Neurofeedback for Dyslexia Combined with Evidence-Based Reading Interventions is Efficacious
- John Davis
- Sep 27
- 20 min read
Updated: Sep 28
Dr. Tanju Sürmeli is a prominent psychiatrist in Türkiye who has published numerous important studies on neurofeedback (e.g., Sürmeli et al., 2017). In 2025, he posted information on the NeuroGuide qEEG forum about a new article by Miguel López-Zamora and colleagues (2025) in Spain, which presents a systematic review of neurofeedback (NFB) for dyslexia. This post summarizes the article.
What is Dyslexia?
According to the Cleveland Clinic (2025), dyslexia is a specific neurodevelopmental learning disability that makes reading, writing, and spelling difficult. There are varying severities of dyslexia, each corresponding to different degrees of impact on one’s school, work, or day-to-day functioning.
Dyslexia is not the result of limited educational opportunity, sensory or motor dysfunction, intellectual deficits, or socioeconomic impoverishment, and it does not represent a loss of ability after reading skills have already been acquired (i.e., adult stroke-related dyslexia is not developmental dyslexia).
As summarized by López-Zamora et al. (2025), associated cognitive deficiencies may include those of phonological awareness, short-term verbal memory, visual-auditory association, and rapid naming.
Developmental dyslexia affects approximately 7% of the global population, regardless of sex or race. However, an additional 13% may have mild and undiagnosed difficulty with reading. A trained health professional does an assessment and diagnosis of dyslexia. Treatment for dyslexia may involve educational methods that train reading and related skills provided by a speech-language pathologist, teacher, or educational specialist.
Dyslexia Research
López-Zamora et al. (2025) reviewed differences in cerebral activation seen in fMRI studies of dyslexia that are localized to the left posterior temporoparietal cortex, the left occipitotemporal cortex, and the left frontal cortex.
Cainelli et al. (2023) conducted a systematic review of EEG in dyslexia, noted, in particular, resting EEG abnormalities of delta and theta (excess) and alpha (deficit) bands that are not especially well-localized, which are apparent at rest and during learning tasks. Differences between children with and without dyslexia during reading tasks appear localized more to left temporoparietal areas, which is compatible with findings of neuroimaging studies.
López-Zamora et al. (2025) suggested that during phonological tasks, increased delta amplitude is seen in the left frontal region. The meta-analysis of fMRI findings by Barquero and colleagues (2014; reported by López-Zamora et al., 2025) showed consistent activation changes in dyslexic subjects following reading intervention, localized to the left thalamus, right inferior frontal insula, left inferior frontal cortex, right posterior cingulate, and the left middle occipital gyrus. These findings suggest that neuromodulation of these brain structures may influence dyslexia.
A recent meta-analysis of noninvasive brain stimulation (Turker & Hartwigsen, 2022) found that stimulation of left-hemisphere sites was a promising adjunct to reading training.
Stimulation sites that showed improvements in reading included those close to F7, T3, T5, P3, and O1 (inferior frontal gyrus, superior temporal gyrus, inferior parietal lobe, posterior middle temporal gyrus, supramarginal gyrus).
This post will summarize and expand on the systematic review by López-Zamora et al. (2025) of NFB for the treatment of developmental dyslexia.
What is a Systematic Review?
Brignardello-Petersen et al. (2025) wrote that a systematic review is:
“…a type of evidence synthesis in which authors develop explicit eligibility criteria, collect all the available studies that meet these criteria, and summarize results using reproducible methods that minimize biases and errors. Systematic reviews serve different purposes and use a different methodology than other types of evidence synthesis, such as narrative reviews, scoping reviews, and overviews of reviews. Systematic reviews can address questions regarding the effects of interventions or exposures, the diagnostic properties of tests, and the prevalence or prognosis of diseases. All rigorous systematic reviews have common processes that include (1) determining the question and eligibility criteria, including a priori specification of subgroup hypotheses, (2) searching for evidence and selecting studies, (3) abstracting data and assessing risk of bias of the included studies, (4) summarizing the data for each outcome of interest, whenever possible using meta-analyses, and (5) assessing the certainty of the evidence and drawing conclusions. There are several tools that can guide and facilitate the systematic review process, but methodological and content expertise are always necessary.” (p. 536)
What is a Meta-analysis?
