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Randomized Controlled Trial
. 2025 Aug 22;15(1):30824.
doi: 10.1038/s41598-025-16767-y.

Empathy and event related potentials before and after EEG based neurofeedback training in autistic adolescents

Julia Fietz  1   2 , Gabriel Auer  3   4   5 , Paul Plener  3   4   5   6 , Luise Poustka  7 , Lilian Konicar  8   9   10
Affiliations
Randomized Controlled Trial

Empathy and event related potentials before and after EEG based neurofeedback training in autistic adolescents

Julia Fietz et al. Sci Rep. .

Abstract

Autism Spectrum Disorder (ASD) is often characterized by deficits in emotion regulation and empathic abilities, potentially linked to alterations in prefrontal brain regions. This randomized, controlled clinical trial examines the efficacy of slow cortical potential neurofeedback training, specifically targeting these prefrontal areas, in improving emotion regulation and empathy among children and adolescents with ASD. The study involved 41 participants, with 21 undergoing slow cortical potential training and 20 receiving treatment as usual. All participants were allowed to continue usual care in progress, if it was kept stable. Emotional processing was evaluated using an adapted and extended version of the Multifaceted Empathy Test, alongside electroencephalography assessments focusing on event-related potentials, including N170, LPP, and P300 components. The main findings indicate a significant group × time interaction in P300 latency, with shorter latencies in the SCP neurofeedback group and longer latencies in controls, though post hoc tests were not significant. A trend toward reduced P300 amplitude in the experimental group suggests possible modulation of attentional processing. Additionally, changes in a late component of LPP amplitude were linked to reaction time in processing positive emotions, with increases associated with slower responses and decreases with faster responses. These results suggest slow cortical potential neurofeedback training may influence cognitive efficiency and emotional processing in autistic individuals. While promising, further research is needed to confirm these findings and optimize neurofeedback protocols for this population.

Keywords: Autism spectrum disorder; Children and adolescents; Event-related potentials (ERP), empathy, emotion regulation; Neurofeedback.

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Conflict of interest statement

Declarations. Ethic statement: This study was approved by the Ethics Committee of the Medical University of Vienna, Austria and conducted according to the Declaration of Helsinki. Written informed consent was obtained of all participants and their caregivers before being involved in the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study Design and Procedure. After randomization no drop out or losses occurred. For two participants (one of each group) Event Related Potentials (ERP) data at T2 were not recorded due to technical reasons. T1 = ERP measures before treatment, T2 = ERP measures after treatment. Group: CG = Control Group; EG = Experimental Group. In case of any other treatment already in progress, participants of both groups (EG and CG) were allowed to continue, if the usual treatment remained stable. *1Different reasons for exclusion were: Lost of study motivation (n = 12), IQ below 70 or Insufficient knowledge of German (n = 8), other neurological / medical conditions (n = 7), left-handed (n = 5), not aged between 12,00–17,00 years (n = 2), relocation or change of school (n = 2), former neurofeedback training (n = 1).
Fig. 2
Fig. 2
Schematic depiction of one trial in the adapted version of the MET-J. The question for CE was: “What does the person feel?”; The question for IAE was: “How much inner excitement does this photo cause in you?”; The question for EAE was: “How much do you empathize with this person?”. The blue squares are place holders for the emotional photographs.
Fig. 3
Fig. 3
Boxplots depicting the distribution for (a) P300 latency and (b) P300 peak amplitude. Time: ”pre”= ERP measures before treatment (SCP Neurofeedack Training and TAU), “post”= ERP measures after treatment. Group: CG = Control Group; EG = Experimental Group.
Fig. 4
Fig. 4
Grand Average P300 waves from and control and experimental group; black = pre treatment (SCP neurofeedback training or TAU), red = post treatment.
See this image and copyright information in PMC

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