Dr. Devon MacEachron\'s Blog

    SUBSCRIBE

    Sign up and I'll let you know when I update the blog.
    * = required field

I’m going to interrupt the Mythbusters series I’ve been publishing this month because something extraordinary has been happening in my world. Something I hope will make a difference.

My daughter, who is a journalist/producer at online news company NowThis, asked me to do a piece on mental health. I decided to do it on the subject of neurodiversity. The piece we did was published about 12 days ago and as of today has over 6 million views and a lot of shares. Here’s a link: http://nowthisnews.com/videos/news/what-you-need-to-know-about-neurodiversity.

I’m wondering why this message has “gone viral.” What is it that so interested and touched people? It certainly wasn’t the messenger (oh my gosh could I have been any stiffer?)

I’ve received a tidal wave of responses. Some – especially those from neuropsychologists – have been critical of the piece for not emphasizing how important disability diagnosis and treatment are. I want to say here that I agree diagnosis is appropriate when needed for identification and services and that addressing areas of challenge is always very important. For everyone, whether they have a disability or not. I have always believed, though, that there are two sides to the coin. Areas of weakness and areas of strength. Some of my colleagues neglect the latter. I think we should all be focusing more on people’s strengths.

I also received an e-mail from a person who had acquired ADHD as the result of an illness and did not see it as an evolutionary advantage. I agree. But even in the case of disability or a debilitating illness I feel that focusing on what we can do, or what we might be able to do with some help and support, can help us more than focusing exclusively on what we can’t do. When my daughter (the one who produced the video) was diagnosed with ADHD and dyslexia we and her school initially focused exclusively on “fixing” what was “broken.” She developed learned helplessness – a condition in which she felt powerless to do things she actually could have done and asked for help with practically everything. By focusing more attention on her strengths (creativity and story-telling skills) she began to bloom.

Most of the e-mails and responses on Facebook pages and Twitter have been positive. Some people shared their personal experiences or those of their child, said they had felt alone, but now felt recognized and more hopeful. Hopeful that society can change and see the beauty in diversity. Some asked how they can volunteer to help the movement – the neurodiversity movement. I’m not sure how to respond to that as I’m not a social activist. I know the movement originated from the autism community and has spread to others. I wish someone would take on a role uniting all of us who believe in this. We need an organizer, a foundation, or a conference. Debbie Reber of Tilt Parenting has taken on the charge of revolutionizing the parenting of differently wired kids in her podcast and new book. I hope others step up to the table. It seems the time is right for this conversation. I sure hope so!

 

 

 

Where does the concept of overexcitability come from?

Overexcitability was introduced to psychology by Polish psychiatrist Kazimierz Dabrowski in the 1960’s as part of a “Theory of Positive Disintegration.” The theory proposed that psychological tension and anxiety are necessary to achieve the highest levels of personal and moral growth. Hence these “disintegrative” processes (tension and anxiety) were seen as “positive.” Dabrowski believed that some people have more “developmental potential” than others, and that high intelligence (giftedness) and overexcitability were predisposing factors.

So what exactly is overexcitability?

Dabrowski defined overexcitability as a heightened physiological experience of stimuli resulting from increased neuronal sensitivities that cause a person to experience life more intensely and to feel the extremes of joy and sorrow more profoundly. He called it a “tragic gift.”

He outlined five forms which have been elaborated by others over the years:

Psychomotor overexcitability manifests as a capacity for being active and energetic. It can include loving to move and being physically active, restlessness, speaking quickly, frequent impulsivity in action, and having high stamina.

Sensual overexcitability manifests as increased pleasure from the senses (e.g. tastes, smells, textures, sounds, and sights) and, conversely, extreme negative reactions to unpleasant sensations. It can include an exceptional dislike for particular stimuli or sensations, like the sensation of a shirt’s tag on one’s neck or the texture of certain foods.

