The Washington PostDemocracy Dies in Darkness

Betsy DeVos has invested millions in this ‘brain training’ company. So I checked it out.

At a clinic in Florida, I found that Neurocore seems to be promising more than it can deliver.

Tomasz Walenta for The Washington Post
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A TECHNICIAN SNAPPED a stretchy electrode cap onto my head, and I felt a cold pinch as she affixed each sensor to my scalp with a dose of icy gel. Perched on an office chair, with a rainbow of wires spiraling from my head, I followed the tech’s instructions to stare at a small orange object while an EEG recording device measured the electrical activity in various regions of my brain.

I was checking out the Palm Beach Gardens, Fla., branch of Neurocore, a “brain performance” company owned by the family of Education Secretary Betsy DeVos. DeVos resigned her Neurocore board seat when she joined the Trump Cabinet, but she and her husband maintain a financial stake of between $5 million and $25 million, according to a financial disclosure statement filed with the Office of Government Ethics. The DeVoses’ private-equity firm, Windquest, identifies Neurocore as part of its “corporate family.” The Windquest website posts Neurocore news and includes links for job seekers to apply to Neurocore openings.

In other words, the family has a lot riding on Neurocore’s claims that it can help you “train your brain to function better” — addressing problems as diverse as attention-deficit/hyperactivity disorder, autism, anxiety, stress, depression, poor sleep, memory loss and migraines. “Unlike medication, which temporarily masks your symptoms, neurofeedback promotes healthy changes in your brain to provide you with a lasting solution,” touts a Neurocore overview video. “. . . We’ve helped thousands of people strengthen their brain to achieve a happy, healthier, more productive life for years to come.” The company currently has nine offices in Michigan and Florida, though there’s been talk of making a national move.

When the DeVos-Neurocore connection made headlines during her confirmation hearings, I was skeptical of the company’s claims. I had come across brain training while working on a book, “Learn Better,” about the science of learning. The field is rife with vague and overblown promises. Last year, the creators of Lumosity paid a $2 million fine to the Federal Trade Commission to settle a complaint that they deceptively advertised that their memory exercises could improve everyday performance and stave off memory loss.

Neurocore hasn’t been subject to any federal complaints, chief executive Mark Murrison told me. But my impression was that the company’s premise runs counter to an immense body of research suggesting that the human brain isn’t all that trainable. Study upon study has failed to support a game or a tool that can boost intellectual RAM.

So what is our education secretary doing investing millions in a brain performance firm? I couldn’t find any public remarks by DeVos about Neurocore or brain training. Her spokesman at the Department of Education did not respond to my requests for comment. But in January, Neurocore’s chief medical officer, Majid Fotuhi, asserted to the New York Times that “Betsy DeVos really believes in improving brain performance and helping children who have syndromes such as attention deficit disorder.”

I wanted to understand what Neurocore was about.

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ON A SUNNY MORNING last month, I found the Palm Beach Gardens Neurocore center in a high-end strip mall, a few steps from a raw juice bar, a sleek exercise studio and a salon dedicated to blowouts.

A Neurocore receptionist greeted me for my scheduled appointment and had me fill out a survey asking about my sleep, concentration and social interactions. Do I wake up in the middle of the night? How often do I get into arguments? That sort of thing. (When I signed up for the evaluation, I listed my profession as “author.” My employer, the admittedly left-leaning think tank Center for American Progress, paid for my trip to Florida and the $250 evaluation.)

Next, a “client advocate” wearing a corporate-issued orange shirt and khakis led me into a small office and set me up with a computer-based assessment of attention and impulse control. I had to click whenever I heard or saw the number 1 and avoid reacting whenever I heard or saw a 2. It was boring, by design.

After that came tests of my blood pressure, heart rate variability and breathing patterns. Then the EEG, which was supposed to assess whether my neural activity was too high (which can indicate stress and anxiety) or too low (which can indicate drowsiness and inattention).

It was while I waited for my results that I got to peek at the inner sanctum of Neurocore: the training room.

It looked a bit like a private movie theater — dark, with cushy, high-backed chairs. I could see clients wearing headsets and sensors while watching films on personal screens. One movie starred Jim Carrey. Another featured Chris Pratt.

