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Review

Pseudoscience and Psychotherapy

THE DOMAN-DELACATO PATTERNING TREATMENT


FOR BRAIN DAMAGE
Terence M. Hines

INTRODUCTION

CCORDING TO THE PHILADELPHIA-BASED INSTItutes for the Achievement of Human Potential,


it has produced a noninvasive treatment for brain
damage. Details are contained in a popular book by
Glenn Doman, founder, in 1955, of the Institutes.1
Doman-Delacato patterning therapy (DDPT) was developed in the 1940s and the 1950s by Doman, a
physcial therapist; Temple Fay, a neurosurgeon; Robert
Doman, a physiatrist; and Carl Delacato, a psychologist.
Its core assumption is that brain damage causes a
blockage in the normal pattern of brain development.
The consequences of this blockage can allegedly be eliminated through what is termed patterning therapy, exercises that supposedly rewire the brain.

THEORETICAL BASES
Before reviewing empirical tests of the Doman/Delacato
exercises, I will first outline the theoretical bases of the
technique. Central to the patterning approach is the
long-discredited view that ontogeny recapitulates phylogeny. According to Delacato,2(p5) The ontogenetic
development of each individuals nervous system, in general, recapitulates that phylogenetic process. Thus, the
Terence M. Hines, PhD, is in the Psychology Department at Pace University,
Pleasantville, New York 10570. E-mail: thines@pace.edu.
THE SCIENTIFIC REVIEW OF ALTERNATIVE MEDICINE

Vol. 5, No. 2 (Spring 2001)

therapy is based on a view of the development and organization of the brain that is simply wrong. This is most
apparent in the developmental profile found in
Domans 1999 book.1 Here, he divides the central nervous system into 7 areas: (1) spinal cord and medulla, (2)
pons, (3) midbrain, (4) initial cortex, (5) early cortex,
(6) primitive cortex, and (7) sophisticated cortex. These
divisions of the cortex correspond to no accepted cytoarchitectonic regions. Domans initial cortex, for example, includes the inferior occipital and posterior inferior temporal lobes. His early cortex is above that. The
primitive cortex is above that, running in a strip from
the inferior frontal lobe back to the middle parietal and
superior occipital lobes. The sophisticated cortex sits
like a cap atop the brain.
Compounding these errors, Domans profile is divided into 6 areas of competence: visual, auditory, tactile, mobile, language, and manual. In the resulting 7-by6 table, each of the 42 cells is assigned 1 or more
functions said to be characteristic of that division of the
brain for the competence in question. Domans chart is
so full of neurological misinformation that I use it as an
exam question in my junior/senior-level physiological
psychology class. Students get 1 point for each error they
identify. A few examples will suffice. Outline perception
is said to be done by the pons, as is vital response to
threatening sounds. The midbrain does creation of
meaningful sound and, in the area of visual competence, it is credited with appreciation of detail within a
configuration; and, in audition, with the appreciation
of meaning sounds. Thus Doman and his collaborators
demonstrate unfamiliarity with even the basics of neu80

Hines: The Doman-Delacato Patterning Treatment for Brain Damage


roanatomy and localization of function. It is as if
someone offering a wonderful new auto repair system
were to assert that fuel combustion takes place in the
tires and that the transmission makes the radio work.
As I have noted elsewhere,3 a reliable sign of a quack
remedy is the claim that the same intervention will be
effective for a variety of different diseases with diverse
etiologies. Note that the full title of Domans1 book is:
What to Do about Your Brain-Injured Child or Your BrainDamaged, Mentally Retarded, Mentally Deficient, Cerebral-Palsied, Spastic, Flaccid, Rigid, Epileptic, Autistic,
Athetoid, Hyperactive, Downs Child. In effect, Doman is
claiming that patterning therapy will cure dozens of different disorders with causes ranging from genetic to traumatic. Such a sweeping assertion is absurd.
A few of Domans published examples of patterning
treatments will provide a feel for the nature of DDPT.
Doman1(p61) describes the technique of homolateral patterning as it is applied to a child hurt in the pons:
This pattern was administered by three adults. One adult
turned the head, while the adult on the side to which the
head was turned flexed the arm and leg. The adult on the
opposite side extended both limbs. As the head was
turned, the flexed limbs extended while the extended
limbs flexed. We found that when this pattern was administered rigidly enough and frequently enough, in a
timed pattern, many children hurt in the pons began to
crawl. When they became able to crawl, they would
rapidly move through creeping to walking and do well.