Intellectual overexcitability manifests as an extreme desire to seek understanding, gain knowledge, and analyze and categorize information. It can include asking a lot of questions, being a quick thinker and observer, love of ideas and theoretical analysis, and the search for truth.

Imaginational overexcitability manifests as an intensified play of the imagination and vividness of imagery. It can include fantasizing, day-dreaming, a craving for novelty, and dramatization.

Emotional overexcitability manifests as a capacity for feeling emotions intensely and deeply. It can include being highly sensitive, empathetic, anxious, sad, lonely, nervous, fearful, having a heightened sense of responsibility, and a tendency toward self-examination.

What’s the link between giftedness and overexcitability?

Dąbrowski’s followers suggest that the gifted disproportionately display overexcitabilities, positive disintegration, and hence the potential to attain higher levels of personal and moral growth. The notion was popularized in the gifted education and research communities by Michael Piechowski initially in the 1970’s, Sal Mendaglio, who edited the book Dabrowski’s Theory of Positive Integration (2008), Susan Daniels and Michael Piechowski, who edited Living with Intensity (also published in 2008) and by Linda Silverman of the Gifted Development Center in Colorado, who worked with Piechowski and others on the development of the Overexcitability Questionnaire II, a self-report form widely used as a research instrument. You can try it out yourself by following the link.

I think parents find the concept appealing because it links giftedness and experiences and behaviors that could otherwise seem problematic or dysfunctional (like melt-downs over labels in clothes and extreme emotional reactivity), suggesting these are just part of the child’s gifted temperament. I personally found solace in the idea when my daughter was hypersensitive as a young child. However I have seen parents who take it to an extreme by attributing everything to only one aspect of their child’s profile (their giftedness), and ignoring areas of challenge that need to be addressed.

Is a link validated by the research?

I don’t think so. But I may get in trouble with my friends and colleagues in the gifted community for saying so. The idea that overexcitabilities are higher in the gifted has so captured the imagination and loyalty of researchers, practitioners, and parents that it has, in effect, become accepted as an article of faith or ideology. Practically every website and book written for parents on the social and emotional aspects of giftedness promulgates the view. There’s very little debate about it in the presentation to the public – it’s simply accepted as truth. That’s why I’m writing about it. It bothers me when everyone jumps on the same bandwagon without questioning where it’s going. Also, I have a problem with the idea that the gifted are more capable of attaining higher levels of moral and personal growth than the non-gifted.

Let’s look at the research literature:

On the “pro” side, in 1984 Colangelo and Piechowski summarized the literature, noting that overexcitabilities were consistently present in the gifted. Falk and Miller conducted a literature review of 28 studies in 2009, reporting that gifted individuals were significantly more overexcitable than the non-gifted, especially in the Emotional, Intellectual, and Imaginational areas. In Taiwan, Kuo and Chang (2013) concluded that gifted persons are significantly overexcitable. Many professionals involved in counseling the gifted (e.g. Linda Silverman, Ann Marie Roeper, Susan Daniels) have cited their personal professional experience as evidence that the gifted are more intense, sensitive, and overexcitable.

On the “con” side, in 2006 Mendaglio and Tillier conducted a literature review and concluded that gifted groups did not significantly outscore non-gifted groups. When Pyrt (2008) analyzed the effect sizes (strength) of the relationships reported in research studies he found most to be “small” and “trivial.” The only relationship that had a decent-sized effect was with Intellectual overexcitability. Jane Piirto, a researcher who’s made overexcitabilities her primary research focus, has administered the overexcitability questionnaire to over 600 gifted students, and who personally organized three of the first Dabrowski conferences in the U.S., was an “early adopter” but has grown skeptical over time. In an article titled “21 Years with Dabrowski Theory” she wrote that almost all the studies conducted have had small numbers of participants, making conclusions suspect, and that the only consistent finding has been for Intellectual overexcitability. A 2014 meta-analysis conducted by Daniel Winkler focused on answering the question: “Do the gifted have greater excitabilities than the non-gifted?” He did find a relationship between Intellectual overexcitability and giftedness. For the Emotional and Imaginational overexcitabilities he found that more studies failed to find a relationship than succeeded. The findings for Sensory overexcitability were deemed “insufficient.” And he reported that no studies conducted in the United States have found that the gifted have greater Psychomotor overexcitability.