Neurocore training relies on a combination of two biofeedback strategies. The approach the company emphasizes — neurofeedback — seeks to help people “optimize” the electrical impulses of their brains; the second approach aims to slow their breathing rate and steady their heart rate. As a technician explained it to me: When the brain sensors indicate too much or too little activity during a training session, the film will pause, and you have to shift your brain activity — by trying to relax or make yourself more alert — to start the film again. Similarly, if you start to breathe too fast or your breathing rate fluctuates, the movie screen size will shrink. I watched one woman’s movie decrease from full-screen mode down to about the size of a cellphone before she coached it back to normal again.

Eventually, I met with Rachel Martin, a Neurocore clinical specialist with a master’s in social work. Martin is one of the co-authors of a study conducted by Neurocore and published in the latest issue of the journal NeuroRegulation. She said she was in Palm Beach Gardens to help get the relatively new branch going.

In a room with blank walls save for a large flat-screen monitor, Martin presented a printout of my results.

The first page featured a pie chart based on my self-reported sleep data. My “overall sleep quality” was at 52 percent, the chart said. As Martin characterized it, there were “opportunities for improvement.”

“So you’re saying it’s bad?” I asked.

“I’ve worked in a lot of customer service jobs,” she told me. They “never use the word ‘bad.’ ”

A few pages later, I was in the red on charts for blood pressure and heart rate variability, tagging me as hypertensive and at high risk for stress-induced diseases. That was something of a surprise, since my doctor typically declares me to be pretty healthy. But my Neurocore visit came at a time of anguish: My father had died a week earlier. Maybe the tests picked up on my grief?

As we continued through the results, Martin noted that I had a deficit when it came to focus, vigilance and attention.

“So does this mean that I have ADHD?” I asked. For as long as I can remember, I’ve had the attention span of a cocker spaniel, and I spent some time in special education as a boy. In other words, an ADHD diagnosis would not have been an eye-opener.

Martin avoided a formal diagnosis. But she pointed to regions of the brain associated with attention, noting that my brain had performed weakly in those areas.

She recommended a brain training package of 30 twice-a-week sessions of 45 minutes each. At Neurocore, that would carry a price tag of more than $2,000. Since Martin knew that I lived in D.C., she recommended some other neurofeedback centers in Washington. (Like many insurers, my carrier, CareFirst, does not cover neurofeedback.)

If I engaged in Neurocore-style treatment, Martin said, “my guess is that it would be easier for you to process things. If you had a big stack of papers or articles, you could get through them faster.”

“Really?” I asked.

Martin nodded. “It will make your thinking clearer. You’ll solve problems more easily,” she said. “You’ll have less of that ‘brain fog.’ ”

They don’t recommend everyone they assess for treatment, Murrison, the chief executive, later told me. “If people’s brains look solid, we tell them they look solid,” he said. But the “great majority” of people who come into their offices can benefit, he added. People are looking for “brain tune-ups.”

I could understand the appeal. Who doesn’t want to be able to process things faster? Think more clearly? Solve problems with less effort?

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Neurocore promises to increase your “brain balance” and treat everything from ADHD to autism. And one of its biggest investors happens to be Betsy DeVos. (Video: Adriana Usero/The Washington Post)

A FEW DAYS LATER, I shared my Neurocore results with Russell Barkley, a psychiatry professor at Virginia Commonwealth University and a specialist in ADHD.

Barkley was blunt. “We do NOT recommend [EEG] tests be used for diagnostic purposes,” he wrote in a follow-up email. “Their level of imprecision and even inaccuracy in diagnosis is too problematic to do so.”

For one thing, it’s hard to establish a useful baseline. “The clinician doesn’t know if you are sleep-deprived,” Barkley said. “The clinician doesn’t know if you had two or three cocktails the night before.”

It’s also not totally clear that unusually slow or fast brain activity is a symptom of a disorder. It could be a sign of your brain compensating for something — maybe a past injury — and so trying to get your neural activity to look more “normal” could actually make your brain function worse.

Barkley was even less kind toward neurofeedback as a way to boost overall attention. While he conceded that people can influence their brain activity through dedicated training — there’s fairly robust science on that — he didn’t think that training would produce meaningful changes, and certainly would not cure something like ADHD. “I can train you to tighten your sphincter muscles. So what?” Barkley told me. “That might be just as good for stress.”

To support its approach, Neurocore cites a bevy of studies. But as I dug into this research, I found that a good number of them weren’t much higher in quality than a high school science experiment.

