Application of neurobiofeedback therapy technology on social skills and emotion regulation in children with autism spectrum disorder

Abstract

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by difficulties in social communication, restricted interests, and repetitive stereotyped behaviors. In recent years, the prevalence of ASD has continued to rise, with boys having a significantly higher incidence rate than girls. Children with ASD often have intellectual and language impairments, which seriously affect their social skills, emotional regulation, and daily life. Although traditional treatment methods have shown some effectiveness, they still have limitations in addressing social and emotional regulation. Neurobiofeedback therapy is a noninvasive, drug-free treatment method that helps individuals regulate physiological responses through feedback mechanisms, and it has shown potential in various psychological disorders and emotional regulation. However, there is limited research on the social skills and emotional regulation in children with ASD. Therefore, this study aims to explore the impact of neurobiofeedback technology on children with ASD through a retrospective cohort study, supplementing existing treatment methods and promoting a more comprehensive treatment of ASD.

AIM

To investigate the effects of neurobiofeedback therapy on social skills and emotional regulation in children with ASD.

METHODS

A retrospective study was conducted on 92 children with ASD who were admitted to our hospital from January 2023 to June 2024. According to their different treatment plans, they were divided into a conventional group (conventional rehabilitation treatment; n = 43) and a combined group (conventional rehabilitation treatment combined with neurobiofeedback therapy; n = 49). The general characteristics, Aberrant Behavior Checklist scores, Chinese version of the Psycho-Educational Profile, Third Edition scores, Social Responsiveness Scale scores, Emotion Regulation Checklist scores, Social Communication Questionnaire scores, and the incidence of adverse reactions were compared between groups.

RESULTS

After intervention, the Aberrant Behavior Checklist and Social Responsiveness Scale scores of the combined group were lower than those of the conventional group. In contrast, scores on the Chinese version of the Psycho-Educational Profile, Third Edition, Emotion Regulation Checklist, and Social Communication Questionnaire were significantly higher in the combined group than in the conventional group (all P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups.

CONCLUSION

Neurobiofeedback therapy can effectively improve clinical symptoms, emotional regulation, and social skills in children with ASD.

Key Words: Autism spectrum disorder; Neurobiofeedback; Social skills; Emotion regulation; Electroencephalogram

Core Tip: By combining electroencephalogram-driven neurofeedback with cartoon-based attention training, this study introduces a child-friendly, noninvasive protocol that directly modulates prefrontal γ-band activity in preschoolers with autism spectrum disorder. Unlike conventional rehabilitation alone, this approach strengthens self-regulated cortical networks underpinning social cognition and emotional control, leading to clinically and statistically superior improvements in Social Responsiveness Scale, Aberrant Behavior Checklist, Emotion Regulation Checklist, and Social Communication Questionnaire scores, without increasing adverse events. The strategy offers an easily scalable, low-risk adjunct that can be embedded into existing early-intervention services to enhance long-term neurodevelopmental outcomes.

INTRODUCTION

Autism spectrum disorder (ASD) is an extremely heterogeneous and complex neurodevelopmental illness characterized by social interaction disorder, restricted interests, and repetitive behaviors[1]. ASD is usually diagnosed before the age of three. With the deepening of understanding of this disease in recent years, epidemiological research has demonstrated that the prevalence of ASD has dramatically increased globally, with boys affected about four to five times more often than girls[2]. This rising prevalence has aroused widespread concern, especially because ASD has a profound impact on the early development of children and their social functions in adulthood. Studies have shown that children with ASD have obvious difficulties in social communication and emotional regulation. These challenges not only directly affect their daily life and academic achievement but may also predispose them to mental problems[3,4] and greatly hinder their ability to establish normal relationships with others. In addition, ASD is often accompanied by other neurodevelopmental diseases, such as mental retardation and language disorders, further complicating the rehabilitation process[5]. Therefore, ASD not only places a significant economic burden on the patient’s family but also generates significant societal pressure. From a sociological and public health perspective, improving the social skills and emotional regulation of children with ASD has become an important research priority. Therefore, finding effective treatment methods, especially interventions to improve children’s social skills and emotional regulation ability, has become a research hotspot in the fields of education, psychology, and clinical medicine. As a noninvasive treatment, neurobiofeedback therapy monitors individual physiological activities through electrodes and sensors, and helps patients learn to self-regulate physical and psychological responses[6]. This treatment uses special equipment to enable patients to realize their physiological changes, thereby adjusting their physiological and psychological state through training to achieve remission or therapeutic effects. Neurobiofeedback therapy has shown its potential in the treatment of a variety of mental health problems and emotional regulation disorders. However, there remains a paucity of evidence on its specific effects on the social ability and emotional regulation of children with ASD. Based on this background, this study used a retrospective cohort design to explore the efficacy of neurobiofeedback therapy in improving social and emotional outcomes in children with ASD.

