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

  • September 2015
Authors:
Ivana Zivoder at University North Croatia
Ivana Zivoder
  • University North Croatia
S. Martic-Biocina
S. Martic-Biocina
S. Martic-Biocina
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Ana Vodanovic Kosic
Ana Vodanovic Kosic
J. Bosak
J. Bosak
J. Bosak
  • This person is not on ResearchGate, or hasn't claimed this research yet.
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Abstract

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 USA and has been used very successfully for over last 20 years. It has proven its efficacy in practise, 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 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 behaviour (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 usage of neurofeedback in Autistic spectrum disorder (ASD) children confirmed previous data that this method can be applied to this category of patients.
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S313
Psychiatria Danubina, 2015; Vol. 27, Suppl. 1, pp 55–291 Conference paper
© Medicinska naklada - Zagreb, Croatia
NEUROFEEDBACK APPLICATION IN THE TREATMENT OF
AUTISTIC SPECTRUM DISORDERS (ASD)
Ivana Zivoder1, Sanja Martic-Biocina2, Ana Vodanovic Kosic1 & Josipa Bosak1
1Mens sana, Practice for Neurofeedback, Zagreb, Croatia
2Psychiatric Clinic Vrapce, Bolnicka cesta 32, Zagreb, Croatia
SUMMARY
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 USA
and has been used very successfully for over last 20 years. It has proven its efficacy in practise, 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 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 behaviour (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
usage of neurofeedback in Autistic spectrum disorder (ASD) children confirmed previous data that this method can be applied to this
category of patients.
Key words: neurofeedback - autistic spectrum disorder – children - treatment
* * * * *
INTRODUCTION
Autism was first described by Leo Kanner in 1943.
He was doing thorough and systematic observation of
children with psychological disorders and he found that
eleven of them seemed physically healthy, but were
showing specific symptoms like speech impairment,
communication and behavioural impairment and by
those symptoms they differed from other psychological
disorders of young children. He called this disorder
infantile autism because of its specific symptoms and
the young age at which it occurs (infantile – occurring
in the first three years of life; autism – dominance of
symptoms related to speech impairment, authos, Greek
– alone).
THERAPEUTIC GUIDELINES
IN TREATMENT OF CHILDREN
WITH AUTISM
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
increasing their functioning. Early intervention is
important, it should be individualized, intensive and
persistent and done by educational programs and
behaviour therapy. This way a child can reach a great
level of independence and even social and work related
skills. One of these methods is neurofeedback.
APPLICATION OF NEUROFEEDBACK IN
TREATING CHILDREN WITH AUTISM
Neurofeedback is a computerized method based on
tracking electrical activity of the brain (EEG) and giving
feedback about it. It represents a learning process that
enables the person to observe; control and change
his/her own brain activity. The method has been deve-
loped in neurophysiological labs of scientific institutes
in the USA and has been used very successfully for over
20 years. It has proven its efficacy in practise, but also
in scientific and clinical research.
Great amounts of research investigating the usage of
neurofeedback in treating children with autism have
shown its great efficiency. A couple of case studies
were published in the mid-1990s, but it has not been
until the new millennium that more rigorous investi-
gations have taken place. Briefly, case studies or case
series have included three single case studies of children
with autism. (Cowan 1994, Sichel 1995, Ibric 2003)
Coben and Pudolsky (2007) have conducted a large
research on 37 children with autistic spectrum disorder
that showed very significant results. They did several
measures of symptoms using various neuropsycho-
logical and neurophysiological parameters of the autistic
spectrum and they have shown marked symptom
decrease (89%) (Coben 2007).
Research by Kouijzer (2009) founded that sixty
percent of the participants in the treatment group
successfully reduced excessive theta power during
Ivana Zivoder, Sanja Martic-Biocina, Ana Vodanovic Kosic & Josipa Bosak: NEUROFEEDBACK APPLICATION IN THE TREATMENT
OF AUTISTIC SPECTRUM DISORDERS (ASD) Psychiatria Danubina, 2015; Vol. 27, Suppl. 1, pp 109–111
S314
neurofeedback treatment. Reduction of theta power was
confirmed by pre- and post-QEEG measures. Parents of
participants in the neurofeedback treatment group
reported significant improvements in reciprocal social
interactions and communication skills, relative to the
parents of the control group. Set-shifting skills impro-
ved following neurofeedback treatment relative to the
control group (Kouijzer 2009).
