by Steven Novella, MD
The line which sharply demarcates mainstream medicine from alternative medicine is the line of science. It is possible to cross that line, however. Any alternative treatment which is tested in a rigorous scientific manner and found to be safe and effective, will be incorporated into mainstream medicine, it will have crossed the line. A therapy, on the other hand, which begins within the halls of mainstream medicine as a legitimate proposal, and is found, when tested scientifically, to be of no real value, will be discarded. Most such discarded therapies are destined to become forgotten footnotes in the annals of medical research. Some, however, are salvaged by practitioners of alternative medicine. These therapies have crossed the line in the other direction, descending from science into pseudoscience.
The method of psychomotor patterning for the treatment of mental deficiencies is one such therapy. It began 30 years ago as a legitimate, if incorrect, scientific concept for a new treatment modality for mental retardation, brain injury, learning disabilities, and other cognitive maladies. The method was subjected to controlled trials and found to be of no value. It was debated in the scientific literature up until the early 1970′s, when finally the medical community arrived at the consensus that patterning should be discarded as a false concept with no therapeutic role. Use of the techniques of patterning, however, has not died, as we will see.
The concept of patterning was invented by Glenn Doman and C. Delacato in the 1960′s, and is therefore often referred to as the Doman-Delacato technique.1 Their theories are primarily an extension of the older concept that ontogeny (the stages through which organisms develop from single cell to maturity) recapitulates phylogeny (the evolutionary history of the species). Therefore, the neurodevelopmental stages of crawling, creeping, crude walking, and mature walking through which normal children develop is directly related to the amphibian, reptilian, and mammalian evolutionary human ancestors. 2
Doman and Delacato’s concept of mental retardation is that of failure of the individual to develop through the proper phylogenetic stages. Their treatment modality is therefore designed to stimulate the proper development of these stages, each of which must be mastered before progress can be made to the next stage. This stimulation is achieved through the method known as patterning.
The patterning treatment involves the patient moving repeatedly in the manner of the current stage. In the “homolateral crawling” stage, for instance, the patient crawls by turning his head to one side while flexing the arm and leg of that side and extending the arm and leg of the opposite side. For patients who are unable to execute this exercise by themselves, they are passively moved in this manner by 4-5 adults, alternating back and forth in a smooth manner. This must be repeated for at least 5 minutes 4 times per day. The purpose of this exercise is to impose the proper “pattern” onto the central nervous system. In the full treatment program, the exercises are combined with sensory stimulation, breathing exercises which are designed to increase oxygen flow to the brain, and a program of restriction and facilitation designed to promote hemispheric dominance. 3
The claim made for the technique by Doman, Delacato and their supporters is that, with this treatment method, mentally retarded and brain injured children can achieve improved, and even normal, development in the areas of visuo-spatial tasks, motor coordination, social skills, and intellect. They have also expanded these claims to include the idea that their techniques can promote superior development in a normal child. 4
The theoretical basis of psychomotor patterning is therefore based on two primary principles, the recapitulationist theory of ontogeny and phylogeny, and the belief that passive movements can influence the development and structure of the brain. Delacato himself writes “Man has evolved phylogenetically in a known pattern. The ontogenetic development of normal humans in general recapitulates that phylogenetic process. We have been able to take children who deviate from normal development (severe brain injured) and through the extrinsic imposition of normal patterns of movement and behavior have been able to neurologically organize them sufficiently so that they can be placed within a human developmental pattern of crawling, creeping, and walking.” 3
Medical treatments are evaluated on two criteria, their theoretical basis and their empirical value. Patterning has been rejected by the scientific community on both accounts. The theory of recapitulation has never been fully accepted, and even by the 1960′s had been all but discarded by evolutionary and biological scientists.
The essential flaw in the theory of recapitulation is that it is based on an incorrect linear concept of evolution. Evolutionary lines continuously branch and deviate, forming a complex bush of relationships, not a linear ladder of descent. Embryological development does not reflect the mature stages of other distant branches of this evolutionary bush. Studying the embryology of the developing fetus also does not reveal any evidence of successive stages reflecting past evolutionary ancestors.
There is also no theoretical basis for the belief that patterns can be impressed upon the developing cortex. Brain development is genetically driven and involves a complex sequence of cell growth, migration, organization, and even programmed cell death. Abnormalities in this process can be caused by genetic flaws, toxic insults, infection, or biochemical abnormalities. There is no model by which any of these disparate causes can be influenced by passive, or even active, movement of the neck and limbs. Thirty years of subsequent neurological, embryological, and medical progress have failed to lend any theoretical support for Doman and Delacato’s principles.