MATERIALS AND METHODS

The Institutional Review Board and Ethics Committee approved this study. Informed consent was not necessary because the study was retrospective, used solely de-identified patient data, and posed no risk or harmful consequences to patients. This waiver complied with the regulatory and ethical criteria for retrospective research. This retrospective analysis included 92 children with ASD treated at our institution between January 2023 and June 2024. According to the treatment modality recorded in the electronic medical record system, patients were assigned to either the conventional group (conventional rehabilitation; n = 43 cases) or the combined group (conventional rehabilitation plus neurobiofeedback therapy; n = 49).

Inclusion criteria

Participants were eligible if they met all of the following conditions:

(1) Diagnosis of ASD based on the Diagnostic and Statistical Manual of Mental Disorders[7]; (2) Childhood Autism Rating Scale, Second Edition - Standard Version[8] score of at least 30; (3) Age younger than 6 years; (4) Absence of significant heart, lung, liver, kidney, or other visceral disorders; and (5) Availability of complete clinical data.

Exclusion criteria

Participants were excluded if they met any of the following conditions:

(1) Presence of severe organic disorders; (2) Basic hearing or speech impairments; and (3) History of organic brain injury.

Treatment

Children in the conventional group received traditional rehabilitative therapy. Based on each child’s evaluation results, physicians designed individualized cognitive understanding courses and promoted the development of various abilities through the principle of behavior shaping. The training included tasks such as requesting, naming, following the therapist’s instructions, responding appropriately, matching, and imitation. Functional games were incorporated to promote interaction with the children based on their individual circumstances, with varying degrees of prompting or support. Assistance was gradually reduced until the child could independently demonstrate the desired behavior. Treatment was administered 5 days a week, 2 hours per session, for 4 weeks per course, with a total of three courses.

Children in the combined group received neurobiofeedback therapy in addition to standard rehabilitation. Before treatment, a detailed electroencephalogram (EEG) analysis was performed to evaluate baseline EEG characteristics. If the child had abnormally high gamma waves, the treatment goals were adjusted to avoid further enhancing overactive gamma waves and to help balance brain activity. Specific methods: The Infiniti 3000A EEG biofeedback equipment from Nanjing Weisi Medical Technology Co., Ltd., was utilized. The child sat with the EEG electrodes on the frontal lobe and two ear electrodes close to the earlobes. Baseline tests were performed and the patient’s brain waves were meticulously recorded. Amplitude integrated electroencephalography (aEEG) was a pop band that appears in the form of amplitude, with a rate of 6 cm/h and a unit of μV. Normal aEEG exhibited continuous normal voltage (upper boundary voltage > 10 μV, lower boundary voltage > 5 μV); Mild abnormal aEEG manifested as discontinuous normal voltage (upper boundary voltage > 10 mV, lower boundary voltage < 5 μV); Severe abnormal aEEG (upper boundary voltage < 10 μV, lower boundary voltage < 5 μV), continuous low voltage, burst suppression, flatness, and epileptic like activity. The children were told to watch cartoons on the screen to keep their attention. When their attention was diverted, the cartoons were paused to increase Gamma EEG activity and offer visual and audible feedback to the children. One course of treatment was five times a week, 30 minutes each, for 4 weeks, and children underwent a total of three courses. Neither group of children received any family intervention.

Aberrant Behavior Checklist scores

Aberrant Behavior Checklist (ABC) scores were compared before and after therapy for both groups of children. The ABC score comprises 57 items divided into five categories: Sensory behavior, social interaction, motor abilities, linguistic communication ability, and social and adaptive skills. Each item was scored 1-3. The higher the score, the more serious the clinical symptoms of the children[9]. Chinese version of the Psycho-Educational Profile, Third Edition (C-PEP-3) score. The C-PEP-3 assesses 95 items in seven domains. The overall score is 131 points; higher scores indicate higher levels of psychological development and learning function[10].

