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0PED IATR ICS (ISSN 0031 4005).Copyright 1982 by theAm erican A cadem y of Pediatrics.

810 PED IA TR IC S Vol. 70 N o. 5 N ovem ber 1982

A M E R IC A N A C A D E M Y O F P E D IA T R IC S

Policy S tatem ent

The D om an-D elacato Treatm ent o fN euro log ically H and icapped C h ild ren

0

O ver the past tw o decades, the Institu tes for the

A chievem ent of H um an Potentia l and their affihi-

a tes have m ade continuing cla im s for the efficacy

of their m ethods of treatm ent for brain dam age and

other disorders.2 A num ber of organizations have

issued cautionary statements regarding theseclaims,8 including a form al sta tem ent by a consor-

tium of A m erican and Canadian organizations pub-

lished by the A m erican Academ y of Pediatrics on

June 1, 1968. R ecent m edia coverage and an in-

creasing num ber of inquiries from parents and pub-

lic offic ia ls dicta te that the A cadem y review the

current s tatus of the controversy, updatean d mod-

ify the 1968 sta tem ent, and propose som e recom -

mendat ions .

The reasons for concern include the follow ing:

The prom otional m ethods em ployed by the In-

stitu tes#{176} m ake it d ifficult for parents to refuse

such treatm ent w ithout calling into question their

adequacy and m otivation as parents.

The regim ens prescribed by the Institute are so

dem anding and inflexible02 that they m ay place

considerable stress on parents and lead to their

neglect of other fam ily m em bers needs.3

A dvocates assert that the childs potentia l w ill be

reduced if therapy is not carried out as rigidly

prescribed and that less than 100%effort is u se le ssand is the cause of any failure of the treatm ent

approach. a

R estric tions are often placed on age-appropria te

activ ities of which the child is capable , such as

w alking or listening to m usic ,34 although these

restrictions are not supported by data or long-term

results published to date .

Claims are m ade for rapid and conclusive diag-

nosis5 based on a Developm ental Profile utilized

by the Institu tes.6 H ow ever, no basis for the Profile

has even been published, nor is there evidence of

any attem pt to validate it by com parison with any

accepted m ethods.

Claims have been m ade for a substantia l num ber

of cures,2 and the claim s have extended beyond

therapy for disease sta tes, asserting that the treat-m ent can m ake norm al children superior,2#{176}79

ease world tensions ,2 and possibly hasten the evo-

lutio na ry proc ess.2 #{1 76}

W ithout supporting data , Dom an and Delacato

have indicated m any typical child rearing practices

as lim iting a childs potential, thereby increasing

the anxiety of already-burdened and confused par-

2,19

N otwithstanding these dram atic cla im s, w e are

aw are of only one study2 since 1967 that has sug-

gested sm all functional im provem ents in som e pa-

tients receiving patterning. The fact that virtually

no new data have been presented since 1967 tosupport the Dom an-Delacato treatm ent is by itse lf

cause to question the extensive cla im s m ade for

patterning.

THE THE O R Y

The theory, w hich is a lleged to be universally

applicable ,282223 is based largely on oversim plified

concepts of hem ispheric dom inance and the rela-tionship of individual sequentia l phylogenic devel-

opm ent.2223 A ccording to the theory, the great m a-

jority of cases of m ental re tardation, learning prob-

lem s, and behavior disorders are caused by braindam age or poor neurological organization,5 and

all these problem s lie som ewhere on a single contin-

uum of brain dam age, for w hich the only effective

treatm ent is that advocated by the Institu te .2#{176}

The inform ation currently available does not sup-

port these contentions. In particular, the lack of

uniform dominance or sidedness is probably not a

significant factor in either the etiology or the ther-

apy of these conditions .2429

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AM ER IC AN AC AD EM Y OF PED IATR IC S 811

Cultura l and anthropologic differences have also

been expla ined by the theory. For exam ple , the

lack of a w ritten language in som e prim itive tribes

0 is a ttributed to restrictions on craw ling and creep-ing,3#{176} v ery narrow and questionable view .

One careful review of the theory has led to the

conclusion that the tenets are either unsupported

or overw helm ingly contradic ted when tested by

theoretica l, experim ental, or logical evidence from

the relevant sc t itific litera ture . A s a scientific hy-

pothes is the theory of neurological organization

seem s to be w ithout m erit.22 A nother review3 con-

cluded that the theoretica l ra tionale for the m ethod

w as not consis tent w ith generally accepted view s

about the nature of neurologic developm ent.

