Nov 18 2010

Brain Balance

I was recently interviewed for an article on Brain Balance, a franchise that promises to treat a variety of neurological disorder from autism to ADHD. Their website claims:

This proprietary, non-medical program has been successful in helping hundreds of children reach their physical, social/behavioral health and academic potential. We work with children who suffer with ADD/ADHD, Dyslexia, Tourette’s, Asperger’s and Autism Spectrum Disorders.

The program has all the red flags of a pseudoscientific clinic. First it claims there is one underlying problem for a host of separate disorders:

Called Functional Disconnection—an imbalance in the connections and function between and within the hemispheres (sides) of your child’s brain—this condition is responsible for a host of behavioral, academic, and social difficulties.

This notion takes a small slice of our understanding of brain function, completely out of context of our broader understanding, and elevates it to a position not warranted by the evidence. It then bypasses the clinical studies that would be necessary to document a specific application of this theory, and makes direct clinical claims. In short – it bypasses the long process of research, clinical studies, peer review, and replication and goes directly to a franchise.

A History of Disconnectionism

The historical context of the underlying claim is interesting, and like many pseudosciences there is a kernel of real science inside the “brain balance” paradigm. If we go back a couple hundred years, neuroscientists were engaged in a fundamental debate about brain structure and function. On the one side there were the phrenologists, who claimed that each part of the brain subsumed a specific neurological function (and further that, with use and ability, these areas would hypertrophy, expanding the overlying skull, and allowing for the “reading” of neurological function through the measurement of bumps on the skull). The other school of thought held that the brain was a homogenous and undifferentiated organ, with functions widely distributed throughout.

The phrenologists actually won this debate, and their views held sway over 19th century neuroscience. Phrenology as a practice eventually died out (it was little more than an astrological cold reading), but not until the 20th century. Looking back from the contemporary perspective, however, it is interesting that the phrenologist were on the right side of the original debate – the brain does have discrete regions with specific functions.

As part of this “localizationist” approach to neuroscience, there was added the concept that connections among specific brain regions are also important. It was recognized that the brain is an information processing organ, and therefore communication of this information is important to function. Many disorders of higher neurological function were explained as “disconnection syndromes” between various localized brain centers.

In the first half of the 20th century this view, however, fell out of favor. Localizationism and disconnectionism were viewed less and less as viable explanations for brain function and neurological disorders, and again the brain was viewed as an undifferentiated organ. Clinicopathological correlation fell out of favor as well. I am not sure, but it is possible that this may have been partly a backlash against phrenology, which was popular among clinical neurologists right up to this time and was not purged from mainstream neurology until the early 20th century.

However, it was also at least partly due to the fact that we did not have the technology to precisely map cortical function and connections. Further, the complexity of the brain frustrated attempts at consistently correlating lesions and syndromes, and this led to the somewhat nihilistic conclusion that perhaps localization was not just difficult, fundamentally impossible.

Then in the mid 20th century came a neuroscientist named Norman Geschwind. He revived the “disconnectionist” paradigm, and set neuroscience back on the path to our modern understanding. For the next thirty years brain disorders and individual deficits were explained as lesions of specific brain centers and their connections to other brain centers.

This is getting closer to the modern synthesis of neuroscience, but the history of our scientific understanding of complex systems, like the brain, is one of initial oversimplification and eventual synthesis of greater and greater complexity. In this mode Geschwind oversimplified his disconnectionist model in two primary ways: he assumed that brain areas were discrete to one function, and he explained all disorders as a consequence of decreased connectivity.

Beginning in the 1980s and through to today our understanding of brain anatomy and function has followed the Geschwind model but has become progressively deeper and more complex. In the last decade this process has been helped by technologies which allow us to better map the connecting pathways within the brain. This reveals another theme in science – how technology constrains our understanding. When we had the tools to map brain regions, we emphasized local brain region function. Now that we have the techniques to better map connections, our understanding of these connections and their role in disorders is likewise increasing.