Social Responsiveness Scale score

Social Responsiveness Scale (SRS) scoring was used to assess the social abilities of two groups of children. SRS includes five dimensions, with a total of 65 items, each with a score of 1 to 4. The higher the score, the worse the social ability of the child[11].

Emotion Regulation Checklist score

Emotion Regulation Checklist (ERC) is a peer-assessment instrument that assesses school-age children’s capacity to regulate their emotions. It is made up of 24 items, including the ERC-Emotion Regulation (ER) score and the ERC-Lability/Negativity subscale (LN)[12]. ERC-ER consists of eight measures that are designed to assess emotional reaction, empathy, and emotional awareness. It primarily focuses on children’s proper emotional expression, empathy, and self-cognition abilities in certain contexts. The higher the ERC-ER score, the greater the degree of emotion regulation ability; the ERC-LN has 15 items that primarily test the inflexibility of children’s emotion regulation, the propensity of dramatic changes in feelings, and the frequency of expressing negative emotions. A high score on the ERC-LN suggests a more negative impact.

Social Communication Questionnaire score

The Social Communication Questionnaire (SCQ) was used before and after intervention to measure the two groups of children’s communication abilities. The SCQ has 40 items and is separated into three categories: Social communication, social interaction, and repeated stereotyped behavior. Each item was answered with a yes or no. No aberrant behavior is scored as 0 points, whereas abnormal behavior is rated as 1 point. A high score suggests great communication skills[13].

Comparison of adverse reactions

After intervention, the incidence of adverse reactions was compared between the two groups of children, including irritability, dysphoria, crying and fussing.

Statistical analysis

SPSS 25.0 statistical software was used to analyze the data. The counting information was expressed as, n (%) and the χ² test was used. The measurement information that was normally distributed was expressed as mean ± SD and a t-test was used. P < 0.05 was considered statistically significant.

RESULTS

Comparison of general data

There were no statistically significant differences in general data between the two groups of ASD children (P > 0.05; Table 1).

Table 1 Comparison of general data, mean ± SD.

Group	Gender, n (%)		Age (years)	BMI (kg/m2)	IQ (fractional)	Disease duration	CARS2-ST score
	Male	Female
Conventional group (n = 43)	36 (83.72)	7 (16.28)	3.44 ± 0.70	25.30 ± 3.48	72.14 ± 2.56​	3.30 ± 0.52	43.12 ± 3.19
Combined group (n = 49)	40 (81.63)	9 (18.37)	3.39 ± 0.67	25.62 ± 2.95	71.94 ± 2.62	3.47 ± 0.69	42.88 ± 2.91
χ2/t	0.070		0.378	0.476	0.371	1.299	0.371
P value	0.792		0.706	0.636	0.712	0.197	0.712

BMI: Body mass index; IQ: Intelligence quotient; CARS2-ST: Childhood Autism Rating Scale, Second Edition - Standard Version.

Comparison of ABC scores

After intervention, the sensory behavior, social interaction, motor ability, language communication ability, social and adaptive skills scores of the combined group were lower than those of the conventional group (P < 0.05; Table 2).

Table 2 Comparison of Aberrant Behavior Checklist scores, mean ± SD.

Group	Before treatment		t	P value	After treatment		t	P value
	Conventional group (n = 43)	Combined group (n = 49)			Conventional group (n = 43)	Combined group (n = 49)
Sensory behavior	13.30 ± 3.70	12.94 ± 3.11	0.512	0.610	9.79 ± 1.70a	7.08 ± 1.18a,b	8.812	< 0.001
Social interaction	19.09 ± 4.81	19.94 ± 4.09	0.912	0.365	15.58 ± 3.89a	12.90 ± 3.63a,b	3.423	0.001
Athletic ability	18.77 ± 4.19	17.98 ± 4.64	0.850	0.398	16.16 ± 3.81a	14.49 ± 3.19a,b	2.292	0.024
Language communication skills	23.74 ± 5.90	23.76 ± 5.28	0.009	0.993	19.16 ± 4.36a	17.78 ± 3.72a,b	2.316	0.023
Social and adaptive skills	15.70 ± 4.09	15.84 ± 3.83	0.168	0.867	9.93 ± 3.11a	8.18 ± 3.03a,b	2.723	0.008

^aP < 0.05 vs before treatment.

^bP < 0.05 vs conventional group.