Coben and Myers (2010) compared results of two
published controlled studies examining the efficacy of
neurofeedback in the treatment of autism. Specifically,
they 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 grea-
ter reduction on various subscales of the Autism Treat-
ment Evaluation Checklist (ATEC) (Coben 2010).
Study from Kouijzer, M. E. G., B. J. L. Gerrits and
J. K. Buitelaar (2011) evaluated the effects of EEG-
biofeedback in ASD in a randomized pre-test and post-
test control group design with blinded active comparator
and six months follow-up. Fifty-four percent of the
participants significantly reduced delta and/or theta
power during EEG-biofeedback sessions and were iden-
tified as EEG-regulators. In these EEG-regulators, no
statistically significant reductions of symptoms of ASD
were observed, but they showed significant improve-
ment in cognitive flexibility as compared to participants
who managed to regulate SC (Kouijzer 2011).
Results of the pilot study with 42 children with ASD
by Sokhadze, E. M., El-Baz, A. S., Tasman, A; (2014)
has proven positive effects of combined transcranial
magnetic stimulation and neurofeedback in the active
treatment group (20 children with ASD), as compared to
control WTL group (22 children with ASD). The active
treatment group (TMS-NFB) showed significant impro-
vements in behavioural and functional outcomes as
compared to the control WTL group (Sokhadze 2014).
APPLICATION OF NEUROFEEDBACK
IN TREATMENT OF CHILDREN
WITH AUTISM – OUR CASE STUDIES
During 2010. and 2011. year, neurofeedback was
administered in treatment of 10 children (N=10, 7 males
and 3 females) age range 4 to 7 years which have been
diagnosed as autistic spectrum disorder (highly func-
tional) with an unspecific impairment of speech deve-
lopment and trouble communicating.
TREATMENT GOALS
Improvement of the quality of life and increase in
everyday functioning by reducing the symptoms related
to the primary diagnosis.
INITIAL ASSESSMENT
Analyses of medical documentation (conducted
diagnostic and therapeutic procedures):
Structured interview (with one or both parents):
Measuring of baseline EEG (one channel, Cz).
CHILD ADJUSTMENT ON
CONDUCTING NEUROFEEDBACK
TREATMENT
Considering the specific problems of these children
and their sensitivity, 90% of them had to go through an
adjustment period – sensor placement, deciding what
kind of feedback is acceptable (auditory or visual),
adjustment to the therapist, etc. The adjustment period
lasted from 5 to 10 arrivals (except for the one child
who did not need any adjustment period). During these
arrivals they were gradually adjusted to the conditions
of the treatment, playing with the sensors. All children
have successfully finished the adjustment period.
IMPLEMENTATION OF
NEUROFEEDBACK
Protocols where determined for each child indivi-
dually according to the initial assessment:
Electrode position (according to the international 10-
20 system);
Frequency bands that will be inhibited or rewarded.
Mean duration of each session was 15-20 minutes.
EVALUATION AND RESULTS
An evaluation of treatment was done according to:
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);
Tracking of changes in electrophysiology.
The results have shown most changes in:
Behaviour (less aggressive, more cooperation, better
communication);
Attention;
Sensory-motor skills.
According to the assessment of parents, teacher,
therapist and other experts all children have
accomplished a certain degree of improvement in the
level of daily functioning. Tracking of trend changes in
electro psychological measures have yielded a positive
shift according to the protocols that have been
administered, but due to a small sample and short
duration of records without artefacts there was no
statistically significant difference.
Ivana Zivoder, Sanja Martic-Biocina, Ana Vodanovic Kosic & Josipa Bosak: NEUROFEEDBACK APPLICATION IN THE TREATMENT
OF AUTISTIC SPECTRUM DISORDERS (ASD) Psychiatria Danubina, 2015; Vol. 27, Suppl. 1, pp 109–111
S315
CASE STUDY 1
A.G. Male; 5 year old (2006)
Initial assessment
Distinctive difficulties in attention span, motoric
skills, social relations, communication, play and imagi-
nation and speech impairment.
