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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 .
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