Our current view can be summarized as follows – brain function if a product of specialized brain regions, both in the cortex and in subcortical regions that largely act as relay centers in the brain. There are multiple types of interconnections in the brain, feeding forward information, but also providing feedback connections. Connections exist both in serial and in parallel. Further, specialized regions can be further divided into subregions with further specialized functions – and in fact cortical regions are collections of subregions with related functions.

While brain regions are specialized and subspecialized, their function also depends upon the various network of connections in which they participate. A brain region may specialize in a certain type of information processing, but specific functions will depend upon the specific network of connections in which it participates.

Further, connections are made between primary sensory areas and sensory association areas, between these areas and subcortical relay areas, and between the hemispheres. The number and types of cortical pathways are many, and our knowledge of them is increasing rapidly. Our understanding of brain disorder is also increasing, and we now understand that there are not only disorder of decreased connections, but also of hyperconnectivity and hyperactivity or sensitivity of specific brain regions.

Brain Balance

With that as a context of the evolution of our understanding of brain function and dysfunction, the brain balance paradigm wants to roll back the clock of our understanding about half a century. The paradigm is that of pure disconnectionism, and further of only a very specific type – of an inbalance between the two hemispheres. This idea in itself may have some merit, and may explain certain disorders. I am not convinced that it has been established as a recognizable disorder, but it is a reasonable hypothesis.

However, it must be put into the context of the current level of complexity of our understanding of brain function. To argue that a broad range of neurological disorders all come down to one narrow subtype of one type of brain dysfunction is pseudoscience – it is good for marketing your one therapy, but not for actually helping people or understanding neuroscience.

In terms of the clinical evidence, there, is not much. I found one paper that is little more than proposing the hypothesis that autism can be explained as a disconnection syndrome between the two hemispheres. It should be noted, however, that over the last two centuries, proponents of every kind of neuroscience theory had no difficulty explaining neurological disorders within their paradigm. “Explaining” is not very compelling. Astrologers can “explain” all events within the paradigm of astrology.

There is also a study looking at: The effect of hemisphere specific remediation strategies on the academic performance outcome of children with ADD/ADHD. They found improvement in cognitive function after a 12 week program, but this study was not blinded or controlled, and so there is no way to rule out non-specific effects (training, attention, etc). Therefore this uncontrolled clinical study cannot be used as evidence to support the underlying hypothesis of hemispheric imbalance.

I also note that these two papers are both by the same group – Mellilo and Leisman from the FR Carrick Institute for Clinical Ergonomics, Rehabilitation and Applied Neuroscience. Robert Mellilo is a chiropractor, not an MD. He and the Carrick clinic promote “chiropractic neurology” (which probably deserves its own post at a later time) – which, as far as I can tell, suffers from its own “disconnection syndrome” – it is disconnected from the history and evidence of actual neuroscience. And, of course, Mellilo is the owner of Brain Balance.

So even though this one study appears in the peer-reviewed literature (via an obscure journal), it is really just an in-house uncontrolled study promoting a franchise.

Harriet Hall has more to say about this in her article on science-based medicine on the topic.

Conclusion

While presenting itself as a genuine neurological theory of disease, “brain balance”, in my opinion, is nothing more than a marketing strategy within the pseudoscience of “chiropractic neurology.” The claims are simplistic, not evidence-based, and seem blissfully unaware of the long and complex history of the relevant ideas.

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15 responses so far

15 Responses to “Brain Balance”

  1. SARAon 18 Nov 2010 at 12:11 pm

    I have some friends who’s child was recently diagnosed with Autism. The complete panic, the overwhelming feeling of inadequacy in how to proceed, the nagging guilt that it might in someway have been their fault and pain at watching and imagining their child life is pretty terrible.

    It is another example of the double edged sword of too much information.
    The internet plays on their fear. Nonsense peddlers distract them with ideas, guilt and confusion.

