POSITION STATEMENT ON DOMAN-DELACATO TREATMENT OF NEUROLOGICALLY HANDICAPPED CHILDREN
The NDSC supports this policy statement of the American Academy of Pediatrics quoted in Vol.70,No.5, November 1982 and reprints it here with permission.
Over the past two decades, the Institutes for the Achievement of Human Potential and their affiliates have made continuing claims for the efficacy of their methods of treatment for brain damage and other disorders.1,2 A number of organizations have issued cautionary statements regarding these claims,3-8 including a formal statement by a consortium of American and Canadian organizations published by the American Academy of Pediatrics on June 1, 1968.9 Recent media coverage and an increasing number of inquiries from parents and public officials dictate that the Academy review the current status of the controversy, update and modify the 1968 statement, and propose some recommendations.
The reason for concern include the following:
The promotional methods employed by the Institutes10,11 make it difficult for parents to refuse such treatment without calling into question their adequacy and motivation as parents.
The regimens prescribed by the Institutes are so demanding and inflexible10,12 that they may place considerable stress on parents and lead to their neglect of other family members' needs.13
Advocates assert that the child's potential will be reduced if therapy is not carried out as rigidly prescribed and that less than 100% effort is useless and is the cause of any failure of the treatment approach.10,11
Restrictions are often placed on age-appropriate activities of which the child is capable, such as walking or listening to music,13,14 although these restrictions are not supported by data or long-term results published to date.
Claims are made for rapid and conclusive diagnosis15 based on a "Developmental Profile" utilized by the Institutes.16 However, no basis for the Profile has ever been published, nor is there evidence of any attempt to validate it by comparison with any accepted methods.
Claims have been made for a substantial number of cures,2 and the claims have extended beyond therapy for disease states, asserting that the treatment can make normal children superior,2,10,17-19 ease world tensions,2 and possibly "hasten the evolutionary process."2,20
Without supporting data, Doman and Delacato have indicated many typical child rearing practices as limiting a child's potential, thereby increasing the anxiety of already-burdened and confused parents.12,19
Notwithstanding these dramatic claims, we are aware of only one study21 since 1967 that has suggested small functional improvements in some patients receiving patterning. The fact that virtually no new data have been presented since 1967 to support the Doman-Delacato treatment is by itself cause to question the extensive claims made for patterning.
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The theory which is alleged to be universally applicable,2,18,22,23 is based largely on the oversimplified concepts of hemispheric dominance and the relationship of individual sequential phylogenic development.22,23 According to the theory, the great majority of cases of mental retardation, learning problems, and behavior disorders are caused by brain damage or "poor neurological organization,"15 and all these problems lie somewhere on a single continuum of brain damage, for which the only affective treatment is that advocated by the Institutes.2,10
The information currently available does not support these contentions. In particular, the lack of uniform dominance or sidedness is probably not a significant factor in either the etiology or the therapy of these conditions.24-29
Cultural and anthropologic differences have also been "explained" by the theory. For example, the lack of a written language in some primitive tribes is attributed to restrictions on crawling and creeping,30 a very narrow and questionable view.
One careful review of the theory has led to the conclusion that "the tenets are either unsupported or overwhelmingly contradicted when tested by theoretical, experimental, or logical evidence for the relevant scientific literature. As a scientific hypothesis the theory of neurological organization seems to be without merit."22 Another review23 concluded that the theoretical rationale for the method was not consistent with generally accepted views about the nature of neurologic development.
CURRENT STATUS OF CLAIMED THERAPEUTIC RESULTS
Results published by or for the Institutes have been inconclusive.15,31,32 Many reports of improvement in reading ability after treatment have been heralded as support for the theory,18,33,34 but statistical analysis reveals few demonstrable benefits.21,35 Controlled studies of the Doman-Delacato treatment with respect to reading claims have shown little or no benefit from the treatment.36-39
It has been pointed out repeatedly that some handicapped children who purportedly benefited from treatment had had their condition misdiagnosed or had been given unduly pessimistic prognoses. The course of maturation in those children is varied, leading to unwarranted claims that improvements were due to a specific form of treatment.12,20,40,41 Some of the cases dramatically publicized by the Institutes have been children with traumatic brain damage or postencephalitis, who may make substantial gains without any special treatment.