Neurofeedback treatment
65 sessions.
Administered protocols
CZ - inhibition of delta and theta waves (2-7 Hz),
strengthening of SMR and beta waves (12-15 Hz),
inhibition of high beta (22-30 Hz) – 30 sessions;
C4 - inhibition of delta and theta waves (2-7 Hz),
strengthening of SMR and beta waves (12-15 Hz),
inhibition of high beta (22-30 Hz) – 15 sessions:
F3 - inhibition of delta and theta waves (2-7 Hz),
strengthening of SMR and beta waves (14-18 Hz),
inhibition of high beta (22-30 Hz) – 20 sessions.
Description of treatment implementation,
evaluation and results
A. G. has attended neurofeedback treatment around
a year. After first 10 arrivals significant changes were
detected in motoric skills and attention span– he started
rollerblading, he was more awake and present during
the day (before therapy he was drowsy and sleepy as
soon as he had to do an assignment that was not to his
interest) and more interested in his surroundings.
After stabilization of these changes, another protocol
was administered directed to improving communication,
emotions and emotional expression. After all 65
treatments that were administered parents said that he is
significantly more communicative, he is more open to
other people, had better understanding and was more
willing to do all kinds of tasks. He uses more
complicated speech, 3 words in a sequence and spoke
very clearly and understandably.
CASE STUDY 2
E.V. Female; 5,5 year old (2005)
Initial assessment
Distinctive difficulties in attention span, speech and
social relations, especially while playing.
Neurofeedback treatment
30 sessions.
Administered protocols
Cz - inhibition of delta and theta waves (2-7 Hz),
strengthening of SMR and beta waves (12-15 Hz),
inhibition of high beta (22-30 Hz) – 20 sessions;
C4 - inhibition of delta and theta waves (2-7 Hz),
strengthening of SMR and beta waves (12-15 Hz),
inhibition of high beta (22-30 Hz) – 10 sessions;
Description of treatment implementation,
evaluation and results
The girl comes primarily because of difficulties in
attention span and social relationships, especially
while playing. She has a younger sister to whom she
never showed any interest regarding playing and
friendship. Her attention span was short and scattered.
Also there were speech difficulties and distinctive
emotional sensitivity. There were 30 sessions adminis-
tered to the sensorimotor area. We have observed
better emotional functioning, social functioning and
attention span. She got interested in her surroundings;
she started to play with her younger sister and to use
the computer for play.
CASE STUDY 3
B.K. Male; 4 year old (2007)
Initial assessment
Difficulties focusing, motoric skills and difficulties
in speech and speech understanding.
Neurofeedback treatment
40 sessions.
Administered protocols
Cz - inhibition of delta and theta waves (2-7 Hz),
strengthening of SMR and beta waves (12-15 Hz),
inhibition of high beta (22-30 Hz) – 20 sessions;
C4 - inhibition of delta and theta waves (2-7 Hz),
strengthening of SMR and beta waves (12-15 Hz),
inhibition of high beta (22-30 Hz) – 10 sessions;
F3 - inhibition of delta and theta waves (2-7 Hz),
strengthening of SMR and beta waves (12-15 Hz),
inhibition of high beta (22-30 Hz) – 10 sessions.
Description of treatment implementation,
evaluation and results
The boy came with problems in focus and motoric,
speech difficulties and understanding abstract thoughts
and difficulties in dialogue with other people. There was
no adaptation period and 40 sessions were adminis-
tered. We have noted better functioning in emotional
and social aspects and focusing. Motor skills also
became better.
CONCLUSION
Our experiences in usage of neurofeedback in
Autistic spectrum disorder (ASD) children confirmed
previous data that this method can applied to this
category of patients. Number of treatments, according to
our results is between 40 and 60. On average, it takes 5
to 10 meetings for children to get accustomed to the
method. Neurofeedback can help children with autism
to increase their functioning through improving atten-
tion, behaviour and sensory motor skills.
