Pediatric TMS and MeRT: Why We Believe Comprehensive Care Matters

At Brain Treatment Center NoVA, families often come to us after a long road.

Some have a child with autism who is struggling with communication, regulation, sensory processing, sleep, attention, or behavior. Others are navigating ADHD, anxiety, developmental differences, or complex combinations of neurological, behavioral, and functional concerns.

Many parents have already tried multiple therapies. They have read the research, talked with other families, and spent years trying to determine what might help their child.

When they find TMS or MeRT, it is understandable to ask one very important question:

Will this work for my child? Our answer begins with transparency. And, We cannot know that before treatment begins.

Every child’s brain, biology, developmental history, medical history, environment, and therapeutic needs are different. TMS and MeRT can be important tools, but we do not believe any single intervention should automatically be viewed as the entire answer.

That philosophy is the foundation of our pediatric program at Brain Treatment Center NoVA.

What Are TMS and MeRT?

Transcranial magnetic stimulation, or TMS, is a noninvasive neuromodulation technology that uses magnetic pulses to influence activity within targeted areas of the brain.

Repetitive transcranial magnetic stimulation, or rTMS, delivers these pulses repeatedly according to defined treatment parameters.

MeRT, or Magnetic e-Resonance Therapy, is a personalized approach to TMS that incorporates EEG data into the development of individualized treatment parameters.

At Brain Treatment Center NoVA, our MeRT program is provided in collaboration with Wave Neuroscience, the developer of the MeRT technology. Brain Treatment Center NoVA’s Ashburn and Alexandria locations are listed by Wave Neuroscience as MeRT providers. (Wave Neuroscience)

Pediatric MeRT begins with a quantitative electroencephalogram, or qEEG, which provides objective information about electrical activity in the brain.

For MeRT patients, that EEG data is submitted through Wave Neuroscience’s proprietary analysis and protocol-development platform. Wave describes this process as analyzing the timing, frequency, and coordination of brainwave activity and using those findings to generate personalized TMS treatment parameters. (Wave Neuroscience) At Brain Treatment Center NoVA, those recommendations are not implemented independently of clinical care.

The protocol information provided through the MeRT process is reviewed within the context of the child’s clinical presentation and is ultimately provided under the guidance and oversight of our physicians, who have advanced training and experience in TMS, neuromodulation, and the clinical oversight required for the MeRT treatment process.

Treatment sessions are then administered by trained neurotechnicians according to the physician-confirmed treatment protocol.

Treatment is not simply started and continued without reassessment. Our general pediatric treatment cycle is: qEEG → Wave Neuro Analysis & Protocol Development → Physician Review → TMS/MeRT Treatment → Repeat qEEG → Clinical and Data Review → Continue or Adjust

During active treatment, repeat qEEGs and clinical reviews are generally performed approximately every two weeks. For MeRT patients, repeat EEG data is again reviewed through the Wave Neuroscience process. The resulting information can then be considered alongside clinical observations, parent feedback, treatment tolerance, functional changes, and the child’s overall progression. The goal is not to assume that a protocol is working simply because treatment is occurring. We want objective data, clinical observations, parent feedback, treatment-tolerance information, and functional changes to inform ongoing decision-making. Technology can provide important information. Clinical judgment still matters. And ultimately, the child remains under the clinical guidance of the physicians overseeing treatment at Brain Treatment Center NoVA.

What Does the Research Say About TMS and Autism?

The scientific literature surrounding TMS for autism is growing, but it is important to describe that literature accurately. A 2018 systematic review and meta-analysis identified 23 reports examining repetitive TMS in autism. The analysis found moderate improvements in repetitive and stereotyped behaviors, social behavior, and some measures of executive functioning. More recent research has continued to expand the evidence base.

Yuan et al. (2024) reviewed 17 TMS studies published after 2018, including seven randomized controlled trials and ten open-label studies. Improvements were reported across measures of stereotyped and repetitive behavior and verbal and social domains. Importantly, however, only two studies were double-blinded, many carried moderate to high risk of bias, and treatment parameters varied substantially across studies. (PubMed)

Smith et al. (2023) conducted a systematic review and meta-analysis examining TMS in intellectually capable autistic youth and young adults. Their analysis found improvements in cognitive outcomes and some autism-related symptom measures following low-frequency rTMS. The authors characterized TMS as promising while emphasizing the need for more robust study designs before broad clinical recommendations can be made. (PubMed)

Importantly, not every contemporary analysis has reached the same conclusion.

