fMRI Tracking taVNS in ASD

In this study, the Investigators main goal is to establish and validate new imaging biomarkers for evaluating and tracking changes in functional networks and dynamic brain states that occur over 1-month transcutaneous auricular vagus nerve stimulation (taVNS) treatment in individuals with autism spectrum disorder (ASD) at home.

In this double-blinded sham-controlled clinical trial, Investigators will recruit up to 16 patients with ASD and co-occurring anxiety symptoms from the outpatient clinics at MUSC, SPARK, Epic, and social media (i.e., Project Rex, SCARO). Each participant will first receive the baseline behavior evaluation using a neuropsychiatric battery. Then, participants will have a high-resolution structural MRI scan and four runs of resting-state fMRI scans (~30-min in total) at MUSC 30 Bee Street Center for Biomedical Imaging. This will be followed by an in-person training session with the subject (and legal guardian if applicable), where they will learn how to self-administer taVNS and ask any pertinent questions. Participants will self-administer taVNS (or sham) at home twice daily for 4 weeks. At the end of 4 weeks, participants will have the post-taVNS MRI scanning and behavioral evaluation. Additionally, participants will also complete the behavioral evaluation virtually right after the 2-week treatment, and follow-up 1 and 4 weeks after the completion of treatment.

Aim 1. Identify dynamic imaging biomarkers capable of tracking the brain state changes of ASD throughout a one-month taVNS treatment at home.

Aim 2. Explore whether dynamic brain state measures derived from baseline can predict symptom improvement and response to taVNS treatment.

Results from this study may help to further optimize this taVNS therapy and lead to more effective treatment for ASD, as well as identify dynamic imaging biomarkers that can quantify and track symptom recovery in this unique population.

Inclusion criteria

• Ages 12-17
• English speaking
• Prior diagnosis of ASD using autism diagnostic observation schedule (ADOS)
• Have the capacity and ability to provide one's own assent, consent will be provided by legal guardian

Exclusion criteria

• Facial/ear pain or recent ear trauma
• Metal implant devices in the head, heart, or neck
• History of brain surgery
• History of myocardial infarction or arrhythmia/bradycardia
• Acute exacerbation of a chronic respiratory disorder or acute COVID-related symptoms
• Active GI symptoms with a history of diabetes mellitus (DM) or gastroparesis secondary to DM
• Personal or family history of seizure or epilepsy or personal use of medications that substantially reduce seizure threshold (e.g., olanzapine, chlorpromazine, lithium)
• Personal history of head injury, concussion, or self-report of moderate to severe traumatic brain injury
• Personal history of frequent/severe headaches
• Personal history of psychosis or mania, or individuals who are actively manic or psychotic
• Individuals who are catatonic or otherwise unable to participate in the informed consent process
• Moderate to severe alcohol or substance use disorder
• Pregnancy