I agree that the data indicates a link between giftedness and Intellectual overexcitability, but this doesn’t impress me.  I expected it. When you look for a relationship between two things that are conflated – like height and basketball prowess – you are likely to find one. The Big Five Factor Model of Personality, which has been strongly validated by the research, has a factor called “Openness” which is near identical to the concept of Intellectual overexcitability. Openness is the degree of intellectual curiosity that a person has. Of course it is associated with giftedness, and of course Intellectual overexcitability is associated with giftedness as well. As for the other excitabilities, it seems the evidence is just not there.

Why, then, is there such a strong ideology built up around this notion?

This makes me wonder why the gifted community has been so dogmatic about its belief in overexcitabilities, despite the lack of empirical evidence. It may be that people decided they liked the idea when it was just a hypothesis and haven’t kept up with the research findings. It was striking how fast thought-leaders in the gifted community jumped on the wagon when the hypothesis was first popularized in the 1980’s, despite a near total lack of any evidence at the time. I think it could also be due to the “halo effect.” Professionals in the gifted community want to see the people they work with through a positive lens. For parents, the idea that their child is oversensitive as part of their giftedness and that’s a good thing may be more appealing than an additional diagnosis of AHDH or Asperger’s or anxiety. Finally, we all want to think that pain and suffering will prove, in the long run, to be for the best. We want to believe it, and so we do.

Why does this matter, and what should parents do?

It matters because making the assumption that a gifted child is more excitable because they are gifted and that it’s fine (even good) to be that way can focus attention away from challenges that need to be addressed. Let’s remove the halo of giftedness, and look at the whole child. The potential for a child to realize their potential and to grow into a happy and productive (and personally and morally developed) member of society is increased when we support both their strengths and their weaknesses.

Mindfulness meditation has enjoyed a tremendous surge in popularity in the past decade. The practice has moved from a largely obscure Buddhist concept founded about 2,600 years ago to a mainstream psychotherapy and educational construct.

What is Mindfulness Meditation?

It’s a technique of meditation that focuses awareness on breathing and encourages positive attitudes to distracting thoughts and feelings that are not ignored, but are rather acknowledged and observed nonjudgmentally as they arise to create a detachment from them and to gain insight and awareness. It involves training attention and awareness in order to bring mental processes under greater voluntary control. It promotes metacognitive awareness. Mindfulness meditation is a western adaptation of Vipasna, or mindful breathing meditation, with influences from other methods.

Other forms of meditation include: transcendental meditation, in which one sits in lotus position and chants internally with the goal of “enlightenment;” Kundalini meditation in which one tries to channel an upstream of energy and experience an altered state of consciousness; Qi Gong meditation from ancient China which utilizes breathing, movement, and posture to circulate energy through the bodies “energy centers;” and Zazen Zen Buddhist meditation, a straight-backed, seated meditation in which one aims to forget all judgmental thoughts, ideas, and images.

One of the main influencers behind the popularity of mindfulness meditation in the west is John Kabat-Zinn. Dr. Kabat-Zinn has written a number of best-selling books including: Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness; Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life; and Everyday Blessings: The Inner Work of Mindful Parenting. He approaches mindfulness as a scientist (PhD in molecular biology, MIT) and has published scientific articles in peer-reviewed journals (e.g. Journal of the American Medical Association) on mindfulness in medicine. His Mindfulness-Based Stress Reduction (MBSR) program, developed in 1979 at the University of Massachusetts Medical School, has been used in hospitals and health clinics to help patients improve the quality of their lives.