Three years after a 1975 critique of an experimental evaluation of sensorimotor patterning,42 investigators undertook a controlled study.43 This study compared three groups of children, all of whom were severely mentally retarded and institutionalized. One group received patterning, a second was treated by motivational techniques, and a third received routine care. Using a wide variety of behavioral measures, the investigators observed that all three groups showed some improvement in performance during the study period; but there was no significant difference among the three groups. Based on this study and other reports, the investigators found that there was nothing to recommend patterning treatment over standardized care.43 Thus, although the results could be legitimately generalized only to institutionalized retarded children, the investigators concluded that patterning cannot be considered superior to any other method of treatment.
Previous cautionary statements have emphasized the need for well-controlled studies of the effects of the treatment. Conducting a study of all aspects of the Institutes' claims present many theoretical and practical difficulties (B.S.Rosner, unpublished data, 1967). A well-designed, comprehensive study (supported by both federal and private agencies) was in the final planning stage when the Institutes reportedly withdrew their original agreement to participate.44 With the failure of this attempt, the burden of proof for claimed results lies with the Institutes, particularly as a more recent, smaller controlled study43 demonstrated no particular benefit from patterning treatment.
The Institutes for the Achievement of Human Potential differ substantially from other groups treating developmental problems in (1) the excessive nature of their poorly documented claims for cure and (2) the major demands placed on parents in unswervingly carrying out an unproven technique to the smallest detail.
In most instances, improvement observed in patients undergoing this method of treatment can be accounted for on the basis of growth and development, the intensive practice of certain isolated skills, or the nonspecific effects of intensive stimulation.
Physicians and therapists should acquaint themselves with the issues in the controversy and the available evidence. Based on past and current analyses, studies, and reports, we must conclude that patterning treatment offers no special merit, that the claims of its advocates are unproven, and that the demands on families are so great that in some cases there may be harm in its use.
1. Bird J: When children can't learn. Saturday Evening Post 240:27-31, 72-74, July 29, 1967
2. Institutes for the Achievement of Human Potential. Hum Potential 1(1), 1967
3. American Academy of Pediatrics Executive Board statement: Doman-Delacato Treatment of Neurologically Handicapped Children. AAP Newsletter 16:1, 6, Dec. 1, 1965
4. American Academy for Cerebral Palsy. Statement of Executive Committee, Feb. 15, 1965
5. United Cerebral Palsy Association of Texas: The Doman-Delacato Treatment of Neurologically Handicapped Children. Information Bulletin, undated
6. Canadian Association for Retarded Children: Institutes for the Achievement of Human Potential. Ment Retard Fall 1965, pp 27-28
7. American Academy of Neurology: Joint Executive Board statement. The Doman-Delacato treatment of neurologically handicapped children. Neurology 17:637, 1967
8. American Academy of Physical Medicine and Rehabilitation: Doman-Delacato treatment of neurologically handicapped children, 1967. Arch Phy Med Rehabil 49:4, 1968
9. Doman-Delacato treatment of neurologically handicapped children, AAP Newsletter(suppl) June 1, 1968
10. Beck J: Unlocking the secrets of the brain. Chicago Tribune Magazine, 1964 (reprinted from articles on Sept 13 and 27)
11. Linton TS: A Parent's Guide to Patterning and Floor Activity. Media, PA, The Neurological Institute and the Neurological Clinic for Children, undated (processed)
12. Maisel AQ: Hope for brain-injured children. Reader's Digest, Oct. 1964, pp 135-140
