Red and Infrared Light Photobiomodulation for Autism Spectrum Disorder (ASD)

Red and Infrared Light Therapy also known as Photobiomodulation (PBM) therapy uses lasers or light-emitting diodes to apply red or near- infrared light to the brain, thereby improving the metabolic capacity of neurons and stimulating anti-inflammatory responses, antioxidants, neurogenesis, and synaptogenesis [study]. Photobiomodulation not only has a direct effect on neurones, but it also has an impact on reducing gliosis and/or inflammation (right side of image below). Through these mechanisms, photobiomodulation has been reported to be disease-modifying or neuroprotective in a range of animal models of disease or trauma, from traumatic brain injury to stroke and from multiple sclerosis to Alzheimer’s, Autism and Parkinson’s disease [study, study, study, study]. 

There are several clinical reports using transcranial photobiomodulation in people with autism. Transcranial photobiomodulation treatment over an eight-week period has been reported to improve a range of behavioural measures, including social awareness, communication and motivation, and a reduction in restricted and repetitive behaviours [study]. In addition, transcranial photobiomodulation treatment for children with autism over a four week period reduced irritability and other symptoms [study]. These positive outcomes, quite remarkably, appear to be maintained for up to 12 months thereafter [study, study]. 

Transcranial photobiomodulation (tPBM) is a safe and feasible treatment approach that has the potential to treat core features of ASD [study]. ASD is not alone in experiencing benefits from PBM applied to the head. tPBM has been used to reat Parkinson’s and improve 55% of symptoms [study]. Intranasal PBM also showed improvements in Parkinson’s symptoms [study]. This study found, The that low-level laser therapy could be an effective tool for reducing irritability and other symptoms and behaviours associated with the autistic spectrum disorder in children and adolescents, with positive changes maintained and augmented over time [study]. One study followed up 6 months after individuals with ASD were treated with red light (Low Light Laser Therapy, LLLT) and the researchers concluded that “clinical improvement might be patho-physiologically explained because LLLT progressively rearrange anatomical, functional and effective connectivity, modifying those neuronal networks related to the complex symptoms found in autism” [study]. Another study found that red light on the head “could be an effective tool for reducing irritability and other symptoms and behaviors associated with the autistic spectrum disorder in children and adolescents, with positive changes maintained and augmented over time” [study]. Further broad healing of the brain as it relates to stroke was also shown to improve with application of tPBM. The researchers concluded “PBM is capable of promoting neurogenesis after ischemic stroke. PBM can shift the phenotype of microglial polarization from the M1 “pro-inflammatory” phenotype to the M2 “anti-inflammatory” phenotype” [study]. One of the common symptoms of ASD is generalized anxiety disorder (GAD). A study found that t-PBM daily, for 20 min (continuous wave; 830 nm peak wavelength; average irradiance 30 mW/cm2; average fluence 36 J/cm2; total energy delivered per session 2.9 kJ: total output power 2.4 W)    Based on our pilot study, t-PBM with NIR is a promising alternative treatment for GAD [study]. 

In a December 2022 study on a ASD induced mouse model concluded that “PBM attenuated many of the pathological behaviors observed in the VPA-induced ASD mouse model. In addition, pathophysiological analyses confirmed that the increase in activated microglia and astrocytes observed in the VPA-induced ASD mouse model was attenuated by PBM treatment.  This suggests that PBM can counteract the behavioural changes caused by neuroinflammation in ASD. Therefore, our data show that PBM has therapeutic potential and may reduce the prevalence of neurodevelopmental disorders such as ASD” [study].

Transcranial Infrared Light Stimulation (TILS) – The molecular target of TILS is cytochrome c oxidase, a mitochondrial enzyme which is crucial for oxygen utilization. People with ASD show impaired mitochondrial function (Siddiqui, Elwell, and Johnson, 2016), as well as alterations in the prefrontal cortex (Amaral, Schumann, and Nordahl, 2008), which plays a key neurological role in mediating attention, impulse control, and social cognition functions.

It has been shown that TILS, delivered to the prefrontal cortex, can be used to improve cognitive functions such as attention (Barrett and Gonzalez-Lima, 2013), executive function (Blanco, Maddox, and Gonzalez-Lima, 2017), and emotional regulation (Zaizar, Papini, Gonzalez-Lima, and Telch, 2021). This cognitive enhancement from TILS is accompanied by an increase in oxygenation of the prefrontal cortex (Holmes, Barrett, Saucedo, O’Connor, Liu, and Gonzalez-Lima, 2019). Recently, the beneficial effects of TILS on ASD symptoms have been safely explored in adults (Ceranoglu et al., 2022) and children/adolescents (Pallanti et al., 2022).

Scientific references:

• Amaral DG, Schumann CM, Nordahl CW. Neuroanatomy of autism. Trends Neurosci. 2008 Mar;31(3):137-45. doi: 10.1016/j.tins.2007.12.005.

• Barrett DW, Gonzalez-Lima F. Transcranial infrared laser stimulation produces beneficial cognitive and emotional effects in humans. Neuroscience. 2013 Jan 29;230:13-23. doi: 10.1016/j.neuroscience.2012.11.016.