    Thank you for creating clarity in a world where there are far too many plausible sounding charlatans.

  2. steve jazon 18 Nov 2010 at 1:20 pm

    The author of this is from the skeptic society and the first poster sells vampire merchandise. Nice group here.

    Lets get to this blog on Brain Balance Centers. First the history is well thought out and laid out, but what did we learn? “Mainstream” thinking was dead wrong for a long time. That’s the premise that should be looked at. The writer acknowledges that it is a reasonable hypothesis and the idea has merit. He then leaves it at that and tries to go on to talk about what’s lacking.

    The thought process needs to be different. If the goal of these centers were to make money, well funded blind studies would be done before the first center was open. It would be widely published and people would be clamoring for one to open in their city. If the goal is to help kids, then when what Dr. Melillo and Dr. Leisman do when they see these great results with kids is to get people out there to work with the kids regardless of whether the studies were blind or not. That is what a practicioner does.

    Would it be great to have these studies? Of course it would, but you would not be helping kids for 5 years? 10 years? 20 years? Is that worth it? We have doctors prescribing medicine in conjunction with 1-5 other medicines without any studies on combining them. That’s OK along with protocols that only have a 20-50% chance of working while having huge costs, but a non-medical approach that’s working with a much more moderate cost isn’t? There’s something wrong with our system if that’s the case.

    I bet Brain Balance would accept if you wanted to help set up a blind study for them to take out the items you deemed to have influenced their first one.

    You’ve said this has merit and all you really want are more facts. If someone really thinks this doesn’t have merit, why don’t they challenge Brain Balance by inviting them to a blind study versus medicine, ABA(if autistic), psychologists, speech pathologist, or whichever protocols should be included. Lets get some real results to compare.

    There are those that are watchers and there are those that are doers. Stop being a watcher and become a doer. Lets make a difference.

  3. HHCon 19 Nov 2010 at 12:09 am

    Doctors, D.C., Ph.D, or M.D., Don’t tell me we have a case of assault with a White Rabbit?

  4. Skepticonon 19 Nov 2010 at 5:54 am

    My daughter has autism and I am very grateful for the many posts that touch on the subject by Steve and has helped me greatly in understanding the condition as well as charging my sceptical energy banks when presented with concepts like Brain Balance.

    I recently came across somebody else by the name of Dr Aditi Shankardass offering neurological treatment for a range of developmental problems including autism. She recently gave a talk on this method at TED which seemed to lend it some credibility.

    Her main claim is that about 50% of children diagnosed with autism are in fact suffering from what she describes as brain seizures that can be detected by EEG. She appears to have some solid credentials and sounds plausible enough but for some reason my sceptic sense is tingling, perhaps because on her website its the offer of a discount on consultations for those who have seen the TED talk. I was therefore hoping Steve might find time to take a look one day and provide an opinion.

  5. Steven Novellaon 19 Nov 2010 at 8:09 am

    jaz – If you want to be taken seriously, next time forgo the gratuitous ad hominem logical fallacy at the beginning of your comment.

    Your reaction is fairly common, but not reasonable. Essentially the defense we often get is – they are too busy treating patients to do the rigorous scientific studies that “skeptics” demand. This is not a reasonable position.

    First – the burden of proof is on those making the claims, especially since they are selling their service for thousands of dollars to often desperate parents. And there is a very good reason to do the science first – because most new ideas in medicine are wrong. Chances are what they are doing is worthless or even counterproductive. Or it may simply be no better than standard educational therapy.

    Also – you took my “has merit” comment out of context of the rest of the article. The notion of a disconnection syndrome is not ridiculous, but put into historical context it is an overly simplistic idea that is about 50 years out of date. Further, it is very unlikely to be the cause of so many different neurological disorders.