Comparison of C-PEP-3 scores

After treatment, the C-PEP-3 score of the combined group was higher than the conventional group (P < 0.05; Table 3).

Table 3 Comparison of Chinese version of the Psycho-Educational Profile, Third Edition scores, mean ± SD.

Group	Before treatment		t	P value	After treatment		t	P value
	Conventional group (n = 43)	Combined group (n = 49)			Conventional group (n = 43)	Combined group (n = 49)
Imitate	3.61 ± 1.21	3.66 ± 1.19	0.332	0.740	4.92 ± 1.33a	6.58 ± 1.91a,b	5.022	< 0.001
Perception	5.71 ± 1.52	5.89 ± 1.67	0.994	0.323	7.11 ± 2.14a	8.63 ± 2.09a,b	3.559	0.001
Fine motor	3.59 ± 1.09	3.70 ± 1.31	0.770	0.443	4.97 ± 1.27a	6.78 ± 1.53a,b	6.039	< 0.001
Gross motor	6.52 ± 2.13	6.58 ± 2.34	0.170	0.865	7.51 ± 2.35a	9.65 ± 2.28a,b	4.186	< 0.001
Hand-eye coordination	4.48 ± 1 .37	4.50 ± 1.26	0.076	0.940	5.43 ± 1.74a	7.02 ± 2.12a,b	3.924	< 0.001
Cognitive performance	2.39 ± 0.85	2.34 ± 0.76	0.135	0.893	4.63 ± 1.12a	6.16 ± 1.34a,b	6.247	< 0.001
Language cognition	1.86 ± 0.74	1.88 ± 0.69	0.369	0.713	2.75 ± 0.91a	3.89 ± 1.17a,b	5.086	< 0.001

^aP < 0.05 vs before treatment.

^bP < 0.05 vs conventional group.

Comparison of SRS scores

After intervention, the scores of the combined group were lower than those of the conventional group (P < 0.05; Table 4).

Table 4 Comparison of Social Responsiveness Scale scores, mean ± SD.

Group	Before treatment		t	P value	After treatment		t	P value
	Conventional group (n = 43)	Combined group (n = 49)			Conventional group (n = 43)	Combined group (n = 49)
Social perception	16.74 ± 1.33	17.12 ± 1.62	1.216	0.227	12.28 ± 1.46a	9.18 ± 1.78a,b	8.845	< 0.001
Social cognition	19.72 ± 1.50	19.81 ± 1.62	0.353	0.725	15.71 ± 1.65a	13.42 ± 1.46a,b	7.025	< 0.001
Social communication	31.77 ± 2.52	32.31 ± 2.46	1.035	0.303	28.59 ± 2.69a	26.07 ± 2.38a,b	4.805	< 0.001
Social motivation	14.91 ± 1.51	15.22 ± 1.67	0.950	0.345	12.87 ± 1.82a	10.64 ± 1.37a,b	6.857	< 0.001
Autistic behavior	18.07 ± 1.68	17.90 ± 1.31	0.550	0.584	14.17 ± 2.06a	11.91 ± 1.84a,b	5.396	< 0.001
Total score	101.21 ± 4.02	102.39 ± 3.91	1.423	0.158	83.60 ± 4.56a	71.16 ± 4.45a,b	13.230	< 0.001

^aP < 0.05 vs before treatment.

^bP < 0.05 vs conventional group.

Comparison of ERC scores

After treatment, the ERC score of the combined group was lower than the conventional group (P < 0.05; Table 5).

Table 5 Comparison of Emotion Regulation Checklist scores, mean ± SD.

Group	Emotion regulation checklist-emotion regulation		Emotion regulation checklist-lability/negativity subscale
	Before treatment	After treatment	Before treatment	After treatment
Conventional group (n = 43)	20.82 ± 2.79	22.19 ± 3.27a	37.35 ± 3.47	35.08 ± 3.51a
Combined group (n = 49)	19.65 ± 2.93	24.52 ± 3.06a,b	36.72 ± 3.11	32.68 ± 3.35a,b
t	1.835	3.525	0.825	3.352
P value	0.070	0.001	0.412	0.001

^aP < 0.05 vs before treatment.

^bP < 0.05 vs conventional group.

Comparison of SCQ scores

After treatment, the SCQ scores of the conventional group were lower than the combined group (P < 0.05; Table 6).

Table 6 Comparison of Social Communication Questionnaire scores, mean ± SD.

