Long-term effects of neurofeedback treatment in autism

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.     

Neurofeedback treatment in autism. Preliminary findings in behavioral,cognitive, and neurophysiological functioning

Effects of neurofeedback treatment were investigated in children with autism spectrum disorders (ASD). Sixty percent of the participants in the treatment group successfully reduced excessive theta power during 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 improved following neurofeedback treatment relative to the control group. The reduction of theta power is assumed to reflect modulation of activity in the anterior cingulate cortex (ACC), which is known to be involved in social and executive dysfunctions in autism.     

EEG power and coherence in autistic spectrum disorder.

OBJECTIVE: Autistic spectrum disorder (ASD) has been defined as a neurodevelopmental disorder with associated deficits in executive function, language, emotional, and social function. ASD has been associated with pathophysiology in cerebral organization. The current study investigated quantitative EEG findings in twenty children diagnosed with autistic disorders as compared to 20 controls matched for gender, age and IQ. METHODS: The EEG was recorded during an eyes-closed resting condition and topographical differences in cerebral functioning were examined using estimates of absolute, relative, and total power, as well as intrahemispheric and interhemispheric coherences. RESULTS: There were group differences in power, intrahemispheric and interhemispheric coherences. Findings included excessive theta, primarily in right posterior regions, in autistics. There was also a pattern of deficient delta over the frontal cortex and excessive midline beta. More significantly, there was a pattern of underconnectivity in autistics compared to controls. This included decreased intrahemispheric delta and theta coherences across short to medium and long inter-electrode distances. Interhemispherically, delta and theta coherences were low across the frontal region. Delta, theta and alpha hypocoherence was also evident over the temporal regions. Lastly, there were low delta, theta and beta coherence measurements across posterior regions. CONCLUSIONS: These results suggest dysfunctional integration of frontal and posterior brain regions in autistics along with a pattern of neural underconnectivity. This is consistent with other EEG, MRI and fMRI research suggesting that neural connectivity anomalies are a major deficit leading to autistic symptomatology. SIGNIFICANCE: This paper reports the largest integrated study of EEG power and coherence during a resting state in children suffering autism spectrum disorder.     

EEG Neurofeedback in the Treatment of Adults with Binge-Eating Disorder: a Randomized Controlled Pilot Study

Specific alterations in electroencephalography (EEG)-based brain activity have recently been linked to binge-eating disorder (BED), generating interest in treatment options targeting these neuronal processes. This randomized-controlled pilot study examined the effectiveness and feasibility of two EEG neurofeedback paradigms in the reduction of binge eating, eating disorder and general psychopathology, executive functioning, and EEG activity. Adults with BED and overweight (N = 39) were randomly assigned to either a food-specific EEG neurofeedback paradigm, aiming at reducing fronto-central beta activity and enhancing theta activity after viewing highly palatable food pictures, or a general EEG neurofeedback paradigm training the regulation of slow cortical potentials. In both conditions, the study design included a waiting period of 6 weeks, followed by 6 weeks EEG neurofeedback (10 sessions à 30 min) and a 3-month follow-up period. Both EEG neurofeedback paradigms significantly reduced objective binge-eating episodes, global eating disorder psychopathology, and food craving. Approximately one third of participants achieved abstinence from objective binge-eating episodes after treatment without any differences between treatments. These results were stable at 3-month follow-up. Among six measured executive functions, only decision making improved at posttreatment in both paradigms, and cognitive flexibility was significantly improved after food-specific neurofeedback only. Both EEG neurofeedback paradigms were equally successful in reducing relative beta and enhancing relative theta power over fronto-central regions. The results highlight EEG neurofeedback as a promising treatment option for individuals with BED. Future studies in larger samples are needed to determine efficacy and treatment mechanisms.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13311-021-01149-9.     

