Efficacy of neurofeedback as a treatment modality for children in the autistic spectrum

Effect of Infra Low Frequency (ILF) neurofeedback training on EEG in children with autism spectrum disorders

Objective

To investigate whether Infra-low frequency Neurofeedback (ILF-NFB) training can improve brain electrical activity in children with autism spectrum disorders ASD.

Method

This single arm pre and post intervention study was carried out at IBMS (Institute of Basic Medical Sciences), Khyber Medical University, Peshawar and Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad from January 2021 to December 2022. A purposive sampling technique was used. Thirty-five ASD children (male=24; female=11; 7-17 years) were provided with 30 sessions of infra low frequency (ILF) neurofeedback training for 15-20 minutes, during 10 weeks. Childhood Autism Rating Scale (CARS) scoring was done and electroencephalogram (EEG) activity was compared before and after ILF-NF training sessions.

Results

Around 62.9% participants had mild-moderate autism and 37.1% had severe autism. Wilcoxon Signed rank test revealed a significant decline in delta (Pre-test=47.31±19.22, Post-test=22.07±6.83; p=<0.001), theta (Pre-test=24.75±16.62, Post-test=12.37±3.59; p=<0.001) and alpha (Pre-test=12.01±9.81, Post-test=4.03±1.61; p=< 0.001) waves. Mann Whitney U test exhibited no significant gender differences in EEG pattern before and after neurofeedback except in theta waves (p=0.03) before the intervention.

Conclusion

Decline in delta, theta, beta and alpha waves propose that ILF-NF training can be effective in improving the EEG activity. ILF-NFB can be perceived as a valuable non-invasive, non-pharmacological intervention for improving EEG pattern via reintegration of brain activity resulting in increased the attention and focus, enhanced mental stability and cognitive engagement.

Neurofeedback Recuperates Cognitive Functions in Children with Autism Spectrum Disorders (ASD)

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impaired social interaction, verbal and nonverbal communication, and behaviors or interests. Besides behavioral, psychopharmacological and biomedical interventions there is increasing evidence of non-invasive treatments like neurofeedback (NFB) that can improve brain activity. In this study, we have investigated whether NFB can improve cognitive functions in children with ASD. Thirty-five children with ASD (7-17 years) were selected by purposive sampling. The subjects underwent 30 sessions of NFB training for 20 min over 10 weeks' period. Psychometric tests i.e. Childhood Autism Rating Scale (CARS), IQ scoring and Reward sensitivity tests were administered at baseline. Pre and post NFB intervention assessment of executive functions, working memory and processing speed were done by NIH Toolbox Cognition Batteries. Friedman test revealed that children showed a statistically significant improvement in the NIH Tool Box cognitive assessments, including the Flankers Inhibitory Control and Attention Test (Pre-test = 3.63, Post-test = 5.22; p = 0.00), the Dimensional Change Card Sorting Test (Pre-test = 2.88, Post-test = 3.26; p = 0.00), the Pattern Comparison Processing Speed Test (Pre-test = 6.00, Post-test = 11:00; p = 0.00) and the List Sorting Working Memory Test (Pre-test = 4.00, Post-test = 6:00; p = 0.00), and displayed a trend of improvement at 2-month follow-up (Flankers Inhibitory Control and Attention Test (Post-test = 5.11 ± 2.79, Follow-Up = 5.31 ± 2.67; p = 0.21), the Dimensional Change Card Sorting Test (Post-test = 3.32 ± 2.37, Follow-Up = 3.67 ± 2.35; p = 0.054), the Pattern Comparison Processing Speed Test (Post-test = 13.69 ± 9.53, Follow-Up = 14.42 ± 10.23 p = 0.079) and the List Sorting Working Memory Test (Post-test = 6.17 ± 4.41, Follow-Up = 5.94 ± 4.03; p = 0.334). Our findings suggest NFB intervention for 10 weeks produce improvement in executive functions (Inhibitory Control and Attention and Cognitive Flexibility), Processing Speed and Working Memory in ASD Children.