Ivana Zivoder, Sanja Martic-Biocina, Ana Vodanovic Kosic & Josipa Bosak: NEUROFEEDBACK APPLICATION IN THE TREATMENT
OF AUTISTIC SPECTRUM DISORDERS (ASD) Psychiatria Danubina, 2015; Vol. 27, Suppl. 1, pp 109–111
S316
Acknowledgements: None.
Conflict of interest: None to declare.
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Correspondence:
Sanja Martic-Biocina, MD, PhD
Psychiatric Clinic Vrapce
Bolnicka cesta 32, Zagreb, Croatia
E-mail: smarticbiocina@gmail.com
... Stoga se neki autori, u razmatranju razloga primjene ove metode u populaciji osoba s AS, referiraju na brojnija istraživanja u osoba s PSA kao srodnog pervazivnog poremećaja. U tom kontekstu mogu se navesti istraživanja prema kojima neurofeedback metoda u ovoj populaciji može utjecati na socijalne i komunikacijske vještine, 9,40 pažnju, 41 prepoznavanje emocija, spontanu imitaciju i aktivnosti svakodnevnog života, 42 poboljšanje pažnje, te bihevioralnih i motoričkih vještina, 43 ili na socijalizaciju, vokalizaciju, anksioznost, školski uspjeh, spavanje i smanjenje tantruma. 39 Imajući u vidu nedostatak istraživanja o primjeni neurofeedback treninga u osoba s AS, posebice u odnosu na primjenu ILF metode, ovo istraživanje može predstavljati poticaj za daljnja istraživanja i kliničku primjenu. ...
... Dok neki autori tvrde da ne bi bilo značajnih promjena, te svoja istraživanja temelje na 20 seansi, 3,31 određeni broj autora koristi preko 30, 39 a neki i preko 40 seansi. 30,43,45,46,47 Usprkos ograničenjima ovoga istraživanja, kao prednost u interpretaciji dobivenih rezultata treba naglasiti činjenicu da tijekom provedbe neurofeedback treninga ispitanik nije sudjelovao u drugim terapijskim intervencijama, te nije primao medikamentoznu terapiju. U tom smislu može se isključiti utjecaj drugih terapija, ili sinergijski učinak različitih metoda. ...
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  • Jun 2020
Background: Neurofeedback (NF) training, as a method of self-regulation of brain activity, may be beneficial in elderly patients with mild cognitive impairment (MCI). In this pilot study, we investigated whether a sensorimotor (SMR)/theta NF training could improve cognitive performance and brain electrical activity in elderly patients with MCI. Methods: Twenty elderly patients with MCI were assigned to 20 consecutive sessions of sensorimotor (SMR)/theta NF training, during 10 weeks, on a basis of two sessions each week. Neuropsychological assessments and questionnaires, as well as electroencephalogram (EEG), were performed and compared between baseline (T0), after the last NF training session at 10 weeks (T1), and 1-month follow-up (T2). Results: Repeated measures ANOVA revealed that from baseline to post-intervention, participants showed significant improvement in the Montreal cognitive assessment (MoCa, F = 4.78; p = 0.012), the delayed recall of the Rey auditory verbal learning test (RAVLT, F = 3.675; p = 0.032), the Forward digit span (F = 13.82; p < 0.0001), the Anxiety Goldberg Scale (F = 4.54; p = 0.015), the Wechsler Adult Intelligence Score–Fourth Edition (WAIS-IV; F = 24.75; p < 0.0001), and the Mac Nair score (F = 4.47; p = 0.016). EEG theta power (F = 4.44; p = 0.016) and alpha power (F = 3.84; p = 0.027) during eyes-closed resting-state significantly increased after the NF training and showed sustained improvement at a 1-month follow-up. Conclusion: Our results suggest that NF training could be effective to reduce cognitive deficits in elderly patients with MCI and improve their EEG activity. If these findings are confirmed by randomized controlled studies with larger samples of patients, NF could be seen as a useful non-invasive, non-pharmacological tool for preventing further decline, rehabilitation of cognitive function in the elderly. Clinical Trial Registration: This pilot study was a preliminary step before the trial registered in www.ClinicalTrials.gov, under the number of NCT03526692.
