qEEG Brain Mapping- Toronto

Neurofeedback for Learning Disabilities

Understanding Learning Disabilities

Learning disabilities (LDs) are a set of conditions that affect a person’s ability to think, learn, remember, analyze or process information and are not related to how intelligent a person is. Just because a person struggles with how they acquire, organize, retrieve, and use information does not mean they are not of average or above average intelligence, but they may need support to demonstrate their intelligence. An analogy to understand a learning disability is comparing them to someone who needs glasses. A person who needs glasses can see when we provide them with the support of glasses. A person with a learning disability is intelligent, but needs support to demonstrate their intelligence. These supports can take the form of more time during tests, a separate, quiet area for writing exams, access to a computer for writing if we are talking about a school setting, but can also be applied to the workplace.

Learning disabilities have a biological or neurological origin. If one of you parents was diagnosed with a learning disability or struggles with symptoms of a learning disability there is a greater chance of you having a learning disability. A learning disability can develop if you have a brain injury that affects an area in the brain responsible for processing, retrieving, expressing, or analyzing information. Learning disabilities are lifelong struggles that children do not “grow out of” or ones that get better with time. Examples of specific learning disabilities include dyscalculia (mathematics disorder), dysgraphia (disorder of written expression), and dyslexia (reading disorder). For more information about learning disabilities and understanding how they are identified and diagnosed, please see our psychological assessment section.

Our Approach to Learning Disabilities

People who have learning disabilities may demonstrate an excess or dominance or slow brainwave patterns such as delta (the brainwave dominant during sleep) and theta (the brainwave associated with daydreaming, tuning out, and being internally aware). This imbalance or excess may explain why people struggle with regulating their focus and attention. There can also be global issues in brain wave balance, communication, and speed of communication. Other areas in the brain can be stuck in fast brain wave patterns such as beta and high beta as your brain tried to compensate for an excess of slow brain wave patterns.


Once we figure out what brain wave patterns are related to your symptoms we can design a personalized program to target and improve them. During each session we monitor your brain waves in real time and when there is greater balance of brain wave patterns we reward you with video and sound. These audio and visual rewards help train and guide your brain to have improved balance and improve your symptoms.


How Do I Get Started?

We start off with a Clinical Intake Interview. This is where we review background, medical, and developmental history, your symptoms and their severity, major life events and do our best to conceptualize the uniqueness of your case.

The next step is a Quantitative Electroencephalogram (QEEG) baseline recording. Just as a stethoscope is placed on your chest to listen to your heart beat, electrodes are placed on your scalp to record your brainwave activity for analysis.

Using the information from your clinical intake interview, baseline recording, and intake package we put the pieces together to create a custom Neurofeedback program that is tailored to suit your needs.

We debrief the results, help you understand the different statistics and brainwave patterns involved in your program, as well as help answer your questions before you can begin Neurofeedback training.

Research Articles on Learning Disabilities

This section is meant to highlight research that has been done in the field. The following brief summaries are resources that we have gathered for the public. For an in-depth look at each research article we recommend using the citation to find and read the original article. We hope to add additional resources when possible!

  • Orlando, P. C., & Rivera, R. O. (2004). Neurofeedback for Elementary Students with Identified Learning Problems. Journal of Neurotherapy, 8(2), 5–19. https://doi.org/10.1300/j184v08n02_02

    The goal of this study was to determine if neurofeedback could improve basic reading, reading comprehension, reading composite, and IQ scores. Sixth, Seventh and Eighth graders identified as having learning difficulties were randomly assigned to neurofeedback or control groups. After an average of 28 sessions, it was found that neurofeedback improved scores on reading tests as well as Verbal and Full Scale IQ tests compared to no neurofeedback. These results support the notion that neurofeedback can help improve reading skills and IQ in students with learning disabilities.

  • Coben, R., Wright, E. K., Decker, S., & Morgan, T. (2015). Impact of Coherence Neurofeedback on Reading Delays in Learning Disabled Children: A Randomized Controlled Study. NeuroRegulation, 2(4), 168–178. https://doi.org/10.15540/nr.2.4.168

    Coben, R. et al (2015) studied 42 school-aged participants which were randomly assigned to 2-channel coherence neurofeedback or control groups. At the end of 20 sessions, it was observed that the neurofeedback group had improved reading scores compared to the control group. The neurofeedback group had an average reading enhancement of 1.2 grade levels.

  • Fernández, T., Herrera, W., Harmony, T., Díaz-Comas, L., Santiago, E., Sánchez, L., Bosch, J., Fernández-Bouzas, A., Otero, G., Ricardo-Garcell, J., Barraza, C., Aubert, E., Galán, L., & Valdés, P. (2003). EEG and Behavioral Changes following Neurofeedback Treatment in Learning Disabled Children. Clinical Electroencephalography, 34(3), 145–152. https://doi.org/10.1177/155005940303400308

    The study looked at 10 children with learning disabilities that had higher than normal ratios of theta to alpha absolute power (theta/alpha) and divided them into the neurofeedback or control group. Neurofeedback was applied to the area with the highest ratio and was conducted for 30 minutes, twice per week. After 20 sessions, it was found that the neurofeedback group had significantly improved on the WISC (Wechsler Intelligence Scale for Children) test compared to the control group. As well, the neurofeedback group had decreased EEG absolute power in delta, theta, alpha and beta bands while the control group only showed decreased EEG absolute power in the delta band. Overall the neurofeedback group had better cognitive performance and greater EEG maturation than the control group indicating the neurofeedback treatment can have a positive impact on children with learning disabilities. 

