Harvard University Study | Brain Balance Program^®

Harvard Study Shows Brain Balance Program® is as Effective as Stimulant Medication in Alleviating ADHD Symptoms in Children 

Harvard University researchers conducted a study to examine ADHD symptoms in children before and after participation in a home-based Brain Balance Program.^® The study revealed comparable results similar to those of low-dose methylphenidate, a drug often used to treat the symptoms of ADHD. 

The results of this exploratory study are promising for individuals diagnosed with ADHD as an alternative to drug therapies currently being used for the management and treatment of ADHD. 

“The Brain Balance training had clinical, behavioral and neurobiological effects on par with pharmacological treatment. This is very encouraging as we believe that the ultimate goal in psychiatry is to develop non-pharmacological treatments for psychiatric disorders that exert enduring beneficial effects,” wrote Dr. Martin Teicher, associate professor of psychiatry at Harvard University and lead investigator of the study. 

The study focused on children between the ages of 8 and 14 who were diagnosed with ADHD.  The children each participated in 15 weeks of a home-based Brain Balance Program, for up to 75 sessions. This included physical, sensory, timing and visual exercises, which were demonstrated in videos for each of the participants. 

The Brain Balance Program was evaluated in this study for its unique focus on strengthening connectivity between different regions of the brain through a combination of physical, sensory, and cognitive activities. 

“You can work the brain just like you work muscles in your body,” explains Dr. Rebecca Jackson, Brain Balance’s vice president of programs & outcomes. “When different brain functions are engaged at the same time, those networks in the brain fire together. Over time, this changes the speed and efficiency in the brain’s communication pathways. These new, efficient connections in the brain lead to improvements in our executive functioning and our ability to complete cognitive tasks.” 

The participants were tested on a variety of measures, including neurocognitive testing, parent and clinician ratings, and brain imaging. Key findings are summarized below:

• Parent reports of ADHD symptoms were obtained by researchers both at the start and at the end of the Brain Balance training program. The results revealed a significant reduction in ADHD index scores, discernible changes in hyperactivity, enhanced cognitive attention, and smaller-scale reductions in oppositional behavior. It should be noted that while the test scores did improve, indicating a minimizing of symptoms, a small difference did remain between those participants with ADHD and those without.
  
  
• Clinician ratings followed similar trends to the parent reports -- a decrease in ADHD score, a reduction in the Hyperactivity Impulsivity subscale, and some reduction in inattention. Most participants with ADHD saw a meaningful reduction in their ADHD-RS scores after treatment.
  
  
• Brain imaging results showed a number of discernible changes in connectivity of various brain areas to the amygdala and hippocampus, both of which play vital roles in memory and stress responses. The brain areas where connections significantly differed were responsible for a range of factors including emotion and response control, language processing, memory retrieval, concentration, and mind wandering. Brain connections were significantly improved post-Brain Balance training, not only immediately after training, but also on reassessment 7 months later. The lasting nature of these results holds promise of long-term interventions for the treatment of ADHD.
  
  
• Objective measures were collected using the Quotient test, which uses a series of computerised tasks and psychological questions. Results here showed that Brain Balance training produced an effect on their ability to sit still that was equivalent, on average, to the effects of a low dose of methylphenidate. Furthermore, the participants who completed Brain Balance training responded in a more consistent and predictable manner compared with children on a low-dose methylphenidate treatment. Participants were able to sit equally still when undergoing Brain Balance training or treatment using low-dose methylphenidate.
  
  
• Researchers concluded that the effects of Brain Balance training are comparable to that of low-dose methylphenidate, which is used widely for the management and treatment of ADHD. The trends seen from the use of low-dose methylphenidate and Brain Balance training were nearly identical. Given the exploratory study was small in its sample size, the next steps in research should focus on repeating the experiment with a larger sample size.

Although this study did not use a personalized training method for each participant (as is typically done in the Brain Balance Program), doing so may improve results seen in ADHD patients. If large-scale trials conducted in the future show similar or better results, via personalised training plans, Brain Balance should and would be a first line of support for anyone with learning difficulties, especially ADHD.

Deep Dive Into the Study

The study focused on children between the ages of 8 and 14 who were diagnosed with ADHD.  The children each participated in 15 weeks of a home-based Brain Balance Program, for up to 75 sessions. This included physical, sensory, timing and visual exercises, which were demonstrated in videos for each of the participants. 

Altogether, 16 children with ADHD participated, as well as 8 typically developing children who did not have ADHD or any other developmental disorders. After the end of 15 weeks of the Brain Balance Program, the study participants were tested again on a variety of measures, including neurocognitive testing, parent and clinician ratings, and brain imaging. 

The Parent Perspective

After the 15 weeks of the Brain Balance Program, the children underwent testing for their ADHD symptoms. They took a test called the Conner’s Parent Rating Scale - Revised (CPRS-R). In this test, researchers are able to obtain parental reports of ADHD conditions. Parents were asked questions on ADHD symptoms like cognitive problems, oppositional behavior, hyperactivity-impulsivity, anxious-shy behaviors, perfectionism, social problems and psychosomatic issues, both at the start and at the end of the BB/IB training program. 

