What They Studied
Researchers examined the effects of 3 months of Brain Balance program participation on the developmental outcomes of 4,041 children and adolescents with pre-existing developmental difficulties. The study was authored by Dr. Rebecca Jackson of Brain Balance and Dr. Joshua T. Jordan of the Department of Psychology at Dominican University of California, and was peer-reviewed by external researchers from Wilfrid Laurier University (Canada), Universidad de La Sabana (Colombia), and Universidad Isabel I de Castilla (Spain).
Participants ranged in age from 4 to 18 years (69.7% male), reflecting the demographics of families who typically seek developmental support for their children. Outcomes were measured using the Brain Balance–Multidomain Developmental Survey (BB-MDS), a parent-rated assessment covering six developmental domains. The BB-MDS has been independently validated in a separate psychometric study of 47,571 participants published in Current Psychology (Springer), confirming its factor structure, internal reliability, and measurement invariance across age and sex.
The study's core analytical approach was to stratify participants by baseline severity — mild, moderate/high, and extreme — and calculate both effect sizes (Cohen's d) and the Reliable Change Index (RCI) for each group. The RCI is a statistical method that determines whether an individual's change exceeds what could be attributed to measurement error alone, making it a more conservative measure of meaningful change than simple pre-post comparisons.
In addition to the parent-rated survey, the study assessed primitive reflex retention and sensorimotor skills before and after program participation.
What They Found
Parent-Rated Developmental Outcomes: Large to Very Large Effects
Participants showed significant improvements across all six domains of the BB-MDS from pre- to post-program. The effect sizes were large for the mild severity group (Cohen's d = 0.87), very large for the moderate/high severity group (d = 1.63), and very large for the extreme severity group (d = 2.08). In the context of behavioral intervention research, effect sizes above 0.80 are considered large; the moderate/high and extreme severity groups exceeded this threshold by a wide margin.
The pattern was consistent: children who started with the most pronounced difficulties showed the greatest degree of improvement. This is a clinically meaningful finding because it suggests the program is most effective for the children who need it most — and it addresses the common concern that parents reporting improvement may simply be experiencing regression to the mean.
Reliable Change Index: Meaningful Improvement Beyond Measurement Error
The Reliable Change Index (RCI) sets a higher bar than effect size alone — it determines whether each individual participant's change was statistically significant and not attributable to measurement noise. The percentage of participants achieving reliable change varied by baseline severity:
| Severity Group | % Achieving Reliable Change (Avg. Across All Domains) | Effect Size (Cohen's d) |
|---|---|---|
| Mild | 21.1% | 0.87 (large) |
| Moderate / High | 46.6% | 1.63 (very large) |
| Extreme | 60.1% | 2.08 (very large) |
For the extreme severity group, 60.1% of participants showed statistically reliable improvement — meaning their change was individually significant, not just a group-level statistical trend. The moderate/high group reached 46.6%, and even the mild group (where there is less room for improvement) reached 21.1%.
Six Developmental Domains: Improvement Across the Board
The BB-MDS measures six distinct developmental domains, and participants showed improvement in all six. The domains assessed were:
Negative emotionality — emotional reactivity, mood regulation, anxiety-like symptoms. Reading/writing difficulties — academic literacy challenges. Hyperactive/disruptive behavior — impulsivity, difficulty sitting still, classroom disruption. Academic disengagement — difficulty sustaining focus on schoolwork, task avoidance. Motor/coordination problems — gross and fine motor skill deficits, clumsiness. Social communication problems — difficulty reading social cues, conversational challenges, peer interaction issues.
The breadth of improvement across these domains is notable because most interventions target a single area (medication for attention, physical therapy for motor skills, social skills groups for communication). The Brain Balance program's multimodal approach addresses multiple domains simultaneously, and this study provides evidence that improvement occurs across all of them rather than in a single area at the expense of others.
Primitive Reflexes and Sensorimotor Skills
In addition to the parent-rated survey outcomes, participants demonstrated significantly diminished primitive reflexes from pre- to post-participation and significant improvements across sensorimotor skill domains including fine motor skills, gait and aerobic ability, proprioception, rhythm and timing, and eye-gaze stability. These physiological measures provide objective evidence of neurological maturation that is independent of parent ratings.
Why It Matters
The Sample Size Question
With 4,041 participants, this is by far the largest study in the Brain Balance research library and one of the largest published studies of any multimodal developmental intervention for children. The sample size makes it difficult to dismiss the results as anomalous or unrepresentative, and it provides the statistical power to analyze outcomes by severity subgroup — something that smaller studies cannot do.
The severity-stratified analysis directly addresses one of the most common objections to pre-post intervention studies: the possibility that improvement reflects natural maturation or regression to the mean rather than a genuine treatment effect. If improvement were simply regression to the mean, all severity groups would converge toward the average by a similar amount. Instead, this study found that the probability and degree of change increased as baseline severity increased — the opposite of what regression to the mean would predict.
The study also addresses the gap in published research on comprehensive multimodal programs for children. As the authors note, interventions for developmental difficulties often target single domains (physical therapy for motor skills, cognitive training for attention, behavioral therapy for conduct). Few published studies examine programs that integrate motor, sensory, cognitive, academic, and nutritional components simultaneously. This study provides evidence that a multimodal approach produces measurable improvement across multiple developmental domains, supporting the theoretical premise that developmental domains are interconnected and that deficits — and improvements — in one area can influence others.
The use of the Reliable Change Index is methodologically important. Many intervention studies report only group-level statistics (mean improvement, effect size), which can mask individual variability. The RCI answers a more specific question: "Did this individual child improve enough that we can be confident the change is real?" Reporting that 60% of the most-affected children met this threshold is a stronger claim than reporting a large average effect size alone.
Study Limitations
This study used a retrospective pre-post design without a control group, meaning improvements cannot be definitively attributed to the program versus natural maturation, placebo effects, or concurrent interventions. Outcomes were based on parent-reported measures, which may be influenced by expectations. The BB-MDS was developed by Brain Balance, though it has been independently validated in a separate peer-reviewed psychometric study. Participants' specific diagnoses (ADHD, autism, learning disabilities, etc.) were not available, limiting the ability to analyze outcomes by diagnostic group. The study did not include a long-term follow-up to assess whether improvements were sustained. Prospective randomized controlled trials with independent outcome measures and longitudinal follow-up are needed to confirm these findings.