  • Pérez-Elvira, R., Oltra-Cucarella, J., Carrobles, J. A., Teodoru, M., Bacila, C., & Neamtu, B. (2021). Individual Alpha Peak Frequency, an Important Biomarker for Live Z-Score Training Neurofeedback in Adolescents with Learning Disabilities. Brain Sciences, 11(2), 167. https://doi.org/10.3390/brainsci11020167

    Learning disabilities have an estimated prevalence between 5% and 9% in the pediatric population and are associated with difficulties in reading, arithmetic, and writing. EEG research has reported a lag in alpha-band development in specific learning disability phenotypes, which offers an explanation for differences in EEG maturation. In this study 40 adolescents aged 10-15 years with learning disabilities underwent 10 sessions of Live Z-Score training Neurofeedback (LZT-NF) Training to improve their cognition and behaviour. Based on their individual alpha frequency levels a group with normal alpha peak frequency and a group with low alpha peak frequency were compared in a pre-and-post-LZT-NF intervention. After the neurofeedback sessions both groups showed greater odds of moving impaired waves towards the norm.

  • Changhee Hong & Inkyoung Lee (2012) Effects of Neurofeedback Training on Attention in Children with Intellectual Disability, Journal of Neurotherapy, 16:2, 110-122, DOI: 10.1080/10874208.2012.677666

    This study investigated the effects of neurofeedback (NFB) training on attention in children with intellectual disability (ID). Twenty-one children with ID were assigned to an NFB training group (n = 7), to a visual perception (VP) training group (n = 7), or to a no-treatment group (n = 7). Two groups received 36 sessions of NFB or VP training, respectively, over 12 weeks. Children's Color Trails Test–2, Stroop Color and Word Test, and Digit Span were administered to all participants before and after training. The follow-up study was conducted with both the NFB and VP groups in the same way after 3 months. The EEGs of the NFB group also were measured. The NFB group showed significantly improved scores on all the tests compared to the 2 control groups. The brainwaves of the frontal lobes of the NFB group declined significantly in theta wave amplitude and theta-to-beta ratio. The NFB results were maintained in the follow-up study. Beta/SMR uptraining seemed to be an effective way to enhance attention in children with ID. 

  • T. Nick Fenger Ph.D (1998) Visual-motor Integration and its Relation to EEG Neurofeedback Brain Wave Patterns, Reading, Spelling, and Arithmetic Achievement in Attention Deficit Disordered and Learning Disabled Students, Journal of Neurotherapy, 3:1, 9-18, DOI: 10.1300/J184v03n01_02

    Studies examining EEG neurofeedback treatment for Attention Deficit Disorders (ADD) and Learning Disabilities (LD) have shown relationships between Theta/Beta ratios (TBS’s) and enhanced attention, and measures of cognitive functioning including visual-motor integration. Thirty-eight children, ages 8-18 received neurofeedback where Beta was rewarded while Theta and EMG were inhibited and demonstrated significant reductions in TBR’s after an average of 46 sessions. They also demonstrated significant improvements in measures of visual-motor integration, and academic achievement.

  • Pérez-Elvira, R.,Oltra-Cucarella, J., and Carrobles J.A. (2021). EFFECTS OF QUANTITATIVE ELECTROENCEPHALOGRAM NORMALIZATION USING 4-CHANNEL LIVE Z-SCORE TRAINING NEUROFEEDBACK FOR CHILDREN WITH LEARNING DISABILITIES: PRELIMINARY DATA. Journal of Behavioural Psychology, 29(1):191-206 (https://www.behavioralpsycho.com/wp-content/uploads/2021/04/10.Perez_29-1En.pdf)

    Children with learning disabilities (LD) can have difficulties in reading at word level, text comprehension, writing or arithmetic. Several studies have shown the efficacy of neurofeedback (NF) in improving learning skills through brainwave operant conditioning in children with LD. Twenty-eight children aged 10-15 years with LD participated in in this study to show the efficacy of live z-score NF training (LZT) for quantitative electroencephalogram (QEEG) normalization in school children with LD. Ten 30-min sessions of QEEG-guided LZT using patient’s highly preferred feedback was applied. After 10 sessions participants showed statistically significant improvements in QEEG normalization and a statistically significant small to medium improvement in the Cognitive and Emotional checklist. The results suggest that LZT-NF produces a tendency towards normalization of brain waves in children with LD.

  • Naeimian, N., Hijab M.Z., & Nokani, M. (2021). The effectiveness of a combination of cognitive (computer) and neurofeedback rehabilitation on specific learning disabilities (math, reading and writing) in primary school children in Tehran's District 5. Journal of Educational Psychology Studies, 17(40):54-75. https://jeps.usb.ac.ir/article_5837.html?lang=en

    In this paper the specific learning disability is described as a defect in general academic skills in the areas of reading, mathematics and written expression. Furthermore, it creates a significant problem in terms of academic achievement, job performance or daily life activities. The study evaluates the effectiveness of the combination of cognitive rehabilitation and neurofeedback on specific learning disabilities in primary aged schoolchildren. 30 patients in two groups were selected as the experimental group, 15 for cognitive rehabilitations and neurofeedback and 15 for the control group using the Learning Disorder Diagnosis Test. Pre-test and post-tests were taken from both the experimental and control groups, after two months, follow-up tests were performed. The results of the study showed that after the invention, the treatment group improved in the specific learning variables of reading, writing and mathematics.

