What They Studied
Researchers evaluated whether the Brain Balance program — previously studied only in Brain Balance centers — could produce meaningful improvements when delivered on-site at a school during school hours. The study was co-authored by Dr. Rebecca Jackson, Chief Programs Officer at Brain Balance, and Dr. Ryan M. Glanz of the University of Iowa.
Twenty-six students at a private school in Mercer, Pennsylvania participated in the study. Fifteen students whose teachers had identified them as having challenges in focus, behavior, social skills, sensory processing, anxiety, or academic performance were enrolled in the Brain Balance program. Eleven non-participating students served as controls. Students in the program attended three one-hour sessions per week throughout the school year, with each session consisting of 45 minutes of sensorimotor exercises and 15 minutes of academic activities, plus home-based exercises and nutritional guidance.
The study measured three categories of outcomes before and after the program: primitive reflexes and sensorimotor skills (assessed by trained Brain Balance technicians), cognitive performance (measured by six Cambridge Brain Sciences computerized tests), and classroom behavior (rated by teachers using the Vanderbilt ADHD Diagnostic Teacher Rating Scale, a validated 35-item instrument widely used in ADHD assessment). This combination of assessor perspectives — technicians, computerized tests, and teachers — is unusual in Brain Balance research, where most prior studies relied primarily on parent-reported outcomes.
What They Found
Primitive Reflexes: Significant Reduction
Brain Balance participants showed a significant overall reduction in primitive reflex activity compared to controls (F6.01, 108.12 = 4.09, p < .001, effect size adj. η² = .185). Primitive reflexes are involuntary movement patterns from infancy that typically disappear during the first year of life; their retention beyond early childhood has been associated with neurodevelopmental difficulties, ADHD symptoms, and learning challenges in multiple prior studies.
Five of eight reflexes tested reached statistical significance individually: the Moro reflex, asymmetric tonic neck reflex, symmetric tonic neck reflex, Landau reflex, and tonic labyrinthine head reflex (all p < .005). Three additional reflexes (palmar, rooting, and spinal galant) showed improvement but did not reach significance.
Sensorimotor Skills: Significant Improvement Across All Six Domains
Brain Balance participants scored significantly higher across all six sensorimotor tasks compared to controls (F5, 100 = 13.65, p < .001, effect size adj. η² = .406 — a large effect). The six domains measured were the vestibulo-ocular reflex, gait and aerobic ability, fine motor skills, proprioception (balance and body awareness), dichotic listening (auditory processing), and rhythm/timing using the Interactive Metronome.
| Sensorimotor Task | BB Group Change | Control Change | Significance |
|---|---|---|---|
| Vestibulo-ocular reflex | +8.99 | +0.12 | p < .001 |
| Gait and aerobic ability | +5.30 | −0.19 | p < .001 |
| Fine motor skills | +4.07 | +0.70 | p < .001 |
| Proprioception | +3.90 | +0.23 | p < .001 |
| Dichotic listening | +2.49 | +0.37 | p = .010 |
| Interactive metronome | +2.02 | +0.28 | p = .009 |
The four tasks showing the largest improvements — vestibulo-ocular reflex, gait, fine motor, and proprioception — all rely on real-time feedback from the body's proprioceptive and vestibular systems. The researchers noted this pattern suggests the program particularly strengthens internal feedback mechanisms critical for voluntary movement control.
Teacher-Rated Classroom Behavior: Significant Improvement
Teachers reported significantly improved behavior in Brain Balance participants compared to controls on the Vanderbilt ADHD Diagnostic Teacher Rating Scale (F2.59, 49.11 = 9.60, p < .001, effect size adj. η² = .336). This instrument measures five subtypes of concern: inattention, hyperactivity/impulsivity, combined ADHD symptoms, oppositional/conduct disorders, and anxiety/depression.
| VADTRS Subtype | BB Change (Mean) | Control Change (Mean) | Significance |
|---|---|---|---|
| Combined (Inattention + Hyperactivity) | −7.71 | −1.64 | p = .003 |
| Inattention | −4.54 | −0.76 | p < .001 |
| Hyperactivity / Impulsivity | −3.18 | −0.89 | p = .076 |
| Oppositional / Conduct Disorders | −0.28 | −0.46 | p = .644 |
| Anxiety / Depression | −0.72 | −1.14 | p = .678 |
The strongest effects were in inattention and the combined ADHD subtype, indicating improved ability to sustain attention, follow verbal instructions, ignore distracting stimuli, and complete schoolwork on time — precisely the behaviors most disruptive to classroom learning.
Cognitive Performance: Improved but Not Statistically Significant
Brain Balance participants improved accuracy on all six Cambridge Brain Sciences cognitive tests and showed faster reaction times on four of the tests, compared to controls who improved on only two tests. However, these differences did not reach statistical significance (p = .080 for accuracy; p = .406 for reaction time).
The researchers' power analysis confirmed the study was underpowered for the cognitive outcome measures (statistical power ß = .50 for accuracy, ß = .20 for reaction time), meaning the sample size was too small to detect the cognitive effects that have been observed in larger Brain Balance studies. The trend toward improvement, combined with significant cognitive effects in previous Brain Balance research with larger samples (N=478 in the Cambridge Brain Sciences study, N=16,330 in the at-home cognitive outcomes study), suggests that cognitive gains may emerge with a larger study population.
Why It Matters
A Different Kind of Evidence
This study is unique in the Brain Balance research library for three reasons. First, it was conducted in a school rather than a Brain Balance center, demonstrating that the program can be implemented in an educational setting during school hours. Second, the behavioral outcome data came from teacher ratings rather than parent ratings — addressing the reasonable question of whether parent-reported improvements might reflect expectations rather than observable change. Third, it measured primitive reflex integration, providing a physiological marker of neurological maturation alongside behavioral outcomes.
The COVID-19 pandemic significantly increased the academic and mental health needs of students while simultaneously creating staffing shortages that left many schools unable to assess and support struggling children. The authors note that partnerships between schools and community-based providers may help fill these service gaps, particularly for schools unable to offer comprehensive occupational therapy, speech-language services, behavioral interventions, and mental health counseling on their own.
The teacher-rated improvements on the Vanderbilt scale are particularly relevant because the VADTRS contains all ADHD diagnostic criteria from the DSM-IV and is widely used as a clinical screening tool. Teachers who completed the ratings were observing students in the natural classroom environment over an extended period — a context that is difficult to replicate in a clinical assessment setting.
The reduction in primitive reflexes is a physiological finding that does not depend on subjective reporting. Retained primitive reflexes have been documented in peer-reviewed research as associated with ADHD symptoms, delayed motor development, reading deficits, and learning difficulties, making their integration a meaningful developmental marker.
Study Limitations
This was a small pilot study (15 Brain Balance participants, 11 controls) conducted at a single school, and participants were not randomly assigned to groups — parents chose whether their child would participate. The control group was a convenience sample rather than a matched comparison group. The study was statistically underpowered for cognitive outcome measures. The study did not assess whether improvements transferred to academic performance on standardized tests. The authors also note that participation costs raise equity concerns; future studies should explore funding models that remove financial barriers. Larger randomized studies across multiple school settings are needed to confirm these preliminary findings.