Neurotherapy: A Promising treatment for autism spectrum disorder (ASD) symptoms.

Neurotherapy has emerged as a potential alternative treatment for autism spectrum disorder (ASD) symptoms. This non-invasive therapy aims to help individuals self-regulate their brain activity, potentially leading to improvements in ASD symptoms and overall functioning.

Effectiveness of Neurotherapy for ASD

Research has shown promising results for the use of neurotherapy in treating ASD. A systematic review found that 94% of non-randomized controlled and experimental trials reported positive outcomes for neurotherapy in ASD treatment. The evidence was even more robust when considering only randomized controlled studies.

Neurotherapy has demonstrated effectiveness in improving various aspects of ASD, including:

Social behavior: Multiple studies have reported improvements in social awareness, communication, and overall social behavior following neurotherapy treatment. These improvements were often maintained and even increased at follow-up assessments.

Attention and sensory motor skills: Children receiving neurotherapy showed better attention spans, reduced distractibility, better emotional regulation, improved sensory motor skills, and enhanced daily functioning.

Reduced anxiety and sensory sensitivity: Clinical observations have shown that neurotherapy can reduce feelings of anxiety and overwhelm and lessen the impact of hypersensitivity to stimuli.

Long-term effects: Studies have found that the positive effects of neurotherapy can be sustained long after treatment, with improvements maintained at 6-month and even 1-year follow-ups.

Advantages of Neurotherapy

Neurotherapy offers several advantages as a treatment option for ASD:

Non-invasive: Unlike pharmacological treatments, neurotherapy has few side effects, all of which are low risk, such as tired or energised, making it an attractive option for children with ASD. The greatest side effect observed with many modalities of neurotherapy is the onset of medication side effects – prompting a review to reduce or cease the dosage.

Personalized approach: Neurotherapy can be tailored to individual needs, focusing on specific EEG patterns and symptoms.

Potential for self-regulation: The goal of neurofeedback is to teach individuals how to influence or control their brainwave activity, whilst other forms of neurotherapy focus on modulating the activity, typically leading to long-term improvements.

Challenges in Recognizing Neurotherapy as Evidence-Based

Despite the promising results, neurotherapy faces several challenges in gaining recognition as an evidence-based treatment for ASD:

Comorbidities: Many of the symptoms that impact people diagnosed with ASD are seen as symptoms of a comorbidity such as ADHD, anxiety, or PTSD. This fails to recognise the complexity of the individual, and the impacts their unique neurophysiology has. ASD has a predisposition to over-arousal of the nervous system which may impact symptoms such as hypersensitivity, anxiety, difficulty with concentration and attention, difficulty making decisions (reliant on routine), and emotional regulation.

Methodological issues: Some studies that dismiss the effectiveness of neurotherapy have been criticized for using flawed methodologies that violate basic principles of research. This includes changing research objectives, ignoring trained researcher input, and using ‘control’ groups that were provided sleep and nutritional coaching, making them not true control groups. This has led to the flawed research being referenced in other reviews and studies, increasing scepticism about the therapy’s effectiveness.

“Gold standard” issues: One common critique that has research dismissed is the lack of randomised double blind control trials – which is considered the gold standard of research. Unfortunately, the nature of the therapy makes it incredibly difficult for a trial to be blinded. With neurofeedback the visual or auditory feedback is provided clearly when the brain is in a certain range and becomes distorted when it is not. Thus, a person who blinks excessively or fidgets will have the visual and auditory feedback distorted. This means the participant and the practitioner will know immediately if the person is being provided with a sham or true feedback. With other forms of neurotherapy the practitioner needs to adjust the settings through the session, making it impossible and unethical for a sham to be attempted.

Placebo arguments: Critics argue that the positive effects of neurotherapy may be due to placebo phenomena rather than specific effects of the treatment. However, this argument fails to consider the evidence supporting neurotherapy’s specificity and effectiveness. Many of these arguments stem from research indicating no statistically significant difference between sham neurotherapy and active neurotherapy. These studies fail to recognise the prior research showing evidence that sham neurofeedback can promote changes when compared to a true control group.

Lack of standardization: Many reviews critique the lack of standardised protocols and fail to recognise that three individuals with the same ASD diagnosis and symptoms may have very different neurophysiological functions underpinning these symptoms. Having individualised protocols for each individual should be regarded as no different to the titration of pharmaceutical interventions based on age, weight and response.

Publication bias: High-impact journals have published studies with methodological flaws, leading to a negative impact on the scientific literature and potentially limiting access to neurotherapy for those who could benefit from it. This is of great concern as these flawed studies are consistently referenced in new reviews and studies further contaminating the research literature.

Conclusion

Neurotherapy shows promise as an alternative treatment for ASD, with evidence supporting its effectiveness in improving social behavior, attention, and overall functioning. While challenges exist in gaining recognition as an evidence-based treatment, continued advocacy from clinicians and participants to build clinical evidence, as well as research that does not ignore the difficulties in providing true double blinded randomised control trials may help establish neurotherapy as a valuable option for individuals with ASD.

References:

Pigott, H. E., Cannon, R., & Trullinger, M. (2018). The Fallacy of Sham-Controlled Neurofeedback Trials: A Reply to Thibault and Colleagues (2018). Journal of Attention Disorders.

Van Hoogdalem, L. E., Feijs, H. M., Bramer, W. M., Ismail, S. Y., & van Dongen, J. D. (2020). The effectiveness of neurofeedback therapy as an alternative treatment for autism spectrum disorders in children. Journal of Psychophysiology.