  • Martínez-Briones, B.J.; Bosch-Bayard, J.; Biscay-Lirio, R.J.; Albarrán-Cárdenas, L.; Silva-Pereyra, J.; Fernández, T. Effects of Neurofeedback in the Working Memory of Children with Learning Disorders: An EEG Power-Spectrum Analysis. Preprints 2021, 2021050517 (doi: 10.20944/preprints202105.0517.v1). https://www.preprints.org/manuscript/202105.0517/v1

    Children are diagnosed with learning disabilities (LD) when they have struggles with reading, writing and/or mathematical skills. These children with LD usually show slower resting state electroencephalogram (EEG) - slower delta and theta power and less gamma activity in posterior sites - and cognitive impairments in working memory (WM). Eighteen children with LD between eight to ten years of age were recruited for the study to determine the effects of neurofeedback (NFB) on their working memory. The children went through either 30 sessions of the NFB treatment or of the placebo-sham treatment. The participants’ behavioural performance and WM-related power-spectrum were analyzed pre- and post-treatment. The NFB treatment group demonstrated faster response times in the WM-task post-treatment. The NFB group also had increased gamma which was related to improved maintenance of memory representations and decreased beta related to reduced anxiety. Positive results were still found in these children with LD after a two-year follow-up.

  • Amir Sabaghi, Mahdi Rezaee, Navid Mirzakhani, Ashkan Irani, Seyyed Mahdi Tabatabai. Effectiveness of Neurofeedback Training on Reading Performance and Working Memory in Students with Dyslexia. J Rehab Med. 2017; 6(3): 11-20.

    This study looked at the effectiveness of neurofeedback training on reading performance and working memory in students with dyslexia. 36 students with reading disorders were equally divided into the control group and the experimental group. The experimental group received academic training along with 20 therapeutic neurofeedback training sessions, while the control group also received academic training, accompanied by 20 sham therapeutic neurofeedback training sessions. All students had 4 sessions a week, each lasting roughly 40 minutes. The Wechsler memory and Nema tests were administered pre- and post-training. As a result, neurofeedback training showed to improve working memory and all components of reading performance except for testing issue marks and naming images.

  • Tešić, M., Stanković I., & Todorović I, S. Application of Neurofeedback Treatment in Children with Specific Language Impairment. 2019. http://www.iefpg.org.rs/Conference/2019/S&L2019_PROCEEDINGS.pdf#page=216

    Children with learning disabilities present high levels of alpha and beta wave activities which harm development of their mental activities. Neurofeedback helps to reduce the proportion of alpha and theta waves and can result in improving reading, writing and mathematics skills. The aim of the study was to determine the effect of neurofeedback on the speed and accuracy of reading in 7-10 year-old children with learning disabilities. The sample, selected based on convenient sampling, consisted of 15 children with learning disabilities within the 7-10 year old age range. Participants received 15 sessions of neurofeedback. They were evaluated and compared in terms of reading and dyslexia tests of NAMA in two stages, before and after neurofeedback sessions. The results revealed that the differences were statistically significant for reading speed but not significant change in reading accuracy was observed before and after treatment.

  • Hamide Ghaemi, Nafiseh Mohammadi, Davood Sobhani-rad, Razieh Yazdani. Effect of Neurofeedback on the Speed and Accuracy of Reading Skill in 7-10 Year-Old Children with Learning Disabilities. J Rehab Med. 2017; 5(4): 76-83.

    Learning disorders are reflected in the educational patterns and information processing demonstrated. Children with these disabilities show high levels of alpha and beta waves which can have a negative effect on their mental activities. This study aimed to explore the effect of neurofeedback on reading speed and accuracy in 7- to 10-year old children with learning disabilities. 15 participants were recruited and underwent 15 sessions of neurofeedback. The participants were assessed through reading and dyslexia tests which were compared before and after neurofeedback sessions. As a result, there was significant improvement in reading speed when comparing pre- and post-test, however there were no significant changes in reading accuracy - indicating that more neurofeedback sessions are probably necessary. Overall, neurofeedback has a positive impact on reading skills of children with learning disabilities.

  • Azizi A, Drikvand FM, Sepahvandi MA. Comparison of the Effect of Cognitive Rehabilitation and Neurofeedback on Sustained Attention Among Elementary School Students with Specific Learning Disorder: A Preliminary Randomized Controlled Clinical Trial. Appl Psychophysiol Biofeed. 2018;43(4):301-307. doi:10.1007/s10484-018-9410-8, 10.1007/s10484-018-9410-8

    This study compared cognitive rehabilitation and neurofeedback on sustained attention in specific learning disorder (SLD). The results showed that the cognitive rehabilitation group reported higher scores for sustained attention compared to the neurofeedback group.