The same patterning approach is also allegedly applicable to sensory impairments. Consider the case of a
10-month-old girl named Mary who is, according to
Doman,1(p157) for all practical purposes deaf. Here, patterning therapy takes advantage of the fact that Mary
still has a normal startle reflex, which means, of course,
that she is not profoundly deaf. In this version of DDPT,
Marys mother will stimulate her auditorially every
waking half hour. . . . Mother will do so by unexpectedly
banging two blocks of wood just behind Marys head.
She does so ten times at three-second intervals in each
of twenty-four sessions.
Or take the case of Sean, who apparently can distinguish hot water from cold, but not warm from cool.
This indicates to Doman that he has a blockage at the
third stage of tactile competence. To overcome this
blockage, Seans mother will dip his hands, alternately,
in warm and cool water 600 times every day.

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EMPIRICAL INVESTIGATIONS
On the face of it, such far-fetched therapeutic regimes as
DDPT would seem quite unlikely to yield any improvement, although the cruel and reckless treatment of Mary
might very well engender a good deal of fear and anxiety.
One would expect that proponents of such implausible
techniques would feel a special obligation to back up
their therapeutic claims, but this is not the case. In fact,
the Institutes for the Achievement of Human Potential
have shown very little interest in providing empirical
support for their methods. In 1967, a well-designed,
comprehensive study (supported by both federal and private agencies) was in the final planning stage when the
Institutes withdrew their original agreement to the design.4(p1215) Here, the Institutes foreshadowed the sort of
behavior that has come to typify the majority of practitioners of what is now known as complementary and alternative medicine (CAM); i.e., pay lip service to the
need for the empirical evidence they ought to have
amassed before selling their treatments, promise to cooperate with critics in supplying it, then renege on the
commitment after reaping the public relations benefits
for having made the promise.
The founders of DDPT have published only one
study of its effectiveness in the medical literature.5 In
this 1960 paper in the Journal of the American Medical Association, the subjects were 76 brain-damaged children
with both traumatic and non-traumatic lesions, but
none who were genetically defective.5(p261) The children were given patterning training for at least 6
months. The authors report that they found significant
improvement when we compared the results of classic
procedures we had previously followed with the results of
the procedures described above.5(p261) Unfortunately,
the paper does not contain a description of what the
classic procedures were. At the beginning and end of
the study, the severity of movement impairment for each
child was rated. The article does not state that these
ratings were blinded, and they almost certainly were not.
It is not even reported who the raters were. Nor were any
statistical analyses of the results presented.
In three books, Delacato2,6,7 summarizes 11 studies
that he claims support the effectiveness of DDPT in
treating reading problems. None of these studies was
published and only 2 were by Delacato himself. All suffer
from serious statistical and/or methodological flaws.
These shortcomings were discussed in detail by Glass
and Robbins,8,9 on whose critiques much of the following
is based.
In his 1959 book, Delacato6 reports an 8-week case

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study of 30 reading-retarded third through fifth graders


who were taken from a number of schools.6(p99) Among
other things, the children all had the subdominant eye
occluded for one hour each morning and one hour each
evening at home.6(p99) The children were forbidden to
listen to music or sing because music, according to Delacato, is an activity of the nondominant hemisphere and
thus musical activities will result in unnecessary use
and therefore activation of the subdominant area.6(p25)
The children were also lectured about the proper posture
to maintain during sleep. Apparently the same reading
test (or tests) were used at the end of the program to
evaluate change as had been used at the start to classify
the children. No untreated control group, let alone a
placebo control group, was run. The median reading
growth was nine months. No further statistical analysis
was presented. There is no hint that Delacato saw the
need to control for confounds such as practice and
placebo effects. Rather, he concludes that the observed
change is due to changes in the neuro-organization of
the children.6(p100)
Delacatos 1963 book7 describes two more studies of
DDPT. The first was by Gayle Piper, a special-education
teacher at an Arizona high school. Subjects were 14 special education students. Prior to patterning therapy, they
took the Gates Basic Reading Test (GBRT). Subsequently, for 6 weeks, the sub-dominant arm of each student . . . [was] tied down to the body during special education classes every day.7(p157) A second version of the
GBRT was then given, followed by 6 more weeks of
therapy, and a third GBRT form, which was administered at the end of the school year. A fourth form of the
GBRT was given at the start of the fall term to see what
effect a three month summer vacation had on the
reading abilities of the student.7(p166) The means and
standard deviations (in parenthesis) for the four testing
sessions were, respectively: 5.07 (1.28); 5.55 (1.33); 5.43
(1.41) and 6.24 (1.48).
Delacatos book7 offers no statistical analysis for
these means. Robbins and Glass9 computed change
scores from the first to the second test administration
and computed a t-value based on these scores, which
was significant at the .01 level. However, a t-test comparing only the first and second tests omits half the data
from this study. A more appropriate analysis would be a
one-way analysis of variance including the data from all
4 testing sessions. The present author performed such an
analysis. One data point was missing, because one child
had transferred to another school. This missing cell was
filled using the method of Winer et al.10(p480)
As expected, there was a significant effect of testing

