A Neurovisceral Approach to Autism: Targeting Self-Regulation and Core Symptoms Using Neurofeedback and Biofeedback

Mu Rhythm Synchrony Neurofeedback (MRS-NFB) has shown promise in improving electrophysiological and behavioral deficits in autism spectrum disorder (ASD). Heart rate variability biofeedback (HRV-BFB), a method for improving self-regulation of the autonomic nervous system (ANS), has yet to be tested as a clinical intervention for ASD. This study evaluated the impact of HRV-BFB on symptoms of ASD; and whether a combined HRV-BFB + MRS-NFB intervention would be more efficacious than HRV-BFB alone. Fifteen children with a verified diagnosis of ASD completed the study. Participants were assigned to either an HRV-BFB group (Group 1) or a combined HRV-BFB + MRS-NFB group (Group 2). All children underwent pre- and postassessments of electroencephalography (EEG), heart rate variability (HRV), and parent-reported behaviors. No significant between-groups differences were observed on any parent-reported behaviors. Group 1 showed significant pre–post improvements in emotion regulation and social behavior, while Group 2 showed significant pre–post improvements in emotional lability and autistic behaviors. Group 2 also showed significant improvements in RMSSD and lnHF (vagal tone) indices of HRV over time, while Group 1 displayed no significant changes in HRV over time. Group 1 showed an increase in mu suppression posttraining, and Group 2 showed a reduction in mu suppression posttraining. The results suggest that HRV-BFB, alone or in combination with MRS-NFB, may improve behavioral features of autism. A combined approach may be more efficacious in enhancing HRV, while the implications of each approach on mu suppression are mixed. Neurovisceral approaches that teach self-regulation offer a novel treatment avenue for ASD.