  • Fernández T, Bosch-Bayard J, Harmony T, Caballero MI, Díaz-Comas L, Galán L, Ricardo-Garcell J, Aubert E, Otero-Ojeda G. Neurofeedback in Learning Disabled Children: Visual versus Auditory Reinforcement. Appl Psychophysiol Biofeedback. 2016 Mar;41(1):27-37. doi: 10.1007/s10484-015-9309-6. PMID: 26294269.

    Children with learning disabilities (LD) frequently have an EEG characterized by an excess of theta and a deficit of alpha activities. NFB using an auditory stimulus as a reinforcer has proven to be a useful tool to treat LD children by positively reinforcing decreases of the theta/alpha ratio. The aim of this study was to optimize the NFB procedure by comparing the efficacy of visual (with eyes open) versus auditory (with eyes closed) reinforcers. Twenty LD children with an abnormally high theta/alpha ratio were randomly assigned to the Auditory or the Visual group, where a 500 Hz tone or a visual stimulus (a white square), respectively, was used as a positive reinforcer when the value of the theta/alpha ratio was reduced. Both groups had signs consistent with EEG maturation, but only the Auditory Group showed behavioral/cognitive improvements. In conclusion, the auditory reinforcer was more efficacious in reducing the theta/alpha ratio, and it improved the cognitive abilities more than the visual reinforcer.

  • Becerra J, Fernández T, Harmony T, Caballero MI, García F, Fernández-Bouzas A, Santiago-Rodríguez E, Prado-Alcalá RA. Follow-up study of learning-disabled children treated with neurofeedback or placebo. Clin EEG Neurosci. 2006 Jul;37(3):198-203. doi: 10.1177/155005940603700307. PMID: 16929704.

    This report is a 2-year follow-up to a previous study describing positive behavioral changes and a spurt of EEG maturation with theta/alpha neurofeedback (NFB) training in a group of Learning Disabled (LD) children. In a control paired group, treated with placebo, behavioral changes were not observed and the smaller maturational EEG changes observed were easily explained by increased age. Two years later, the EEG maturational lag in Control Group children increased, reaching abnormally high theta Relative Power values; the absence of positive behavioral changes continued and the neurological diagnosis remained LD. In contrast, after 2 years EEG maturation did continue in children who belonged to the Experimental Group with previous neurofeedback training; this was accompanied by positive behavioral changes, which were reflected in remission of LD symptoms.

  • Sharifi K, Babamir H. Efficacy of neurofeedback on Brain executive functions in children with mathematics disorder. Rooyesh. 2018; 7 (6) :17-34 URL: http://frooyesh.ir/article-1-32-en.html

     Mathematics disorder is a condition in which a child’s math ability is far below normal for their age, intelligence and education. The purpose of this study was to evaluate the effectiveness of Neurofeedback (NFB) training on the executive functioning of children with mathematics disorder. The researchers conducted a quasi-experimental study consisting of 10 students with dyscalculia (learning disability in math). The students were randomly assigned to an experimental NFB group and a control group. The NFB group underwent 20 sessions over 45 days and the control group sat in front of the computer for 20 sessions without any NFB training. After the training, all students performed various performance tests; Tower of London, Stroop test, and the Cornwald working memory test to evaluate their executive functioning. The results of the study showed that neurofeedback training had a significant effect on the executive functioning of students with dyscalculia. 

  • Parsons, B., Faubert, J. Enhancing learning in a perceptual-cognitive training paradigm using EEG-neurofeedback. Sci Rep 11, 4061 (2021). https://doi.org/10.1038/s41598-021-83456-x

    This study provides evidence for a highly efficient closed-loop paradigm that modifies a learning scenario using real time brain activity for the purpose of improving learning performance in a perceptual-cognitive training paradigm known as 3 dimensional multiple object tracking (3D-MOT). 40 participants free of any diagnosed cognitive or emotional impairments or psychoactive medication were seperated into 4 groups; the NT group that underwent standard 3D-MOT training, the CON group that was a non-active control, the NT-NFB group which was the active neurofeedback group and a sham neurofeedback group. All participants underwent training over 6 months. The results showed that over 10 sessions, the speed and the degree of learning can be substantially improved compared to a classic learning system or an active sham-control group. Specifically, the NT-NFB group out-performed all other groups and demonstrated a better learning curve. The researchers also found that superior performance persisted even after the feedback signal was removed which suggests that the effects of the NFB training are consolidated and do not depend on continued feedback. 

  • Abbasi Fashami N, Akbari B, Hossein Khanzadeh A A. Comparison of the Effectiveness of Cognitive Rehabilitation and Neurofeedback on Improving the Executive Functions in Children with Dyslexia. J Child Ment Health. 2020; 7 (2) :294-311 URL: http://childmentalhealth.ir/article-1-1070-en.html

     The purpose of this study was to compare the effectiveness of cognitive rehabilitation and neurofeedback on the improvement of executive functions in children with dyslexia. The researchers conducted a quasi-experimental study which included thirty-six 8-12 year old children with dyslexia. The participants were randomly assigned to one of the two experimental groups or the control group. One of the experimental groups received eleven 60min sessions of cognitive rehabilitation with a working memory training software and the other experimental group received 45min sessions of neurofeedback therapy. The control group received no intervention. All three groups’ performances were evaluated at pre-intervention, post-intervention and at a two-month followup period using the Reading and Dyslexia Test and Behavior Rating Inventory of Executive Function. The results of the study found that both cognitive rehabilitation and neurofeedback were both significantly effective in improving executive functioning at pre and post-test. There were no significant differences between the use of cognitive rehabilitation and neurofeedback. This study demonstrates that using both cognitive rehabilitation and neurofeedback can be extremely effective in improving the executive functioning of children with dyslexia. 

