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Neurofeedback AutismAutism spectrum disorder (ASD) presents with core deficits in human social behaviors among children and adults. Increasing in frequency, children and adults with ASD show deficits in social and communicative skills, including imitation, empathy, shared attention, as well as restricted interests and repetitive patterns of behaviors. Many of the symptoms may coincide with other obvious or masked symptoms including sensory processing disorders(SPD), anxiety, attention disorders, behavioral disorders(i.e. Reactive Attachment Disorder(RAD), Obsessive Compulsive Disorder(OCD), Oppositional Defiant Disorder(ODD), and learning disorders(i.e. Dyslexia). These deficits substantially impair satisfactory social interactions and prevent children and adults from establishing adequate relations with families and friends and reaching educational goals.

Sensory processing disorders(SPD) are caused by a block or “traffic jam” in the processing of external stimuli such as touch, taste, sight, sounds, and smells. Signals are either intensified or diluted as they are processed through our nervous system such that an appropriate response fails to be organized. Even simple everyday tasks become a significant challenge.

Brain mapping studies of people with ASD and SPD have revealed distinctive patterns of neural dysregulation. As with many brain-based disorders, autism and sensory processing disorders are distinguished by abnormalities in the brain’s electrical activity patterns, a factor that neurofeedback therapy has been clinically proven to help correct.

Neurofeedback reduces symptoms by improving self-regulation in children with ASD and SPD through balancing brain rhythms or electrical patterns. Neurofeedback is able to reduce sensory “overload”, improve behavioral dysregulation and communication and enhanced learning. Neurofeedback therapy can be used on its own, or in conjunction with other treatments such as occupational therapy. Improvements reported include increase in verbal and socially engaging, reduced self-stimulatory behavior(i.e. hand flapping), improvement in following through with verbal requests, increase in empathy, better sleep onset and duration, less anxiety, improved behavior, and improved sensory response. For children with ASD and SPD, neurofeedback therapy presents an incredibly safe and side-effect-free option for managing and reducing problems with autism and sensory processing.


An Effective Neurofeedback Intervention to Improve Social Interactions in Children with Autism Spectrum Disorder.

J Autism Dev Disord. 2015 Dec;45(12):4084-100. doi: 10.1007/s10803-015-2523-5

Neurofeedback training (NFT) approaches were investigated to improve behavior, cognition and emotion regulation in children with autism spectrum disorder (ASD). Thirteen children with ASD completed pre-/post-assessments and 16 NFT-sessions. The NFT was based on a game that encouraged social interactions and provided feedback based on imitation and emotional responsiveness. Bidirectional training of EEG mu suppression and enhancement (8-12 Hz over somatosensory cortex) was compared to the standard method of enhancing mu. Children learned to control mu rhythm with both methods and showed improvements in (1) electrophysiology: increased mu suppression, (2) emotional responsiveness: improved emotion recognition and spontaneous imitation, and (3) behavior: significantly better behavior in everyday life. Thus, these NFT paradigms improve aspects of behavior necessary for successful social interactions.

Neurofeedback application in the treatment of autistic spectrum disorders (ASD).

Psychiatr Danub. 2015 Sep;27 Suppl 1: S391-4.

The aim of this paper is to describe neurofeedback (NFB) treatment in Autistic spectrum disorder (ASD) children. There is no specific cure for autism and therapeutic guidelines are directed to improve the quality of life of people with autism by reducing the symptoms and by increasing their functioning. Neurofeedback is a computerized method based on tracking electrical activity of the brain (EEG) and giving a feedback about it. The method has been developed in neurophysiological labs of scientific institutes in the USA and has been used very successfully for over last 20 years. It has proven its efficacy in practice, but also in scientific and clinical research. During 2010 and 2011 neurofeedback treatment was administered to 10 children (N=10, 7 males, and 3 females) age range 4 to 7 years which have been diagnosed as autistic spectrum disorder (highly functional) with an unspecific impairment of speech development and trouble communicating. An evaluation of treatment was done according to the estimation of changes in functioning (parents, teachers and therapists’ ratings and all other experts that were monitoring the child before, during and after the treatment) and tracking of changes in electrophysiology. The results have shown most changes in behavior (less aggressive, more cooperation, better communication), attention span and sensory motor skills. According to the assessment of parents, teachers, therapists and other experts, all children have accomplished a certain degree of improvement in the level of daily functioning. Our experiences in the usage of neurofeedback in Autistic spectrum disorder (ASD) children confirmed previous data that this method can be applied to this category of patients.

