children with learning disabilities to be exposed to auditory

It is better for children with learning disabilities to be exposed to auditory (rather than visual) reinforcement during neurofeedback

Dr Shelley Hyman

Neurofeedback using a reinforcer is useful in treating children with learning disabilities. Here, neurofeedback aims to increase EEG alpha activity and decrease theta activity.

Visual reinforcement (e.g. a white square presented when eyes are open) is often used during neurofeedback. This seems logical as vision often has an advantage over other senses in environments and thus visual dominance emergences, because the visual system is less vulnerable to competition than say, the auditory system.

However, research has suggested that auditory stimuli produces faster cortical activation and are thus better at eliciting faster, stronger responses than visual stimuli.

Alpha activity is also higher when children are not exposed to any sensory stimulation (E.g. when the eyes are closed). Furthermore, children with reading disability show abnormal activity when processing using visual rather than auditory stimuli.

A recent study by Fernandez and colleagues (2016) compared the effectiveness of visual (a white square presented with eye open) versus auditory (a tone presented with eyes closed) reinforcement during neurofeedback. Twenty children (aged 6-12 years) with learning disabilities were randomly assigned to receive either auditory or visual reinforcement.

This study found that using auditory (rather than visual) reinforcers during neurofeedback improved theta/alpha activity, and markedly improved cognition and behaviour. This difference in neurofeedback learning acquired could be because auditory stimuli often take a shorter period of time to reach the brain, compared to visual stimuli.

It should be noted that significant differences between the visual and auditory groups were apparent before neurofeedback due to children being randomly assigned to groups. This means that a pseudo-random method may be required in the future.

Nevertheless, neurofeedback using auditory rather than visual reinforcers may produce better outcomes and downstream consequences for children with learning disabilities.

Sashika de Silva


  • Fernández, T., Bosch-Bayard, J., Harmony, T., Caballero, M. I., Díaz-Comas, L., Galán, L., . . . Otero-Ojeda, G. (2015). Neurofeedback in Learning Disabled Children: Visual versus Auditory Reinforcement. Applied Psychophysiology and Biofeedback Appl Psychophysiol Biofeedback, 41(1), 27-37.


Dr Shelley Hyman

About Dr Shelley Hyman

Senior Clinical Neuropsychologist. BSc (psychol) Hons, MClinNeuropsych, PhD (Med) MAPS CCN. Founder and director of the centre that was founded in 2006.