  • Narimani, M., MohajeriAval, N., Ensafi, E. (2017). Examining the effectiveness of neurofeedback treatment in brainwave, executive function and math performance of children with specific learning disorder with mathematics specifier. Journal of Learning Disabilities, 6(3), 122-142. doi: 10.22098/jld.2017.523

     The purpose of this study was to examine the effectiveness of NFB treatment on executive functioning and math performance of children with specific learning disorder with mathematics specifier.  This case study consisted of a multiple baseline design of different people focusing on one behavior. 3 subjects, 7-9 years of age, with dyscalculia received 20 sessions of neurofeedback therapy, two sessions a week. The NFB training targeted the frontal area; the center of executive functions and cognitive activity. To evaluate their performance, all participants completed a clinical CAS test and math test; before and after the treatment. The results of the study showed that NFB training was effective on high beta/beta ratio, theta/beta ratio, beta balance, alpha push and attention, successive processing, simultaneous processing (CAS test) and mathematics skills. 

  • Li, S., & Chen, Z. (2017). Effects of Neurofeedback Training on Dyslexic Students’ Aggression: An Experimental Study. Neuroquantology, 15. (file:///C:/Users/npc.NEURO/Downloads/1072-2864-1-SM.pdf)

     This study investigated the use of NFB  training on perceived control of brain waves and expressed aggression. The researchers conducted a field experiment with a pre-test/post-test control group design which involved 40 dyslexic students from five learning disabilities centers in China. 20 participants were randomly assigned to the experimental group where they underwent 8 neurofeedback training classes and 20 participants were assigned to the control group where they received no training. Results of the study demonstrated that the NFB training programs had a positive effect on dyslexic students’ aggression by protecting dyslexic students from an increase in expresseed aggression during the reading of words and texts. Additionally, the perceived control of brain waves increased in the NFB group but remained unchanged for the control group.  This study provides evidence for the beneficial use of neurofeedback on dyslexic students with aggression. 

  • Hashemian P & Hashemian P. (2015). Effectiveness of Neurofeedback on Mathematics Disorder. Journal of Psychiatry. (18)2:1-3. DOI: 10.4172/2378-5756.1000243

    This study evaluated the treatment of mathematics disorder using neurofeedback.  The neurofeedback treatment focused on the enhancement of beta/theta ratio in Cz region. Twenty-eight 3rd grade students participated in the study, with 14 students receiving NFB treatment and 14 students receiving a placebo treatment. Each student received 20 sessions of NFB therapy for 10-12 weeks. A mathematics test was completed 3 times; before treatment, after the 20th session and after a year. Results of the study showed that the effect of the real NFB treatment was significant compared to the placebo group. They also found that the difference between the pre-test and post-test was significant only in males and not significant in females. Overall they found that mathematics performance was improved significantly and that this effect was also seen after 1 year.

  • Bakhshipour, A., Mahmood Alilou, M., Nazari, M., Mousanezhad Jeddi, E. (2022). The effect of coherence training via neurofeedback on the improvement of reading in children with dyslexia. Journal of Modern Psychological Researches, 17(65).

    Research has shown that in dyslexic children,  the phonological representations are intact but the ability to access them is impaired and this may be due to a dysfunctional fronto-temporal connection in the brain network. This study aims to use coherence training through neurofeedback (NFB) to provide the possibility of voluntary control on functional networks of the brain and examine its effectiveness when performing a complex cognitive activity such as reading. Four dyslexic children aged 7-9 completed 30 minutes of coherence NFB training in this study. The results showed improvement in reading abilities and coherence values between target regions after intervention. These results suggest that coherence-guided neurofeedback may be capable of modifying these disturbances.

  • Albarrán-Cárdenas, L.; Silva-Pereyra, J.; Martínez-Briones, B.J.; Bosch-Bayard, J.; Fernández, T. Neurofeedback Effects on EEG Connectivity in Children with Reading Disorder: I. Coherence. Preprints 2021, 2021080427 (doi: 10.20944/preprints202108.0427.v1)

    Previous research has found that the EEGs of children with reading disorders (RD) are characterized by high power and coherence in slow frequencies such as delta and theta along with lower power and coherence in alpha compared to typically developing children. Neurofeedback (NFB) has the ability to reinforce the reduction of the theta/alpha ratio in order to support EEG power normalization and cognitive-behavioral improvement.  The aim of the present study is to explore the effects of NFB on the functional connectivity (coherence) of children with RD. In the experiment, 20 children with RD and abnormally high theta/alpha ratio underwent 30 sessions of NFB. The results of the study showed that 90% of the participants had learned to decrease their theta/alpha ratio and on average, their reading accuracy and comprehension scores had increased. More specifically, coherence between the hemispheres reduced significantly in the delta, theta and beta bands mainly in the frontopolar regions. Coherence within the hemispheres had also decreased in delta, theta and beta bands and increased in alpha. These findings suggest that NFB treatment could impact functions in the brain networks related to reading in children with RD. 

