Patterning (Doman-Delacato Method)
The Doman-Delacato method, commonly known as patterning, is designed to improve a child’s “neurological organization” through a series of specific prescribed sensory and motor experiences conducted on a rigorous daily schedule. These methods were presumed to improve functioning of the central nervous system in children with severe brain injuries (Doman et al. 1960).
The Doman-Delacato method is an approach to address neurological functioning by a series of motor activities thought to alter the structure and function of specific areas of the brain. The method was developed by Glen Doman, a physical therapist, and Carl Delacato, a doctor of education. Doman and Delacato focused on maximizing the development of typical children. Spurring what Doman coined as the “Gentle Revolution,” he began to publish books aimed at teaching parents how to make their babies mentally and physically superior. Titles of their published books include “How to Teach Your Baby to Read” (Doman 1964b), “How to Teach Your Baby Math” (Doman et al. 1979), and “How Smart Is Your Baby?: Develop and Nurture Your Newborn’s Full Potential” (Doman and Doman 2006). Many of the titles from the Gentle Revolution series were coauthored with Doman’s son and daughter, Douglas and Janet Doman. Doman also published a book focused primarily on children with brain injury. In 1974, he published “What to Do About Your Brain Injured Child: Or Your Brain Damaged, Mentally Retarded, Mentally Deficient, Cerebral-Palsied, Spastic, Flaccid, Rigid, Epileptic, Autistic, Athetoid, Hyperactive Child” (Doman 1974).
In 1955, Doman founded the headquarters for the Institutes for the Achievement of Human Potential in the Philadelphia area. The IAHP (commonly referred to as “the Institutes”) is a nonprofit organization offering inpatient and outpatient treatment for brain-damaged children. The IAHP was created as a means for distributing the Doman-Delacato method, as described in a paper on neurological organization published in the Journal of the American Medical Association in 1960 (Doman et al. 1960). The IAHP has gained a global following, with offices in Japan, Italy, Mexico, Guatemala, Singapore, Brazil, Spain, and France.
Rationale or Underlying Theory
Temple Fay first applied the recapitulationist view of ontogenesis to children with nervous system disorders (Fay 1955), and the Doman-Delacato method is an extension of this work (MacKay et al. 1986). According to the recapitulationist theory, ontogeny (the development of an individual from fertilized egg to its adult form) mimics phylogeny (the evolutionary history of a species). Stated another way, the development of an individual being imitates the evolutionary steps of the species. The recapitulationist school of thought was popular in the 1920s and 1930s. However, the theory has been refuted in modern biology and has not found support in the greater scientific community (Novella 1996).
Doman and Delacato advocate that children are expected to move through a series of locomotor patterns which reflect earlier forms of movements that human evolutionary ancestors performed, such as creeping and crawling. As such, skipping one of these evolutionary steps in one’s own development is believed to result in perceptual and motor difficulty as well as disturbances in language and communication skills (Doman 1974). The method presumes that basic motor sequences are essential to the neurological organization of an individual. According to the authors, the different stages of crawling, creeping, and walking are each associated with a unique neurological function and a gap in the appropriate sequence does not allow for an individual to fully develop (Doman 1964b). For example, a child who failed to crawl before walking is hypothesized to have skipped a critical step unique to human development, and this gap leaves the child subjected to both higher and lower order neurological deficits. Based on this rationale, it follows that the child must be “patterned” by a team of adults trained to position the child’s body in such a way that mimics this critical prerequisite step. As a result, the child’s neurons would be “repatterned” and reorganized in a way that allows them to continue with their typical development and encourage learning readiness in academic skills. According to this theory, intellectual disabilities, learning, and behavior disorders are caused by brain damage. Most importantly, these deficiencies are believed to exist on a single continuum for which the only solution is to regress to earlier forms of primitive movement (Cohen et al. 1970).
Truncal movement: Comparable to the swimming movement of a fish and believed to impact the medullary level of the brain.
Homolateral crawling: Defined as a crawling motion in which the arm and leg on the side to which the head is turned and flexed, while the opposite extremities are extended. This is hypothesized to reflect amphibian motility and believed to affect a pontine level of brain organization.
Cross-pattern creeping: Defined as creeping with a flexed arm and extended leg on the side toward which the head is turned. This creeping is believed to be related to reptilian movement and is hypothesized to be related to midbrain functioning.
Crude walking: Defined as walking without a cross pattern. This reflects a primitive upright form of locomotion consistent with cortical functioning.
Cross-pattern walking: Defined as the only uniquely human gait and associated with advanced cerebral function and hemispheric dominance.
In addition, the importance of establishing cerebral dominance is believed to be unique to humans, and this lateral neurological function is said to account for the human ability to read, write, and talk. As such, the lateralization of movement is central in the theory and practice of this method (Holm 1983). The authors also emphasize the importance of adding ongoing sensory stimulation to the patterning movements, as learning begins with the stimulation of the senses.
Goals and Objectives
Treatment goals of the Doman-Delacato method aim to improve physical, intellectual, and social capability in children with brain injuries by correcting “neurological organization.”
Proponents of the method believe that treatment is suitable for all children classified as “brain-injured.” As defined by the IAHP, the term “brain-injured” encompasses nearly 300 potential childhood disorders. The IAHP does not differentiate across severity, and even the most severely handicapped children may be admitted. Doman and Delacato have repeatedly emphasized that only those parents who are most dedicated to their children’s recovery can expect to see a result from the prescribed demanding regimen.