A 2024 network meta-analysis of randomized controlled trials examining several forms of noninvasive brain stimulation found that rTMS did not significantly outperform sham treatment for its principal autism symptom outcomes. (PubMed)

What About MeRT Specifically?

MeRT is built upon TMS technology but uses an individualized, EEG-informed protocol-development approach. The evidence specifically evaluating personalized EEG-guided TMS is substantially smaller than the overall TMS literature. A 2024 open-label pilot study evaluated personalized rTMS guided by spectral EEG information in 123 autistic participants who were also receiving applied behavior analysis. Investigators reported improvements in clinical measures among participants alongside changes in EEG measures (Makale et al., 2024). (PubMed) The research continues to support TMS as a promising area of neuromodulation for autism and other neurodevelopmental presentations, while also showing why individualized treatment matters. Children do not all present with the same neurological patterns, developmental history, functional challenges, or treatment needs. Likewise, they should not be expected to respond in exactly the same way. That variability is one of the reasons our MeRT program incorporates qEEG data, individualized protocol development through Wave Neuroscience, physician oversight, repeat measurement, and ongoing clinical review.

The goal is not simply to apply the same protocol to every child.

It is to use the available data to develop and continually reassess a treatment approach that is specific to the individual child.

Research into EEG-guided TMS continues to develop. A recent systematic review specifically evaluating EEG-guided TMS in autistic children and adolescents found only seven studies meeting final inclusion criteria, further illustrating how early this particular evidence base remains. (PubMed)

That is one reason we believe parents deserve both optimism and appropriate expectations.

There is meaningful scientific interest in individualized neuromodulation, but the research is still developing.

A Change in a qEEG Is Not the Same Thing as a Guaranteed Developmental Outcome

This is one of the most important conversations we have with parents.

We may see measurable changes in brain electrical activity over a course of treatment.

A family may also notice changes in sleep, engagement, regulation, attention, communication, sensory behavior, or other areas of everyday functioning.

But those changes do not necessarily occur together. A positive change in qEEG measurements does not guarantee that a specific behavioral, developmental, or functional change will follow. Likewise, one area may change before another.

Children are complex biological and developmental systems. Their progress cannot always be reduced to a single measurement.

Behavior May Also Fluctuate

Parents sometimes become concerned when a familiar behavior increases or changes during treatment.

Children with autism and other neurodevelopmental conditions may already experience fluctuations in stimming, repetitive or ritualistic behaviors, sensory seeking, activity level, emotional regulation, sleep, attention, communication, and anxiety.

These behaviors can serve different functions for different children. Stimming, movement, rituals, and repetitive behaviors, for example, may be familiar ways a child regulates, self-soothes, manages sensory input, or responds when the world around them feels overwhelming.

During pediatric TMS/MeRT treatment, we sometimes observe what appears to be an increased awareness of the child’s environment, internal state, or sensory experiences. Families may simultaneously notice an increase or greater visibility of familiar self-soothing behaviors, including stimming, movement, sensory seeking, or rituals.

We do not automatically interpret this as either improvement or deterioration.

Instead, we ask a more useful question: What is this behavior doing for this child?

If stimming, movement, or ritualized behavior is one of a child’s established tools for regulation, it makes sense to consider the behavior within that larger context. As a child becomes more engaged with their environment or experiences changes in regulation, attention, communication, or sensory processing, familiar coping strategies may become more noticeable.

This is also one of the reasons we believe TMS/MeRT is often most valuable as one part of a larger therapeutic program rather than a stand-alone intervention. Neuromodulation may influence brain activity and regulation, but a child may still need help developing the functional skills to navigate what they are experiencing.

Occupational therapy can help expand sensory, motor, regulation, and functional strategies. Speech and language therapy can support communication and the ability to express needs. Psychological, behavioral, developmental, and other appropriate therapies can provide additional tools for emotional regulation, coping, interaction, and participation in everyday life.

The goal is not simply to take away a child’s existing coping mechanisms. It is to expand the child’s toolkit. That distinction is important. A child who relies on stimming, movement, or rituals for regulation should not simply have those behaviors suppressed without understanding their function. Instead, comprehensive care can help give the child more ways to communicate, regulate, engage, and respond to the world around them.

This is why our pediatric model looks beyond TMS alone.

For this reason, we do not automatically classify every behavioral change during treatment as either “good” or “bad.” We monitor it, listen to the family, consider what else is occurring in the child’s life and therapeutic program, and evaluate the change within the context of the whole child.