  • Taskov T, Dushanova J. (2022). Improving Functional Connectivity in Developmental Dyslexia through Combined Neurofeedback and Visual Training. Symmetry. 14(2):369. https://doi.org/10.3390/sym14020369

    This study investigated the effects of using both neurofeedback (NF) and visual training (VT) on children with developmental dyslexia. The researchers wanted to know whether the functional connectivities of the EEG frequency networks change after combined NF-VT training. In the study, participants completed NF sessions of voluntary alpha/theta rhythm control in a low-spatial frequency (LSF) illusion contrast discrimination which provides feedback with visual cues to improve the brain signals and cognitive abilities in DD children. The results of the study showed that in high-contrast LSF illusion, the z-score neurofeedback reduced the alpha/theta scores in various brain areas due to their suppression in the local hub theta-network and the changing characteristics of the theta-frequency network. Alternatively, in the low-contrast condition the z-score neurofeedback increased the alpha/theta scores which induced hubs in the left-side alpha frequency network and altered global characteristics of the alpha-frequency network. They also found that the z-NF-VT compensated for the more ventral brain regions in the low-contrast LSF illusion as these regions had deficits that affected the ventral and occipital-temporal pathways. NF-VT has also increased the segregation of the alpha, beta, theta as well as the gamma-2 networks post-training compared to pre-training. The remediation also compensated more for the dorsal dysfunction of the theta network in DD in the high-contrast LSF illusion. Overall, this study provides evidence for the direct effect of NF-VT as well as the brain’s functional plasticity in children with developmental dyslexia. 

  • Plerou A, Vlamos P, Triantafillidis C. The Effectiveness of Neurofeedback Training in Algorithmic Thinking Skills Enhancement. Adv Exp Med Biol. 2017;988:181-191. doi: 10.1007/978-3-319-56246-9_14.

    Previous research on learning difficulties have not considered studies related to algorithmic thinking difficulties as this is a new field. This study uses an interactive evaluation screener enhanced with neurofeedback elements that refer to algorithmic tasks solving equations. The researchers evaluated the effect of HCl, color, narration and neurofeedback using an algorithmic tasks assessment. The results of the study indicated improved performance in the neurofeedback trained group in terms of total correct and optimal algorithmic tasks solution. Additionally, skills concerning the way an algorithm is conceived, designed, applied and evaluated are also shown improvements post-neurofeedback training.

  • Cancer A, Vanutelli ME, Lucchiari C, Antonietti A. Using Neurofeedback to Restore Inter-Hemispheric Imbalance: A Study Protocol for Adults With Dyslexia. Front Psychol. 2021 Nov 5;12:768061. doi: 10.3389/fpsyg.2021.768061.

    This study proposed a study protocol for testing the efficacy of a NF training specifically designed for inducing a functional hemispheric imbalance of the tempo-parietal regions in adults with DD. They described a randomized clinical trial aimed at comparing two experimental conditions: (a) Enhancing left beta/theta power ratio NF training in combination with reducing right beta/theta power ratio NF training and (b) sham NF training. Previous studies measured the effect of modulating the excitability of the left TP cortex using non-invasive brain stimulation (NIBS) in individuals with reading difficulties, showing significant reading improvements. NIBS exclusion criteria and safety guidelines may limit its application in settings without medical supervision and in younger populations. Neurofeedback (NF) training could be an alternative intervention method for modulating the inter-hemispheric balance of the temporal–parietal regions in DD.

  • Jiang Y, Jessee W, Hoyng S, Borhani S, Liu Z, Zhao X, Price LK, High W, Suhl J, Cerel-Suhl S. Sharpening Working Memory With Real-Time Electrophysiological Brain Signals: Which Neurofeedback Paradigms Work? Front Aging Neurosci. 2022 Mar 28;14:780817. doi: 10.3389/fnagi.2022.780817. A review

    In this review paper, the authors discuss recent advancements of real time neurofeedback to improve memory training in healthy young and older adults. They argue that neurofeedback training should be better targeted beyond a single frequency approach to include frequency interactions and event-related potentials. The review confirms that neurofeedback training is effective to improve memory and cognition in most studies. Yet, the training typically takes multiple weeks with 2-3 sessions per week. The authors state that a well-known issue in such training is that some people simply do not respond to neurofeedback. They also review the literature of placebo effects and "BCI illiteracy" (Brain Computer Interface illiteracy). The authors recommend the use of Neural modulation sensitivity or BCI insensitivity in the neurofeedback literature. Future directions include much needed research in mild cognitive impairment, in non-Alzheimer's dementia populations, and neurofeedback using EEG features during resting and sleep for memory enhancement and as sensitive outcome measures.

  • Au, A., Ho, G., Choi, E., Leung, P., Waye, M., Kang, K. & Au, K. (2014). Does it help to train attention in dyslexic children: pilot case studies with a ten-session neurofeedback program. International Journal on Disability and Human Development, 13(1), 45-54. https://doi.org/10.1515/ijdhd-2013-0005

    This case study examined the effect of Neurofeedback on dyslexia using a multiple baseline design. Four dyslexic children completed 10 weekly sessions of theta suppression and beta enhancement neurofeedback training in the sensorimotor cortex. Pre- and post-assessments consisted of neurophysiological measures, neuropsychological assessments, and parental reports. Neurofeedback training reduced theta/beta ratios in all participants. All participants also improved in measures of auditory vigilance and phonological awareness.

