Neurofeedback for autism spectrum disorder: Current evidence, challenges, and future directions

Table 1 Key neurofeedback therapy findings and limitations[9-13]

Domain	Key findings	Effect size/Latency change	Limitations
Social communication	SRS scores enhance	15% reduction	Small samples; no active sham
Emotion regulation	ABC scores decrease; P300 latency decrease	∆41.95 ms (P < 0.05)	Short-term follow-up
Cognitive function	Executive function (Flanker test) enhance	∆1.59 (P < 0.001)	High-functioning ASD bias

SRS: Social Responsiveness Scale; ABC: Aberrant Behavior Checklist; ASD: Autism spectrum disorder.

Table 2 Emerging innovations in neurofeedback therapy and their clinical applications

Innovation domain	Key technological advance	Clinical application	Evidence strength
Hybrid neuromodulation	rTMS priming + NFT reinforcement	Enhanced reduction of repetitive behaviors and hyperactivity in ASD	Controlled trials[6]
Artificial intelligence integration	Machine learning-driven real-time parameter adjustment	Personalized training intensity based on moment-to-moment brain states	Platform development[3]
Telehealth expansion	Portable EEG devices with cloud connectivity	Home-based treatment for ASD with remote supervision	Market report[2]
Biomarker personalization	EEG neuromarkers (e.g., P300, gamma ratios) for prediction	Protocol selection based on individual neurophysiological profiles	Research validation[4]

rTMS: Repetitive transcranial magnetic stimulation; NFT: Neurofeedback therapy; ASD: Autism spectrum disorder; EEG: Electroencephalography.

Table 3 Key future research directions in neurofeedback therapy

Research direction	Primary objectives	Key considerations & challenges
Large-scale RCTs	Establish causal efficacy, isolate NFT-specific effects from placebo	Requires significant funding, multi-site collaboration, development of credible sham protocols
Biomarker personalization	Identify predictive neuromarkers (e.g., P300, gamma), develop adaptive algorithms	High inter-individual variability, need for standardized measurement and analysis
Hybrid neuromodulation	Explore synergistic effects of NFT with rTMS/tDCS, prime neural circuits	Protocol optimization, safety of combined modalities, mechanistic understanding
Telehealth & home-based NFT	Increase accessibility, reduce costs, enable remote training	Device affordability and reliability, data security, user adherence, signal quality
Longitudinal & developmental	Assess durability of effects, identify critical intervention windows	Long-term funding, participant retention, controlling for confounding life factors
Multimodal integration	Enhance outcomes by combining NFT with behavioral therapy, OT, exercise, VR	Treatment coordination, cost, measuring specific contribution of each component

RCT: Randomized controlled trial; NFT: Neurofeedback therapy; rTMS: Repetitive transcranial magnetic stimulation; tDCS: Transcranial direct current stimulation; OT: Occupational therapy; VR: Virtual reality.