A behavior occurring after treatment also does not, by timing alone, establish that treatment caused it. Conversely, a new or concerning change should never simply be dismissed because a child is undergoing TMS.

Parents are asked to report meaningful behavioral, neurological, physical, sleep, or functional changes so that the clinical team can evaluate what is occurring and determine whether additional assessment, physician review, temporary treatment interruption, or treatment modification may be appropriate.

Pediatric TMS Safety Matters

Pediatric TMS has also been evaluated in the safety literature.

A systematic review by Allen et al. (2017) examined TMS studies involving children and found that the available evidence suggested an overall risk profile comparable to that observed in adults, while emphasizing the importance of appropriate safety procedures and ongoing surveillance. Research specifically examining TMS in autism has similarly found that reported adverse effects are generally mild and transient.

A 2022 systematic review and meta-analysis of 11 studies found an overall adverse-event prevalence of approximately 25%. Reported effects included headache, facial discomfort, irritability, discomfort at the stimulation site, and dizziness (Huashuang et al., 2022). (PubMed) Pediatric neuromodulation nevertheless remains an evolving field.

Appropriate screening, physician oversight, monitoring, and communication with families are essential.

The Bigger Question: What Does This Child Need?

This is where our philosophy becomes broader than TMS.

If a child has difficulty communicating, TMS does not replace speech-language therapy.

If a child struggles with fine-motor skills, sensory processing, self-care, motor planning, or functional participation, TMS does not replace occupational therapy.

If a child has significant gastrointestinal, nutritional, metabolic, sleep, medication, or other medical concerns, neuromodulation does not replace appropriate medical evaluation.

If a child needs behavioral, developmental, psychological, educational, or psychiatric support, those needs do not disappear because the child is receiving TMS.

Comprehensive pediatric care requires looking beyond a single intervention and asking what combination of support is appropriate for the individual child.

That is very close to how we think about pediatric care at Brain Treatment Center NoVA, and why we offer a broader comprehensive approach with providers that are highly trained in these areas.

TMS May Be Part of the Puzzle. It Is Rarely the Entire Puzzle.

At Brain Treatment Center NoVA, our pediatric model can bring together multiple disciplines depending upon the individual child.

That may include:

qEEG Brain Mapping + TMS/MeRT + Occupational Therapy/SPIN + Functional and Integrative Health + Neurofeedback + Autism Assessment + Collaboration With Outside Providers

Not every child needs every service. That is the point.

Comprehensive care should not mean doing everything to every child.

It should mean asking enough questions to understand what this particular child needs.

For one child, regulation may be the primary barrier. For another, it may be communication.

Another may have significant sensory-motor challenges. Another may be struggling with sleep, anxiety, attention, nutrition, gastrointestinal symptoms, medication tolerance, or several of these simultaneously. Sometimes there are multiple pieces of the puzzle.

Our job is to determine which pieces are relevant rather than assuming that one therapy can address everything. The therapeutic plan should follow the child, not force the child into a predetermined therapeutic plan.

Why We Repeat the qEEG

We also believe reassessment matters.

During pediatric MeRT treatment, repeat qEEGs are generally obtained approximately every two weeks. For MeRT patients, those recordings are submitted through the Wave Neuroscience process for continued analysis and protocol recommendations. The information is then considered alongside treatment tolerance, clinical observations, parent reports, functional changes, and physician assessment. Treatment may continue or the protocol may be modified when appropriate. An initial treatment period should therefore not automatically be interpreted as the complete course for every child. Some children may demonstrate continued progression for which additional treatment is considered. Others may show limited meaningful change. Additional treatment should not be recommended simply because more treatment is possible.

The question should remain:

What does the available information tell us about this child?

Setting Clear Expectations From the Beginning

Transparency has always been an important part of our pediatric TMS and MeRT process.

These are conversations we have routinely had with families before and throughout treatment: how the process works, why we repeat the qEEG, why treatment length may differ between children, what families may or may not observe, and why specific outcomes cannot be promised. As our pediatric program has continued to grow, we have made that conversation more formal within the intake process through a written Pediatric MeRT Parent Expectations & Understanding acknowledgment. The purpose is not to introduce a new philosophy. It is to make sure the philosophy we already practice is clearly communicated, consistently reviewed, and documented from the beginning.

Families should understand that: Results cannot be guaranteed.

We cannot predict exactly which developmental domain may change first.