• Blanco NJ, Maddox WT, Gonzalez-Lima F. Improving executive function using transcranial infrared laser stimulation. J Neuropsychol. 2017 Mar;11(1):14-25. doi: 10.1111/jnp.12074.

• Ceranoglu TA, et al. Transcranial photobiomodulation in adults with high-functioning autism spectrum disorder: positive findings from a proof-of-concept study. Photobiomodul Photomed Laser Surg. 2022 Jan;40(1):4-12. doi: 10.1089/photob.2020.4986.

• Holmes E, Barrett DW, Saucedo CL, O'Connor P, Liu H, Gonzalez-Lima F. Cognitive enhancement by transcranial photobiomodulation Is associated with cerebrovascular oxygenation of the prefrontal cortex. Front Neurosci. 2019 Oct 18;13:1129. doi: 10.3389/fnins.2019.01129.

• Pallanti S, Di Ponzio M, Grassi E, Vannini G, Cauli G. Transcranial photobiomodulation for the treatment of children with autism spectrum disorder (ASD): A retrospective study. Children (Basel). 2022 May 20;9(5):755. doi: 10.3390/children9050755.

• Siddiqui MF, Elwell C, Johnson MH. Mitochondrial dysfunction in autism spectrum disorders. Autism Open Access. 2016 Sep 27;6(5):1000190. doi: 10.4172/2165-7890.1000190.

• Zaizar ED, Papini S, Gonzalez-Lima F, Telch MJ. Singular and combined effects of transcranial infrared laser stimulation and exposure therapy on pathological fear: a randomized clinical trial. Psychol Med. 2023 Feb;53(3):908-917. doi: 10.1017/S0033291721002270.

• Pallanti S, Di Ponzio M, Grassi E, Vannini G, Cauli G. Transcranial Photobiomodulation for the Treatment of Children with Autism Spectrum Disorder (ASD): A Retrospective Study. Children (Basel). 2022 May 20;9(5):755. doi: 10.3390/children9050755. PMID: 35626932; PMCID: PMC9139753.

• Hamilton, C.; Liebert, A.; Pang, V.; Magistretti, P.; Mitrofanis, J. Lights on for Autism: Exploring Photobiomodulation as an Effective Therapeutic Option. Neurol. Int. 2022, 14, 884-893. https://doi.org/10.3390/neurolint14040071

• Ceranoglu TA, Cassano P, Hoskova B, Green A, Dallenbach N, DiSalvo M, Biederman J, Joshi G. Transcranial Photobiomodulation in Adults with High-Functioning Autism Spectrum Disorder: Positive Findings from a Proof-of-Concept Study. Photobiomodul Photomed Laser Surg. 2022 Jan;40(1):4-12. doi: 10.1089/photob.2020.4986. Epub 2021 Dec 23. PMID: 34941429.

• Leisman G, Machado C, Machado Y, Chinchilla-Acosta M. Effects of Low-Level Laser Therapy in Autism Spectrum Disorder. Adv Exp Med Biol. 2018;1116:111-130. doi: 10.1007/5584_2018_234. PMID: 29956199.

• Yang L, Tucker D, Dong Y, Wu C, Lu Y, Li Y, Zhang J, Liu TC, Zhang Q. Photobiomodulation therapy promotes neurogenesis by improving post-stroke local microenvironment and stimulating neuroprogenitor cells. Exp Neurol. 2018 Jan;299(Pt A):86-96. doi: 10.1016/j.expneurol.2017.10.013. Epub 2017 Oct 19. PMID: 29056360; PMCID: PMC5723531.

• C Machado, Y Machado, M Chinchilla, Y Machado, Follow-Up Assessment of Autistic Children 6 Months after Finishing Low Lever Laser Therapy. Internet J. Neurol, 2019•researchgate.net https://www.researchgate.net/profile/Calixto-Machado/publication/338396385_FOLLOW-UP_ASSESSMENT_OF_AUTISTIC_CHILDREN_12_MONTHS_AFTER_FINISHING_LOW_LEVER_LASER_THERAPY/links/5e12260992851c8364b26bb8/FOLLOW-UP-ASSESSMENT-OF-AUTISTIC-CHILDREN-12-MONTHS-AFTER-FINISHING-LOW-LEVER-LASER-THERAPY.pdf 

• Maiello M, Losiewicz OM, Bui E, Spera V, Hamblin MR, Marques L, Cassano P. Transcranial Photobiomodulation with Near-Infrared Light for Generalized Anxiety Disorder: A Pilot Study. Photobiomodul Photomed Laser Surg. 2019 Oct;37(10):644-650. doi: 10.1089/photob.2019.4677. PMID: 31647775; PMCID: PMC6818480.

• Kim UJ, Hong N, Ahn JC. Photobiomodulation Attenuated Cognitive Dysfunction and Neuroinflammation in a Prenatal Valproic Acid-Induced Autism Spectrum Disorder Mouse Model. Int J Mol Sci. 2022 Dec 17;23(24):16099. doi: 10.3390/ijms232416099. PMID: 36555737; PMCID: PMC9785820.