (CARS) and Autism Behavior Checklist (ABC), intervention efficacy using the Autism Treatment Evaluation Checklist (ATEC), sociability using the Social Responsiveness Scale (SRS), and sleep quality using the Chinese version of the Children’s Sleep Habits Questionnaire (CSHQ).
RESULTS
Following intervention data, PEP-3 scores in the observation group were significantly higher than both pre-intervention results and those in the control group. In contrast, CARS, ABC, ATEC (speech/language communication, sociability, health/physical/behavior, and total score, excluding sensory/cognitive awareness), SRS (social awareness, social cognition, social communication, social motivation, autistic mannerisms, and total score), and CSHQ scores were significantly lower than both pre-intervention results and those in the control group.
CONCLUSION
rTMS combined with sandplay therapy improves developmental levels in children with ASD and effectively alleviates autism severity, supporting its potential clinical application.
Core Tip: To further improve intervention outcomes in children with autism spectrum disorder, this study evaluated the combination of repetitive transcranial magnetic stimulation and sandplay therapy. Compared with sandplay therapy alone, the combined intervention yielded significantly greater improvements in children’s developmental level, intervention efficacy, and sociability. It also reduced autism severity and improved sleep quality.