A meta-analysis (Himmelfarb Health Sciences Library, 2025) may be included in a systematic review to quantify the statistical significance of a “pooled estimate” of the overall relationship between variables or the overall effect size of a treatment. Because the data from several studies are combined, the larger sample size may be more representative of the population of individuals with a condition or who receive a treatment, and the results may have greater statistical power (i.e., a lower likelihood of missing true differences between experimental and control conditions). If a meta-analysis includes randomized controlled designs (RCTs) its results produce the highest level of scientific evidence for critical appraisal in the hierarchy of evidence types. A systematic review is the second-highest level of scientific evidence for critical appraisal (Himmelfarb Health Sciences Library, 2025).
What is Critical Appraisal?
Critical appraisal involves several steps such as using a method to systematically search for relevant information, evaluating the research question and experimental design according to scientific standards, assessing how subjects were sampled, examining measurement and statistical methods, assessing risk of bias, considering the size of relationship between variables or size of treatment effect, and judging how reproducible the findings are.
Practitioners of neurofeedback should base their decisions on the best available scientific evidence. This suggests the importance of critically appraising evidence to enact the ethical values of doing good (beneficence) and avoiding harm (nonmaleficence; Beauchamp, 2010).
Summary of the Systematic Review of Neurofeedback for Dyslexia by López-Zamora et al. (2025)
Neurofeedback practitioners may not typically consider NFB as beneficial for dyslexia, but a substantial body of research supports its effectiveness as a complement to standard speech-language and educational interventions. López-Zamora et al. (2025) employed standardized methodological guidelines for conducting a systematic review of neurofeedback for dyslexia, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines (Page et al., 2021). Search guidelines included subjects diagnosed with dyslexia, neurofeedback-based interventions, and publications in either Spanish or English, with a focus on those published within the past 20 years.
Twelve articles met the selection criteria. These included children and adolescents with a diagnosis of dyslexia, who had outcome measures related to reading performance, and were published in peer-reviewed journals. A total of 144 subjects, aged 6 to 12, were included in the 12 studies, with only 3 having control groups and only one employing a randomized controlled design. López-Zamora et al. (2025) categorize the 12 studies into four groups based on neurofeedback protocol (reducing theta and increasing mid-beta, reducing theta and increasing alpha, SMR sensorimotor rhythm, qEEG-based).
Several of the studies (Mehran et al., 2016; Mosanezhad-Jeddi et al., 2013; Nazari et al., 2012; Raesi et al., 2016, Sadeghi & Nazari, 2015) set protocols to deliver feedback when EEG amplitude was both below threshold for frequencies 8 Hz or below and above threshold for frequencies from 15 to 18 Hz at left frontal and left temporal sites (i.e., F3, F7, T3). Each study demonstrated improvement with NFB, although only two measured reading-related variables (Nazari et al., 2012; Raesi et al., 2016), and only one included a control group (Mehran et al., 2016).
Two other studies provided feedback aimed at reducing the ratio of theta z-scores to alpha z-scores at the site where the ratio was highest before training (Fernández et al., 2007; Fernández et al., 2016). Measures of reading were not used, but measures of attention showed improvement following NFB. Only the 2016 study by Ferńandez et al. included a control group.
Au et al. (2014) set their NFB protocol to provide feedback when theta and 22-30 Hz beta were below amplitude thresholds and concurrently 15-20 Hz beta was above threshold at C3 and C4. Attention and phonological awareness improved.
Harandi and Moghadam (2017) compared SMR training at C3 and C4 to a multisensory training method in a randomized controlled experiment with six subjects. Both groups improved their writing-to-dictation. The improvement did not differ significantly between groups, although the effect size of the SMR group was somewhat larger.