Differentiating autistic children with quantitative encephalography: a 3-month longitudinal study

The present study used a single-channel quantitative electroencephalographic (EEG) assessment to differentiate autistic children from normal control subjects. One hundred five normal and 17 autistic children participated in the study. In addition to amplitude measures of the frequency bands of delta, theta, alpha, sensorimotor rhythm, and beta and the theta to beta ratio, intra- (6 minutes) and intersessional (3 months) consistencies were also examined. The results indicated that autistic children showed significantly higher quantitative EEG amplitudes in many of the frequency bands than normal children; furthermore, their quantitative EEG activities were found to be relatively unstable within a 6-minute session compared with normal children. Discriminant function analyses revealed that absolute sensorimotor rhythm and beta amplitudes were the best predictors that correctly differentiated autistic children from normal children in the present sample, with a high accuracy rate of 95.2%. In addition, quantitative EEG measurements of normal and autistic children were found to be generally consistent across the 3-month period.     

Factors impacting on the outcomes of Greek intervention programmes for children with autistic spectrum disorders

This study explored the best predictors of the progress of children with autistic spectrum disorders (ASD), on some developmental domains (autistic severity, language, communication and socialisation), which are related to the core features of ASD. Eighty-six children (2.5–14 years old) with ASD, from 10 schools in Greece, were included in the study, and their developmental progress was assessed over a period of 9 months. The data indicated that, apart from the factors related to the child (e.g., non-verbal IQ, language, adaptive behaviour, autistic severity, behavioural problems at baseline, as well as the age that the child started treatment), which were correlated to the child's developmental progress, there are also factors in the child's environment that influence his or her developmental progress; the most important being the levels of parental stress, and the parents’ abilities to discipline their child. These findings suggested that there are some factors (age that a child starts treatment, parental stress and parents’ abilities to discipline their child) that the intervention programmes, the teachers and the parents could take into account, in order to enhance the children's gains.     

Private Speech and Executive Functioning among High-Functioning Children with Autistic Spectrum Disorders

Private speech used by high-functioning children with autistic spectrum disorders (ASD) (n = 33) during two executive functioning tasks was compared to that of typically developing children (n = 28), and children with ADHD (n = 21). Children with ASD were as likely as others to talk to themselves and their speech was similarly relevant and likely to appear in moments of task difficulty. Unlike others, children with ASD were more likely to get items correct when they were talking than when they were silent. Group differences in performance were observed when children were silent but not when children were talking. Findings suggest that autistic children talk to themselves in relevant ways during problem-solving and that such speech is helpful in normalizing their executive performance relative to controls.     

Social and non-social deficits in children with high-functioning autism and their cooperative behaviors

The persistent deficits in social communication and social interactions of individuals with high-functioning autism (HFA) may impair their cooperative behaviors. This study investigated the relationship between social and non-social deficits in children with HFA and the cooperative behaviors of such children. Theory of mind (ToM), executive function, and central coherence of children with HFA and typically developing (TD) children, aged 6–12 years, were investigated, and the effects of these social and non-social deficits on children's cooperativeness were examined. The classical prisoner's dilemma game (PDG) and cooperative implemental tasks were used to assess children's cooperativeness. ToM was measured using a series of classical false belief tasks and the face test. The Wisconsin Card Sorting Task (WCST) and the Embedded Figures Test (EFT) were administered to assess executive function and central coherence, respectively. The results showed that there was no significant difference in cooperation in PDG between HFA and TD children, while cooperation in children with HFA in the interruption period of the implemental tasks was significantly lower than that of TD children. Children with HFA had social deficits and had more poorly developed ToM than TD children, and executive function in children with HFA was poorer than that in TD children. Different types of deficits were predictive of HFA children's degree of cooperation on different tasks: the social perceptual component of ToM and executive function predicted children's cooperativeness in the PDG, and executive function predicted HFA children's cooperativeness during the interruption period of an implemental task. By contrast, central coherence did not predict either of the two types of cooperation. It might indicate that the two different types of cooperative tasks may require different mental abilities.     

The usage of neurofeedback in children with ADHD: the method and its evaluation

Neurofeedback is a computer-based behavior training, which is gaining increasing interest in the treatment of children with attention-deficit/hyperactivity disorder (ADHD). This article gives an introduction to neurofeedback and summarizes the state of research, discussing inter alia methodical aspects (e. g., requirements to a control training). Evaluation studies conducted so far indicate clinical efficacy. For example, neurofeedback training was superior to a computerized attention training in a randomized controlled trial (medium effect size). Follow-up investigations suggest that treatment effects remain stable (at least six months). At the clinical level, comparable improvements could be obtained for the neurofeedback protocols theta/beta training and training of slow cortical potentials. Neurophysiological findings document different mechanisms of theta/beta training and slow cortical potential training. Future studies should further elucidate the specificity of training effects related to the kind of training and certain disorders and address how to optimize and individualize neurofeedback training.     