C U R REN T STA TUS O F C LA IM ED TH ER APE UTICR E S U LT S

Results published by or for the Institu te have

been inconclusive .153132 M any reports of im prove-

m ent in reading ability after trea tm ent have been

heralded as support for the theory,8 but s ta tis-

tica l analysis reveals few dem onstrable benefits.2135

Controlled studies of the D om an-D elacato treat-m ent with respect to reading claim s have show n

little or no benefit from the treatm ent.39

It has been pointed out repeatedly that som e

0 handicapped children w ho purportedly benefitedfrom treatm ent had had their condition m isdi-

agnosed or had been given unduly pessim istic prog-

noses. The course of m aturation in these children

is varied, leading to unw arranted claim s that im -

provem ents were due to a specific form of treat-m ent2224#{176}4Som e of the cases dram atically publi-

cized by the Institu tes have been children w ith

traumatic brain dam age or postencephalitis, who

m ay m ake substantial gains w ithout any specia l

treatment.

Three years after a 1975 critique of an experi-

m ental evaluation of sensorim otor patterning,42 in-

vestigators undertook a controlled study.43 This

study com pared three groups of children, a ll of

whom w ere severely m entally retarded and insti-

tutionalized. O ne group received patterning, a sec-

ond w as treated by m otivational techniques, and a

third received routine care . U sing a wide variety ofbehaviora l m easures , the investigators observed

that all three groups show ed som e im provem ent in

perform ance during the study period; but there w as

no significant difference am ong the three groups.

Based on this study and other reports, the investi-

gators found that there w as nothing to recom m end

patterning treatm ent over standardized care .43

0 Thus, although their results could be legitim ate lygeneralized only to institutionalized retarded chil-

dren, the investigators concluded that patterning

cannot be considered superior to any other m ethod

o f t re at m en t.

Previous cautionary statem ents have em phasized

the need for well-controlled studies of the effects of

the treatm ent. C onducting a study of all aspects of

the Institu tes c la im s presents m any theoretical and

practical difficulties (B . S. R osner, unpublished

data , 1967). A w ell-designed, com prehensive s tudy

(supported by both federal and private agencies)

w as in the final planning stage w hen the Institutes

reportedly w ithdrew their original agreem ent to

partic ipate .44 W ith the fa ilure of this a ttem pt, the

burden of proof for cla im ed results lies w ith the

Institutes, particularly as a m ore recent, sm aller

controlled study43 dem onstra ted no particular bene-

fit from patterning treatm ent.

S U M M A RY

The Institu tes for the Achievem ent of H um an

P oten tial diffe r substantia lly from other groupstreating developm ental problem s in (1) the exces-

sive nature of their poorly docum ented claim s for

cure and (2) the m ajor dem ands placed on parents

in unsw ervingly carrying out an unproven tech-

m que to the sm allest deta il.

In m ost instances, im provem ent observed in pa-

tients undergoing this m ethod of treatm ent can be

accounted for on the basis of grow th and develop-

m ent, the intensive practice of certa in isolated

skills, or the nonspecific effects of intensive stim u-

lation.

Physicians and therapists should acquaint them -selves with the issues in the controversy and the

availab le evidence. Based on pastand current anal-

yses, studies, and reports, we m ust conclude that

patterning treatm ent offers no specia l m erit, that

the claim s of its advocates are unproven, and that

the dem ands on fam ilies are so great that in som e

cases there m ay beharm in its use .

REFERENCES

1. B ird J: W hen children cant learn .Saturday Evening Post240:27-31 , 72-74 , July 29 ,1967

2. Institutes for the A chievem ent of H um an Potential.H umPotential 1(1), 1967

3. A m erican A cadem y of Pediatrics Executive B oard state-m ent: D om an-D elacato Treatm ent of Neurologically H and-icapped Children. AA P N ew sletter 16:1, 6, D ec 1, 1965

4. A m erican A cadem y for Cerebral Palsy:Statem ent of Exec-u tive C om mittee , Fe b 15 , 1965

5. U nited C erebra l P alsy A ssocia tion of Texas:The D om an-D elacato Trea tm ent of N eurologica lly H andicapped Chil-dren. Inform ation B ulletin, undated

6. C anadian A ssociation for Retarded Children: Institu te forthe A chievem ent of H um an Potential.M ent Reta rd, Fall1965, pp 27-28

by guest on July 15, 2013pediatrics.aappublications.orgDownloaded from

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7 . A m er ica n A cademy of N eurology: Joint Executive Boardstatement. T he D oman-D elacato treatment of neurologicallyhandicapped children. N eurology 1 7:6 37 , 1 96 7

8. A merican A cademy of Physical M edicine and Rehabilita-tion: D oman-D elacato treatment of neurologically handi-capped chi ldren, 1967. A rch P hys M ed R ehabil 49:4, 1968

9. Doman-D elacato treatment of neurologically handicapped

children. A A P N ew sletter (suppl) June 1, 196810. Beck J: U nlocking the secrets of the brain.C hicago Tribune

M agazine, 1964 (reprinted from articles on Sept 13 and27)11. L inton T S: A P arents G uide to P atterning and F loor

A ctivity. M edia, PA , T he N eurological Institute andtheN eurological Clinic for Children, undated (processed)

