Brain Bit with Baumel, Episode 1: Brain Balance and ADHD

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[INTRO]

I hope you are having a great day! Welcome to the introduction of Brain Bit with Baumel where each month we discuss a different topic in the field of Neuroscience from my perspective. I have recently taken a very keen interest in ADHD and its treatment so today I will be discussing a potential treatment that is constantly getting mixed reviews, The Brain Balance Program. I will be discussing the good and the bad about the Brain Balance Program in hopes of giving you a better understanding of whether it might be the right option for you. As always, the transcript is below so let’s get right into it.

[WHAT IS ADHD?]

ADHD or Attention Deficit Hyperactivity Disorder is a disorder seen in children and adults alike that is represented by symptoms of inattention, hyperactivity, and impulsivity. This means that many people with ADHD struggle with things such as focusing on a specific task, sitting still, or at times making well-thought-out decisions. These symptoms can be seen all three together or separately.  The symptoms usually appear between the ages of 3 and 6 with the average age of diagnosis at 7.  The rates of diagnoses are increasing every year and have been for about 4 decades now. This is believed to be partly due to increased awareness of symptoms and better ways of identifying in development. The rates of diagnoses are still higher in biological males (13%) than in biological females (6%). This is said to be in part due to the lack of appropriate female-centric testing as well as societal biases (Guy 2023). One of the key facts to note is that nearly 10% of American children between the ages of 3 and 17 have been diagnosed with ADHD. Interestingly, concerning treatment, 77% are receiving treatment, 30% receive medication alone, 15% receive behavioral treatment alone, and 32% receive both (CDC 2022). The other 23% is where Brain Balance falls in.

[WHAT IS BRAIN BALANCE?]

Brain Balance seeks to provide another treatment option for children with ADHD that have tried medication or behavioral treatment and were unsuccessful or for those that want to avoid medication and behavioral treatment altogether (Guy 2023). Brain Balance markets itself as a “center-based program that aims to integrate sensory input and strengthen motor skills through regular frequency and duration of multimodal activities that target sensory functioning, motor skills, and exercises to address retained primitive reflexes, along with academic engagement, nutritional support, and complementary home-based exercises” (Jackson Robertson 2020). Founder Robert Melillo, a chiropractor, describes the cause of ADHD as a brain imbalance, more specifically Functional Disconnection Syndrome. By this, he means that the two parts or hemispheres of the brain are not equally balanced in how much they are used and when they are used. He claims they lack synchronization and all of these factors add up to mature one side of the brain faster than the other and thus cause issues such as ADHD (Guy 2023). The issue is that Functional Disconnection Syndrome, the very concept Brain Balance is based on, is heavily disputed and it is incredibly difficult to find any research or credible information on it that is not from Robert Melillo or other people he works with (Boulton 2010). This variety of factors that make people unsure of Brain Balance as a treatment has led to a call for deeper research on it as a treatment and its effects.

[WHAT DOES THEIR RESEARCH SAY?]

Unfortunately, there is little research on Brain Balance that has been done by anyone external to the company. The results of the internal studies are the following. The first study, Jackson and Robertson 2020, was based on archived parental survey data of Brain Balance participants. In this study, there were found significant improvements in anxiety and emotional function scores. The second study, Jackson and Wild 2021, shows significant positive effects on the cognitive performance of children with ADHD following the Brain Balance program meaning that the Brain Balance program seemed to help these children with their ADHD. The third study, Jackson and Jordan 2022, found significant improvement on another parent-rated scale called the Brown Attention-Deficit Disorder Scale (BADDS). They asked the parents to complete this survey before and after the Brain Balance Program and compared the scores. The fourth study, Jackson and Jordan 2023, showed that the methods Brain Balance uses are effective in improving some of the most common symptoms of children with ADHD as reported by parental surveys. The only outside research, Teicher et al. 2023, found positive effects similar to low doses of an ADHD medication called methylphenidate.