A pilot feasibility study of neurofeedback for children with autism.

Appl Psychophysiol Biofeedback. 2014 Jun;39(2):99-107. doi: 10.1007/s10484-014-9241-1.

Neurofeedback (NFB) is an emerging treatment for children with autism spectrum disorder (ASD). This pilot study examined the feasibility of NFB for children with ASD. Ten children ages 7-12 with high functioning ASD and attention difficulties received an NFB attention training intervention. A standardized checklist captured feasibility, including focus during exercises and academic tasks, as well as off-task behaviors. Active behaviors and vocalizations were the most frequent off-task behaviors. Positive reinforcement and breaks including calm breathing exercises were the most common supports. Low motivation was associated with higher feasibility challenges, yet parental involvement and accommodations were helpful. This pilot study shows that it is feasible to conduct NFB sessions with children with high functioning autism and attention difficulties.

Neurofeedback training produces normalization in behavioral and electrophysiological measures of high-functioning autism.

Philos Trans R Soc Lond B Biol Sci. 2014 Apr 28;369(1644):20130183. doi: 10.1098/rstb.2013.0183. Print 2014.

Autism spectrum disorder (ASD) is a neurodevelopmental condition exhibiting impairments in behavior, social and communication skills. These deficits may arise from aberrant functional connections that impact synchronization and effective neural communication. Neurofeedback training (NFT), based on operant conditioning of the electroencephalogram (EEG), has shown promise in addressing abnormalities in functional and structural connectivity. We tested the efficacy of NFT in reducing symptoms in children with ASD by targeting training to the mirror neuron system (MNS) via modulation of EEG mu rhythms. The human MNS has provided a neurobiological substrate for understanding concepts in social cognition relevant to behavioral and cognitive deficits observed in ASD. Furthermore, mu rhythms resemble MNS phenomenology supporting the argument that they are linked to perception and action. Thirty hours of NFT on ASD and typically developing (TD) children were assessed. Both groups completed an eyes-open/-closed EEG session as well as a mu suppression index assessment before and after training. Parents filled out pre- and post-behavioural questionnaires. The results showed improvements in ASD subjects but not in TDs. This suggests that induction of neuroplastic changes via NFT can normalize dysfunctional mirroring networks in children with autism, but the benefits are different for TD brains.

Neurofeedback outcomes in clients with Asperger’s syndrome.

Appl Psychophysiol Biofeedback. 2010 Mar;35(1):63-81. doi: 10.1007/s10484-009-9120-3.