12. M aisel A Q: H ope for brain-injured children.R eaders D igest,Oc t 1964, pp 135-140

13. Freeman RD : Controversy over patterning as a treatmentfor brain damage in children. JA M A 202:385, 1967

14. Institutes for the Achievement of Human Potential: Instruc-

ti on S heets. T he R om p er, 1963; T he H a rn ess, 196415. Institutes for the A chievement of H uman Potential: A Sum-

mary of Concepts, Procedures and Organization, 196416. Institutes for the A chievement of H uman Potential: T he

D oman-D elacato Profile for the D oman-M oran GraphicSummary, 1963 (rev 1965)

1 7. Institutes for the A chievement of H uman Potential.Bulletin1 2 : 5 7 , 1967

18. Institutes for the A chievement of H uman Potential: State-ment of objectives, undated

19. D oman G, D elacato CH : T rain your baby to be a genius.M cC alls 65:169, M arch 1965

20. D elacato CH : T he T reatment and Prevention of ReadingProblems: T he N euro-Psychological A pproach. Springfield,I L, Charles C T homas, Publisher, 1959

21. N eman H , Roos P, M cCann B: Experimental evaluation of

sensorimotor patterning used with mentally retarded chil-then. A m J M ent D efic 79:372, 1975

22. Robbins M P, Glass GV : The D oman-Delacato rationale: A

critical analysis, in H eilmuth J (ed):E ducational Therapy.Seattle, Special Child Publication, 1968, vol 2

23. Cohen JH , Birch H G, Taft LT: Some considerations forevaluating the D oman-D elacato patterning method. P e-

diatrics 45:302, 197024. M oney J: D yslexia: A postconference review, in M oney J

(ed): R eading D isability: P rogress and R esearch N eeds inD yslexia. Baltimore, John H opkins Press, 1962, pp 9-33

25. M oney J: Reading disorders in children, inBrenneman-

K elley P ractice of P ediatrics. H agerstown, M D , Paul BH oeber, I nc, 1967, vol 4, chap 14A , pp 1-14

26. Belmont L , Birch HG: Lateral dominance, lateral awareness,

and r ead in g d isab il it y. C hild D ev 36:57, 196527. Spitzer RL , Rabkin H , K ramer Y :The relationship between,

mixed dominance and reading disabilities. J Pediatr 54:76,1959

28. Stephens W E, Cunningham ES, Stigler BJ: Reading readi-ness and eye-hand preference patterns inlu-st gr ade chi ldren.

E xcept C hild 3 3 : 4 8 1 , 196729. Bettman JW Jr, Sterne EL , W hitsell U , et al: Cerebral

dominance i n developmental dyslexia. A rch O phthalm ol7 8 : 7 2 2 , 1967

30. Green LI: Functional neurological performance in primitive

cultures. H u m P otentia l 1:19, 196731. D oman H A, Spitz ER, Zucman E, et al: Children with severe

brain injuries: N eurological organization in terms of mobility.JA M A 174:257, 1960

32. Freeman RD : Review of K ershner: A n investigation of theD oman-D elacato theory of neuropsychology asit applies totrainable mentally retarded children in public schools.JP ediatr 71:914, 1967

33. D elacato CH :The D iagnosis and Treatm ent ofSpeech andR eading P roblem s. Springfield, IL , Charles C T homas, Pub-lisher, 1963

34. D elacato CH : N eurological O rganization and R eading.Springfield, IL , Charles C T homas, Publisher, 1964

35. Glass GV : A C ritique of E xperim ents on the R ole of N eu-rological O rganization in Reading P erform ance. Urbana,

IL , U niversity of I llinois College of Education, Oct 196636. Robbins M P: T he D elacato Interpretation of N eurological

O rganization: A n E m pirical Study. D o ct or al d isser tat io n,unpublished. U niversity of Chicago, 196537 . R obbi ns M P: A study of the validity of D elacatos theory of

neurological organizat ion. E xcept C hild 32:417, 196638. Robbins M P: Creeping, laterality and reading.Academ ic

Therapy Q 1:20 0, 196639. Robbins M P: T est of the D oman-D elacato rationale with

retarded readers. JA M A 202:389, 196740. K och H , Graliker B, Bronston W , et al: M ental retardation

i n earl y chi ldhood. A m J D is C hild 109:243, 196541. M asland RL : U nproven methods of treatment. Pediatrics

37:713, 196642. Z igler E, Seitz V : On an experimental evaluation of sensori-

motor patterning: A critique. A m J M ent D efic 79:483, 197543. Sparrow S, Z igler E: Evaluation of patterning treatment for

retarded children. Pediatrics 62:137, 197844. Rosner BS: Final Report on Planning Grant: T reatment of

Brain-injured Children. Read before the V ocational Reha-

bilitation A dministration, N ational A ssociation for RetardedChildren, G i ven F ou nd at io n, 1967

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