Predetermined patterns of movement are imposed on the child by manipulation of the child’s extremities. Such manipulations are performed by teams of up to five people, often consisting of therapists, parents, and volunteers. In the sessions, each adult is responsible for manipulating one of the child’s limbs or the head. It is required that it should be performed smoothly and rhythmically and in complete accordance with the movement of the other limbs in order to mimic the natural movement of the body (Doman et al. 1960). The IAHP recommends that these exercises be conducted a minimum of at least 5 min, four times a day every day of the week. While the treatment team is initially composed of therapists, it gradually becomes the responsibility of parents and volunteers to conduct the sessions. Typically, the treatment therapists conduct follow-up visits in 60- to 90-day intervals. It is hypothesized that such patterning sessions will ingrain the movements into the central nervous system.
Parents are also required to provide their children with a program of sensory stimulation. In addition, masking, or rebreathing expired air into a face mask for 30 to 60 s once every waking hour, is promoted to increase cerebral blood flow, increase carbon dioxide intake, and aid in the establishment of hemispheric dominance (Freeman 1967). According to the IAHP, this rebreathing treatment is also recommended in the treatment of seizure disorders, and the IAHP requires that all patients be gradually weaned off of anticonvulsant medications to maximize the effectiveness of their own treatment regimen. Restricting salt, sugar, and fluids and limiting exposure to music are additional recommendations.
The Doman-Delacato method has not been scientifically investigated with individuals on the autism spectrum. To date, the concept of neurological organization that serves as the foundation for the method has not been subjected to scientific research, and those programs which offer patterning have not been shown to improved learning or functioning. Many have contested that the theoretical rationale for the treatment is without merit and is inconsistent with accepted views of neurologic development (Novella 1996). Although any intervention that calls for one-to-one daily interaction for hours at a time on a daily basis might have the potential to have some positive effect, evidence for any permanent and lasting change from patterning is lacking (Howlin 1997). As a result, this method has been met with controversy and criticism.
The American Academy of Pediatrics Committee on Children with Disabilities has issued several cautionary statements regarding the Doman-Delacato method. Due to the lack of empirical support for the strategies, warnings were published as early as 1968, with the most recent statement reaffirmed in 2005 (American Academy of Pediatrics 1982; 1999). This was a joint statement approved by several organizations, including but not limited to the American Academy for Cerebral Palsy, American Academy of Neurology, American Academy for Physical Medicine and Rehabilitation, American Academy of Orthopedics, Canadian Association for Retarded Children, and the National Association for Retarded Citizens (Hyatt 2007).
The primary outcome measurement tool for this therapy was developed by the inventors of this method. The Doman-Delacato developmental profile, which is used for both planning treatment and monitoring progress, enables the therapist to ascertain at which level of neurological organization a brain-injured child is functioning. The profile is based on chronological age development when the following domains are hypothesized to develop mobility, language, manual competence (writing), vision (reading), auditory competence, and tactile competence. Each of these domains is divided into seven chronological stages of functional development which corresponds with ascending brain levels.
The validity of this tool for planning treatment or measuring outcome has yet to be demonstrated (Sparrow and Zigler 1978). Because the administration of this instrument at intake informs the course of treatment, changes with treatment may reflect teaching to the test and do not necessarily correlate with a generalizable improvement in functioning. To date, this measurement has not been standardized against any accepted measures of development, although inter-rater reliability is reported to be valid. The dimensions measured by the assessment make the comparison to any standard measure difficult.
Qualifications of Treatment Providers
Staff at the IAHP are trained as “child brain developmentalists.” These developmentalists specialize in one of the following: intellectual excellence, physical excellence, or physiological excellence. According to IAHP literature, this certification requires rigorous training and yearly recertification. No certification or licensure process exists outside of the Institutes for the Achievement of Human Potential, and the required qualifications of these child brain developmentalists are not publically disclosed. The IAHP continually holds courses in seminars throughout the world to educate parents on how to conduct patterning with their children.
References and Reading
- American Academy of Pediatrics, Committee on Children With Disabilities. (1982). The Doman-Delacato treatment of neurologically handicapped children. Pediatrics, 70, 810–812.Google Scholar
- Doman, G. J. (1964a). The five principles of human development through organization of the brain. Retrieved 28 June 2012 from http://www.iahp.org/fileadmin/PDFs/Five_Principles.pdf.
- Doman, G. J. (1964b). How to teach your baby to read. New York: Random House.Google Scholar
- Doman, G. (1974). What to do about your brain-injured child: Or your brain-damaged, mentally retarded, mentally deficient, cerebral-palsied, spastic, flaccid, rigid, autistic, athetoid, hyperactive, Down’s child. New York: Doubleday.Google Scholar
- Doman, G. J., & Doman, J. (2006). How smart is your baby?: Develop and nurture your newborn’s full potential. New York: Square One.Google Scholar
- Doman, G. J., Doman, J., Aisen, S., & Institutes for the Achievement of Human Potential. (1979). How to teach your baby math. New York: Simon and Schuster.Google Scholar
- Freeman, R. D. (1967). Controversy over “patterning” as a treatment for brain damage in children. Journal of the American Medical Association, 202(5), 83–86.Google Scholar
- Novella, S. (1996). Psychomotor patterning. The Connecticut Skeptic, 1(4). Retrieved 28 June 2012 from http://www.srmhp.org/archives/patterning.html.