... For example, using EEG neurofeedback sessions in ASD patients, the marked normalization of behavioral and electrophysiological parameters due to increasing the structural and functional interrelationship of brain regions [88]. Under EEG neurofeedback procedures in ASD patients, the positive changes have been revealed in several characteristics, such as behavior (they become less aggressive and more contact), in indicators of attention, memory and motor skills, as well as in the overall level of daily functioning [89]. EEG neurofeedback is considered to be an effective method of correcting psychophysiological characteristics in patients with ASD [90]. ...
Modern Technologies in Studying the Mechanisms, Diagnostics, and Treatment of Autism Spectrum Disorders (Review)
Article
Full-text available
  • Mar 2019
... Also because the poor prognosis of mental diseases like autism usually occurs as the poor control of unwanted behavior and prefrontal cortex has a central role in controlling these unwanted behaviors, DBS has also been used for treating severe patients [73]. In addition, neurofeedback has been used successfully for improving autistic children [74]. In neurofeedback, a patient learns to be aware of his/her brain dysfunction and learns to control it. ...
Overview of the Recent Advances in Pathophysiology and Treatment for Autism
Article
  • Jul 2018
Background & objective: Autism is a developmental disorder that manifests itself in early childhood. Autism is characterized by inability to acquire social skills, repetitive behaviors and failure of speech and nonverbal communication development. Recent studies have shown that genetic mutations occur in majority of individuals with autism. These mutations cause a variety of disorders that ultimately lead to brain disorders. It is noteworthy that all mutations do not follow the same pattern. They encompass various kinds of mutations. Autism needs to be treated during childhood as untreated patients usually do not progress to the later stages of development. In this regard, many studies have been performed and numerous treatments have been proposed to improve the outcome of this disease. Conclusion: In this review, we have discussed new advancements made in understanding the pathophysiology of autism. Furthermore, we have also discussed new treatments which have been proposed and have successfully translated affected children. Overall, it is concluded that new advances have largely helped these patients.
'Specialization in ICTs and Special Education: Psychopedagogy of Integration' Postgraduate ProgramBRAIN – COMPUTER INTERFACE SYSTEMS AS INTERVENTION TOOLS IN AUTISM SPECTRUM DISORDER
Thesis
Full-text available
  • Jun 2020
Autism is a pervasive neurodevelopmental disorder of multifactorial causation and phenotypical variation. The nature of the disorder together with the difficulty in planning and implementing highly effective treatment models, have directed the scientific research towards discovering and implementing new intervention or/and therapeutic models, of different type and philosophy. Brain – computer interface systems as intervention tools in autism comprise an approach consistent with the demands of the new era. The dissertation aims at examining applied, non-invasive research protocols of this kind, placing emphasis on the way they were implemented and their effectiveness. The review was conducted on published research in the last decade, concerning ages 4-21.
Diagnostic Assessment Techniques and Non-Invasive Biomarkers for Autism Spectrum Disorder
Article
Full-text available
  • Jul 2019
Autism spectrum disorder (ASD) is a complex heterogeneous neurological disorder that has led to a spectrum of diagnosis techniques. The screening instruments, medical and technological tools initiate the diagnosis process. Clinicians and psychologists propose therapies depending on the examination done by these methodologies. The literature has accounted dozens of diagnostic methods and alternative and complementary therapies but still lack in highlighting the proper biomarker for early detection and intervention. The emerging multi-modal neuro-imaging techniques have correlated the brain’s functional and structural measures and diagnosed ASD with more sensitivity than individual approaches. The purpose of this review article is: (i) to provide an overview of the emerging ASD diagnosis methods and different markers and; (ii) to present the idea of integrating all the individual methods in to a multi-modal diagnostic system to enhance detection sensitivity. This system possesses the potential to diagnose and predict ASD clinically, neurologically & objectively with high detection sensitivity. Copyright © 2019, IGI Global. Copying or distributing in print or electronic forms without written permission of IGI Global is prohibited.
