Neurofeedback for autism spectrum disorder: Current evidence, challenges, and future directions

Table 3 Key future research directions in neurofeedback therapy

Research direction	Primary objectives	Key considerations & challenges
Large-scale RCTs	Establish causal efficacy, isolate NFT-specific effects from placebo	Requires significant funding, multi-site collaboration, development of credible sham protocols
Biomarker personalization	Identify predictive neuromarkers (e.g., P300, gamma), develop adaptive algorithms	High inter-individual variability, need for standardized measurement and analysis
Hybrid neuromodulation	Explore synergistic effects of NFT with rTMS/tDCS, prime neural circuits	Protocol optimization, safety of combined modalities, mechanistic understanding
Telehealth & home-based NFT	Increase accessibility, reduce costs, enable remote training	Device affordability and reliability, data security, user adherence, signal quality
Longitudinal & developmental	Assess durability of effects, identify critical intervention windows	Long-term funding, participant retention, controlling for confounding life factors
Multimodal integration	Enhance outcomes by combining NFT with behavioral therapy, OT, exercise, VR	Treatment coordination, cost, measuring specific contribution of each component

RCT: Randomized controlled trial; NFT: Neurofeedback therapy; rTMS: Repetitive transcranial magnetic stimulation; tDCS: Transcranial direct current stimulation; OT: Occupational therapy; VR: Virtual reality.