What has my personal experience been with it?

My 26-year old 2e son got me into it. He gave me Full Catastrophe Living for Christmas and we did an 8-week self-guided MBSR meditation course based on Kabat-Zinn’s teachings. We’d text each other when it was time to meditate then text again afterward and call to chat about the experience. I also took a 6-week online course from Mindful Schools for educators. I still feel like an amateur! In my experience this is not something one can read a book about or take one course and immediately implement successfully. I think that’s one reason it’s called a “practice.” You have to practice a lot to get it down and even then you may lose direction. My son, who has been practicing on a daily basis for several years now, feels it is very helpful for improving his attention and focus (he has ADHD) and for reducing anxiety and a tendency to ruminate on negative thoughts. He thinks one of the biggest challenges with implementing it as a “treatment” is that teaching and coaching methods are not standardized and one often doesn’t know if one is “doing it right.”

How could it help 2e learners?

Mindfulness meditation could help 2e learners who have ADHD, autism, anxiety, and/or depression. The following benefits are mentioned:

• Improved attentional control and focus. Boosts to working memory.
• Stress reduction.
• Less emotional reactivity and emotional dysregulation.
• Reduced rumination via disengagement from perseverative cognitive activities.

Is it effective?

A 2017 article was published by science reporter Brian Resnick on Vox.com called: Is mindfulness meditation good for kids? Here’s what the science actually says. Resnick read more than a dozen studies — including systematic meta-reviews, which accounted for thousands of other papers — analyzing the research on mindfulness in both children and adults (there was much more research available on adults). He writes: “The evidence for mindfulness in adults is limited but promising” – especially for anxiety, depression, and stress reduction. He found less evidence for children, in part because there were so few studies.

Dr. Erica Sibinga, a pediatrician  at Johns Hopkins, conducts well-controlled trials using mindfulness in Baltimore’s poorest public schools. She and her colleagues recently conducted a randomized clinical trial with 300 fifth- to eighth-graders. Half the students got mindfulness instruction for 12 weeks. The other half got 12 weeks of health education and were the study’s controls. The results were quite strong: depression, anxiety, self-hostility, coping, and post-traumatic symptoms moved from “concerning levels” to “normal levels.”

A 2014 review published in Frontiers in Psychology found, across 24 studies (11 which had not been published in peer-reviewed journals), that mindfulness improved measures of cognitive performance but had less impact on stress and coping.

A second 2014  meta-analysis published in Education Psychological Review looked at 15 studies of school meditation programs and found “school based meditation is beneficial in the majority of cases,” but “the majority of effects of meditation upon student outcomes are small.”

And a third meta review, published in the Journal of School Psychology in August 2017, compiled 72 mindfulness studies of youth both in and outside of classroom settings. They found “universally small, positive therapeutic effects” for attention, introspection, and emotion regulation.

Overall, the evidence suggests that mindfulness does appear to have a positive effect for children, especially on anxiety and cognitive measures. The studies suggest that it is most beneficial for children who are disadvantaged or at-risk, and may not be as effective for children who are closer to a “normal” baseline. I feel our 2e children are “at-risk” and stand to benefit.

How do you teach a child how to do it?

Some schools incorporate the teaching of mindfulness in the school day. Mindful Schools  and MindUP are great programs designed for implementation in schools. Parents might be able to find a local private instructor, parent/child, or child-centered course to enroll in. They might find a therapist to engage their child in mindfulness-based therapy. There are numerous apps designed for children including Headspace for Kids and Mindfulness for Children. Parents willing to develop their own knowledge and skills might “home school” their child in mindfulness. Practitioners suggest that however a parent chooses to teach their child mindfulness, parents who also practice it themselves tend to have the greatest impact on their children.