Neuromodulation Integrating rTMS and Neurofeedback for the Treatment of Autism Spectrum Disorder: An Exploratory Study
Article
Full-text available
Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized by deficits in social interaction, language, stereotyped behaviors, and restricted range of interests. In previous studies low frequency repetitive transcranial magnetic stimulation (rTMS) has been used, with positive behavioral and electrophysiological results, for the experimental treatment in ASD. In this study we combined prefrontal rTMS sessions with electroencephalographic (EEG) neurofeedback (NFB) to prolong and reinforce TMS-induced EEG changes. The pilot trial recruited 42 children with ASD (~14.5 years). Outcome measures included behavioral evaluations and reaction time test with event-related potential (ERP) recording. For the main goal of this exploratory study we used rTMS-neurofeedback combination (TMS-NFB, N = 20) and waitlist (WTL, N = 22) groups to examine effects of 18 sessions of integrated rTMS-NFB treatment or wait period) on behavioral responses, stimulus and response-locked ERPs, and other functional and clinical outcomes. The underlying hypothesis was that combined TMS-NFB will improve executive functions in autistic patients as compared to the WTL group. Behavioral and ERP outcomes were collected in pre- and post-treatment tests in both groups. Results of the study supported our hypothesis by demonstration of positive effects of combined TMS-NFB neurotherapy in active treatment group as compared to control WTL group, as the TMS-NFB group showed significant improvements in behavioral and functional outcomes as compared to the WTL group.
Assessment-Guided Neurofeedback for Autistic Spectrum Disorder
Article
Full-text available
  • Jun 2007
Background. Research reviewing the epidemiology of Autism (Medical Research Council, 2001) indicated that approximately 60 per 10,000 children (1/166) are diagnosed with Autistic Spectrum Disorder (ASD). Jarusiewicz (2002) published the only controlled study documenting the effectiveness of neurofeedback for Autism based on one outcome measure. The present study extended these findings with a larger sample size, broader range of assessments, and physiological measures of brain functioning.Methods. Assessment-guided neurofeedback was conducted in 20 sessions for 37 patients with ASD. The experimental and control groups were matched for age, gender, race, handedness, other treatments, and severity of ASD.Results. Improved ratings of ASD symptoms reflected an 89% success rate. Statistical analyses revealed significant improvement in Autistics who received Neurofeedback compared to a wait list control group. Other major findings included a 40% reduction in core ASD symptomatology (indicated by ATEC Total Scores), and 76% of the experimental group had decreased hyper-connectivity. Reduced cerebral hyperconnectivity was associated with positive clinical outcomes in this population. In all cases of reported improvement in ASD symptomatology, positive treatment outcomes were confirmed by neuropsychological and neurophysiological assessment.Conclusions. Evidence from multiple measures has demonstrated that neurofeedback can be an effective treatment for ASD. In this population, a crucial factor in explaining improved clinical outcomes in the experimental group may be the use of assessment-guided neurofeedback to reduce cerebral hyperconnectivity. Implications of these findings are discussed.
Is EEG-biofeedback an Effective Treatment in Autism Spectrum Disorders? A Randomized Controlled Trial
Article
Full-text available
EEG-biofeedback has been reported to reduce symptoms of autism spectrum disorders (ASD) in several studies. However, these studies did not control for nonspecific effects of EEG-biofeedback and did not distinguish between participants who succeeded in influencing their own EEG activity and participants who did not. To overcome these methodological shortcomings, this study evaluated the effects of EEG-biofeedback in ASD in a randomized pretest-posttest control group design with blinded active comparator and six months follow-up. Thirty-eight participants were randomly allocated to the EEG-biofeedback, skin conductance (SC)-biofeedback or waiting list group. EEG- and SC-biofeedback sessions were similar and participants were blinded to the type of feedback they received. Assessments pre-treatment, post-treatment, and after 6 months included parent ratings of symptoms of ASD, executive function tasks, and 19-channel EEG recordings. Fifty-four percent of the participants significantly reduced delta and/or theta power during EEG-biofeedback sessions and were identified as EEG-regulators. In these EEG-regulators, no statistically significant reductions of symptoms of ASD were observed, but they showed significant improvement in cognitive flexibility as compared to participants who managed to regulate SC. EEG-biofeedback seems to be an applicable tool to regulate EEG activity and has specific effects on cognitive flexibility, but it did not result in significant reductions in symptoms of ASD. An important finding was that no nonspecific effects of EEG-biofeedback were demonstrated.