[ISSUES WITH THEIR RESEARCH]

There are a variety of issues with the research behind the Brain Balance program. Their researchers, including their founder, are very secretive about their educational background. It took incredible deep diving to find out that Robert Melillo was a chiropractor. He markets himself as a “clinician, professor, brain researcher, and bestselling author” according to his website. Something that has continuously come up in my classes is the fact that they are very secretive about a lot of what they do and why they do it at Brain Balance and that goes all the way down to their credentials. This continues into their research as well. In Jackson and Robertson 2020, there was no control group and the results were based solely on parental data which is known to be biased. These parents are paying large sums of money for their children to participate in the Brain Balance program and thus have a vested interest in it helping their children whether it truly helps or they just choose to believe it helps. Direct measures based on a proven scale of ADHD symptoms would be a more effective way to measure improvements. They used somewhat more direct measures in the next study, Jackson and Wild 2021, but once again there were major limitations. First, the study had a control group but the control group was made up of children who started the Brain Balance Program and did not finish it, thus not a true control group. Second, the study only contained the data of 12 children, an extremely small sample size. Third, both Jackson and Roberts 2020 as well as Jackson and Wild 2021 are published in journals that many would consider predatory or not super credible. When I searched up the journal that Jackson and Wild 2021 was published in, I found that it said it was not credible enough to be included in large research databases such as PubMed. This is not the best sign for the validity of this research. When it comes to Jackson and Jordan 2022 many of the same issues appear: no true control group, small sample size, and data being parental surveys which can hold major biases. Unfortunately, much of the same holds true for Jackson and Jordan 2023 in that there was no true control group and it was based on parental surveys. The limitations of the only outside research, Teicher et al. 2023, are rather similar. This study had a very small sample size of 16 children. Another issue is that the researchers and participants alike knew who was in which condition and thus there was a lot of potential bias. Third, more than half of the initial participants did not finish the program (59% dropped the program). Lastly, they had a control group, but the control group was made up of 9 typically developing children who did not have ADHD. As can be seen, much of the research has very large limitations that must be considered when thinking whether the Brain Balance Program is truly effective. 

[WHAT THE EXPERTS SAY ABOUT THE BRAIN BALANCE PROGRAM?]

This goes beyond just the research as well and all the way down to the very concept that Brain Balance is based upon, Functional Disconnection Syndrome. Dr. Mina Dulcan a psychiatrist at Northwestern’s Feinberg School of Medicine says “None of the neuro research would even come close to suggesting that. The notion that one half of the brain developed faster than the other just doesn’t fit with anything we know about the brain” (Boulton 2010). Dr. Duncan is not alone in her open criticism of the Brain Balance Program either. Dr. Steven Novella, an assistant professor of neurology at Yale School of Medicine, discusses how when looking at Brain Balance, nearly all their claims are backed by anecdotes of parents whose children have gone through Brain Balance and not actual science and true, credible research. Dr. Novella adds, “Even if they thought their ideas were right, what they should be doing is studying them in a rigorous way. Instead they are writing books and selling franchises. That should tell you something about where they are coming from.” (Boulton 2010).  Novella then also adds “You hit [the parents] with exactly what they want to hear,” and “[t]hey have a good sales pitch. They don’t have the science to back that up.” (Boulton 2010). I tend to agree with Dr. Novella and Dr. Duncan. From the research I have done, the Brain Balance Program seems to be very good at marketing and that is how they make their money. They get people to ignore the science and fall into the marketing and personal anecdotes. In a 2010 interview Jeremy Fritz, a co-owner of a Brain Balance Franchise, made the claim that the program was in fact based on science and the research was just not out yet making the claim, “[t]alk to me in two years from now” (Boulton 2010). It has now been almost 13 years since he said that and the Brain Balance Program is still facing many of the same criticisms of needing more credible research behind their methodologies. Should parents really be paying over $10,000 for a program that does not have credible research behind its methods? Unfortunately, just as there are positive parental anecdotes, there are extremely negative anecdotes. One set of parents describes how it did not work at all for their family. They went in hopeful in a somewhat emotional situation hoping that Brain Balance could be the missing treatment that they had been searching for. They even acknowledged that their son knew how much they spent on it and thus was trying very hard in the trainings and to get it to work. The parents said it was not money well spent. They did not see any significant changes in their son. Their son has since been put on medication and participates in targeted activities and they have seen a major improvement since (Einhorn 2019). What puts a major strain on parents is that because Brain Balance is not scientifically proven and an approved treatment, it is not covered by insurance. This puts many parents into deep financial strain to the point that many have to start seeking money from other sources such as GoFundMe pages. A different family describes how many emotions went into the $15,000 they spent on their sons Brain Balance program for it not to work. They had to take money out of their retirement simply to pay for their son’s treatment. The issue is that they were so reeled in and hopeful that this would be the miracle solution that they did not even question the financial burden that this was going to put on them. Unfortunately for families, Robert Melillo does not believe that any families really care about the science or the data. He believes that they care about results but he may be falsely marketing results to them through biased evaluations of their children’s improvements. It seems clear that Melillo’s intentions may not be as noble as he attempts to make them seem. There is little doubt that Melillo and the other founders are trying to hide something and that is blatantly unfair to the families they claim to help (Benderev 2018).