“I love the cute caterpillar!” autistic children's production of internal state language across contexts and relations to Joint Attention and theory of mind

Research on internal state language in autistic children reveals an uneven pattern. While some studies show that high-ability autistic children are impaired across a broad range of internal state term categories (e.g., desires, emotions and cognitive terms), other research shows that autistic children are more selectively impaired in their talk about cognitive states. Finally, some studies even demonstrate no impairments. The different findings have largely been explained by context effects. However, to date, studies have yet to compare the same children across different contexts to corroborate this interpretation. Further, studies involving contexts where autistic children's reactivity is actively triggered by providing clear joint attention cues or by exploiting autistic children's intense interest in objects are lacking. Thus, this study tested internal state language from different categories across three different contexts (narrative context, motivating mechanical toy context, elicited interactive joint attention context) and related it to joint attention skills and children's theory of mind. Results revealed that deficits in autistic children's internal state language were highly specific and relation to theory of mind varied by context. In sum, this research suggests that both theorists and practitioners need to take into account context when studying or promoting autistic individuals’ psychological comprehension.     

Atypical understanding of mental terms in Chinese-speaking children with autism spectrum disorder

The present study investigated how Chinese children with autism spectrum disorder (ASD) understand mental terms, especially their knowledge of verb factivity. We examined these children's ability to understand mental terms representing true belief (i.e., zhi1dao4, know) and false belief (i.e., yi3wei2, thought) and compared their ability with that of typically developing (TD) children matched with age, and TD children matched with verbal mental age (VMA). Children were asked to participate in a game to find a toy according to the experimenter's testimony, which involved these mental terms. Results showed that all children from these three groups understood zhi1dao4 better than yi3wei2. Particularly, children with ASD performed statistically significantly worse in understanding mental terms than their age-matched TD children, but not differently from VMA-matched TD children. The understanding of mental verbs was correlated with the language ability of children with ASD, and with age, language ability and executive function of TD children. After controlling for the effects of age, general language ability, and executive functions, the group difference of mental verb understanding still existed.     

Altered immune function associated with disordered neural connectivity and executive dysfunctions: A neurophysiological study on children with autism spectrum disorders

Previous studies have shown that children with autism spectrum disorders (ASDs) have impaired executive function, disordered neural connectivity, and abnormal immunologic function. The present study examined whether these abnormalities were associated. Seventeen high-functioning (HFA) and 17 low-functioning (LFA) children with ASD, aged 8–17 years, participated voluntarily in the study. The two groups of children were compared on their general intelligence in terms of IQ; executive function as measured by the Hong Kong List Learning Test, D2 Test of Concentration, Five Point Test, Children's Color Trail Test, Tower of California Test, and Go/No-Go task; a non-executive task as measured by the Picture Completion Task; neural connectivity as measured by theta coherence in the anterior and posterior regions; and immunologic function as measured by the level of circulating CD3+ CD8+ suppressor/cytotoxic T lymphocytes in a blood sample. Results on executive function showed that LFA children performed significantly poorer than HFA children as shown on their lower Executive Composite as well as individual executive function scores. However, there was no group difference on the Picture Completion Task. Results on neural connectivity showed that LFA children demonstrated a different pattern of electroencephalography (EEG) coherence from HFA children as shown in the significantly elevated theta coherence in the anterior network, as well as at the left intra-hemispheric (LA-LP) and right-to-left inter-hemisphere (RA-LP) connections of LFA children. In immunologic function, results showed that LFA children had significantly elevated level of suppressor/cytotoxic T lymphocytes (CD3+ CD8+) (p < 0.05). In addition, the executive dysfunction, disordered neural connectivity, and abnormal immunologic function were found to be associated. These results provided some initial evidence to support the notion that immunologic factors are associated with neuronal damage, measureable by EEG coherence and manifested as executive dysfunctions.     

Methods for assessing sleep in children with autism spectrum disorders: A review

A literature review completed by Bauer and Blunden (2008) determined that compared to objective measures, subjective assessments of sleep for typically developing children (e.g., parental reports) were of limited utility. No comparable literature review has been undertaken to determine whether subjective measures are appropriate for assessing sleep in children with autism spectrum disorders (ASD). Such a review is necessary as children with ASD have more sleep problems than typically developing children and children's sleep difficulties can negatively affect the child and other family members. It is, therefore, important to have measures of sleep for children with ASD that can reliably detect sleep problems and track improvements in sleep. This literature review described frequently used measures of children's sleep and evaluated their utility for assessing sleep in children with ASD. It was determined that, with the exception of sleep latency, parents’ reports of children's sleep are not consistently associated with objective measures of children's sleep. This was true for single-item parent-reports and for a widely used multi-item parent-report measure of children's sleep. Limitations of objective sleep measures (e.g., polysomnography, actigraphy), including the inability of children with ASD to tolerate such methods, are described.     

Long-term effects of theta/beta neurofeedback on EEG power spectra in children with attention deficit hyperactivity disorder

ObjectiveNeurofeedback has been proposed as an effective alternative for pharmacological treatment in children with attention-deficit/hyperactivity disorder (ADHD), with potentially long-term and delayed benefits. However, the specificity of such long-term behavioral improvements remains inconclusive and therefore additional research into the neurophysiological effects of neurofeedback is needed. We compared long-term effects of theta/beta neurofeedback (NFB) to methylphenidate (MPH) and physical activity (PA, semi-active control intervention) on electroencephalogram (EEG) power spectra. Based on the vigilance stabilization model, we hypothesized further reductions in theta and alpha power in the NFB compared to the control groups.MethodEEG power spectra (theta, alpha and beta) during resting and task conditions were recorded at pre-, post-intervention and 6-months follow-up in 67 children, aged 7–13 (NFB: n = 24, MPH: n = 23, or PA: n = 20).ResultsAnalyses revealed no power spectra differences at follow-up between MPH and NFB (range p = .165–.905) and PA and NFB (range p = .172–.822).ConclusionsNo evidence was found for the specificity of theta/beta NFB at follow-up.SignificanceThis was the first study into long-term neurophysiological effects of theta/beta NFB. Future studies are encouraged to explore both specific and non-specific mechanisms of NFB.Clinical trials registration: Train Your Brain? Exercise and neurofeedback intervention for ADHD, https://clinicaltrials.gov/show/NCT01363544, Ref. No. NCT01363544.     

Individual EEG Alpha Activity Analysis for Enhancement Neurofeedback Efficiency: Two Case Studies

The hypothesis was tested of whether neurofeedback training applied in order to increase or decrease power of individual EEG frequency ranges is more efficient than neurofeedback training of standard EEG frequency ranges. The sessions of decreasing the theta/beta ratio and reinforcing alpha neurofeedback training were carried out on two outpatients with attention deficit disorder (a schoolboy) and functional pain contraction (a professional musician). The neurofeedback utilizing standard EEG frequency ranges (theta 4-8, alpha 8-12, beta 13-18) was inefficient and even resulted in aggravation of symptoms in both cases. The individualized neurofeedback that utilized individual frequency ranges resulted in substantial clinical improvement.     

Neurofeedback Efficacy in the Treatment of a 43-Year-Old Female Stroke Victim: A Case Study

Introduction. A 43-year-old Caucasian woman presented with a series of physical and mental deficits following a right hemisphere cerebral artery embolus suffered at age 42.

Method. For both the pretreatment and posttreatment evaluation, the client's EEG data were collected. Prior to beginning neurofeedback a self-developed symptom checklist was provided to the participant and was repeated every 10 sessions. The participant received 52 neurofeedback sessions with the use of Neurocybernetics equipment. To determine statistical changes between the pretreatment and posttreatment conditions, average cross-spectral matrices were computed for bands delta (1–3.5 Hz), theta (3.5–7.5 Hz), alpha (7.5–12.5 Hz), beta1 (12.5–25 Hz), beta2 (25–32 Hz), and gamma (37–47 Hz). In this study the pretreatment cross-spectra for each epoch were then compared to the posttreatment epoch cross-spectra using the previously mentioned frequency band ranges. For each condition, cross-spectral matrices were computed and averaged over 2-s epochs resulting in one cross-spectral matrix for each epoch and for each of the discrete frequencies within each band. Based on previous LORETA analyses, we used a rectangular window. No time frame or frequency wise normalization was performed.

