Using Neurofeedback Training in Occupational Therapy for Children with Autism

  • Guy McCormack, PhD, OTR/L, Gina Barnes, MOTS,

    Melissa Husband, MOTS, Tina Nguyen, MOTS, Melanie Ramos, MOTS

    Neurofeedback training is the process of using computer technology to monitor brain wave activity as a child plays games on a computer screen. Neurofeedback is like biofeedback in that it provides immediate information about how the brain is working while the child’s mind is engaged in a meaningful activity. It is a safe and non-invasive method of monitoring brain wave activity in real time. Small surface electrodes or sensors are placed on the child’s scalp with a nontoxic paste to record the frequency of brain wave activity. The brain waves are derived from assemblies of brain cells near the surface of the brain. Therefore, neurofeedback does not transmit any electrical currents into the brain but simply records the brain’s own electrical activity as it takes place in real time. The brain waves are then converted by an amplifier to images and sounds that match the child’s patterns of attention. The games involve age appropriate moving objects in a maze or rockets through space to maintain the child’s attention throughout the sessions. If the child is attentive, the game advances and they are rewarded with visual and auditory prompts. At the same moment, the practitioner can see the child’s brain wave activity on another monitor and reduce the level of difficulty to make the game successful or increase the level of difficulty to find “just the right challenge”.

    Children with autism tend to have slower (theta) brain waves that represent more of a dream-like state. Typically, brain wave frequencies tend to match the child’s level of arousal as they interact with the challenges in their environment. When a child is rewarded by seeing the game advance, the brain releases its own natural neurotransmitters such as dopamine. This is perceived to be a positive outcome because dopamine causes some arousal and acts as a reward stimulus. Dopamine is the substance that makes us feel good when we win a contest or when we do something well.

    Neurofeedback also works by using operant conditioning, which can systematically shape behavior. The term ‘Operant conditioning’ was coined by behaviorist B.F. Skinner. Operant conditioning is a method of learning that occurs through rewards for desirable behavior. Through operant conditioning, an association is made between a behavior and a consequence for that behavior. While playing the neurofeedback game, the child learns to pay attention because the game provides positive reinforcement for paying attention and negative reinforcement (the game stops) when their attention is diverted.

    Eventually, as a child’s attention improves, the brain waves shift to a slightly faster frequency, which promotes a state of arousal that is more conducive to learning. Ultimately, the goal of neurofeedback is to help the child develop more attention and self-regulation of their behavior. These improvements in attention and self-regulation help children learn more effectively at school.

    The therapy sessions take place two times a week and last about 30-40 minutes for approximately forty sessions. Neurofeedback training sessions are designed to train people on how to change their brainwave patterns over time. For example, slow brainwaves called Theta waves (operate at a frequency of 4-8 Hz) influence levels of arousal. Theta waves are associated with daydreaming, fantasizing, emotions, and sensations. In other words, too much Theta wave activity restricts the ability to focus and maintain attention. Theta is believed to reflect activity from the deep limbic regions of the brain. In contrast, Alpha waves operate at a frequency between 8 and 12(Hz) and occur whenever a person is alert. Alpha rhythm is the brain’s most important frequency to learn and apply information taught in the classroom. Alpha rhythms are reported to be derived from the white matter of the brain, which is important for connectivity. The neurofeedback computer program allows the practitioner to pre-set parameters which reward the alpha wave activity and inhibit the theta wave activity. By paying attention to the feedback they are receiving from the computer games a person can learn to self-regulate their brain waves through this operant conditioning process.

    We have been studying the benefits of neurofeedback training in children with autism. We have conducted several studies on children with autism and have followed research by a number of neuropsychologists. The studies suggest that on standardized measures, the children show improvements in social behavior and on measures of attention. In short, neurofeedback is a behavioral intervention that is cost effective and does not run the risk of side effects as seen with prescription drugs.

    We are currently recruiting a few children in the Occupational Therapy program at Samuel Merritt University. If you are interested, please contact Guy McCormack, PhD, OTR/L at 510-869-6511X 1537.


                Guy L. McCormack, PhD., OTR/L, FAOTA is currently a Professor in the Department of Occupational Therapy at Samuel Merritt University. He has published and presented several papers at state, national and international conferences. He has been funded to conduct research on the use of Neurofeedback Training for Children with Autism Spectrum Disorders.



    Holtmann, M., Steiner, S., Hohmann, S., Poustka, L., Banaschewski, T., & Bölte, S. (2011). Neurofeedback in autism spectrum disorders. Developmental Medicine & Child Neurology.

    Cleary, M. J. (2011). Developments in neurofeedback: Should health educators be paying attention? Health Educator.

    Coben, R., Linden, M., & Myers, T. (2010). Neurofeedback for autistic spectrum disorder: A review of the literature. Applied Psychophysiology and Biofeedback.

    McCormack, G. L., Pauley, S., Douglas, B. & Sinquefield, L. (2010). Neurofeedback training can help clients with neurological conditions learn new mechanisms for sensory stimulation and self-regulation. OT Practice.

    Lane, S. J., & Schaaf, R. C. (2010). Examining the neurofeedback evidence for sensory-driven neuroplasticity: implications for sensory-based occupational therapy for children and adolescents. The American Journal of Occupational Therapy.

    Thompson, L., Thompson, M., & Reid, A. (2010). Neurofeedback outcomes in clients with asperger’s syndrome. Applied Psychophysiology and Biofeedback.

    Kouijzer, M. J., de Moor, J. H., Gerrits, B. L., Congedo, M., & van Schie, H. T. (2009). Neurofeedback improves executive functioning in children with ASD. Research in ASD.

    Pineda, J. A., Brang, D., Hecht, E., Edwards, L., Carey, S., Bacon, M., et al. (2008). Positive behavioral and electrophysiological changes following neurofeedback training in children with autism. Research in ASD.

    Heinrich, H., Gevensleben, H., & Strehl, U. (2007). Annotation: Neurofeedback – train your brain to train behaviour. Journal of Child Psychology and Psychiatry, and Allied Discipline.

    Coben, R., & Padolsky, I. (2007). Assessment-guided neurofeedback for autistic spectrum disorder. Journal of Neurotherapy.

    Coben, R. (2007). Connectivity-guided neurofeedback for ASD. Biofeedback.

    Hammond, D. C. (2006). What is neurofeedback? Journal of Neurotherapy.

    Vernon, D. J. (2005). Can neurofeedback training enhance performance? An evaluation of the evidence with implications for future research. Applied Psychophysiology and Biofeedback.


Comments are closed.