Approved pharmacological preparations for the treatment of 
Attention Deficit Hyperactive Disorder (ADHD) are not 
readily available in most low and middle-income countries. 
There is a growing body of alternative non-pharmacological 
interventions based on neuroplasticity that may address this 
treatment gap.  
Balance Auditory Vision Integration 
Exercises (Bal-A-Vis-X) are based on a series of gradually 
complex but modifiable rhythmic movements using sand 
bags and racquetballs. Sustained attention is demanded for 
the smooth execution of the exercises. The outcome of using 
Bal-A-Vis-X in children with a Diagnostic Statistical 
Manual (DSMV) diagnosis of ADHD is described. 
Methods: Parents of 18 children with a clinical diagnosis of 
ADHD referred to a psychiatrist were offered Bal-A-Vis-X, 
methylphenidate or both, over a 6-week period. Eleven 
opted for Bal-A-Vis-X, 4 decided on oral methylphenidate, 
and 3 requested both methylphenidate and Bal-A-Vis-X. 
Our primary outcome measure was duration of sustained 
attention after the 6-week period. Secondary outcome 
measures included a theta to beta ratio as measured by an 
Electroencephalogram (EEG).  
Results: After 6 weeks of Bal-A-Vis-X, sustained attention 
increased by more than 15 minutes in 9 of 11 children who  received the Bal-A-Vis-X. Duration of sustained 
rhythmic movements measured in minutes during Bal-A
Vis-X appeared to predict global improvement in 
schoolwork. 
Conclusion: Bal-A-Vis-X has the potential of reaching 
out and making a difference to thousands of children in 
Africa who have no access to medication for ADHD. 
There is need for adequately powered double-blinded 
randomized controlled trials aimed at establishing the 
efficacy and cost effectiveness of this promising 
technique.