Results. Following treatment, comparative QEEG and eLoreta analyses illustrated significant decreases in the absolute and relative power theta measures and significant elevations of absolute and relative power occipital beta. These findings correspond to client self-report data demonstrating improvement in cognitive functioning and depressed mood.

Conclusion. Overall, findings suggest the utility of neurofeedback for the treatment of stroke,with particular gains noted in the areas of cognitive functioning, sleep quality, emotional regulation, and energy.     

Patterns of gaze behavior during an eye-tracking measure of joint attention in typically developing children and children with autism spectrum disorder

This study evaluated whether diagnostic classifications or features of ASD were associated with individual differences in children's gaze pattern during an eye-tracking measure of joint attention. The sample included 21 children with ASD (mean age, 7.3 ± 1.5 years) and 24 typically developing children (mean age, 6.8 ± 1.6 years), matched on receptive language abilities. Results revealed no significant group differences on global measures of gaze allocation (total gaze time allocation). However, significant group differences emerged using a measure evaluating a microstructure of children's gaze (duration of first fixation). In addition, individual differences in children's gaze pattern were reliably predicted by parent report measures of children's social abilities. The majority of children in this sample (including all typically developing children and those children with ASD who scored lowest on the SRS Social Awareness subscale) showed significant modulation in eye-gaze between the two experimental conditions. In contrast, children with ASD who also scored the highest on the SRS Social Awareness subscale consistently failed to modulate their eye gaze in accordance with the experimental condition. This failure to flexibly modulate gaze in the context of a joint attention eye-tracking paradigm may reveal children's limited awareness of social cues that may further limit social learning.     

Pragmatic difficulties in children with autism associated with childhood epilepsy

Purpose: The intention of this study was to examine specific pragmatic functions in 35 children, aged 6–11 years, with a history of epilepsy (mean length of duration 6.5 years), who demonstrated autistic features, ASD or autistic regression. Method: The children's ability to recognize and convey communicative intentions, conversational engagement and paralinguistic features were investigated using the Pragmatics Profile of Everyday Communication Skills in Children using semi-structured key-worker interviews. The association between weak or abnormal prosody and epileptic focus was also examined. Results: Findings demonstrate a strong association between early onset epilepsy with autism or autistic regression and additional pragmatic impairment. A number of children exhibited weak or abnormal prosody in association with temporal lobe EEG abnormalities, particularly in the non-dominant hemisphere. Consideration is given to recent studies of the converse—the presence of a reducing prevalence of epilepsy in the autism population and acknowledgment of implications for learning within the autistic population.     

Executive processes in Asperger syndrome: patterns of performance in a multiple case series

Mixed evidence exists for executive dysfunction in autism spectrum disorders (ASD). This may be because of the nature of the tasks used, the heterogeneity of participants, and difficulties with recruiting appropriate control groups. A comprehensive battery of ‘executive’ tests was administered to 22 individuals with Asperger syndrome and 22 well-matched controls. Performance was analysed both between groups and on an individual basis to identify outliers in both the ASD and control groups. There were no differences between the groups on all ‘classical’ tests of executive function. However, differences were found on newer tests of executive function. Specifically, deficits in planning, abstract problem solving and especially multitasking. On the tests that discriminated the groups, all of the ASD individuals except one were identified as significantly impaired (i.e. below the 5th percentile of the control mean) on at least one executive measure. This study provides evidence for significant executive dysfunction in Asperger syndrome. Greatest dysfunction appeared in response initiation and intentionality at the highest level—the ability to engage and disengage actions in the service of overarching goals. These deficits are best observed through using more recent, ecologically valid tests of executive dysfunction. Moreover, performance on these measures correlated with autistic symptomatology.