Psychomotor Patterning: A Critical Look
Steven Novella, M.D.
In the 1960s, psychomotor patterning was proposed as a new treatment modality for people with 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 1970s, when the scientific medical community arrived at the consensus that is should be discarded as a false concept with no therapeutic role. Its use, however, has not stopped.
The concept of patterning was invented by Glenn Doman and C. Delacato and is therefore often referred to as the Doman-Delacato technique . Their theories are primarily an extension of the outdated concept that ontogeny (the stages through which organisms develop from single cell to maturity) recapitulates phylogeny (the evolutionary history of the species). Thus 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 .
Doman and Delacato postulated that mental retardation represents a failure of the individual to develop through the proper phylogenetic stages. Their treatment modality supposedly stimulates proper development of these stages, each of which must be mastered before progress can be made to the next stage. This stimulation is done through what they call "patterning," in which the patient moves repeatedly in the manner of the current stage. In the "homolateral crawling" stage, for instance, patients crawl by turning their head to one side while flexing the arm and leg of that side and extending the arm and leg of the opposite side. Patients who are unable to execute this exercise by themselves 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. This exercise is intended to impose the proper "pattern" onto the central nervous system. In the full treatment program, the exercises are combined with sensory stimulation, breathing exercises intended to increase oxygen flow to the brain, and a program of restriction and facilitation intended to promote hemispheric dominance . Advocates claim that patterning enables mentally retarded and brain injured children to achieve improved, and even normal, development in the areas of visuo-spatial tasks, motor coordination, social skills, and intellect. They also claim to promote superior development in a normal child .
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. As Delacato stated in 1963:
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 .
Medical treatments are evaluated on two criteria, their theoretical basis and their empirical value. The scientific community has rejected patterning on both counts. By the 1960s, it became clear that recapitulation 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 or clinical support for Doman and Delacato's principles.
Their use of breathing exercises to promote oxygen delivery to the brain also lacks an acceptable 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 this helps the developing brain.
In 1982, the American Academy of Pediatrics issued a position statement concluding that "patterning" has no special merit, that its proponents' claims are unproven, and that the demands on families are so great that in some cases there may be actual harm in its use. The National Down Syndrome Congress endorsed this statement and displayed it on its Web site for several years .
Of course, if clinical evidence could demonstrate that patterning improves neurological development, it would be still accepted and used. Many mainstream interventions 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. During approximately ten years in the late 60s and early 70s, dozens of clinical trials compared groups of developmentally delayed children given patterning treatment to comparable who received no treatment but similar amounts of attention [2,6-8]. None confirmed the claims of Doman and Delacato. Some found modest improvements in motor or visuo-spatial skills, but none showed improved intellectual development. The few positive studies were neither impressive nor reproducible. Eventually, such clinical trials stopped and the scientific community abandoned the technique as a blind alley.
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, similar to 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 should be considered cruel. Doman and Delacato were widely criticized for publicizing their unsubstantiated claims and 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 incorporated the patterning technique into their program at the Institutes for the Achievement of Human Potential (IAHP), which was established in Philadelphia in the 1950s and still operates today. A second facility, the National Academy of Child Development (NACD) in Huntsville, Utah, offers patterning as part of their treatment program. The NACD is run by Robert Doman, the nephew of Glenn Doman, although both institutions state that there is 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 typical of the lay media, Kathy Lee provided an emotionally appealing view of patterning without even a hint of skepticism. The segment did bring out 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.
The IAHP and the NACD both rely heavily on the family as the primary deliverers of the patterning treatment. 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 that begin with purchasing and listening to a set of audiotapes. 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 follows the same principle. The program requires families to alter their lives to institute a daily program of patterning exercises, breathing exercises, and 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 program also illuminated another important feature of the patterning phenomenon, the difference between anecdotal and scientific evaluation of its effectiveness. Most children, even severely mentally retarded children, still grow and develop, although more slowly 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 encouraged to believe that they had witnessed a miracle cure.