Group	Before treatment	After treatment	t	P value
Conventional group (n = 43)	15.35 ± 3.73	18.42 ± 4.55a	3.303	0.001
Combined group (n = 49)	15.62 ± 3.11	20.92 ± 4.56a,b	6.763	< 0.001
t	0.263	2.713	-	-
P value	0.793	0.008	-	-

^aP < 0.05 vs before treatment.

^bP < 0.05 vs conventional group.

Comparison of adverse reactions

There was no significant difference in the incidence of adverse reactions between the two groups of children after intervention (Table 7).

Table 7 Comparison of adverse reactions, n (%).

Group	Irritability	Dysphoria	Crying and fussing	Total occurrences
Conventional group (n = 43)	1 (2.33)	1 (2.33)	2 (4.65)	5 (11.63)
Combined group (n = 49)	0	2 (4.08)	2 (4.08)	4 (8.16)
χ2	-	-	-	0.311
P value	-	-	-	0.577

DISCUSSION

ASD is a prevalent early neurodevelopmental disease that heavily influences children’s social interaction, speech, and behavior[14,15]. Studies have shown that ASD affects more than 1% of children, and the prevalence is increasing. The prevalence is higher than that of congenital brain malformations or Down syndrome[16]. Research has found that right brain and neurological dysfunction may be potential causes of ASD-related symptoms[17]. As research continues to deepen, an increasing number of treatments have been proposed, such as medication[18], behavioral intervention strategies[19], and transcranial magnetic stimulation[20]. So far, neurofeedback has been extensively employed as a non-invasive therapy for ASD patients and proposed as a potential treatment method[21-23]. The basic principle of neurofeedback is to promote learning through associations by self-regulating brain activity in specific areas or networks, enabling individuals to perceive and adjust cognitive strategies, thereby improving brain function and ultimately inducing lasting functional and structural neural changes[24]. Furthermore, as an emerging intervention tool, neurobiofeedback has shown considerable promise in the treatment of ASD in recent years[25]. The ability to regulate emotions is an instinct derived from the executive function of the prefrontal cortex of the brain. This ability is not taught, but rather the result of the continuous maturation of executive function and the interaction between individuals and their environment. The enhancement of stimulus-preceding negativity potential or the high-frequency oscillation of γ-band EEG in the frontal region is closely related to social skills and emotional regulation. Neurobiofeedback therapy technology helps individuals self-regulate brain function by real-time monitoring and feedback of brain electrical activity, thereby improving their emotional regulation, behavioral control, and cognitive function. Based on this, we aimed to provide new ideas and basis for the treatment of ASD by comparing the improvement of social skills and emotional regulation between two groups. One of the primary signs of ASD is social impairment. Many ASD children have great difficulties in interacting with others, including poor topic management, abnormal intonation, and ASD-related paralanguage[26]. In addition, difficulties in social interaction and communication among ASD patients may increase the prevalence and severity of social anxiety disorder, and the exacerbation of anxiety may further exacerbate existing social deficits[27]. SRS is a quantitative measurement method utilized to recognize those who exhibit unusual social conduct and is one of the commonly used screening tools for ASD in children[28]. This study evaluated the social skills of the two groups of children using the SRS score. Neurobiofeedback training provides real-time feedback on the children’s EEG activity, allowing them to gradually learn to regulate brain activity to adapt to various stimuli in social situations. This training helps to enhance prefrontal cortex function, a brain area that is closely related to emotion regulation, decision-making, and social interaction[29]. Through neurobiofeedback, children can adjust their response patterns more flexibly during social interactions, reduce impulsive behaviors, and increase sensitivity to the emotional states of others, thereby improving their social skills. Emotional regulation dysfunction is one of the main problems faced by children with ASD, and this issue is particularly prominent in clinical practice. Numerous clinical observations and research results have shown that children with ASD often exhibit significant emotional instability when encountering emotional stress events, which is usually manifested as strong anxiety, irritability, low mood, and other forms of negative emotional reactions[30]. In addition, these children often lack effective emotional regulation mechanisms, making it difficult to restore psychological and physiological balance and homeostasis. These emotional regulation difficulties not only affect the emotional experience of children, but also have adverse effects on their adaptability in various aspects such as social interaction, learning activities, and family life, thereby becoming a key factor affecting their social function development. In this study, to systematically evaluate the emotional regulation level of children with ASD, we used C-PEP-3 and ERC scores. The results showed that the combined group exhibited significant improvement in emotional regulation ability, with ERC-ER and ERC-LN showing a negative correlation, indicating an increase in emotional regulation ability and a decrease in negative impact in children with ASD after intervention. This