The Relative Efficacy of Connectivity Guided and Symptom Based EEG Biofeedback for Autistic Disorders
Article
Full-text available
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 autisic symptoms. Different patterns of hyper- and hypo-connectivity have been identified with the use of quantitative electroencephalogray (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.
Positive Outcome with Neurofeedback Treatment in a Case of Mild Autism
Article
  • Jun 1995
This article looks at the experience of Frankie, an autistic 8 and 1/2 year old boy. He was diagnosed mildly autistic by several specialists. One specialist claimed he was brain damaged and "autistic-like " and that there was no hope for improvement. At Frankie's mother's request, neurotherapy diagnosis and treatment was begun. After 31 sessions, Frankie showed Positive changes in all the diagnostic dimensions defining autism in DSM-111-P, This has profound implications for treatment in a field with few low-risk alternatives.
Long-term effects of neurofeedback treatment in autism
Article
Previously we demonstrated significant improvement of executive functions and social behavior in children with autism spectrum disorders (ASD) treated with 40 sessions of EEG neurofeedback in a nonrandomized waiting list control group design. In this paper we extend these findings by reporting the long-term results of neurofeedback treatment in the same group of children with ASD after 12 months. The present study indicates maintenance of improvement of executive functions and social behavior after 12 months in comparison with the immediate outcomes. Neurofeedback mediated suppression of theta power is supposed to promote more flexible functioning of the brain by enhancing activation in the medial prefrontal cortex and improving flexibility of activation in the default mode network supporting the improvement of executive functions and theory of mind in ASD.
Efficacy of Neurofeedback for Children in the Autistic Spectrum: A Pilot Study
Article
  • Sep 2002
Background. The efficacy of neurofeedback training was evaluated in 12 children in the autistic spectrum with matched controls, based on established training protocols for other conditions with similar symptoms.Method. Twenty-four autistic children were divided into two groups, matched by sex, age, and disorder severity. One group received neurofeedback training and the second acted as a control group. Responses to the Autism Treatment Evaluation Checklists (ATEC) and parental assessments of problem behaviors were analyzed to evaluate the effectiveness of neurofeedback training for this condition.Results. Neurofeedback training resulted in a 26% average reduction in total ATEC rated autism symptoms, compared to 3% for the control group. Parental assessments reported improvement in all behavioral categories: socialization, vocalization, anxiety, schoolwork, tantrums, and sleep, compared with minimal changes in the control group.Discussion. Autistic spectrum children who underwent neurofeedback training showed significant improvements in autism symptoms and behaviors. The magnitude of improvement was independent of initial severity or age.
Effects of electroencephalogram biofeedback with Asperger's syndrome
Article
This article reports the pilot study of electroencephalogram (EEG) biofeedback to improve focusing and decrease anxiety in 10 adolescent boys diagnosed with Asperger's syndrome attending a therapeutic day school. Five of the boys dropped out of the study before 12 sessions were completed. The analysis of pre- and post-intervention quantitative EEGs for the five students who completed the study showed a trend to "normalization", but did not reach statistical significance. All five boys who completed 24 sessions showed improved behavior as rated by parents and teachers, but other factors, such as maturation could not be ruled out as causes of the improvement. The challenges facing this research and proposals for further exploration are outlined.
Hemoencephalography for autistic spectrum disorder
  • Jan 2006
  • R Coben
Coben, R. (2006). Hemoencephalography for autistic spectrum disorder. Presented at the14th Annual Conference of the International Society for Neuronal Regulation, Atlanta, Georgia.
Mu-like rhythms in Autistic spectrum disorder: EEG analyses and neurofeedback
  • Jan 2006
  • R Coben
  • W Hudspeth
Coben, R. & Hudspeth, W. (2006). Mu-like rhythms in Autistic spectrum disorder: EEG analyses and neurofeedback. Presented at the 14th Annual Conference of the International Society for Neuronal Regulation, Atlanta, Georgia.