# Multi-level treatment outcome evaluation in adolescents with autism spectrum disorder

## TL;DR

This study examines how neurofeedback training affects brain activity and behavior in adolescents with autism, showing that changes in brain waves correlate with improved emotional well-being.

## Contribution

The study introduces a multi-level evaluation approach combining rsEEG and psychological assessments to evaluate treatment outcomes in ASD.

## Key findings

- Neurofeedback training increased alpha brain activity and improved positive affect in adolescents with ASD.
- Reductions in delta brain activity were linked to decreases in negative emotions after the intervention.
- Baseline alpha power correlated with the severity of ASD symptoms and negative affect.

## Abstract

Aberrant resting state electroencephalography (rsEEG) is a well-established indicator of psychopathological brain activity in clinical disorders. In Autism Spectrum Disorder (ASD), a substantial body of research reports reduced Alpha activity in the electrocortical resting state of affected individuals. However, effective interventions based on neurophysiological patterns and objective biological markers of treatment outcome remain scarce.

In this randomized controlled trial, the primary objective was to examine rsEEG changes in adolescents with ASD following 24 sessions of slow cortical potential neurofeedback training (n = 21) compared to a treatment-as-usual control group (n = 20). A repeated-measures analysis of variance was used to assess group differences over time. Additionally, Pearson correlation analyses were conducted to exploratorily investigate associations between rsEEG measures and clinical psychopathology and affective well-being, as assessed via parental and self-report questionnaires at baseline and post-intervention.

Analyses revealed significant differences in the development of rsEEG between the intervention groups: while Alpha activity increased in the experimental neurofeedback group, it decreased in the control group, demonstrating an opposite trend. Exploratory analyses showed that Delta activity decreased in both groups, with a more pronounced decrease in the experimental group. Correlational analyses revealed significant associations between subjective-psychological and electrocortical levels: lower alpha power at baseline was related to greater severity of ASD symptoms, while both lower alpha and higher delta power were associated with greater negative affect at baseline. Increases in alpha power after NF-training were linked with enhanced positive affect, whereas reductions in delta power corresponded to decreases in negative affect.

This study provides insights into changes in resting-state neural activity before and after clinical interventions alongside clinical-psychological assessment, overcoming single-level assessments and emphasizing the need for multi-level outcome measures for a more comprehensive treatment evaluation.

Clinical Trial Registration: DRKS00012339.

The online version contains supplementary material available at 10.1186/s13034-025-00909-1.