Recommendation: 

I often recommend mindfulness meditation to the families of 2e learners I work with, as I do think it can help. I am concerned, though, that instruction and methodology can be a bit vague and many families may not know how best to go about it. Also, it’s not a “quick fix” but more of a “lifestyle change” requiring a  significant commitment to see results. I feel that the most benefit is gained when some rigor is put into implementation (e.g. scheduled daily family practice, instruction and ongoing guidance by a trained professional). Practice makes perfect!

What is sensory integration and sensory integration therapy?

Sensory integration refers to the process by which the brain organizes and interprets external stimuli such as touch, movement, body awareness, sight, sound, and gravity. Sensory integration therapy is an occupational therapy intervention that uses individually tailored  activities in an effort to facilitate adaptive responses and functional behaviors. The therapy sessions typically involve months to years of 1-3 times per week, 30-60 minutes sessions and some homework.

Practitioners of sensory integration therapy propose that there is something called “sensory integration dysfunction” or “sensory processing disorder” that impairs the central nervous system, affecting the vestibular, proprioceptive, and/or tactile systems. The vestibular system provides sensory input to the brain about the body’s movement through space. Ostensible signs of vestibular impairment include poor posture and dyspraxia (difficulty planning motor activities). Therapy intended to stimulate the vestibular system might include swinging, rolling, jumping on a trampoline, or riding on scooter boards. The proprioceptive system provides sensory input from the muscles and joints. Proprioceptive impairment is said to be revealed by the presence of stereotyped body movements, such as flapping one’s hands or rocking one’s body back and forth. Impairments in the tactile system are supposed to be evidenced by over- or under-sensitivity to sensory stimuli. Activities to stimulate the proprioceptive or tactile systems might include “smooshing” the child between gym pads or pillows to provide “deep pressure,” brushing the child’s body, providing “joint compression” by repeatedly tightening the joints at the wrist or elbow, and playing with textured toys.

The goal of sensory integration therapy is to remediate sensory difficulties so the child’s overall functioning will improve over time, and allow the child to process and react to sensations more efficiently.

Is there really such a thing as a “Sensory Processing Disorder?”

Practitioners of sensory integration therapy are the sole users of the terms “sensory processing disorder” and “sensory integration dysfunction.” The prevailing view in the broader scientific community is that “sensory symptoms” are ill-defined for purposes of diagnostic categorization and also for identification of a course of treatment or intervention. Sensory “issues” are seen as a nonspecific indicator of neurodevelopmental immaturity rather than as a distinct disorder.

In 2012 the American Academy of Pediatrics (AAP) issued a policy statement recommending that pediatricians not use sensory processing disorder as a diagnosis. The AAP left the window open for therapy by adding that while there may not be a diagnostic category, occupational therapy using sensory-based therapies “may be acceptable as one component of a comprehensive treatment plan.”

Why would sensory integration therapy be recommended for a child with Asperger’s/autism?

Many children with Asperger’s and autism have “sensory issues,” such as over-sensitivity to touch, sounds, smells, tastes, brightness, and movement. They may have trouble tolerating scratchy clothing, shirt tags, or “squishy” substances on their skin. They may be overly sensitive to loud noises or very picky about what they eat. They may evidence repetitive motor acts such as hand flapping. These difficulties can make ordinary situations overwhelming, create extreme stress, and trigger meltdowns. In fact, the latest edition of the American Psychiatric Association’s diagnostic manual, the DSM-5, lists sensory problems as a criteria for autism diagnosis.

Similar symptoms may occur with other neurodevelopmental and behavioral problems, especially ADHD and anxiety. My daughter, who has both, had sensory integration therapy. She couldn’t tolerate labels in clothing and loud noises (automatically flushing toilets were to be avoided at all costs). After a family vacation to Disneyland where she was overwhelmed by the noises and smells, she said “that would have been a great vacation except for that awful theme park.” For the most part, she’s outgrown her sensitivities. And I think she would have outgrown her sensitivities without a year of OT. But many children with autism continue to have sensory issues of one kind or another throughout their lives.