[CONCLUSION]

When everything is taken into consideration, there is not a lot of great support for the Brain Balance Program in helping children with ADHD other than parental anecdotes. Does that mean that the program does not work? Absolutely not, but it does give reason to be weary of spending a lot of money on the program for your children. There is potential that the program could be effective and it is unlikely that all the positive parental reviews are simply lies or coerced or biased, but more credible research must be published before I believe the scientific community will accept the Brain Balance Program as a legitimate treatment. Until then, I suggest conducting your own research and making your decision for yourself based on the research and what the experts in the field are saying. Until next time, enjoy your day and remember come b-rain or shine I will be here discussing neuro topics on Brain Bit with Baumel!

[REFERENCES]

Benderev, C. (2018, June 18). 'cutting edge' program for children with autism and ADHD rests on razor-thin evidence. NPR. Retrieved April 17, 2023, from https://www.npr.org/sections/health-shots/2018/06/18/616805015/cutting-edge-program-for-children-with-autism-and-adhd-rests-on-razor-thin-evide 

Boulton, G. (2010, November 14). Doctors skeptical of Center's claims - Milwaukee Journal Sentinel. Milwaukee Journal Sentinel. Retrieved April 16, 2023, from https://archive.jsonline.com/business/108047584.html/

Centers for Disease Control and Prevention (CDC). (2022, August 9). Data and statistics about ADHD. Centers for Disease Control and Prevention. Retrieved April 16, 2023, from https://www.cdc.gov/ncbddd/adhd/data.html

Dr. Robert Melillo. (2022, October 4). About Dr. Robert Melillo. Dr. Robert Melillo. Retrieved April 16, 2023, from https://www.drrobertmelillo.com/about/

Einhorn, E. (2019, December 20). Inside 'brain training' centers that claim to rewire the brains of kids with autism and ADHD. NBCNews.com. Retrieved April 17, 2023, from https://www.nbcnews.com/news/education/parents-pay-thousands-brain-training-help-kids-adhd-autism-does-n1100681 

Guy, M. (2023). Education, Neuroscience, and Brain Training [PowerPoint slides]. Department of Psychology, Loyola University Chicago.

Guy, M. (2023). Developmental Psychopathology: ADHD [PowerPoint slides]. Department of Psychology, Loyola University Chicago.

Jackson, R., & Jordan, J. T. (2022). Reliable change in parent-rated scores on the brown attention-deficit disorder scales® from pre- to post-participation in the brain balance® program. Humanities and Social Sciences Communications, 9(1). https://doi.org/10.1057/s41599-022-01333-y

Jackson, R., & Jordan, J. T. (2023). Measurement properties of the brain balance® multidomain developmental survey: Validated factor structure, internal reliability, and measurement invariance. Current Psychology. https://doi.org/10.1007/s12144-023-04248-2

Jackson, R., & Robertson, M. (2020). A retrospective review of parent-reported anxiety and emotional functioning in children with developmental challenges after participation in the brain balance® program. Journal of Mental Health & Clinical Psychology, 4(1), 10–20. https://doi.org/10.29245/2578-2959/2019/1.1192

Jackson, R., & Wild, C. J. (2021). Effect of the brain balance program® on cognitive performance in children and adolescents with developmental and attentional issues. Journal of Advances in Medicine and Medical Research, 27–41. https://doi.org/10.9734/jammr/2021/v33i630857

Teicher, M. H., Bolger, E., Hafezi, P., Garcia, L. C., McGreenery, C. E., Weiser, L., Ohashi, K., & Khan, A. (2023). Open assessment of the therapeutic and rate-dependent effects of Brain Balance Center® and interactive metronome® exercises on children with attention deficit hyperactivity disorder. Psychiatry Research, 319, 114973. https://doi.org/10.1016/j.psychres.2022.114973