Their practice of using breathing exercises to promote oxygen delivery to the brain also lacks an accepted theoretical basis. The brain and the cardiovascular system are designed to give highest priority to oxygen flow to the brain cells. Elaborate and powerful feedback mechanisms ensure adequate delivery. It is true that carbon dioxide retention, in this case achieved through breathing techniques, does increase blood flow to the brain. There is absolutely no reason to believe, however, that such increased flow is at all helpful to the developing brain.
Despite the fact that patterning is theoretically bankrupt, if empirical evidence existed which demonstrated that patterning improves neurological development, it would be accepted and used. There are many mainstream interventions which are employed in modern medicine that lack a fully understood theoretical basis. Physicians are, at their heart, practical individuals, and if something works, it works. They require proof, however, that an intervention does indeed work and is safe.
On this score, patterning has just not delivered. Over a period of approximately ten years in the late 60′s and early 70′s there were dozens of clinical trials comparing improvement in groups of developmentally delayed children given patterning treatment compared to controls who were given no treatment but similar amounts of attention. 2,5-7 Although most of the studies had significant methodological flaws, some were fairly well designed. None were perfect. More importantly, none confirmed the claims of Doman and Delacato. Some of the studies did show modest improvement in motor skills or visuo-spatial skills over controls. None showed improved intellectual development. The few positive results found were not impressive or reproducible. Eventually, such clinical trials stopped, as the technique was abandoned as a blind alley. This point marked the unequivocal crossing over of patterning from science to pseudoscience.
The tragedy of this story does not stem from the fact that patterning is a failed theory. It is regrettable that patterning did not deliver as promised, for any legitimate treatment for brain injured and retarded children would be most welcome. The real tragedy began, however, when Doman and Delacato released their claims for a new dramatic treatment before their theories had been scientifically validated.
This behavior, reminiscent of the cold fusion fiasco, is more than just professionally irresponsible. In physics, such behavior is merely bad form; when dealing with the desperate parents of brain injured children, it can be considered cruel. Doman and Delacato were widely criticized for publicizing their unsubstantiated claims, giving false hope to vulnerable parents and their afflicted children.
The saga, however, did not end with the scientific death of patterning. Doman, Delacato and their associates began incorporating the patterning technique into their Institutes for the Achievement of Human Potential (IAHP), which was established in Philadelphia in the 1950′s. They continued to advertise and use patterning uninterrupted right through the scientific controversy, past the scientific condemnation, and on into the present day.
I was also able to locate one other institution, the National Academy of Child Development (NACD), located in Huntsville, Utah, that offers patterning as part of their treatment program. The NACD is run by Robert Doman, the nephew of Glenn Doman, although both institutions are eager to point out that there is currently no association between the two.
On August 8, 1996, NBC aired a program titled “Miracle Babies”, hosted by Kathy Lee Gifford. The program included a segment portraying an apparent “miracle cure” of a child suffering from moderate mental retardation. As is all too typical of the lay press, Kathy Lee provided an emotionally appealing yet completely uncritical presentation of the patterning technique, touting its virtues without even a hint of skepticism. There was no evidence that NBC did any investigative reporting into the background and validity of the intervention they were promoting on their program.
The segment did bring out, however, even if for the wrong reasons, the desperateness of the parents. They were clearly devastated, as any parents would be, by the need to finally accept that their child was not developing normally. In their desperation, they sought any possible hope, and it was offered to them by the IAHP. The hope that they purchased, however, came at a heavy price, both financial and emotional.
Both the IAHP and the NACD rely heavily on the family as the primary deliverers of the patterning treatment method. In order to even reach the stage where their child can be enrolled into the aggressive treatment program, they must first complete a training and evaluation course which begin for both institutions with purchasing and listening to a set of audio tapes. The IAHP states in their literature that only the most dedicated and capable parents will make it to the final stage of treatment. The NACD appears less demanding, but they follow the same principle.
The end result is that the parents and other family members of the patient must alter their lives to institute a daily program of patterning exercises, breathing exercises, and programs of sensory stimulation. The mother interviewed by Kathy Lee stated that the program was so demanding that it dominated her life, resulting in emotional and physical exhaustion. The exceptional demands of the patterning method is the primary reason cited in the medical literature for caution in evaluating patterning, for the obvious harm that would ensue if the method were recommended prematurely, without good proof that it is effective.
