How should researchers create repetitive transcranial magnetic stimulation (rTMS) treatment studies for youth?

Community Summary of: Neurodevelopmental considerations for transcranial magnetic stimulation trials in youth

Authors of the article in Neuropsychopharmacology: Christine A. Conelea and Alana Lieske

Published online: September 8, 2025

Community summary posted on November, 14, 2025

Word count: 826

Reading grade level: 10

Why does this study matter?

Repetitive transcranial magnetic stimulation (rTMS) is a treatment that uses magnetic fields to change how the brain works. During TMS, a small magnetic coil is placed on a specific part of the scalp. An electrical current is pulsed through the coil. This creates a brief magnetic field that activates the brain cells (neurons) underneath. Research has shown that rTMS can help improve conditions like depression and OCD by changing how brain cells and circuits work.

This technology has been used in research for 40 years. Most of the research has focused on brain conditions in adults, but it was recently shown to be effective, safe, and well-tolerated in adolescents with depression that hasn’t improved with therapy or medication.

As research expands to test rTMS in youth with other diagnoses and at younger ages, it is important to think about how developmental factors should impact study design. Researchers and providers have known for a long time that youth are not just “little adults.” There are many important differences between children, adolescents, and adults that impact how treatment and research should be done for each group.

For example, as researchers offer rTMS to children and adolescents, it is important for them to consider how young people are developing in their brains and bodies. Things like cortical thickness, brain volume, and brain surface area can be significantly different in kids vs. adults. These differences can be even greater in kids with neurodevelopmental, mood, and anxiety disorders, especially in adolescence.

What happened?

The authors read many published articles on TMS, rTMS, and other brain issues for youth and adults. Based on those articles and their experiences as researchers and clinicians, they created categories and recommendations. These categories include important things that other researchers should think about when they design studies. The categories include:

Neuroanatomy
Brain network topography
Neuroplasticity
Neurotransmitters
Hormones
Brain state effects
Psychosocial development
Adverse effect (AE) monitoring

The authors highlight ways to adapt rTMS while also making sure that studies are safe, feasible to do, and can be tolerated by youth. Finally, they highlight the importance of ethics, including making sure studies are respectful of people, and provide beneficence and justice. These categories and the information provided by the authors will help other researchers create high-quality studies to explore important questions.

What did the authors learn?

Some recommendations from the paper include:

Researchers should develop pediatric-specific rTMS protocols rather than only use protocols that have “worked” in adults.
It will be helpful for researchers to figure out the best rTMS locations (place to put the coil on the scalp) and settings for different types of symptoms. This includes figuring out ways to personalize rTMS for individuals based on their own brain.
The effect of rTMS can vary depending on things like a person’s behavior, emotions, and wakefulness around the time of stimulation. Researchers should figure out how these factors affect rTMS in kids. They should also consider ways to “boost” rTMS effects by pairing it with therapy or behavioral skills practice.
rTMS protocols may need to be adjusted for trauma-exposed youth because trauma can accelerate neural development.
Investigator teams should always include experts in child development and experience working with the target population. All study staff who work with participants should be trained on best practices when working with specific pediatric groups and disorder populations.
Researchers should take steps to manage safety in rTMS studies. This includes building trust with participants to ensure they feel comfortable sharing information, mindfully observing the participant during rTMS, and asking about sleep, medication and substance use, and caffeine consumption in the past 24 h prior to each rTMS session.
Researchers should collect information about side effects at every study visit and share these data in research reports.
It might help to make changes to the environment where youth undergo rTMS, including child-friendly room design, virtual pre-study equipment introductions for youth/families, individualized comfort measures guided by parent and child input, experimenter scripts with age-appropriate language, and avoiding frightening wording (e.g., like “zap” or “shock”).
An often overlooked discipline that may be particularly helpful to include in rTMS trials is Child Life. Certified child life specialists are trained to develop developmentally-appropriate strategies for medical procedures.
Researchers should work to ensure youth from a diverse array of backgrounds are included in rTMS studies.

What can researchers do next?

rTMS holds promise for becoming another treatment option for young people with various neuropsychiatric conditions. The authors suggested some directions for future research, including:

Designing clinical trials in ways that consider biological, contextual, and psychosocial aspects of development. All of these factors influence whether, how, and how well rTMS may ultimately work for youth.
Developing rTMS protocols that will be able to be implemented in “real-world” clinical settings.
Establishing clear standards for how pediatric rTMS studies should assess for and report side effects and tolerability challenges.
Consider ways to extend rTMS to earlier stages of illness when the brain has more neuroplasticity.

How can you find out more?

Read the full article