Walker (2012; Walker & Norman, 2006) employed qEEG-guided NFB in a pre-post test design, observing improvements in reading and writing.
Breteler et al. (2010) conducted a randomized controlled trial comparing NFB plus counseling for reading and spelling to counseling for reading and spelling without NFB. NFB protocols were based on qEEG assessment. Although reading performance improved equally for subjects in both groups, spelling improved significantly more for subjects receiving NFB.
The López-Zamora et al. (2025) article noted the heterogeneity of research. It concludes that there is currently insufficient evidence to suggest that NFB alone has a significant and reliable effect on improving reading skills in individuals with dyslexia.
López-Zamora et al. (2025) wrote in their abstract that “there is no significant evidence to determine the efficacy of neurofeedback interventions in the dyslexic population.”
However, in their discussion, they provided a more nuanced conclusion, stating that most studies they reviewed“ reported direct improvements in reading accuracy” and related variables. They suggested that the positive results of NFB occur when combined with speech therapy or training in reading processes.
Summary of the Systematic Review by Joveini et al. (2024)
López-Zamora et al. (2025) stated that theirs is the first systematic review of NFB for dyslexia. However, it appears that just as they were submitting their manuscript for publication review in mid-2024, another systematic review of NFB for children with dyslexia was being published by Joveini et al. (2024). These authors employed the same PRISMA methods for systematic reviews as did López-Zamora et al. (2025), but included articles in both Persian and English, as Iran is the center of much NFB research and the location of Joveini and colleagues.
Their 2024 systematic review identified 39 studies, including 10 RCTs, 15 non-randomized experimental studies, and 14 case studies [corrected count based on article re-reviews]. Data from this pool of studies showed some evidence of changes in EEG function, reading skills, cognitive skills underlying reading, and psychological function.
Based on the studies they reviewed, Joveini et al. (2024) concluded that the use of NFB for training children with dyslexia is supported by significant evidence and can be used as part of a multidimensional approach that includes other established treatments such as speech-language pathology and educational methods.
Protocols that inhibit frequencies below 8 Hz and reward mid-beta frequencies, decrease the ratio of theta to alpha amplitude, and increasing individually-identified coherence deficiencies are most supported. Left hemisphere electrode sites such as F3, F7, C3, T7, and O1 are electrode placements to consider.
The 10 RCTs included in Joveini et al. (2024) include those of Albarrán-Cárdenas et al. (2023), Asghari and Fekri (2019), Breteler et al. (2010) (reviewed by López-Zamora et al. 2025), Coben et al. (2015), Darabi et al. (2022); Eroğlu et al. (2022), Fashami et al. (2022), Khanjani et al. (2013), Li and Chen (2017), and Taskov and Dushanova (2022).
Albarrán-Cárdenas et al. (2023) randomly assigned children with reading disorders to either NFB, aimed at downtraining the theta/alpha ratio at the 10-20 site with the greatest baseline value, or to sham NFB. Increased reading accuracy and comprehension were seen only in the NFB group.
Asghari and Fekri (2019) randomly assigned dyslexic students to either NFB or a no-treatment control group, finding that those receiving NFB showed improvements in reading and writing skills.
Coben et al. (2015) randomized dyslexic children to receive coherence NFB training plus resource room reading supports or to resource room supports alone. NFB involved two-channel coherence training over the left hemisphere based on bands and sites determined with qEEG pre-assessment. Reading scores improved only for the NFB plus resource room subjects.
Darabi et al. (2022) randomly assigned children with dyslexia to either NFB, a patterning treatment, or no-treatment. NFB group showed improvement in several reading measures, whereas the patterning treatment showed less improvement, but more than the no-treatment control group.
Eroğlu et al. (2022) randomly assigned students with dyslexia to NFB or special education. The NFB was based on a mobile app that incorporated principles of multisensory learning. It downtrained theta at Broca’s and Wernicke’s areas if the amplitude was above the norm, and downtrained theta at any of 12 EEG recording sites that had the highest amplitude of theta on the left and on the right side. Reading comprehension improved most in the NFB group.