This paper summarizes data from a review of neurofeedback (NFB) training with 150 clients with Asperger’s Syndrome (AS) and 9 clients with Autistic Spectrum Disorder (ASD) seen over a 15 year period (1993-2008) in a clinical setting. The main objective was to investigate whether electroencephalographic (EEG) biofeedback, also called neurofeedback (NFB), made a significant difference in clients diagnosed with AS. An earlier paper (Thompson et al. 2009) reviews the symptoms of AS, highlights research findings and theories concerning this disorder, discusses QEEG patterns in AS (both single and 19-channel), and details a hypothesis, based on functional neuroanatomy, concerning how NFB, often paired with biofeedback (BFB), might produce a change in symptoms. A further aim of the current report is to provide practitioners with a detailed description of the method used to address some of the key symptoms of AS in order to encourage further research and clinical work to refine the use of NFB plus BFB in the treatment of AS. All charts were included for review where there was a diagnosis of AS or ASD and pre- and post-training testing results were available for one or more of the standardized tests used. Clients received 40-60 sessions of NFB, which was combined with training in metacognitive strategies and, for most older adolescent and adult clients, with BFB of respiration, electrodermal response, and, more recently, heart rate variability. For the majority of clients, feedback was contingent on decreasing slow wave activity (usually 3-7 Hz), decreasing beta spindling if it was present (usually between 23 and 35 Hz), and increasing fast wave activity termed sensorimotor rhythm (SMR) (12-15 or 13-15 Hz depending on assessment findings). The most common initial montage was referential placement at the vertex (CZ) for children and at FCz (midway between FZ and CZ) for adults, referenced to the right ear. Metacognitive strategies relevant to social understanding, spatial reasoning, reading comprehension, and math were taught when the feedback indicated that the client was relaxed, calm, and focused. Significant improvements were found on measures of attention (T.O.V.A. and IVA), core symptoms (Australian Scale for Asperger’s Syndrome, Conners’ Global Index, SNAP version of the DSM-IV criteria for ADHD, and the ADD-Q), achievement (Wide Range Achievement Test), and intelligence (Wechsler Intelligence Scales). The average gain for the Full-Scale IQ score was 9 points. A decrease in relevant EEG ratios was also observed. The ratios measured were (4-8 Hz)(2)/(13-21 Hz)(2), (4-8 Hz)/(16-20 Hz), and (3-7 Hz)/(12-15 Hz). The positive outcomes of decreased symptoms of Asperger’s and ADHD (including a decrease in difficulties with attention, anxiety, aprosodias, and social functioning) plus improved academic and intellectual functioning, provide preliminary support for the use of neurofeedback as a helpful component of effective intervention in people with AS.

Neurofeedback for autistic spectrum disorder: a review of the literature.

Appl Psychophysiol Biofeedback. 2010 Mar;35(1):83-105. doi: 10.1007/s10484-009-9117-y.
There is a need for effective interventions to address the core symptoms and problems associated with autistic spectrum disorder (ASD). Behavior therapy improves communication and behavioral functioning. Additional treatment options include psychopharmacological and biomedical interventions. Although these approaches help children with autistic problems, they may be associated with side effects, risks or require ongoing or long-term treatment. Neurofeedback is a noninvasive approach shown to enhance neuroregulation and metabolic function in ASD. We present a review of the literature on the application of Neurofeedback to the multiple problems associated with ASD. Directions for future research are discussed.

The relative efficacy of connectivity guided and symptom-based EEG biofeedback for autistic disorders.

Appl Psychophysiol Biofeedback. 2010 Mar;35(1):13-23. doi: 10.1007/s10484-009-9102-5. Epub 2009 Aug 1.

Autism is a neurodevelopmental disorder characterized by deficits in communication, social interaction, and a limited range of interests with repetitive stereotypical behavior. Various abnormalities have been documented in the brains of individuals with autism, both anatomically and functionally. The connectivity theory of autism is a recently developed theory of the neurobiological cause of autistic symptoms. Different patterns of hyper- and hypo-connectivity have been identified with the use of quantitative electroencephalography (QEEG), which may be amenable to neurofeedback. In this study, we compared the results of two published controlled studies examining the efficacy of neurofeedback in the treatment of autism. Specifically, we examined whether a symptom-based approach or an assessment/connectivity guided based approach was more effective. Although both methods demonstrated significant improvement in symptoms of autism, connectivity-guided neurofeedback demonstrated greater reduction on various subscales of the Autism Treatment Evaluation Checklist (ATEC). Furthermore, when individuals were matched for severity of symptoms, the amount of change per session was significantly higher in the Coben and Padolsky (J Neurother 11:5-23, 2007) study for all five measures of the ATEC. Our findings suggest that an approach guided by QEEG based connectivity assessment may be more efficacious in the treatment of autism. This permits the targeting and amelioration of abnormal connectivity patterns in the brains of people who are autistic.