  • Barnea, A., Rassis, A., & Zaidel, E. (2005). Effect of neurofeedback on hemispheric word recognition. Brain and cognition, 59(3), 314–321. https://doi.org/10.1016/j.bandc.2004.05.008

    This study examined the effect of neurofeedback training on lateralized lexical decision-making in Hebrew. SMR/theta neurofeedback training was performed at central sites of 20 participants aged 10–12 years. Half of the subjects received C3 training and the other half C4 training, consisting of 20 half-hour sessions. The lateralized lexical decision test is designed to reveal an independent contribution of each hemisphere to word recognition. Training increased left hemisphere (LH) specialization under some conditions but it did not affect interhemispheric transfer. Training did affect psycholinguistic processing in the two hemispheres, differentially at C3 and C4. Training also increased hemispheric independence. In boys, C4 training improved LH accuracy, whereas in girls C3 training improved LH accuracy. The results suggest that the lateralized NF protocol activates asymmetric hemispheric control circuits which modify distant hemispheric networks and are organized differently in boys and girls. 

  • Fernandez, del C. Rodriguez, M., Garcia, F., Prado-Alcala, R. A., Becerra, J., Harmony, T., & Otero, G. (2016). EEG-neurofeedback in children with learning disability (ld) and an eeg maturational lag: comparison between positive and negative reinforcement. Three years-follow-up study. International Journal of Psychophysiology, 108, 50–50. https://doi.org/10.1016/j.ijpsycho.2016.07.167

    The EEG has served as a useful tool in running diagnostics and treating patients with previous strokes. The objective of this study was to modify the electroencephalographic pattern in patients with repercussions secondary to a previous stroke through the use of Neurofeedback, with the objective of decreasing low waves (theta), increasing the time in which quick waves (beta) are present and improving attention span. A sample of 9 patients (6 men and 3 women, with an average age of 45.5 years and average education of 14 years) with a previous stroke and a comatose state that lasted a month at least. All patients were seen in the Reaprende Centre for Neurospicological Rehabilitation for the rehabilitation of altered cognitive functions. The participants underwent an average of 43 sessions, 3 times a week. The Neurofeedback program took place in two stages. The first stage focused on beta/theta waves located topographically in C4T4A2 y en C3T3A1, according to Ayers protocol. The second stage was based on working on theta/beta waves on frontal areas Fp1CzA2 and/or Fp2PzA2. Results showed an important reduction in slow wave amplitude (theta) (25mv - 15mv) after treatment. This reduction was accompanied by a better predominance of fast wave time (beta) (25% - 31.75%). In conclusion, the incorporation of Neurofeedback as an important part of multidisciplinary rehabilitation aids in the improvement of attention span, the neuropsychological rehabilitation of patients with a previous stroke and serves as a useful resource to evaluate the results of a neuropsychological intervention.

  • Breteler, M.H.M., Arns, M., Peters, S., Giepmans, I., & Verhoeven, L. (2010). Improvements in Spelling after QEEG-based Neurofeedback in Dyslexia: A Randomized Controlled Treatment Study. Appl Psychophysiol Biofeedback, 35:5-11

    The objective of this study was to use neurofeedback training to reduce reading and spelling deficits in children with dyslexia. 10 children were randomly assigned to the experimental group which received neurofeedback, and 9 to the control group. It was found that spelling improved considerably in the experimental group, although no improvements in reading were found. Further, no front-central changes were found which correlates with the lack of reading improvements. However, an increase in alpha coherence was found, which may be related to attentional processes that accounted for the spelling improvement. Future studies should consider the various subtypes of dyslexia to refine the above results. 

  • Luctkar-Flude M, Tyerman J, Burnett S, Giroux J, Groll D. Exploring the effect of neurofeedback on post-cancer cognitive impairment and fatigue: A pilot feasibility study. Can Oncol Nurs J. 2022 Apr 1;32(2):214-222. doi: 10.5737/23688076322214222.

    The purpose of this study was to evaluate the effect of neurofeedback on cognitive functioning and fatigue in cancer survivors. This pilot feasibility study used a 10-week wait-list design. Participants served as their own controls and received neurofeedback training twice a week for 10 weeks. The sample consisted of breast cancer survivors from Kingston, Ontario (n = 16). Outcomes were assessed using validated, self-report scales and neuropsychological tests before, during, and after neurofeedback. Neurofeedback resulted in significant decreases in perceived cognitive deficits, fatigue, sleep, and psychological symptoms. Overall, neurofeedback seems like a feasible and effective method to treat symptoms of post-cancer cognitive impairment. 