Khanjani et al. (2013) randomly assigned two children to each of three conditions: NFB alone, NFB plus multisensory treatment, and multisensory treatment alone. The combined approach yielded the best results, followed by multisensory treatment, and then NFB.
Li and Chen (2017) randomized children with dyslexia to either NFB (increased 15-18 Hz, decreased 1-8 Hz) at T3 or a training course. An interesting hypothesis of this study was that NFB would help children remain calmer when encountering the frustrating challenges of reading. Those in the NFB group, in fact, showed less aggressive behavior than those in the control group following training, and exhibited an increased perception of control over brainwaves. The control group showed an increase in reading problems at the end of the study, whereas the NFB showed a smaller increase.
Taskov and Dushanova (2022) randomized dyslexic children to NFB plus visual training or to a no-treatment control group. NFB was provided with z-score feedback based on EEG responses to visual stimuli. Brain activation changes relevant to dyslexia were seen only for the NFB group.
Abbasi Fashami et al. (2022) did not present specific information about their NFB protocol or measures.
Summary of Evidence Supporting NFB for Dyslexia
Of the studies reviewed by López-Zamora et al. (2025) and Joveini et al. (2024), 24 measured reading, writing, or spelling (i.e., variables related to deficient dyslexic performance). These provide some preliminary evidence regarding the usefulness of NFB for dyslexia, particularly when it is used as an adjunct to directed reading training in the context of careful assessment and consideration of neurological models of the condition and its remediation.
However, the NFB protocols used in the available research are diverse, the number of subjects studied was relatively small, and the tests used to measure reading were inconsistently employed.
Rather than ask “Does NFB help to reduce dyslexia?” a better question is to ask “What type of NFB helps to reduce dyslexia or some of its symptoms?”.
When an individual study employs a randomized controlled trial (RCT) experimental design, it provides the strongest type of scientific evidence pertaining to its research question. Although not all used the same research question, 11 RCTs have been conducted with dyslexic subjects (Albarrán-Cárdenas et al., 2023; Asghari & Fekri, 2019; Breteler et al. 2010; Coben et al. 2015; Dagrabi et al. 2022; Eroğlu et al. 2022; Fashami et al., 2022; Li & Chen, 2017; Harandi & Moghadam, 2017; Khanjani et al. 2013; Taskov & Dushanova, 2022), one of which (Taskov & Dushanova, 2022) did not measure reading variables, and one of which (Abbasi Fashami et al., 2022) did not present details regarding NFB protocol or outcome measures.
Of the remaining nine RCTs that measured reading variables, eight compared NFB to a group receiving an active treatment. Five of these eight studies found that NFB resulted in a better outcome (Albarrán-Cárdenas et al., 2023; Breteler et al., 2010; Coben et al., 2015; Dagrabi et al., 2022; Eroğlu et al., 2022). Two studies found that when NFB was added to reading instruction, the combination was superior (Breteler et al., 2010; Coben et al., 2015). One of these (Dagrabi et al. 2022) only has an English abstract of the Persian article.
Of the three other RCTs that used an active control, two (Harandi & Moghadam, 2017; Li & Chen, 2017) found that NFB yielded results comparable to the control, and one (Khanjani et al., 2013) found that NFB performed worse than the control group.
A ninth (Asghari & Fekri, 2019) RCT compared NFB to no treatment and found NFB to give better results.
Reiterating that it is important in clinical applications to conduct individualized assessment and consider the neuroscience related to dyslexia, these nine RCTs in sum suggest that frequencies, variables, and sites to consider for training may include increasing coherence of delta, theta, or alpha in the left hemisphere (Breteler et al. 2010; Coben et al. 2015).
Several of these nine studies used protocols with inhibits for delta and theta bands at left hemisphere sites (Albarrán-Cárdenas et al., 2023; Asghari & Fekri, 2019; Coben et al., 2015; Eroğlu et al., 2022; Harandi & Moghadam, 2017; Li & Chen, 2017). The cortical sites involved in coherence and amplitude training often involved left hemisphere prefrontal and temporal locations, although other left hemisphere sites were sometimes used, as well as right hemisphere sites if amplitude was either significantly above or below the norm.