session [F(3, 39) = 20.26, p < .001]. This shows only that
the 4 means differed statistically. A Tukey post-hoc test
was then applied. This allows comparisons of individual
means, but controls for the increasing likelihood of
finding significant differences by chance alone as the
number of such comparisons grows. The critical difference at the .05 level was 1.4. Thus, while the overall pattern of test score changes across the 4 tests was statistically significant, no 2 pairs of means, considered
individually, were significantly different. It is, nonetheless, important to note that the largest difference between 2 adjacent means occurred for tests 3 and 4, given
at the end of the spring term and the beginning of the
next fall term, respectively. The only intervention
during this interval was summer vacation.
Delacato7 nonetheless takes these results as support
for his methods. In reality, they provide virtually none
because the study lacks both placebo and no-treatment
control groups. In the absence of these comparisons, it is
impossible to distinguish any putative benefits of the
therapy from those of several possible confounds. The
latter include practice effects from taking similar versions of the same test four times, simple maturational effects, the effects of additional experiences over time,
and improvements due to regular school instruction.
That maturational factors had a major effect can be seen
from the fact that the biggest single improvement (.81)
is found between the means for the assessments before
and after summer vacation, a period in which no therapy
(or classroom instruction) was given. By contrast, additional therapy was given between tests 2 and 3, but there
was no improvement in reading scores. In fact, scores decreased by a statistically insignificant amount.
Robbins and Glass9 also fault Pipers study with respect to a possible regression artifact, arguing that because the students scored lower than normal on their initial reading assessment, their scores would be expected to
regress toward the mean and thus improve on the next
test. It is not clear, however, that regression is a problem
here. The participants were special education students
and thus scored below the average of the entire school
population on this reading test. However, they were not
compared to normal students in this study, nor is there
any indication that they were picked because they were
below the mean of the special education population in
the school. Thus, regression does not seem to be an issue.
Nonetheless, this study suffers from enough other
methodological deficits to render it useless as support
for DDPT.
If regression effects are not a problem for the Piper
study, they dominate the second study reported by Dela-

Hines: The Doman-Delacato Patterning Treatment for Brain Damage


cato.7 This study was apparently done by Delacatos
group itself, as the pronoun we is used throughout.
The participants consisted of all 25 students in the junior
class of an all-male private high school. The verbal score
on the Scholastic Aptitude Test (SAT) was the dependent measure. On the basis of their first SAT results, the
boys were divided into two groups: a patterning therapy
group containing 9 students and a control group containing 16 students. No rationale was offered for not dividing the students more equally. Astonishingly, the experimental group was intentionally chosen to include

the 9 students who scored the lowest (X = 398) on the


verbal section of the SAT. The control group consisted

of the 16 boys who scored the highest (X = 547). After


six weeks of DDPT, the SAT was readministered. On the
second test, the control group showed an improvement
of only 7 points, the new mean being 554. The experimental group, however, showed an increase of 66 points,
their new mean rising to 464. It is almost as if the study
had been designed to demonstrate a regression artifact.
Delacato7 does address the issue of why the control
and experimental groups were not matched, but his rationale shows no awareness of the problems regression artifacts can create. He says, We did not match the groups
because of the great importance to each boy of the test
scores. We felt that it would not be ethical to possibly sacrifice the opportunity to go to college for a group of boys
merely for the sake of purity of experimental design.7(p17273) Did they not consider that if the therapy had
really proved effective in a pure experimental design, it
would have been a simple matter to provide it to the control group following completion of the experiment?
Moreover, it is unlikely that the subjects in the experimental group actually received much therapy. Delacato describes the therapeutic intervention, which
varied according to individual needs from creeping to
visual training:7(p172) Each boy in the experimental
group was diagnosed and was taught to follow a program
of neurological organization for one-half hour per day
without supervision for a six week period (emphasis
added).7(p17172) In other words, no one ensured that the
experimental subjects crawled around, occluded one eye,
and so on, during this 6-week period. How many male
high school juniors would comply, on their own, with an
odd regimen like this for 6 hours, let alone 6 weeks?
It is in Delacatos 1966 book2 that the majority of
the 11 unpublished studies he considers support for
DDPT appear. Eight, none conducted by Delacato, are
described. The relative inexperience of these investigators in conducting and evaluating experimental research
apparently did not concern Delacato.