In March, a team of Neurocore staffers, including Martin, published the first study of their therapy regimen in NeuroRegulation, a peer-reviewed journal associated with the International Society of Neurofeedback and Research. “Peer-reviewed,” in this case, might suggest more authority than the journal deserves. Its editor, Rex Cannon, is himself involved in the brain training business, developing neurofeedback protocols for outlets in South Florida. The journal once published research that found dark chocolate can boost attention — research sponsored by Hershey’s.

The Neurocore study concludes that 82.8 percent of clients with symptoms of anxiety and 81.1 percent of clients with symptoms of depression saw “improvements of clinical importance.” Even more impressive, the majority of those who initially came in seeming anxious or depressed could be considered “normal” after treatment.

This was far from gold- or even bronze-standard research, though. For the study, Neurocore examined the files of past clients, meaning staffers would have told the study subjects about their baseline results and how training was supposed to help them, just as in my experience. The authors also did not separate the effects of neurofeedback vs. heart rate variability training, so there’s no way to know if neurofeedback alone would have done anything. And the improvement of clients’ depression and anxiety was measured in terms of self-reported symptoms. It seems likely that people who had just dropped $2,000 on a treatment would want to note that they had improved in some way.

If that wasn’t dubious enough, there was no control group to establish how the Neurocore regime compared with placebo treatments or the current standards of care for depression or anxiety. This makes it hard to say the approach actually helped anyone. “These results don’t necessarily imply that feedback or training improves outcomes,” Ryan Moore, an expert in research methods at American University, wrote in an email. “Maybe the participants would have improved naturally over time. Maybe they would have improved just by virtue of making 30 visits to a center and having 30 friendly chats with center staff.”

I asked Neurocore’s Murrison why the study didn’t rely on commonly accepted scientific methods, such as using a control group. He brushed off my concerns. “This would not pass the muster of higher-level clinical studies — that’s not the intent,” Murrison said. “We are not a research firm. We are trying to demonstrate how well we are providing our services to our clients.”

There are similar problems with some of the third-party studies Neurocore cites. Another seemingly impressive investigation suggests that brain training interventions might increase IQ by an average of 12 points. But that study is almost 20 years old, had no control group and included only 55 subjects.

The seven studies cited on the company’s website that supposedly show that its approach will cure depression and anxiety? Two of the studies didn’t actually look at neurofeedback, the company’s selling point. Instead, they examined the relationship between heart rate and depression. Another four had fewer than two dozen participants.

While some early evaluations of neurofeedback uncovered positive results, more recent research, using more rigorous methods, has shown little to no effects. A meta-analysis of 13 different neurofeedback studies with more than 500 subjects published last year in the Journal of the American Academy of Child and Adolescent Psychiatry concludes, “Evidence from well-controlled trials with probably blinded outcomes currently fails to support neurofeedback as an effective treatment for ADHD.”

When I asked Neurocore’s Martin if the company is promising more than the current science supports, she replied, “Although we are confident in the high standard of care we provide, we are also very careful not to overpromise.” She also noted that some of the authors of that recent meta-analysis had received speaking fees or research support from pharmaceutical companies that make ADHD drugs.

To be clear, the science on neurofeedback is far from final. Large, rigorous, long-term studies could still show that brain training is an effective way to treat some of the conditions Neurocore is targeting, such as attention and anxiety issues. Maybe Neurocore’s methods will even be shown to boost overall cognitive horsepower. As Stanford University psychiatrist Matthew Sacchet wrote to me via email, “The scientific community has definitely not reached consensus on the utility of neurofeedback.”

But right now, mainstream medical organizations are steering clear. Mark Wolraich, director of the Child Study Center at the University of Oklahoma Health Sciences Center, reviewed the research for the American Academy of Pediatrics in 2011, and he told me that “there was not sufficient evidence for the AAP to endorse neurofeedback.”

What Neurocore and similar operations are doing, then, is simply misusing science. By making claims based on flimsy research, they’re misleading people.

Just as disconcerting, many brain training firms actively dismiss high-quality interventions as weak or misguided. Recall that line in the Neurocore video: “Unlike medication, which temporarily masks your symptoms, neurofeedback promotes healthy changes in your brain to provide you with a lasting solution.” Neurocore founder Tim Royer once tweeted, “#Meds keep us from fixing the real problem” and compared using them to responding to an engine malfunction with duct tape. The company sets up its recent study by stating that many people with anxiety or depression “do not gain satisfactory results from pharmaceutical approaches . . . which furthermore cause substantial side effects.”

