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.