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The first study was conducted by a Sister M. Edwin


at a Chicago-area Catholic school. The study started
with 108 kindergarten children but, for unspecified reasons, only 84 actually took part in the entire study, 41 in
a control group and 43 in the experimental group. Over
a 5-week period, the experimental group received 105
minutes daily of patterning activities such as creeping
and cross-pattern walking. The control group received
no special treatment whatever, except that their mothers
or older siblings were asked to read or tell a story to the
child for at least ten minutes daily.2(p51)
A battery of 7 unspecified tests was given at the start
and the end of the 5-week period. It is not stated
whether these evaluations were blinded. No statistical
analysis is presented but it is claimed that there was a
79% increase in something called controlled attention
span and a 70% increase in uncontrolled attention
span.2(p52) It is not clear whether these differences are
between the experimental and the control group at the
end of the program or between the experimental group
at the start compared to the same group at the end of the
program. Either way, the amount of personal attention
that children in the experimental group received, rather
than any specific benefits of the patterning procedures,
could easily account for these observed differences.
The second study reported by Delacato2 used
middle-class children who had reading problems. They
were attending summer remedial reading classes but
their ages and grade levels were unspecified. Nineteen
teachers participated in the experiment. Each taught 1
class of children from the experimental group and 1 class
of children from the control group. DDPT was provided
outside of class, requiring that children in the experimental group come to school 15 minutes early and stay
an additional 15 minutes after class for the 6-week duration of the trial. Probably because of this, each
teachers first morning class was designated the experimental class while the second class was always the control group.
The study began with 422 subjects, though only 242
completed the 6-week trial. The relative dropout rates of
experimental and control subjects was not reported but
Robbins and Glass9 note that this high attrition was unlikely to have been distributed evenly between the 2
conditions. Because the regimen imposed on the experimental group was much more onerous than that of the
control group (i.e., nothing), we can be reasonably sure
that the dropout rate was substantially higher in the
former. Disproportionate thinning of the experimental
group could have affected the outcome in various ways.
First, the classes in the experimental group would be-

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come smaller, allowing the teachers to give additional attention to each child, compared to those in the larger
control classes. Second, it is likely that those who
dropped out were, on average, less motivated and less
able readers than those who stayed. Finally, differences
in parental involvement could have been related to the
differential attrition rates, making it likely those who
stayed in might have received more help and encouragement at home as well. Such differences could have
produced a spurious treatment effect for the remaining
experimental subjects.
In addition to the foregoing problems, the absence
of a placebo control and blinding of evaluators also suggests alternative explanations for the observed results. It
is likely that some combination of these artifacts was responsible for the small, but statistically significant, improvement for the experimental group.
A Father Francis McGrath conducted the next study
reported by Delacato.2 The 92 third- to eleventh-grade
participants were recruited from those who were reading
below grade level. They were given about 45 minutes of
DDPT a day, 5 days per week, for 6 weeks. There was
neither a nontreated control group nor a placebo control
group. At the end of the 6-week program, there was a
statistically significant improvement, amounting to sixtenths of a grade level. However, due to the lack of experimental controls, once again, any improvement could
easily be accounted for by regression to the mean and
placebo effects.
In his chapter 14, Delacato2 recounts another study
of DDPT, by Ruth Kabot of the Morton Street School of
Newark, NJ. Twenty-two third graders were equally divided into an untreated control group and an experimental group. The latter received daily half-hour patterning treatments over an 8-week period. The 2 groups
were carefully matched as to IQ, reading scores, reading
retardation and laterality.2(p119)
A major flaw in this study was that different tests of
reading were used before and after the therapeutic intervention. The Stanford Reading Test was used as the
pretest and the California Reading Test as the post-test.
Given that different tests were used, it is hard to see
how pretest and post-test scores could be compared.
Kabot reported that the control group showed a gain of
6 months over the 8-week intervention, but this figure
is reported as a decimal (.6) in the table in the report.
The experimental group showed a gain of 8 months (or
.8). This difference was not significant.
In a footnote, Delacato himself reports a follow-up of
these subjects, one year later, to see if the experimental
group showed further improvement over that time.