Is there a sound theoretical argument for sensory integration therapy? 

Not really. A major limitation with sensory integration theory is the dearth of evidence for its main tenet, which is that the integration of sensory input is necessary for higher level functioning. This tenet is based on the outmoded view that the development of the child mirrors the evolutionary development of the species. The argument is that sensory systems arose relatively early in the evolutionary history of humans and were a prerequisite for the emergence of more complex cognitive skills. The vestibular, proprioceptive, and tactile systems are thus said to reside in the “primitive” subcortical pathways that need to develop before the formation of more advanced cortical systems. There is no sound scientific basis for this idea, and it sounds a lot like the specious arguments made by Brain Balance Centers (see my Myth Busters Blog on that topic). Rather, the functional organization of the nervous system is better conceptualized as a co-occurring and interactive network of cortical and subcortical systems that mediate voluntary and involuntary responses to stimuli. As such, a linear model that posits that one system must reach some prerequisite level of development in order for a “higher” system to function properly is just inaccurate.

In some of the sensory integration literature biological theories are complemented by hypothetical constructs such as “inner drives” for self-actualization, “sensory deprivation and/or overload,” and “sensory defensiveness.” These constructs do not have any demonstrated scientific basis or even clear definition that would permit their valid and reliable measurement.

O.K. So maybe there’s not much scientific logic to support the theory. But does it work anyway?

Does sensory integration therapy help children with Asperger’s/autism? 

Many parents think it does. Many colleagues who I respect think it does. More colleagues who I respect think it doesn’t. The research evidence (so far) is rather unconvincing.

I took a close look at four analyses published since 2012. Lang, et. al.  reported in 2012 in the journal Research in Autism Disorders that when 25 studies were analyzed, 3 studies suggested it was effective, 8 studies found mixed results, and 14 reported no benefits. Not very compelling. Many of the studies (including the 3 that found positive results) had “serious methodological flaws” (e.g. no experimental design), precluding any valid conclusions. The authors concluded: “There is insufficient evidence to support the use of sensory integration therapy for children with ASD.”

Case-Smith and Scaff reported in 2014 in the journal Autism that among 5 studies, 1 was a case study so could not be generalized, 1 found no treatment effect, and the other 3 had mixed results. Of the 3 with mixed results, one utilized scientifically rigorous methodology (e.g. a control group). The findings from that study were positive according to parent and teacher report: children who received sensory integration therapy had a greater reduction in ASD symptoms. However, the authors cautioned: “additional rigorous trials using manualized protocols for sensory integration therapy are needed to evaluate the effects for children with autism spectrum disorders.”

Barton, et. al.  reported in the journal Research in Developmental Disabilities in 2015 on the findings from 30 studies. They concluded that there was so much heterogeneity in implementation, measurement, and study rigor that not much could be ascertained. They wrote: “The research on sensory-based treatments is limited to insubstantial treatment outcomes, weak experimental designs, or high risk of bias. Although many people use and advocate for the use of sensory-based treatments and there is substantial empirical literature on sensory-based treatments for children with disabilities, insufficient evidence exists to support its use.”

Finally, there is a chapter on sensory integration in the 2015 book  Controversial Therapies for Autism and Intellectual Disabilities: Fad, Fashion, and Science in Professional Practice by Foxx and Mulick. In addition to reporting in detail on prior studies, the authors report their own review of  data from 2011-2014. When they analyzed 10 studies, 3 were single-subject (one child) studies that did not show any benefit. 4 studies reported positive results but were criticized as “speculative at best” because they did not randomly assign children to groups and examiners were not “blinded” to group assignment. The 2 studies that did utilize sound scientific methodology provided inconclusive results, The authors conclude that sensory integration therapy has “limited scientific support,” but note that it “remains popular despite professional ethical guidelines that call for the use of evidence-based practice.” In other words, they feel it’s unethical for professionals to recommend sensory integration therapy because its not an evidence-based practice.