The impact of ILF neurofeedback on inhibitory control in high-functioning adolescents with autism spectrum disorder: Preliminary evidence of a randomized controlled trial

BACKGROUND

Individuals with Autism Spectrum Disorder (ASD) often exhibit impairments in inhibitory control, which can impact their cognitive functioning. This study aimed to investigate the effectiveness of Infra-Low Frequency (ILF) neurofeedback in improving inhibitory control among high-functioning adolescents with ASD.

METHODS

A single-blind, two-armed randomized controlled trial was conducted with 24 adolescents with ASD randomly divided into two groups (active and sham; n = 12 per group). Both groups participated in 15 sessions of one-hour ILF neurofeedback, three times per week. The ILF neurofeedback protocol was applied to the active group, while the sham group received an inactive intervention. Outcomes were measured at the pretest, post-test, and follow-up stages.

RESULTS

ILF neurofeedback significantly improved inhibitory control in adolescents with ASD, as indicated by improvements in behavioral measures and absolute power analysis. The most significant differences were observed in alpha, theta, and gamma waves located in the central areas of the left gyrus. However, no significant effect was observed at the follow-up level on either behavioral measures or absolute power.

CONCLUSION

The results suggest that ILF neurofeedback is effective in improving inhibitory control in high-functioning adolescents with ASD. This non-invasive intervention has the potential to improve inhibitory control in this population. However, future research is needed to determine the long-term effects of ILF neurofeedback.

Simplified Attachable EEG Revealed Child Development Dependent Neurofeedback Brain Acute Activities in Comparison with Visual Numerical Discrimination Task and Resting

The development of an easy-to-attach electroencephalograph (EEG) would enable its frequent use for the assessment of neurodevelopment and clinical monitoring. In this study, we designed a two-channel EEG headband measurement device that could be used safely and was easily attachable and removable without the need for restraint or electrode paste or gel. Next, we explored the use of this device for neurofeedback applications relevant to education or neurocognitive development. We developed a prototype visual neurofeedback game in which the size of a familiar local mascot changes in the PC display depending on the user's brain wave activity. We tested this application at a local children's play event. Children at the event were invited to experience the game and, upon agreement, were provided with an explanation of the game and support in attaching the EEG device. The game began with a consecutive number visual discrimination task which was followed by an open-eye resting condition and then a neurofeedback task. Preliminary linear regression analyses by the least-squares method of the acquired EEG and age data in 30 participants from 5 to 20 years old suggested an age-dependent left brain lateralization of beta waves at the neurofeedback stage (p = 0.052) and of alpha waves at the open-eye resting stage (p = 0.044) with potential involvement of other wave bands. These results require further validation.

Effects of an intensive slow cortical potentials neurofeedback training in female and male adolescents with autism spectrum disorder : Are there sex differences?

Background

This study aims to compare the effects of neurofeedback training on male and female adolescents with autism spectrum disorder (ASD). Furthermore, it examines sex differences regarding improvements in co-occurring psychopathological symptoms, cognitive flexibility and emotion recognition abilities. The study might provide first hints whether there is an influence of sex on treatment outcomes.

Methods

Six female and six male adolescents with ASD were matched according to age, IQ and symptom severity. All participants received 24 sessions of electroencephalography-based neurofeedback training. Before and after the intervention, psychological data for measuring co-occurring psychopathological symptoms as well as behavioral data for measuring cognitive flexibility and emotion recognition abilities were recorded.

Results

Caregivers rated statistically significant higher psychopathological problems in female than in male adolescents with ASD at baseline. Apart from that, no statistically significant sex-related differences were revealed in this sample; however, male adolescents tended to report greater improvements of externalizing, internalizing and total symptoms, whereas females experienced smaller improvements of externalizing and total problems, but no improvements of internalizing problems. Regarding caregivers’ assessments, more improvement of total problems was reported for females. For males, only improvements of internalizing and total problems were described.

Conclusion

This study reveals preliminary results that sex-related differences might play a role when evaluating treatment outcomes after neurofeedback training regarding comorbid psychopathological symptoms. Adolescents’ self-report and parental assessments, especially concerning psychopathological symptoms, should be combined and considered in future studies to help prevent sex bias in adolescents with ASD.