  6. imalcolmon 19 Nov 2010 at 2:52 pm

    Dr. Novella, I am extremely grateful to you for doing such a solid treatment of Brain Balance here. When I first got wind of this program, my skeptical suspicions were aroused. Ever since, I have been trying like a good skeptic to investigate the program and find out more about it. This has been something like nailing jell-o to the wall. I think your article has summarized the relationship of Brain Balance to science quite nicely.

    I do wonder who Jaz is. I have run across a number of discussions regarding Brain Balance in which people like Jaz extol the virtues of the program, refer to Robert Melillo as “Dr. Melillo,” and defend Brain Balance against criticism. The rapidity with which Jaz posted on this article is also telling, I think. Jaz, are you a Brain Balance employee or franchise owner? People who do this almost always end up having a vested interest in the program. What is your real identity?

    I think I speak for all skeptics when I say that I would welcome solid scientific evidence of Brain Balance’s efficacy. No such evidence exists now. However, Jaz seems to be of the opinion that this is the responsibility of Brain Balance critics to organize and execute. On the contrary, since Brain Balance makes the claims (and owns the big money franchise), it is incumbent on them to provide the evidence. It is not up to skeptics to do the legwork. Sorry Jaz.

  7. BillyJoe7on 19 Nov 2010 at 11:34 pm

    steve jaz

    …but what did we learn? “Mainstream” thinking was dead wrong for a long time.

    That’s right. It is self-correcting. Would you rather they stuck to being wrong?

    If the goal of these centers were to make money, well funded blind studies would be done before the first center was open.

    Who’s being naive here?

    Would it be great to have these studies? Of course it would, but you would not be helping kids for 5 years? 10 years? 20 years? Is that worth it?

    As opposed to harming them with time-consuming, costly, and useless treatments?

    I bet Brain Balance would accept if you wanted to help set up a blind study

    Lots of luck with that one.
    I take your bet and quadruple it.

    There are those that are watchers and there are those that are doers. Stop being a watcher and become a doer.

    Better still, let’s not waste our time and money and do stuff that has actually been shown to work.

  8. lizditzon 20 Nov 2010 at 10:56 am

    Dear Dr. Novella,

    Thanks for this essay. You wrote:

    “chiropractic neurology” (which probably deserves its own post at a later time)

    I wish you would do a debunking post on chiropractic neurology. Most of the websites I’ve seen advance the position that a chiropractic neurologist is the medical equal of a board-certified MD neurologist.

    In particular, I wish you’d take the time to look at the training a “chiropractic neurologist” receives — in particular the number of hours of training and the academic and clinical rigor of the programs.

    The newspaper article for which you were interviewed concludes with a quote from Jeremy Fritz, a chiropractor who is co-owner of a BrainBalance franchise.

    He acknowledged that there are no studies in peer-reviewed journals backing Brain Balance’s claims. But the centers are developing methods to track their outcomes. And he admitted that the program eventually will need to publish studies of its results in respected journals to win broader acceptance.

    “Talk to me in two years from now,” he said.

    What Melillo and his franchisees are doing is taking money from desperate and sometimes frightened parents, with no evidence at all that the treatments will have any benefit for their children. What the article failed to point out is that Melillo’s approach has been around long enough to evaluate for effectiveness.

    Melillo has been flogging Brain Balance for four years, and possibly longer, as this article from Dynamic Chiropractic shows:

    http://dcpracticeinsights.org/mpacms/dc/article.php?t=34&id=51097

    Dynamic Chiropractic – March 12, 2006, Vol. 24, Issue 06

    At the University of Bridgeport College of Chiropractic, Dr. Robert J. Melillo has been working with children in the area of neurobehavioral disorders like ADHD, dyslexia, learning disabilities, and autism for more than 10 years. He started to research the problem in 1995; at that time, the statistics showed a 250 percent increase in the use of Ritalin between 1990 and 1995. With these disturbing facts in mind, Dr. Melillo chose to devote much of his professional career toward trying to understand not only what causes ADHD and other neurobehavioral disorders, but also what can be done to correct these problems on a long-term basis, without the use of medication.