Why do families engage in sensory integration therapy if the evidence is so scanty? 

In an online survey about 60% of parents of children with ASD reported that their children engaged in a course of sensory integration therapy.

Why do they do it given the weak scientific evidence?

Maybe they haven’t looked at the science. Maybe they were convinced by the pseudoscientific arguments. Maybe they hope scientific research will someday catch up with practice and show it to be efficacious. Maybe they relied on a story from a friend or a friend of a friend that was convinced it helped their child. I think this happens a lot. Or maybe parents are so desperate to do anything to help their child they will grasp at straws.

Recommendation: While it probably won’t do much, if you want to do sensory integration therapy as one part of a comprehensive treatment plan, there’s probably no harm in proceeding. But please don’t divert time, money, and attention away from therapies that are scientifically validated as effective.

 

What is it? In 2006 Dr. Robert Melillo – a chiropractor – entered into a partnership with his nephew to launch the Brain Balance franchise model. Since then, over 130 franchises have been purchased across the country. The concept is based on Dr. Melillo’s book: Disconnected Kids: The Groundbreaking Brain Balance Program for Children with Autism, ADHD, Dyslexia, and Other Neurological Disorders. He describes his program as a “non-medical and drug-free approach” based on “cutting edge brain science” for achieving “optimum body and brain balance.” He argues that kids who have learning or behavioral issues have “inadequately developed sensory and motor systems” and because “the brain is built from the bottom up,” sensory and motor work must be done “before any higher learning, behavioral or academic changes can truly happen.”

He addresses this presumed deficit with “motor” exercises (e.g. rhythm and timing, primitive and postural reflexes, eye-muscle balance) and “sensory” exercises (e.g. hearing, vision, smell, taste, touch). Academic skills are also (briefly) addressed. The sensory, motor, and academic work is all condensed into 3 one-hour sessions per week at a center. Your child is taught by a “coach” – an unlicensed person who need have no background in education, health, occupational therapy, chiropractic, or any related field. A blogger who got details from a former center employee insider’s perspective reports that “most staff are very young (21/22 on average), with no real relevant qualifications, and there’s a high turnover; most don’t stay longer than a few months. That could be partly because of the wages; $10 an hour.”

In addition to the 3 hours per week your child gets at a center, the program includes nutritional recommendations and exercises to be done at home.

Most families are advised that their child requires two 3-month sessions at a cost of $6,000 per session, plus several hundred dollars for the assessment and proprietary nutritional supplements (including KidGenius vitamins “that help promote brain growth!”). Total cost is approximately $13-14,000. Cost per session works out to about $182/hour, of which the coach gets approximately $10. None of the cost is covered by health insurance.

Can it help? Let’s break the question down into what part (s) of it work, and for who?

Let’s start with “who.” I’m skeptical that children with all the different issues they claim to treat can be helped with the same basic treatment. A blog titled Total and Utter Neurobollocks states: “They claim to effectively treat pretty much any developmental disorder under the sun, including autism, ADHD, Asperger’s, Tourette’s and dyslexia, without the use of any drugs. This is because all these disorders are (apparently) caused by an “underlying functional imbalance or under-connectivity of electrical (brain) activity within and between the right and left sides of the brain.” Any alarm bells ringing yet? They should be. Whenever someone comes along with a miracle-cure for a range of unrelated conditions, and has come up with the equivalent of a Unified Field Theory of neurodevelopmental disorders, something must be a bit fishy.”

There are also multiple parts of “it” to consider – sensory motor exercises, academic skills tutoring, and dietary changes each would be expected to have different effects (if any). Some aspects of the program’s interventions might prove helpful to individual children. I’m all for good nutrition, academic skills tutoring, and parents spending quality time exercising with their children, for example. But there is no indication that the core theoretical basis of the program – that sensory-motor exercises will “balance” the brain and improve “functional connectivity” – has any basis in fact. That aspect of the program is based on speculation, not on credible evidence.