13. Freeman RD: Controversy over "patterning" as a treatment for brain damage in children. JAMA 202:385, 1967
14. Institutes for the Achievement of Human Potential: Instruction Sheets. The Romper, 1963. The Harness, 1964
15. Institutes for the Achievement of Human Potential: A Summary of Concepts, Procedures and Organization, 1964
16. Institutes for the Achievement of Human Potential: The Doman-Delacato Profile for the Doman-Moran Graphic Summary, 1963 (rev 1965)
17. Institutes for the Achievement of Human Potential: Bulletin 12:57, 1967
18. Institutes for the Achievement of Human Potential: Statement of objectives, undated
19. Doman G, Delacato CH: Train your baby to be a genius. McCall's 65:169, March 1965
20. Delacato CH: The treatment and Prevention of Reading Problems: The Neuro-Psychological Approach. Springfield, IL. Charles C. Thomas, Publisher, 1959
21. Newman R, Roos P, McCann B: Experimental Evaluation of sensorimotor patterning used with mentally retarded children. Am J Ment Defic 79:372, 1975
22. Robbins MP, Glass GV: The Doman-Delacato rationale: A critical analysis, in Hellmuth J (ed): Educational Therapy. Seattle, Special Child Publication, 1968, vol 2
23. Cohen JH, Birch HG, Taft LT: Some considerations for evaluating the Doman-Delacato "patterning" method. Pediatrics 45:302, 1970
24. Money J: Dyslexia: A postconference review, in Money J (ed) Reading Disability: Progress and Research Needs in Dyslexia. Baltimore, Johns Hopkins Press, 1962, pp 9-33
25. Money J: Reading disorders in children, in Brenneman Kelley Practice of Pediatrics. Hagerstown, MD, Paul Hoeber, Inc, 1967, vol 4, chap 14A, pp 1-14
26. Belmont L, Birch HG: Lateral dominance, lateral awareness, and reading disability. Child Det 36:57, 1965
27. Spitzer RL, Rabkin R, Kramer Y: The relationship between mixed dominance and reading disabilities. J Pediatr 54:76, 1959
28. Stephens WE, Cunningham ES, Stigler BJ: Reading readiness and eye-hand preference patterns in first grade children. Except Child 33:481, 1967
29. Bettman JW Jr, Steme EL, Whitsell LJ, et al: Cerebral dominance in developmental dyslexia. Arch Ophthalmol 78:722, 1967
30. Green LJ: Functional neurological performance in primitive cultures. Human Potential 1:19, 1967
31. Doman, RJ, Spitz ER, Zucman E, et al: Children with severe brain injuries: Neurological organization in terms of mobility. JAMA 174:257, 1960
32. Freeman RD: Review Kershner: An investigation of the Doman-Delacato theory of neuropsychology as it applies to trainable mentally retarded children in public schools. J Pediatr 71:914, 1967
33. Delacato CH: The Diagnosis and Treatment of Speech and Reading Problems. Springfield, IL , Charles C. Thomas, Publisher, 1963
34. Delacato CH: Neurological Organization and Reading. Springfield, IL, Charles C. Thomas, Publisher, 1964
35. Glass GV: A Critique of Experiments on the role of neurological Organization in Reading Performance. Urbana, IL, University of Illinois College of Education, Oct. 1966
36. Robbins MP: The Delacato Interpretation of Neurological Organization: An Empirical Study. Doctoral dissertation, unpublished. University of Chicago, 1965
37. Robbins MP: A study of the validity of Delacato's theory of neurological organization. Except Child 32:417, 1966
38. Robbins MP: Creeping laterality and reading. Academic Therapy Q 1:200, 1966
39. Robbins MP: Test of the Doman-Delacato rationale with retarded readers. JAMA 202:389, 1967
40. Koch R, Graliker B, Bronston W, et al: Mental retardation in early childhood. Am J Dis Child 109:243, 1965
41. Masland RL: Unproven methods of treatment. Pediatrics 37:713, 1966
42. Zigler E, Seitz V: On an experimental evaluation of sensorimotor patterning: A critique. Am J Ment Defic 79:483, 1975
43. Sparrows S, Zigler E: Evaluation of patterning treatment for retarded children. Pediatrics 62:137, 1978
44. Rosner BS: Final Report on Planning Grant Treatment of Brain-injured Children. Read before the Vocational Rehabilitation Administration, National Association for Retarded Children, Given Foundation 1967