Four controlled studies and 11 case studies that measured variables related to deficient dyslexic performance were also reviewed by López-Zamora et al. (2025) and Joveini et al. (2024). Of these various studies, a large proportion used thresholds to inhibit feedback when theta and delta amplitudes were high simultaneously, as well as when SMR or mid-beta (15-18 Hz) was high. Some studies also used qEEG-guided NFB to determine coherence variables for rewarding or inhibiting. Training was typically conducted with left-hemisphere sites, using prefrontal, temporal, or central locations.
AAPB efficacy levels (Khazan et al., 2023) can be applied to the question of whether NFB provides benefit in cases of developmental dyslexia, based on the 24 studies reviewed here that include measures of reading, writing, spelling, or other reading-related variables.
Neurofeedback Alone is Probably Efficacious
Neurofeedback using delta and theta inhibits or left-sided coherence training based on qEEG findings were promising despite methodological limitations. Although multiple RCTs have shown equal or better outcomes compared to typical treatments on measures of dyslexia-related performance deficiencies, the conservative rating of probably efficacious (level 3) should probably be applied due to the relatively small number of subjects, the use of multiple NFB methods and dyslexia measures, the absence of multicenter replications of identical NFB methods, and the lack of large effect sizes.
Joveini et al. (2024) and López-Zamora et al. (2025) largely reached the same conclusions. They also helpfully noted the limitations of the existing studies, among which are a dearth of follow-up studies and a small total number of participants.
Neurofeedback Integrated with Evidence-Based Reading Interventions
When these NFB methods are delivered in conjunction with specific training to remediate symptoms of dyslexia, NFB likely merits a rating of level 4 - efficacious using the AABP efficacy level hierarchy.
Four Take-Aways
Neurofeedback may be particularly helpful when it is based on a careful baseline EEG assessment and combined with reading training. Left hemisphere coherence training and inhibition of frontotemporal theta should be considered as training parameters.
Ethical considerations are important. Clinicians should aspire to do good and avoid harm. They can best achieve this by conducting thorough, individualized assessments and providing NFB for dyslexia in combination with treatment to address dyslexia-related deficiencies, if evidence from EEG assessments and neuroscientific models suggests the presence of abnormal EEG findings.
Critical appraisal is important for clinical work. qEEG and neurofeedback forums are very helpful sources of information about science and practice that colleagues generously share. When considering any information, however, it is essential to evaluate its quality and its applicability to one’s individual client. Although meta-analyses and systematic reviews are considered the pinnacle of scientific evidence, authors of different meta-analyses and systematic reviews on the same topic may review different research and come to different conclusions. Therefore, critical appraisal of such studies is important.
There is a growing interest in neurofeedback-related clinical science for dyslexia worldwide. Here we see a prominent psychiatrist and researcher from Türkiye (Sürmeli) use a qEEG forum based in the US (NeuroGuide) to share a systematic review from Spain (López-Zamora et al., 2025) that examines research from centers that have been exploring neurofeedback for dyslexia in Iran (Nazeri et al., 2012) and Mexico (Fernández et al., 2016) that caught the eye of a Canadian (this writer) who was stimulated by the article Sürmeli shared, and collaborated with Dr. Shaffer in Missouri to produce this post. These connections enable us to see how our understanding and treatment of mind-body health are being extended through the study of biofeedback, neurofeedback, and neuromodulation internationally.