    In 2004, Dr. Melillo published a textbook titled Neurobehavioral Disorders of Childhood – An Evolutionary Perspective, which describes what he believes to be the primary neurophysiologic mechanism that produces many of the most common neurobehavioral disorders. Applying this neurophysiologic mechanism to chiropractic, he focuses on three main areas: sensory/motor systems, biomechanical/nutritional, and neuropsychological, with the main concept revolving around hemispheric balance. His belief is that most of the symptoms seen in children with ADHD can best be explained by decreased activity in one hemisphere in the brain, often caused by an imbalance in the way that postural, vestibular and occulomotor information is being sent to the brain. As a result, one hemisphere is underactive, preventing the proper synchronization of the two hemispheres, which is necessary to properly share and process information.

    From a chiropractic standpoint, an imbalance in postural muscle tone producing an observable subluxation complex may result in more gross postural disturbances, such as head tilts, which also could have central neurological consequences affecting and involving cognitive and behavioral functions.

    Dr. Melillo recognizes that each child is different and should therefore be treated specifically; however, he has made his courses and treatment approaches more protocol-driven throughout the years for teaching purposes. He has developed specific protocols that involve not only precise adjustments, but also particular nutritional-, sensory-, motor- and cognitive-based protocols as well. The key, as he sees it, is to get the doctors to start seeing results, and protocols are the best means to that end.

    A graduate education in neurology is not necessary for chiropractors wishing to take either of these new programs. The courses provide the chiropractor with all of the information necessary to treat children with ADHD and to help them feel comfortable interacting with other professionals such as teachers, occupational therapists, psychologists, and optometrists who also treat these children.

    This is just another example of the fleecing of the autism community.

  9. ChrisHon 21 Nov 2010 at 12:12 am

    Let me also echo Ms. Ditz’s request on an article on chiropractic neurology. I encountered those pushing this as legitimate often on the listserve I was on for my son’s disability.

    Not long ago I had someone claiming to know be an expert in “neurology” suggest cranial sacral therapy for my son (something that some of the chiropractic neurologists do). I told her a light head massage would not repair damage in Broca’s and Wernicke’s areas She pointedly avoided me for the rest of the workshop we were in (obviously I was a not a good “mark” for the “con”).

    And I thank you again for your article on the Doman/Delacato method you wrote close to fifteen years ago. I found it an antidote to reading Doman’s deplorable book length advertisement to his Pennsylvania institute of intensive physical therapy, along with Berneen Bratt’s book No Time for Jello (which is unfortunately out of print)>

  10. Rebekah Dekkeron 28 Nov 2010 at 12:06 pm

    Late comment, but I found a funny on their website:

    Testimonial – “It’s holistic — that’s the difference. Brain Balance is the 360 that Catherine needed.”

    Did they want a 360? Wouldn’t a 180 have been better?

  11. steve jazon 20 Dec 2010 at 2:37 pm

    I don’t agree with your thoughts on testimonials though. I had laser surgery on my eyes. Guess what they have there for you to see? A book full of testimonials. My doctor has a phd, md, and past president of society of ophthalmologists.
    Sounds like a regular doctor to me that relies on them.

    If you’re having knee, hip, or other surgery, they willingly give you people’s names to call. Who would do any of these without talking to someone who has used that person before?

  12. steve jazon 20 Dec 2010 at 2:52 pm

    You argue that the study used here is incomplete, but I don’t hear you say the same thing about drug studies. I wonder why that is. The threshold to overcome for a new ADHD drug is that it is better than nothing. How absurd is that. In order for a new drug to be approved, it should have to show a more than 10% improvement on the current drug out there with less side effects. This would also apply to an updated version of an existing drug (often times about to go off patent).