NACD and IAHP literature both caution that individual results will vary. It also implies that if the patient fails to make significant progress, the parents are to blame. The NACD also embraces other scientifically questionable practices. Its Web site offers the following screening test for "food sensitivities":
Check the following list. If three or more apply to your child, food sensitivity may be a problem:
Although the problems listed above undoubtedly have a number of possible causes, food sensitivities must be considered as one of the most likely .
Food sensitivties have no proven relationship to behavior, and most of the above symptoms are not related to food sensitivity. The NACD has also offered a consultation with an "orthomolecular physician" and a "holistic nutritionist." Such practitioners are clearly outside of the scientific mainstream.
Current AAP Position
Reacting to promotion through the media, the American Academy of Pediatrics published an updated review in 1999 that it reaffirmed in 2006. This review concludes:
Treatment programs that offer patterning remain unfounded; ie, they are based on oversimplified theories, are claimed to be effective for a variety of unrelated conditions, and are supported by case reports or anecdotal data and not by carefully designed research studies. In most cases, improvement observed in patients undergoing this method of treatment can be accounted for based on growth and development, the intensive practice of certain isolated skills, or the nonspecific effects of intensive stimulation.
Physicians and therapists need to remain aware of the issues in the controversy over this specific treatment and the available evidence. On the basis of past and current analyses, studies, and reports, the AAP concludes that patterning treatment continues to offer no special merit, that the claims of its advocates remain unproved, and that the demands and expectations placed on families are so great that in some cases their financial resources may be depleted substantially and parental and sibling relationships could be stressed .
The Bottom Line
The Doman-Delacato patterning technique is premised on a bankrupt and discarded theory and has failed when tested under controlled conditions. Its promotion with unsubstantiated claims can cause significant financial and emotional damage. Such claims can instill false hope in many people who are already plagued by guilt and depression, setting them up for a further disappointment, guilt, and feelings of inadequacy. The process can also waste their time, energy, emotion, and money. These resources may be taken away from their children. Parents can also be 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. Parents are encouraged, in fact, to remain in a state of denial while they are pursuing a false cure.
- Doman RJ, Spitz EB, Zucman E, Delacato CH, Doman G. Children with severe brain injuries: Neurologic organization in terms of mobility. JAMA 174:257, 1960.
- Cohen HJ, Birch HG, Taft LT. Some considerations for evaluating the Doman-Delacato "Patterning" method. Pediatrics 45:302- 14, 1970.
- Delacato CH. The Diagnosis and Treatment of Speech and Reading Problems. Springfield, Illinois: Charles C Thomas, 1963.
- Doman G, Delacato CH. Train your baby to be a genius. McCall's magazine, March 1965, p 65.
- American Academy of Pediatrics. Policy statement: The Doman-Delacato treatment of neurologically handicapped children. Pediatrics 70:810-812, 1982.
- Neman R and others. Experimental experimental evaluation of sensorimotor patterning used with mentally retarded children. American Journal of Mental Deficiency 79:372-84, 1975.
- Ziegler E, Victoria S. On "An experimental evaluation of sensorimotor patterning": A Critique. American Journal of Mental Deficiency 79:483-92, 1975.
- Freeman RD. Controversy over "patterning" as a treatment for brain damage in children. JAMA 202:83-86, 1967.
- Doman RJ. Food sensitivities: The hidden problems. Journal of the National Academy of Child Development 4(2): 1984.
- Committee on Children with Disabilities. The treatment of neurologically impaired children using patterning. Pediatrics 104:1149-1151, 1999. Reaffirmed Jan 2006.
Dr. Novella, a member of Quackwatch's advisory board, is Assistant Professor of Neurology at Yale University School of Medicine and president of The New England Skeptical Society. This article is adapted from an article in The Connecticut Skeptic, Vol. 1 Issue 4, Fall 1996.
This article was revised on February 9, 2008.