Glossary
alpha band: an EEG frequency range (8–12 Hz) typically associated with relaxed wakefulness and cortical idling. In dyslexia research, deficiencies in alpha power, especially in temporo-occipital and frontocentral regions, have been noted as markers of altered neural processing.
amplitude: the magnitude of electrical activity in an EEG signal, usually measured in microvolts (µV). Increased or decreased amplitudes in specific bands (e.g., delta, theta) are used to assess brain function and guide neurofeedback protocols.
beta band: an EEG frequency range (13–30 Hz) associated with alertness, active thinking, and motor activity. In some neurofeedback protocols for dyslexia, mid-beta (15–18 Hz) is rewarded to enhance attentional processes.
coherence: a measure of synchronization between two EEG signals recorded at different scalp locations. In neurofeedback, coherence training may aim to increase functional connectivity between left-hemisphere sites implicated in reading and language.
critical appraisal: a systematic evaluation of research evidence to judge its validity, reliability, and clinical relevance. This process includes examining study design, risk of bias, effect sizes, and reproducibility to inform evidence-based practice.
delta band: the slowest EEG frequency range (0.5–4 Hz), typically linked to deep sleep and pathological slowing when seen in excess during wakefulness. In dyslexia, increased delta activity in frontal regions during phonological tasks has been observed.
developmental dyslexia: a neurodevelopmental learning disorder characterized by difficulties in reading, spelling, and writing that are not explained by intellectual disability, inadequate schooling, or sensory deficits. It affects about 7% of the global population and is associated with abnormal cortical activation patterns.
dyslexia: a general term for a specific learning disability that primarily affects reading, spelling, and writing skills. It involves difficulties with accurate and/or fluent word recognition and poor decoding abilities, often due to deficits in the phonological component of language. Dyslexia is not caused by intellectual disability, sensory deficits, or inadequate education, and it varies in severity among individuals.
electrode sites: standardized scalp locations (e.g., F3, T3, O1) based on the international 10–20 system used for EEG recording. Dyslexia-related neurofeedback often employs left-hemisphere frontal and temporal sites for training.
electroencephalography (EEG): a technique for recording the brain’s electrical activity through scalp electrodes. It provides information about frequency bands, amplitudes, and connectivity that can reveal abnormalities in conditions such as dyslexia.
evidence-based reading interventions: structured educational methods for teaching reading that are supported by high-quality scientific research demonstrating their effectiveness. These interventions are systematic, explicit, and data-driven, focusing on core components of reading, including phonological awareness, phonics, vocabulary, fluency, and comprehension.
meta-analysis: a statistical method that combines results from multiple studies to estimate overall effect sizes with greater power and precision. It often forms part of systematic reviews and is considered among the highest levels of scientific evidence.
neurofeedback (NFB): a biofeedback method that provides individuals with real-time feedback on their brainwave activity, allowing them to learn voluntary regulation of EEG patterns. In dyslexia, protocols typically aim to reduce theta and increase beta or alpha activity.
phonological awareness: the ability to recognize and manipulate the sound structure of language, including syllables and phonemes. Deficits in phonological awareness are a core cognitive feature of dyslexia.
posterior dominant rhythm (PDR): the alpha rhythm generated in the occipital cortex during relaxed wakefulness with eyes closed. Abnormalities in PDR may indicate altered cortical organization relevant to reading disorders.
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses): a methodological framework that standardizes how systematic reviews and meta-analyses are conducted and reported, ensuring transparency and reproducibility.
randomized controlled trial (RCT): an experimental study design in which participants are randomly assigned to treatment and control groups. RCTs provide the highest level of evidence for causal inference in intervention research.
sensorimotor rhythm (SMR): an EEG rhythm (12–15 Hz) over the sensorimotor cortex associated with motor inhibition and attentional control. SMR training is sometimes applied in dyslexia-related neurofeedback to enhance reading and writing performance.
systematic review: a structured synthesis of evidence from multiple studies using explicit eligibility criteria and reproducible methods to minimize bias. It differs from narrative reviews in its rigor and use of predefined methodology.
theta band: an EEG frequency range (4–7 Hz) linked to drowsiness and working memory. In dyslexia, excessive theta activity in frontal and temporal regions is a common finding, and many neurofeedback protocols aim to reduce theta amplitude.
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About the Author
Dr. John Raymond Davis is an adjunct lecturer in the Department of Psychiatry and Behavioural Neurosciences at McMaster University's Faculty of Health Sciences. His scholarly contributions include research on EEG changes in major depression and case studies on neurological conditions.
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