One parent, Natalie Hanson, chronicled her family’s experience in a blog. She wrote: “We went into it very hopeful.” “So…he’s a chiropractor. Whatever. If the program works, who cares?” Two years later she wrote: “many of you have reached out via the blog and via email for guidance about whether to pursue Brain Balance for your children. It’s so hard to hear your stories and your desperation, which (in many cases) mirrors our own.” But, “knowing what we know now, I don’t think we would do it again… The most valuable thing we’ve done is remove gluten and dairy from our kids’ diet, and get their genome mapped so that we can address underlying issues with their biochemistry through food, supplements, and ultimately medications.” Later that year she wrote: “I continue to get so many questions about Brain Balance from hopeful parents. I would just like to reiterate again that I WOULD NOT recommend investing in this program for your kids. It is extremely expensive, and the results are fleeting at best. You’re better off changing their food habits and finding other ways to address the behaviors. I know this may be unpopular for those of you looking for answers, but these programs are not what you’re looking for – what they are promising is, sadly, too good to be true.”

Dr. Harriet Hall, a retired family physician who writes about pseudoscience and questionable medical practices on the website Science-Based Medicine, wrote a critical review, saying she was initially skeptical because “miraculous results are reported (“He spoke for the first time!”),” but says the biggest red flag is that they claim their program is “clinically proven,” yet they provide mostly testimonials as evidence. Anecdotal reports do not provide evidence of the efficacy of a treatment. Dr. Hall examines the one research study then mentioned on the website in which “They speculate that ADHD is related to a “functional dysconnectivity,” hemispheric imbalance, subcortical dysfunction, a lack of temporal coherence, and a difference in arousal level between the hemispheres. They provide no evidence that these are characteristic of ADHD or were present in their subjects, or that their treatments specifically changed any of them. They assumed an underactive right hemisphere (it was not clear why) and they provided interventions that they assumed (without any supporting evidence) ought to remedy the alleged imbalance.”

When I checked the Brain Balance website for listings of research I found that several articles and a few studies are now listed. Some sound astonishingly compelling. A 2013 randomized control study (that part sounded good!) reports the “elimination of ADHD symptoms in 81% of participating children after completing a 12 week program.” As if that weren’t enough, 60% also achieved a two-grade level academic increase and 35% achieved a four grade level increase in academic skills! Sounds too good to be true, doesn’t it?

The lead author was Dr. Gary Leisman. I googled his name, and the fifth hit that shows up is a Finding of Scientific Misconduct published by the NIH in 1994. Apparently, this “authority” falsely claimed to have earned an M.D. degree he never earned, to have been a professor of neurology at Harvard Medical School (he had no such affiliation), and to have been awarded 13 U.S. Patents (he never was). Since that time, he has been working in Cuba and Israel.

Other articles include tenuous links to Brain Balance methodologies from some solid research findings. For example, the finding that children with autism have higher than normal connectivity between certain areas of the brain was extrapolated to “lend further support to the Brain Balance theory of Functional Disconnection…The Brain Balance Program combines customized sensory-motor and cognitive activities to repair the miscommunication.”

Why isn’t their more research? Well, first of all, neuroscience has moved far beyond the simple left brain/right brain dichotomy. Furthermore, the idea that diverse conditions are caused by a disconnection syndrome between the two hemispheres is preposterous enough to fail to get research funding.

Why don’t the people making money from Brain Balance programs fund some research? Melillo has argued that Brain Balance is too busy treating patients to do rigorous scientific studies. How convenient.

Can it hurt? Yes – your pocketbook.

What should parents do? Spend their time and money on treatments that are efficacious. Dietary changes, academic skills tutoring, exercise, and maybe even some sensory-motor therapy – depending on the child’s needs – provided by someone trained and licensed to provide it (a good occupational or physical therapist, for example).