    You argue that a peer reviewed journal must be used to lend credibility. Would this be the same peer reviewed journal that one of the experts in the above mentioned article, Mina Dulcan was the editor for and falsified ADHD drug trials for the company that still pays her to this day. It was found out that the study on this particular ADHD drug caused children to commit suicide, stunt their growth, and worked worse than the placebo, but that isn’t what was published. The drug company knew about this for 10 years prior, the researchers knew about it, and the editor knew about it. Why are we supposed to trust this type of process? This is a product that can cause serious problems yet you have no issue with that. Maybe I’ve missed it, but I’ve looked through your history and haven’t come up with a drug related to ADHD or Autism that you’ve found fault with. I wonder why that is. There’s plenty of problems there.

    For example, how many multi-drug studies have been that take into account either ADHD meds or Autism meds? None. Yet when you go to the doctor, they will tell you it is just fine to take them. Just like doctors were telling mothers that taking Paxil was just fine for them even though a study out of Toronto said it could cause lung problems in newborns. Paxil fought for years until the FDA just made them change their listing requirements on their bottle last year. The study came out in 2004. It was found out that the company knew about this issue dating back before 2000. They just didn’t care.

    If you want someone to focus this rage at, it is the pharmaceutical industry. These chemicals are causing serious problems in both adults and children. Check out your local drug and alcohol treatment center. Ask them how many of their children are currently taking these meds. I did with my local one. Guess what percentage? 100%

  13. mike stantonon 31 Jan 2011 at 6:44 pm

    This nonsense has now spread to the UK. A couple in Kent have launched an appeal in their local paper to raise 30000 UKP to pay for 6 months treatment in America. They claim that they have seen more progress after three months of Brain Balance than they did after two years of other unspecified therapies. Having already spent their life savings on one visit to Atlanta I understand their desire to believe in Brain Balance. Has anyone investigated how quacktitioners are able to solicit so many glowing testimonals from the people they are ripping off?

  14. ngarberon 11 May 2012 at 10:24 pm

    I noticed Steve Novella doesn’t have an “MD” at the end of his name.

    Thesis, research, analytical studies, and reports aren’t conclusive using Scientific Method. A hypotheses has to be tested. This review would benefit us a great deal if Steve interviewed parents who’s children tried the Brain Balance program to “test” it out before drawing his conclusion.

    My ASD/ADD 18 year old son increased his academic and cognitive skills by 3 grades in 12 weeks. We’ve been dealing with his disorder a VERY long time and have NEVER experienced results like these! Due to these results, we enrolled him into the Brain Balance program another 12 weeks. Tho my husband and I were skeptical at first, the results made us believers.

    My son took pre WIAT and post WIAT tests in addition to pre and post multi sensory tests. His results showed the increase in performance on paper that we already noticed at home.

    For any parents who’s children are suffering with a learning disability, I’d encourage you to run to a Brain Balance Center for help. My son’s pediatrician, therapist, special ed teachers, teachers, home school program have not been able to achieve the results that Brain Balance did. Even my son commented on how happy he is to finally be waking up to the world he never understood before.

    Steve’s review is incomplete. He needs to give us parents who enrolled our children in Brain Balance a voice!

  15. Karen Woodruffon 16 Mar 2014 at 12:29 am

    I have searched everywhere for a reliable review on Brain Balance and have not found one. I was able to get my ADHD daughter assessed with a coupon through Living Social and then did nothing for three months. I don’t jump into $6,000 decisions so I decided to do my own live research. After stalking Brain Balance participants and finding out these testimonials are real I enrolled my daughter. To spare others from frustrating research I started a blog that details her every visit. We just started, but I already have pictures of the facility and descriptions of what they do and as I see results I will post them. I also post what other parents say. So far, I have noticed that parents of autistic children are extremely happy with Brain Balance, but parents of dyslexic children seem to have expected more from them. Here is the link to my unbiased blog: http://brainbalancereview.blogspot.com/
    Whether Brain Balance fails or works, I want everyone to know about it.

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