suggests that this intervention method has a certain clinical effect in improving emotional regulation in children with ASD. Specifically, neurobiofeedback training converts brain electrical activity into visual or audible feedback signals, enabling children to monitor their neurophysiological status in real-time and adjust their EEG patterns through cognitive strategies. This process enables children to manage their emotions more effectively, thereby reducing the frequency and intensity of emotional overreactions and enhancing their ability to cope with emotional stress. Through this approach, neurobiofeedback intervention not only helps improve emotional regulation function, but may also alleviate the emotional distress of ASD children in social interaction and daily life to a certain extent, promoting their mental health and social adaptation. The ABC score is a widely used scale for evaluating the behavioral characteristics of children with ASD[31], which includes assessing various aspects such as aggressive behavior, repetitive behavior, and social interaction. The improvement of ABC score in the joint group indicates that after receiving neurobiological feedback therapy, the children have undergone significant positive changes in behavior, especially in social interaction and language expression, showing more positive interactive behavior and language communication. This improvement in behavior may be related to neurobiological feedback regulating brain function, promoting balance and stability of the nervous system, and thereby reducing common behavioral problems in ASD children, such as aggressive behavior and compulsive repetitive behavior. In addition, the SCQ score is used to assess the severity of symptoms in ASD children, covering assessments of social, communication, interest, and behavioral aspects. Specifically, the improvement of emotional expression, social skills, and interest expansion in the joint group of children may reflect the improvement in comprehensive symptoms of ASD children through the optimization of neural activity patterns in the brain by neurobiological feedback. In addition, neurobiofeedback therapy has no serious adverse effects on pediatric patients and is relatively safe. Therefore, combining neurobiofeedback therapy may become an effective intervention for alleviating ASD symptoms and improving the behavior of children with ASD and has certain clinical promotion value. Neurofeedback therapy affects emotions and behavior by directly regulating brain activity, especially the frequency patterns of brainwaves, while applied behavior analysis therapy intervenes in children’s social and emotional skills through behavior shaping and environmental reinforcement. Transcranial magnetic stimulation regulates neural activity by acting on specific areas of the brain through magnetic fields. Applied Behavior Analysis therapy has significant effects in behavioral adjustment, while neurofeedback focuses more on improving the stability and self-regulation ability of brain function. Transcranial Magnetic Stimulation stands out in certain neural activation patterns, but the individualized adjustment and non-invasive nature of neurofeedback may make it more advantageous in long-term effects. The unique advantage of neurofeedback therapy lies in its non-invasive, personalized intervention and sustained impact on brain function, which can avoid the dependence or instability that traditional therapies may bring. Therefore, as an emerging neuroregulatory technique, neurofeedback therapy can complement behavioral intervention and other biofeedback techniques, and work together with other therapies to maximize intervention effectiveness. Although this study showed the beneficial effects of neurobiofeedback therapy in ASD children, there are still some limitations. First, this study’s sample size was somewhat limited because it only included one research facility. In the future, the sample size should be increased to verify the application effect of neurobiofeedback technology in children with ASD in different regions, different age groups and different degrees of severity. Secondly, although neurobiofeedback training has shown positive effects in improving social skills and emotion regulation, its long-term effects are still unclear. Future studies should focus on the maintenance of treatment effects and evaluate whether neurobiofeedback can produce sustained therapeutic effects. In addition, the implementation of neurobiofeedback training requires professional equipment and technical support, so its popularization and promotion may face certain challenges. Although behavioral scales and clinical evaluations have shown significant improvements in social and emotional management abilities, there is a lack of direct neuroscience data. Future research should combine neuroimaging or electrophysiological techniques to further explore functional changes in brain regions such as the prefrontal cortex during treatment, providing a more solid scientific basis for the mechanism of neurobiofeedback therapy. In summary, neurobiofeedback therapy technology has positive application prospects for the social skills and emotion regulation of children with ASD, and it is expected to become an emerging means of treating ASD, providing children with more personalized and efficient treatment plans.

CONCLUSION

Neurobiofeedback therapy can effectively improve the clinical symptoms of children with ASD and enhance their emotion regulation and social skills.