We cannot assume every behavioral change was caused by TMS.

We cannot promise that a change in qEEG will translate into a particular functional outcome.

And we cannot tell a parent before treatment begins exactly how many weeks their child will need.

What we can do is evaluate, treat, reassess, listen, monitor, communicate, and make thoughtful recommendations based upon the information available throughout the child’s treatment course. That is what individualized care should look like.

The Goal Is Not a Promise. It Is Better Information.

Families seeking care for a child with developmental or neurological differences are often accustomed to promises.

We believe they deserve something better.

They deserve transparency about what we know.

Transparency about what science is still trying to understand.

Objective measurement whenever possible.

A clinical team willing to reassess.

Experienced physician oversight.

Collaboration with the technology and clinical resources behind the MeRT platform.

Communication with the other professionals caring for their child.

And a comprehensive treatment model that recognizes something parents already know:

Their child is more than a diagnosis, more than a qEEG, and more than the response to any single therapy.

TMS and MeRT may represent one important piece of that child’s therapeutic puzzle.

Our philosophy is also built from lived experience. We know what it is like to be the parent searching for answers, trying to understand what comes next, and carrying all of the layers that come with advocating for your child. That experience is part of why we are deeply invested in helping families find answers, identify meaningful options, and feel supported throughout the process.

We do not believe there is a single “magic” treatment for a complex child. But we do believe that thoughtful, layered, comprehensive care can make a significant difference.

TMS and MeRT may represent one important piece of that child’s therapeutic puzzle.

Our job is to keep looking at the whole picture.

Brain Treatment Center NoVA

Ashburn + Alexandria, VirginiaNorthern Virginia | Washington, DC | DMV

We Can Help.

BTCNVA.com | 703-857-2560

References

Allen, C. H., Kluger, B. M., & Buard, I. (2017). Safety of transcranial magnetic stimulation in children: A systematic review of the literature. Pediatric Neurology, 68, 3–17. https://doi.org/10.1016/j.pediatrneurol.2016.12.009

Barahona-Corrêa, J. B., Velosa, A., Chainho, A., Lopes, R., & Oliveira-Maia, A. J. (2018). Repetitive transcranial magnetic stimulation for treatment of autism spectrum disorder: A systematic review and meta-analysis. Frontiers in Integrative Neuroscience, 12, 27. https://doi.org/10.3389/fnint.2018.00027

Houtrow, A., & Murphy, N. (2019). Prescribing physical, occupational, and speech therapy services for children with disabilities. Pediatrics, 143(4), e20190285. https://doi.org/10.1542/peds.2019-0285

Huashuang, Z., Yang, L., Chensheng, H., Jing, X., Bo, C., Dongming, Z., Kangfu, L., & Shi-Bin, W. (2022). Prevalence of adverse effects associated with transcranial magnetic stimulation for autism spectrum disorder: A systematic review and meta-analysis. Frontiers in

Psychiatry, 13, 875591. https://doi.org/10.3389/fpsyt.2022.875591

Hyman, S. L., Levy, S. E., & Myers, S. M. (2020). Identification, evaluation, and management of children with autism spectrum disorder. Pediatrics, 145(1), e20193447. https://doi.org/10.1542/peds.2019-3447

Makale, M. T., Nybo, C., Blum, K., Dennen, C. A., Elman, I., & Murphy, K. T. (2024). Pilot study of personalized transcranial magnetic stimulation with spectral electroencephalogram analyses for assessing and treating persons with autism. Journal of Personalized Medicine, 14(8), 857. https://doi.org/10.3390/jpm14080857

Smith, J. R., DiSalvo, M., Green, A., Ceranoglu, T. A., Anteraper, S. A., Croarkin, P., & Joshi, G. (2023). Treatment response of transcranial magnetic stimulation in intellectually capable youth and young adults with autism spectrum disorder: A systematic review and meta-analysis. Neuropsychology Review, 33(4), 834–855. https://doi.org/10.1007/s11065-022-09564-1

Yuan, L.-X., Wang, X.-K., Yang, C., Zhang, Q.-R., Ma, S.-Z., Zang, Y.-F., & Dong, W.-Q. (2024). A systematic review of transcranial magnetic stimulation treatment for autism spectrum disorder. Heliyon, 10(11), e32251. https://doi.org/10.1016/j.heliyon.2024.e32251

Wave Neuroscience. (2026). MeRT: Personalized transcranial magnetic stimulation. Wave Neuroscience.