Adjunctive Deep Transcranial Magnetic Stimulation (dTMS) for Managing Emotional Dysregulation in Children and Adolescents with Externalizing Behavior Disorders: An Open-label Trial.

Background: High-frequency deep transcranial magnetic stimulation (dTMS) targeting the Anterior Cingulate Cortex (ACC) and Medial Prefrontal Cortex (mPFC) has demonstrated effectiveness in modulating emotional experiences; however, its potential in children and adolescents with externalizing behavior disorders (EBDs) remains unexplored. We aimed to evaluate the safety and efficacy of adjunctive high-frequency dTMS on emotional regulation in children and adolescents with EBDs.

Methods: Fifteen participants with EBDs experiencing emotional regulation challenges completed this study. During the three weeks, participants received 15 sessions of dTMS. Assessments were conducted at baseline and posttreatment using the Difficulty in Emotional Regulation Scale (DERS), Modified Overt Aggression Scale (MOAS), Affective Reactivity Index (ARI), Barrett Impulsivity Scale (BIS), and Clinical Global Impressions Severity Scale (CGI-S). A side effect checklist was administered after each session to monitor adverse events.

Results: We observed a significant improvement in emotional regulation, as well as other clinical variables. A significant reduction in DERS score (≥50%) was achieved (p < .001), indicating substantial improvement in emotional dysregulation. Clinical remission, (defined as CGI-S ≤3) was attained (p < .001) with a number needed to treat (NNT) of 2. These results indicate the putative potential of dTMS as an adjuvant intervention for this population.

Conclusions: The findings of this study suggest a potential role for dTMS as an adjunctive intervention in managing emotional dysregulation in children and adolescents with EBDs, contributing to a promising approach to the existing therapeutic repertoire for this population. Further research with larger sample sizes and a sham-controlled design is needed to support these findings.