Is EEG-biofeedback an Effective Treatment in Autism Spectrum Disorders? A Randomized Controlled Trial

Abstract

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.

Eyes-Closed Resting EEG Predicts the Learning of Alpha Down-Regulation in Neurofeedback Training

“…Specifically, it has been found that EEG learning is closely related to the improvement of performance after training in a variety of NF protocols (Egner and Gruzelier, 2003; Ros et al, 2009; Keizer et al, 2010; Nan et al, 2012; Gruzelier, 2014a), and it influences the transfer effects of NF from laboratory to real-world conditions (Sitaram et al, 2017). Although many trainees can gain successful learning to regulate the brain activity of interest in a desired direction, a substantial portion of subjects have been reported unsuccessful in EEG learning, regardless of the NF protocol and subject population (Lubar et al, 1995; Kotchoubey et al, 1999; Hanslmayr et al, 2005; Kropotov et al, 2005; Doehnert et al, 2008; Weber et al, 2011; Zoefel et al, 2011; Kouijzer et al, 2013; Enriquez-Geppert et al, 2014; Schabus et al, 2014; Reichert et al, 2015; Baumeister et al, 2016; Hsueh et al, 2016; Quaedflieg et al, 2016). The rates of this type of so-called non-learners vary, up to around 50% in some studies (Hanslmayr et al, 2005; Doehnert et al, 2008; Okumura et al, 2017).…”

“…The rates of this type of so-called non-learners vary, up to around 50% in some studies (Hanslmayr et al, 2005; Doehnert et al, 2008; Okumura et al, 2017). What is more, the non-learners often show less improvement on behavior/symptoms than learners (Lubar et al, 1995; Kropotov et al, 2005) or even no improvement after NF training (Hanslmayr et al, 2005; Kouijzer et al, 2013; Hsueh et al, 2016), which seriously affects the efficacy of NF training.…”

Connectivity-Guided EEG Biofeedback for Autism Spectrum Disorder: Evidence of Neurophysiological Changes

“…For example, Kouijzer et al (2013) showed no difference in effect between EEG biofeedback and skin conductance biofeedback, but both were better in reducing autistic symptoms as compared to a nontreatment control group. They concluded that the beneficial effects might be due to treatment expectancy, implicit training of attention and/or intensive one-to-one contact with a therapist.…”

“…Others have recently hypothesized that the positive effects of neurofeedback for individuals with autism might be due to non-specific factors (Heinrich, Gevensleben, & Strehl, 2007;Kouijzer, van Schie, Gerrits, Buitelaar, & de Moor, 2013). For example, Kouijzer et al (2013) showed no difference in effect between EEG biofeedback and skin conductance biofeedback, but both were better in reducing autistic symptoms as compared to a nontreatment control group.…”

Defining Developing Evidence-Based Medicine Databases Proving Treatment Efficacy

“…Most of the papers published are case or multiple case reports, with only a few randomized controlled studies. [10][11][12][13][14][15][16][17][18][19] Shorter-term studies are commonly used in medical research as a form of clinical trial, or a means to test a particular hypothesis of clinical importance. Such studies typically follow two groups of patients for a period of time and compare an endpoint or outcome measure between the two.…”