Accessibility to developmental interventions for children and adolescents could be increased through virtual, at home delivery of home based training programs incorporating technology. Virtual childhood training programs and their effects on cognitive outcomes in children and adolescents with developmental delays have not been well studied. To that end, this study examined the effects of the virtual at-home Brain Balance (BB) program on the cognitive task performance of children and adolescents with baseline developmental and attentional difficulties (aged 4-17 years). The at-home BB program is delivered through: (1) a computer based format utilizing multimodal program activities previously studied in-center (multisensory stimulation with gross motor, coordination, balance, and timing activities, along with nutritional recommendations); and (2) the BB app (visual motor, auditory and visual processing, and rhythm and timing training), creating a comprehensive program experience delivered remotely. Cognitive performance was measured by six online cognitive assessments from Creyos Health before and after 3 months of participation in the at-home BB program (N = 316) or in-center BB program (N = 4,232), compared to controls. Results showed that overall cognitive assessment scores (including attention, response inhibition, and working memory) improved after participation in either the at-home or the in-center program, compared to controls. Importantly, significant improvements over the controls were observed for two tasks, Double Trouble and Feature Match, in both programs. Further, two analyses support that the effects on cognitive performance from either delivery format, in-center or at home, are comparable in magnitude. This research: (1) presents new findings demonstrating improved cognitive performance after 3 months of the at-home BB program; (2) replicates previous findings of cognitive improvements after 3 months of the in-center BB program; and (3) suggests that the cognitive effects of virtual at-home BB training are similar to those observed for in-center BB training. Overall, the results demonstrate the effectiveness of the at-home BB program in improving cognitive functioning in pediatric populations with preexisting developmental and attentional difficulties. With virtual delivery and ease of use, at-home programs have the potential to increase access to much-needed developmental and cognitive support, ultimately reaching populations that may otherwise lack easy access to high-quality, evidence-based developmental programs.

R. Jackson is an employee of Brain Balance Achievement Centers but has no financial stake in the outcome of this study or in the publication of the results. Y. Meng was hired as a contractor for statistical analyses and interpretation of the data for this paper, and has no financial stake in the outcome of this study or in the publication of the results.

No external funding was received for this study.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Ethics Committee/IRB of Advarra waived ethical approval for this work citing "Using the Department of Health and Human Services regulations found at 45 CFR 46.104(d)(4), the IRB determined that your research project is exempt from IRB oversight."

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors.