Science & Pseudoscience Review in Mental Health

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Psychomotor Patterning


Steven Novella, MD
- used with permission from The Connecticut Skeptic Vol.1 Issue 4 (Fall '96) pg 6

The line which sharply demarcates mainstream medicine from alternative medicine is the line of science. It is possible to cross that line, however. Any alternative treatment which is tested in a rigorous scientific manner and found to be safe and effective, will be incorporated into mainstream medicine, it will have crossed the line. A therapy, on the other hand, which begins within the halls of mainstream medicine as a legitimate proposal, and is found, when tested scientifically, to be of no real value, will be discarded. Most such discarded therapies are destined to become forgotten footnotes in the annals of medical research. Some, however, are salvaged by practitioners of alternative medicine. These therapies have crossed the line in the other direction, descending from science into pseudoscience.

The method of psychomotor patterning for the treatment of mental deficiencies is one such therapy. It began 30 years ago as a legitimate, if incorrect, scientific concept for a new treatment modality for 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 1970's, when finally the medical community arrived at the consensus that patterning should be discarded as a false concept with no therapeutic role. Use of the techniques of patterning, however, has not died, as we will see.

The concept of patterning was invented by Glenn Doman and C. Delacato in the 1960's, and is therefore often referred to as the Doman-Delacato technique.1 Their theories are primarily an extension of the older concept that ontogeny (the stages through which organisms develop from single cell to maturity) recapitulates phylogeny (the evolutionary history of the species). Therefore, 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. 2

Doman and Delacato's concept of mental retardation is that of failure of the individual to develop through the proper phylogenetic stages. Their treatment modality is therefore designed to stimulate the proper development of these stages, each of which must be mastered before progress can be made to the next stage. This stimulation is achieved through the method known as patterning.

The patterning treatment involves the patient moving repeatedly in the manner of the current stage. In the "homolateral crawling" stage, for instance, the patient crawls by turning his head to one side while flexing the arm and leg of that side and extending the arm and leg of the opposite side. For patients who are unable to execute this exercise by themselves, they 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. The purpose of this exercise is to impose the proper "pattern" onto the central nervous system. In the full treatment program, the exercises are combined with sensory stimulation, breathing exercises which are designed to increase oxygen flow to the brain, and a program of restriction and facilitation designed to promote hemispheric dominance. 3

The claim made for the technique by Doman, Delacato and their supporters is that, with this treatment method, mentally retarded and brain injured children can achieve improved, and even normal, development in the areas of visuo-spatial tasks, motor coordination, social skills, and intellect. They have also expanded these claims to include the idea that their techniques can promote superior development in a normal child. 4

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. Delacato himself writes "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." 3

Medical treatments are evaluated on two criteria, their theoretical basis and their empirical value. Patterning has been rejected by the scientific community on both accounts. The theory of recapitulation has never been fully accepted, and even by the 1960's had been all but discarded by evolutionary and biological scientists.

The essential flaw in the theory of recapitulation is that 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 support for Doman and Delacato's principles.

Their practice of using breathing exercises to promote oxygen delivery to the brain also lacks an accepted 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 such increased flow is at all helpful to the developing brain.

Despite the fact that patterning is theoretically bankrupt, if empirical evidence existed which demonstrated that patterning improves neurological development, it would be accepted and used. There are many mainstream interventions which are employed in modern medicine that 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. Over a period of approximately ten years in the late 60's and early 70's there were dozens of clinical trials comparing improvement in groups of developmentally delayed children given patterning treatment compared to controls who were given no treatment but similar amounts of attention. 2,5-7 Although most of the studies had significant methodological flaws, some were fairly well designed. None were perfect. More importantly, none confirmed the claims of Doman and Delacato. Some of the studies did show modest improvement in motor skills or visuo-spatial skills over controls. None showed improved intellectual development. The few positive results found were not impressive or reproducible. Eventually, such clinical trials stopped, as the technique was abandoned as a blind alley. This point marked the unequivocal crossing over of patterning from science to pseudoscience.

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, reminiscent of 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 can be considered cruel. Doman and Delacato were widely criticized for publicizing their unsubstantiated claims, 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 began incorporating the patterning technique into their Institutes for the Achievement of Human Potential (IAHP), which was established in Philadelphia in the 1950's. They continued to advertise and use patterning uninterrupted right through the scientific controversy, past the scientific condemnation, and on into the present day.

I was also able to locate one other institution, the National Academy of Child Development (NACD), located in Huntsville, Utah, that offers patterning as part of their treatment program. The NACD is run by Robert Doman, the nephew of Glenn Doman, although both institutions are eager to point out that there is currently 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 all too typical of the lay press, Kathy Lee provided an emotionally appealing yet completely uncritical presentation of the patterning technique, touting its virtues without even a hint of skepticism. There was no evidence that NBC did any investigative reporting into the background and validity of the intervention they were promoting on their program.

The segment did bring out, however, even if for the wrong reasons, 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.

Both the IAHP and the NACD rely heavily on the family as the primary deliverers of the patterning treatment method. 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 which begin for both institutions with purchasing and listening to a set of audio tapes. 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 they follow the same principle.

The end result is that the parents and other family members of the patient must alter their lives to institute a daily program of patterning exercises, breathing exercises, and programs of 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 exceptional demands of the patterning method is the primary reason cited in the medical literature for caution in evaluating patterning, for the obvious harm that would ensue if the method were recommended prematurely, without good proof that it is effective.

The program also illuminated another important feature of the patterning phenomenon, the difference between anecdotal and scientific evaluation of its effectiveness. One important fact to understand is that most children, even severely mentally retarded children, still grow and develop, although on a slower curve 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 meant to come away with the sense that they had witnessed a miracle cure.

The NACD and IAHP literature both caution that individual results will vary. By emphasizing the need for dedicated capable parents, they also create a situation in which, if a patient fails to make significant progress, the parents are the ones to blame. These parents now have the added guilt of feeling inadequate to have helped their injured child.

Most practitioners of alternative medicine either practice or are at least accepting of many different forms of alternative cures. This results from the fact that if one has a casual, or even anti, science attitude regarding one alternative modality, then they will likely have a similar attitude towards other modalities. It is not surprising, therefore, that the NACD embraces other scientifically questionable practices.

For instance, the NACD advertises on their web site that they also evaluate and treat for food sensitivities. Although there is not the space here to adequately address this complex issue, suffice to say that food sensitivities are controversial at best, and certainly lack scientific acceptance. The excerpt in the box below is quite revealing. 8 I doubt there are many children who do not have three or more of these symptoms, especially since many are vague or qualified enough to apply to anyone. The NACD also offers a consultation with an "orthomolecular physician." Again, I will not delve into this issue here, but suffice to say such "physicians" are clearly outside of the mainstream.

Unproved therapies can be harmful in many ways, not always by direct toxicity or physical harm. The promotion of psychomotor patterning by institutions which make bold unsubstantiated claims about its effectiveness may cause significant financial and emotional damage. Such claims instill false hope in people who are likely already plagued by guilt and depression. By doing so, these desperate parents are being set up for a crushing disappointment or further guilt of inadequacy. In the process they must spend a great deal of their resources of time, energy, emotion, and money. These resources are taken away from their other children and other important facets of their lives, resources they might not be willing to spend if not for the fantastic claims which have lured them to this path. They are also 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. They are encouraged, in fact, to remain in a state of denial while they are pursuing a false cure.

The Doman-Delacato patterning technique is pseudoscience because it is premised on a bankrupt and discarded theory and, more importantly, has failed to demonstrate any significant effectiveness under controlled conditions, and yet it is being purveyed as an innovative and effective treatment, and even possibly a cure. The IAHP and NACD cannot support the claims that they make, and are therefore guilty of fraud. Current regulations should prevent such abuse, but unfortunately such institutions as the FDA lack the manpower and the teeth to properly enforce such regulations and fulfill their role to protect the public from the snake-oil salesman, dressed up in the modern clothes of alternative medicine, that increasingly prey upon the vulnerable, the sick, and the desperate.


  1. Doman RJ, Spitz EB, Zucman E, Delacato CH, and Doman G: Children with severe brain injuries, Neurologic organization in terms of mobility. JAMA, 174:257, 1960
  2. Cohen HJ, Birch HG, Taft LT: Some considerations for evaluating the Doman-Delacato "Patterning" method. Pediatrics, 45:302- 14, 1970
  3. Delacato CH: The Diagnosis and Treatment of Speech and Reading Problems. Springfield, Illinois: Charles C Thomas, 1963.
  4. Doman G, Delacato CH: Train Your Baby to be a Genius. McCall's Maga zine, p. 65, March 1965
  5. Neman R, Roos P, McCann BM, Menolascino FJ, Heal LW: Experimen tal Evaluation of Sensorimotor Patterning used with Mentally Retarded Children. Am J Mental Deficiency, 79:372-84, 1975
  6. Ziegler E, Victoria S: On "An Experimental Evaluation of Sensorimotor Patterning": A Critique. Am J Mental Deficiency, 79:483-92, 1975
  7. Freeman RD: Controversy Over "Patterning" as a Treatment for Brain Damage in Children. JAMA, 202:83-86, 1967
  8. NACD website, URL-

The American Academy of Pediatrics has a position statement (Nov 1999) condemning "Patterning" as a "treatment" of neurologically handicapped children:

The Treatment of Neurologically Impaired Children Using Patterning
Committee on Children With Disabilities

ABSTRACT. This statement reviews patterning as a treatment for children with neurologic impairments. This treatment is based on an outmoded and oversimplified theory of brain development. Current information does not support the claims of proponents that this treatment is efficacious, and its use continues to be unwarranted.

ABBREVIATION. AAP, American Academy of Pediatrics.

Patterning has been advocated for more than 40 years for treating children with brain damage and other disorders, such as learning disabilities, Down syndrome, cerebral palsy, and autism.1-5 A number of organizations have issued cautionary statements about claims for efficacy of this therapy,6-10 including the American Academy of Pediatrics (AAP) in 1968 and 1982.3,11 Media coverage,12 inquiries from parents and public officials, the use of alternative forms of treatment by parents for their children,13 and the existence of a new generation of pediatricians who may be unaware of the programs that involve patterning have prompted the AAP to review the current status of this controversial treatment.

Patterning is a series of exercises designed to improve the "neurologic organization" of a child's neurologic impairments. It requires that these exercises be performed over many hours during the day by several persons who manipulate a child's head and extremities in patterns purporting to simulate prenatal and postnatal movements of nonimpaired children.14 Concern about patterning has been raised because promotional methods have made it difficult for parents to refuse treatment for their children without questioning their motivation and adequacy as parents.3 Moreover, dire health consequences for children are implied if parents do not make arrangements to have their child begin patterning.

Several treatment options are offered, ranging from a home program to an intensive treatment program, which states that each succeeding option "offers greater chance of success." Participation in the intensive treatment program requires completion of 3 of the 5 preceding programs, is by invitation only for the "most capable families," and potentially could deplete substantially a family's financial resources. The regimens prescribed can be so demanding, time-consuming, and inflexible that they may place considerable stress on parents and lead them to neglect other family members.15,16(pp251-252)

Patterning programs use a developmental profile designed by the Institute for the Achievement of Human Potential both to assess a child's neurologic functioning and to document change over time.16(p40)17 However, the validity of using this profile for these domains has not been demonstrated, nor has it been compared with currently accepted methods of measuring a child's development. In addition to making claims that a number of conditions may be improved or cured by patterning, proponents of the program assert that patterning can make healthy children superior in physical and cognitive skills.18-22

The aims of treatment programs include attainment of normality of physical, intellectual, and social growth in children with brain injuries. According to providers of patterning therapy,1 the majority of children treated are claimed to achieve at least 1 of those goals. To our knowledge, however, no new data have been presented to support the use of patterning since the AAP reissued its policy statement in 1982. The lack of supporting evidence for the use of this therapy brings into question once again its effectiveness in neurologically impaired children.


Neurologic organization, the principle central to the patterning theory of brain functioning, is an oversimplified concept of hemispheric dominance and the relationship of individual sequential phylogenetic development.16,23-25 This theory also states that failure to complete properly any stage of neurologic organization adversely affects all subsequent stages and that the best way to treat a damaged nervous system is "to regress to more primitive modes of function and to practice them."17 According to this theory, the majority of cases of mental retardation, learning problems, and behavior disorders are caused by brain damage or improper neurologic organization, and these problems lie on a single continuum of brain damage, for which the most effective treatments are those advocated by patterning.3,16

Current information does not support these contentions. In particular, the lack of dominance or sidedness probably is not an important factor in the cause of, or the therapy for, these conditions.3,16,17 Several careful reviews of the theory have concluded that it is unsupported, contradicted, or without merit based on scientific study.16,17,23,25 Others have described the hypothesis of neurologic organization to be without merit23 and concluded that the theoretical rationale for the treatment is inconsistent with accepted views of neurologic development.24,27(pp207-235)28(pp207-247)


Results published on patterning have been inconclusive.29-31 Although reports of improvement in reading ability after treatment have been heralded as support for the theory,32,33 statistical analysis revealed few demonstrable benefits.34,35 Controlled studies of reading skills have shown little or no benefit from treatment.16(pp333-352)36-38

Some disabled children who purportedly benefited from treatment had been given a misdiagnosis or an unduly pessimistic prognosis. The course of maturation in children with neurologic impairments varies, which leads to unwarranted claims that improvements in their conditions were the result of a specific form of treatment.17,39 Some of the cases publicized involved children with traumatic brain injury or encephalitis, who may make substantial health improvements without special treatment.

A well-controlled investigation40 compared 3 groups of children, all of whom were severely mentally disabled 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 found no significant differences among the 3 groups. On the basis of this study, the investigators found nothing to recommend patterning treatment over routine care.40 They concluded that patterning cannot be considered superior to any other method of treatment for institutionalized mentally disabled children.

Other less well-designed studies41,42 also investigated the effect of patterning therapy on children with a heterogeneous range of disabilities. One showed a significant, but short-term, effect on developmental progress in comparison with that attained by children receiving traditional programs in New Zealand.41 The investigators disclosed that the relative success of the program was linked to the families' desire to take greater responsibility for their children's education. Another investigation demonstrated no significant progress in the development of mentally disabled children who had undergone patterning therapy.42 A review of the use of patterning to arouse children in a coma and for sensory stimulation in brain-injured children and adults also gave no scientific evidence or theoretical rationale for its use.43


Pediatricians need to work closely with the families of their patients with neurologic disabilities and ensure that they have access to all standard services available in their communities. After the proper diagnosis is made, physicians should discuss controversial treatments as part of the child's initial management plan. Pediatricians, therefore, need to be acquainted with routine and controversial treatments, schedule ample time for their discussion, and explain to parents the placebo effect and the importance of basing treatment decisions on controlled research trials.

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.


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The recommendations in this statement do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

Copyright 1999 by the American Academy of Pediatrics. No part of this statement may be reproduced in any form or by any means without prior written permission from the American Academy of Pediatrics except for one copy for personal use.