The program also illuminated another important feature of the patterning phenomenon, the difference between anecdotal and scientific evaluation of its effectiveness. One important fact to understand is that most children, even severely mentally retarded children, still grow and develop, although on a slower curve than average. Therefore, any child admitted into any treatment program will make some progress as an inevitable consequence of time and their natural development, even if that treatment program is completely worthless. Without adequate controls, it is therefore impossible to evaluate any such treatment. Of course, Kathy Lee and the parents of the child on the program reported remarkable progress. Whether or not the treatments played any role, however, cannot be known. The viewers, however, were meant to come away with the sense that they had witnessed a miracle cure.
The NACD and IAHP literature both caution that individual results will vary. By emphasizing the need for dedicated capable parents, they also create a situation in which, if a patient fails to make significant progress, the parents are the ones to blame. These parents now have the added guilt of feeling inadequate to have helped their injured child.
Most practitioners of alternative medicine either practice or are at least accepting of many different forms of alternative cures. This results from the fact that if one has a casual, or even anti, science attitude regarding one alternative modality, then they will likely have a similar attitude towards other modalities. It is not surprising, therefore, that the NACD embraces other scientifically questionable practices.
For instance, the NACD advertises on their web site that they also evaluate and treat for food sensitivities. Although there is not the space here to adequately address this complex issue, suffice to say that food sensitivities are controversial at best, and certainly lack scientific acceptance. The excerpt in the box below is quite revealing. 8 I doubt there are many children who do not have three or more of these symptoms, especially since many are vague or qualified enough to apply to anyone. The NACD also offers a consultation with an “orthomolecular physician.” Again, I will not delve into this issue here, but suffice to say such “physicians” are clearly outside of the mainstream.
Unproved therapies can be harmful in many ways, not always by direct toxicity or physical harm. The promotion of psychomotor patterning by institutions which make bold unsubstantiated claims about its effectiveness may cause significant financial and emotional damage. Such claims instill false hope in people who are likely already plagued by guilt and depression. By doing so, these desperate parents are being set up for a crushing disappointment or further guilt of inadequacy. In the process they must spend a great deal of their resources of time, energy, emotion, and money. These resources are taken away from their other children and other important facets of their lives, resources they might not be willing to spend if not for the fantastic claims which have lured them to this path. They are also distracted from dealing with the situation in other practical ways and coping psychologically as a family with the reality of having a brain injured or mentally retarded child. They are encouraged, in fact, to remain in a state of denial while they are pursuing a false cure.
The Doman-Delacato patterning technique is pseudoscience because it is premised on a bankrupt and discarded theory and, more importantly, has failed to demonstrate any significant effectiveness under controlled conditions, and yet it is being purveyed as an innovative and effective treatment, and even possibly a cure. The IAHP and NACD cannot support the claims that they make, and are therefore guilty of fraud. Current regulations should prevent such abuse, but unfortunately such institutions as the FDA lack the manpower and the teeth to properly enforce such regulations and fulfill their role to protect the public from the snake-oil salesman, dressed up in the modern clothes of alternative medicine, that increasingly prey upon the vulnerable, the sick, and the desperate.
1. Doman RJ, Spitz EB, Zucman E, Delacato CH, and Doman G: Children with severe brain injuries, Neurologic organization in terms of mobility. JAMA, 174:257, 1960
2. Cohen HJ, Birch HG, Taft LT: Some considerations for evaluating the Doman-Delacato “Patterning” method. Pediatrics, 45:302- 14, 1970
3. Delacato CH: The Diagnosis and Treatment of Speech and Reading Prob lems. Springfield, Illinois: Charles C Thomas, 1963.
4. Doman G, Delacato CH: Train Your Baby to be a Genius. McCall’s Maga zine, p. 65, March 1965
5. Neman R, Roos P, McCann BM, Menolascino FJ, Heal LW: Experimen tal Evaluation of Sensorimotor Patterning used with Mentally Retarded Children. Am J Mental Deficiency, 79:372-84, 1975
6. Ziegler E, Victoria S: On “An Experimental Evaluation of Sensorimotor Patterning”: A Critique. Am J Mental Deficiency, 79:483-92, 1975
7. Freeman RD: Controversy Over “Patterning” as a Treatment for Brain Damage in Children. JAMA, 202:83-86, 1967
8. NACD website, URL-http://www.nacd.org/articles/food.html