Results from the test revealed a significant reduction in ADHD index scores. Prior to treatment, ADHD youth had higher scores by an average of 21 points compared to typically developing controls. These scores were reduced to a score average of 12 points following Brain Balance training.  Additionally, the findings revealed that majority parents observed discernable benefits in ADHD youth. Some of the changes observed by parents included a highly significant reduction in hyperactivity, enhanced cognitive attention and a non-significant reduction of oppositional behavior. It should be noted that the test scores after Brain Balance training were not completely normalized to the same levels of typically developing controls

A Clinician’s Perspective

Similar to the parent results discussed above, clinician results were based on the Attention Deficit Hyperactivity Disorder for DSM-IV Rating Scale (ADHD-RS), which is based on parent reports and the clinician’s observations of the child. The results following Brain Balance training followed similar trends to the parent reports - a decrease in ADHD score, a reduction in the Hyperactivity Impulsivity subscale, and some reduction in inattention. Most participants with ADHD saw a meaningful reduction in their ADHD-RS scores after treatment. Once more, although a significant before-after result was seen for ADHD participants, these results were still significantly different from typically developing controls.

Results from Objective Measures

To give context to the results above, the results from the Brain Balance Program were compared against methylphenidate, a commonly prescribed stimulant in the treatment and management of ADHD. The effects of these were measured employing the Quotient test, which uses a series of computerised tasks and psychological questions. 

Methylphenidate helps ADHD by modulating certain molecules in the brain which then increases attention span and focus, and, in this way, helps control behavioral and attentional problems. The results within this arm of the study were remarkable - Brain Balance showed comparable results to low-dose methylphenidate. The trends seen from the use of low-dose methylphenidate and Brain Balance training were nearly identical. 

Results also indicated that Brain Balance training showed consistency in participants' responses when compared against the effects of low-dose methylphenidate which were more variable. In other words, ADHD youth responded more predictably after undergoing Brain Balance training, compared with youth getting low-dose methylphenidate treatment. Participants were able to sit equally still when undergoing Brain Balance training or treatment using low-dose methylphenidate. 

Results from Neuropsychological Testing

To ensure that the successful results seen so far were not due to the passage of time but because of Brain Balance training, 6 ADHD participants were assessed at baseline (i.e. before any treatment), reassessed after 15 weeks without any intervention and then again a third time after Brain Balance training. Assessments were conducted using 3 neuropsychological tests: The Corsi Block Tapping Task, the Tower of London test, and the Mackworth Clock test. 

The Tower of London test (which assesses executive functioning to detect deficits in planning) showed substantial effects post treatment. The Mackworth Clock Test (which assesses vigilance and concentration times) showed significant improvement after treatment that was comparable with typically developing controls. The Corsi Block Tapping Task (which assesses visuo spatial and working short term memory) showed no significant change in results after Brain Balance training. 

Results from Brain Imaging

The brain is made up of billions of interconnected neurons that communicate with each other. The brain is active even when we are not focused on anything or even asleep. Researchers have identified different networks of areas in the brain which work together to subserve different functions.  One particular brain network, called the Default Mode Network, becomes activated in a resting-state -- when we daydream, for example.  Other areas of the brain are active when we are doing various tasks, sensing and perceiving the world, feeling emotions, or doing other things.  

The amygdala and hippocampus are two brain regions that are part of the limbic system, a network of brain regions that underlie emotion, cognition, and memory and are therefore affected in many developmental disorders. It is hypothesized that the Brain Balance Program works by modulating various vital interconnections that couple different areas of the brain to the amygdala and hippocampus. 

In this study, brain imaging results showed a number of discernible changes in connectivity of various brain areas to the amygdala and hippocampus, both of which play vital roles in memory and stress responses. The brain areas where connections significantly differed were responsible for a range of factors including emotion and response control, language processing, memory retrieval, concentration, and mind wandering. Brain connections were significantly improved post-Brain Balance training, not only immediately after training, but also on reassessment 7 months later. The lasting nature of these results holds promise of long-term interventions for the treatment of ADHD. 

Connections between different areas of the brain and the amygdala and/or hippocampus appeared to have been significantly increased or decreased. These different areas are responsible for emotion and response control, language, memory retrieval, and so on. 

Brain imaging studies require a large number of participants, both in the treatment and control group, to be able to obtain conclusive insights.  Based on the preliminary findings, follow-up studies are warranted with a larger sample size to confirm the initial findings.  Additional studies can help to confirm the hypothesis that Brain Balance may work by strengthening and weakening various vital interconnections that link different areas of the brain to the amygdala and hippocampus. 

Read more current and ongoing research associated with the Brain Balance Program® or read this study's white paper.