But this view discounts interventions that have been proved to work. There’s a rich literature supporting medications for people with depression or ADHD, and strategies such as cognitive behavioral therapy have shown positive effects in many studies of anxiety. Beneficial interventions don’t have to involve drugs or doctors, either — exercise has demonstrated itself to be very helpful for anxiety and depression. (Unsurprisingly, most insurance companies cover well-validated approaches, making them far less pricey options.)

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SO WHAT DOES IT SAY that our education secretary is backing Neurocore?

For one, it seems that feeble science doesn’t bother DeVos. The budget document released by her department on Tuesday emphasizes that education decisions should be informed by “reliable data, strong research, and rigorous evaluations.” But like her boss, President Trump, DeVos apparently isn’t one to let evidence get in the way of what she wants to do. A recent study of school vouchers by DeVos’s agency showed that one program dragged down math scores by as much as seven points. Still, DeVos champions voucher programs, dismissing her opponents this past week as “flat-earthers.”

We don’t yet have any indication that DeVos intends to introduce neurofeedback into the nation’s public schools. But her enormous investment in Neurocore is ethically inappropriate. It means she has a financial stake in a particular approach to education. Some brain training companies promote themselves specifically for the classroom, and a few K-12 schools have begun partnering with brain training companies. Oaks Christian School in California provides neurofeedback with the help of an outside vendor, and Universal Academy in Dallas recently signed a contract with the firm C8 Sciences (which promises that it “can close the achievement gap in low performing schools and enhance focus, memory, and self-control to greatly improve academic outcomes!”). For his part, Murrison denies that Neurocore has any plan to go into schools. But the company’s marketing clearly targets children — and their distressed parents.

And certainly the DeVos family has used its connections before to open doors for Neurocore. DeVos’s father-in-law owns the Orlando Magic, and the basketball team has hired a division of Neurocore “to reach performance levels not previously achieved,” according to the company. Quarterback Kirk Cousins’s brother works for Neurocore, and the Washington football player swears by neurofeedback. “I see brain training as being that next thing, the next frontier,” he says on one of the company’s promotional pages.

At the very least, DeVos appears to be dangerously naive about what it takes to help people learn — especially children with special needs.

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Brain training companies use the veneer of science to promise effortless fixes. In the case of Neurocore, the firm claims that the intervention is “easy,” just a matter of watching TV in its offices a couple of times a week. Other companies peddle games, promising that some online diversions can boost intellect.

But as I wrote in my book on the science of learning, gaining expertise of any kind is difficult. Indeed, some researchers, such as psychologist Lisa Son, believe that more difficult forms of learning are better forms of learning. This explains why quizzing yourself has been shown to be far more effective than re-reading at helping people understand and retain information: It makes the learning experience a little more strenuous.

The same is true for treating cognitive disorders such as ADHD or anxiety: Interventions that work typically cause some personal strain. Effective treatments are often emotionally difficult (like talk therapy), require a lot of personal investment (like behavior modification), come with uncomfortable side effects (like Ritalin) or simply take time (like working out). This makes promises of “fun” and “easy” solutions seem tone-deaf at best, cruel at worst.

Still, scared and anguished parents, hunting for hope, will open their wallets, even if an approach has little scientific support. “A lot of times in autism, families are so desperate for an answer, they literally will take a website as evidence” for a treatment, Tom Frazier, chief science officer for Autism Speaks, told me. “It’s very concerning.”

In his book “Autism’s False Prophets,” pediatrician Paul Offit goes further, pointing out that unproven claims do more than fritter away time and money. They can injure both the healthy and the already sick. “The false alarm about vaccines and autism continues to harm a lot of children,” Offit writes. “Harm from not getting needed vaccines, harm from potentially dangerous treatments to eliminate mercury, and harm from therapies as absurd as testosterone ablation and electric shock.”

I’ll admit that before I stepped into Neurocore, I had little intention of signing up for the company’s treatment. I had read too many articles skeptical of brain training to think that I should pay for its services. But it took talking to experts and a visit to Florida to discover that the firm was also hurtful — a Trump University for people with cognitive struggles. By wrapping weak science in sleek packaging, by promising something that it cannot fully deliver, Neurocore offers false hope to people who need honest help. In this regard, what’s most remarkable is that DeVos, the nation’s foremost pedagogue, is behind it all, promoting a form of education that doesn’t actually seem to educate.