  • Nazari, M. A., Mosanezhad, E., Hashemi, T., & Jahan, A. (2012). The effectiveness of neurofeedback training on EEG coherence and neuropsychological functions in children with reading disability. Clinical EEG and neuroscience, 43(4), 315–322. https://doi.org/10.1177/1550059412451880

    It is known that neurofeedback training can help regulate electroencephalogram (EEG) abnormalities thereby improving behavioural deficits. The objective of this study was to measure improvements in reading ability and phonological awareness deficit, and to evaluate changes in the EEG following neurofeedback training in children with reading disabilities. This study included 6 children between the ages of 8-10 who completed twenty 30-minute sessions of neurofeedback, and follow-up measurements 2 months after the completion of training. It was found that reading and phonological awareness skills significantly improved following training. Additionally, though there were no significant changes in the power of the targeted bands (delta, theta and beta), there was a normalization of coherence of the theta band at T3-T4, delta band at Cz-Fz, and beta band at Cz-Fz, Cz-Pz, and Cz-C4. These significant changes in coherence may indicate increased integration of sensory and motor areas, which could explain the improvements in reading skills and phonological awareness. 

  • Fernández, T., Harmony, T., Fernández-Bouzas, A., Díaz-Comas, L., Prado-Alcalá, R. A., Valdés-Sosa, P., Otero, G., Bosch, J., Galán, L., Santiago-Rodríguez, E., Aubert, E., & García-Martínez, F. (2007). Changes in EEG current sources induced by neurofeedback in learning disabled children. An exploratory study. Applied psychophysiology and biofeedback, 32(3-4), 169–183. https://doi.org/10.1007/s10484-007-9044-8

    The objective of this study was to determine the effects of neurofeedback in Learning Disabled (LD) children. Children in the experimental group were given twenty 30-minute neurofeedback sessions while the control group underwent placebo treatment under the same characteristics. Immediately following treatment, children in the experimental group showed behavioural and cognitive improvements. Although no immediate change in current source analysis was found, 2 months after treatment various changes were notable. Firstly, a decrease in current frequencies within the theta band, mainly in the left frontal and cingulate regions. Secondly, an enhancement in current of frequencies within the alpha band, mainly in the right temporal lobe and right frontal regions, and of frequencies within the beta band, mainly in left temporal, right frontal and cingulate cortex regions. There were no behavioural or EEG current source changes in the control group. Overall, it was found that neurofeedback is an effective treatment for LD children with an abnormally high theta/alpha ratio in any lead. The EEG current source changes may reflect the neurophysiological basis of the behavioural and cognitive improvements observed in the children. 

  • Eroğlu G, Gürkan M, Teber S, Ertürk K, Kırmızı M, Ekici B, Arman F, Balcisoy S, Özgüz V, Çetin M. Changes in EEG complexity with neurofeedback and multi-sensory learning in children with dyslexia: A multiscale entropy analysis. Appl Neuropsychol Child. 2022 Apr-Jun;11(2):133-144. doi: 10.1080/21622965.2020.1772794. Epub 2020 Jun 9. PMID: 32516009.

    Multiscale entropy analysis (MSE) is a novel entropy-based approach for measuring dynamical complexity in physiological systems over a range of temporal scales. The objective of this study was to apply MSE to children with dyslexia and observe MSE changes following neurofeedback. EEG data from a group of children with dyslexia was compared to age-matched typically developing children with no reading or writing problems. MSE was calculated for one continuous 60-s epoch for each experimental and control group's EEG session data. It was found that children with dyslexia had significantly lower complexity at the lowest and medium temporal scales compared to typically developing children. Further, the experimental group underwent 60 neurofeedback and multi-sensory learning sessions, each lasting 30 minutes using Auto Train Brain. It was found that, post-treatment, the experimental group’s lower complexity increased to the typically developing group’s levels at lower and medium temporal scales in all channels.

  • Acevedo BP, Dattatri N, Le J, Lappinga C, Collins NL. Cognitive Training with Neurofeedback Using fNIRS Improves Cognitive Function in Older Adults. Int J Environ Res Public Health. 2022 May 2;19(9):5531. doi: 10.3390/ijerph19095531.

    This study analyzed the effects of a 4-week cognitive training program with neurofeedback with a sample of 86 healthy adults between the ages of 54 and 84. The participants were randomized to either a treatment (app-based ABC games) or a control group (Tetris). As part of the program, participants completed seven cognitive assessments, both pre- and post-intervention, and measured cortical brain activity using a XB-01 functional near-infrared spectroscopy (fNIRS) brain sensor while completing neurofeedback training. The treatment group showed significant improvements in multiple measures of cognitive function such as memory, verbal memory, and composite cognitive function, while the control group did not. Additionally, both groups showed significant improvements in processing speed and executive function. In all, the authors concluded that cognitive training with neurofeedback improves cognition across multiple domains.

  • Martínez-Briones BJ, Flores-Gallegos R, Cárdenas SY, Barrera-Díaz BE, Fernández T and Silva-Pereyra J (2023) Effects of neurofeedback on the self-concept of children with learning disorders. Front. Psychol. 14:1167961. doi: 10.3389/fpsyg.2023.1167961

    When comparing children with learning disabilities (LDs) to their counterparts without LDs, LDs frequently exhibit worse self-concepts. A pilot study was carried out to investigate the effects of neurofeedback (NFB) treatment on the self-concept of thirty-four (8–11) children with learning disabilities. According to the study, there were notable gains in reading, math, and overall self-concept ratings for the group who received NFB, especially in the categories of happiness, non-anxiety, physical beauty, and popularity. According to the study, non-formal behavior therapy (NFB) can improve children with learning disabilities' academic performance and self-concept, making it a potentially effective way to manage symptoms including anxiety and poor self-esteem.

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