However, only 7 pairs of students appear in the followup. No mention is made of why 5 pairs were not included. Nor does Delacato specify what test was used
for the follow-up evaluations. He does not report the
mean scores at follow-up, but simply asserts that the experiments group showed a .54 (units unspecified) greater
improvement than the control group and that this was
statistically significant at the .05 level.
Chapter 16 of Delacatos book2 is devoted to a study
of high school students enrolled in a summer remedial
reading clinic. Students attending the 8 A.M. class were
designated the experimental group. Every day for 7
weeks, these students spent 1 hour in the gym doing patterning therapy. This period represented half of their
total daily class time. The control group was made up of
students in a 10 A.M. class who received no special treatment and spent the entire 2-hour period, with the exception of a short break, in the same classroom. There
was no placebo treatment group. At the beginning and
the end of the 7-week program, both groups were given
the Nelson Test of Mental Abilities and 7 subtests from
the Stanford Achievement Test. On 2 of these (paragraph meaning and word meaning) the experimental
group showed significantly higher scores than the control
group at the end of the program. The experimental group
also scored significantly higher than the control group,
post-treatment, on the Nelson Mental Abilities test.
The most obvious of the many problems with this
study was the lack of a placebo control. As the report itself admits, the fact that the control group had to stay in
the same classroom for 2 hours, while the experimental
group was allowed to go to the gym for an hour, had a
major differential effect. The authors of the study noted
that there was a problem of class control in the control
group: There was an undertone of restlessness and poor
attitude that was not present in the experimental
group.2(p141) In addition, some subjects were moved from
one group to the other. And finally, 12 subjects (8 experimental and 4 control) unaccountably vanished from
the data analysis. The report states, with no explanation,
that there were 28 control and 22 experimental subjects, but data were analyzed for only 14 experimental
and 24 control subjects.
A study by John Noonan Jr. of the Boston University School of Education occupies chapter 17 of Delacatos book.2 Eleven sixth- and seventh-grade students
participated. Nine were reading between 2 and 5 years
below grade level. For the entire school year, 9 students
(not necessarily the 9 reading below grade level) received 45 minutes of DDPT each school day. The remaining 2 students started the program late and so re-

Hines: The Doman-Delacato Patterning Treatment for Brain Damage


ceived patterning training for only half the year. The
Iowa Silent Reading Test was the dependent measure.
There was neither an untreated control group nor a
placebo control group. On 4 of the Iowa tests 6 measures
of reading ability, there was a significant improvement
over the course of the year, averaging 3 years and 3
months. There was an improvement of 1 year and 3
months on the other 2 measures, but this was not statistically significant. These results can easily be explained
by a combination of regression effects (since most of the
students were reading well below grade level initially)
and the normal effects of a year of schooling, as well as
a placebo effect. Once again, the study provides no convincing support for the patterning exercises.
Unlike any of the foregoing unpublished studies
summarized by Delacato, the one by a Sister Alcuin
(chapter 18) does include appropriate control groups.
She employed 3 groups of 40 children each, ranging from
6 to 14 years old. They were enrolled in a 6-week
summer school course. A nontreated control group received only the standard curriculum. A placebo control
group of sorts received 3 20-minute periods per day of
unspecified psychological training and some calisthenics. The experimental group received 3 20-minute
periods per day of neurological training, i.e., DDPT.
Given the relative sophistication shown by the inclusion of 2 control groups, it is unfortunate that assignment of students to the 3 conditions was apparently not
done randomly. Assignment was based on students
pretest scores on the Stanford Reading Achievement
Test and the individual teachers judgement. It appears
that students who were the least able readers may have
been placed in the experimental group. This group
showed an improvement of .73 years reading level over
the 6-week program. The nontreated and placebo control groups showed improvements of .40 and .42 years,
respectively. The difference between the experimental
and the 2 control groups was statistically significant. To
the extent that the experimental group consisted of the
more disabled readers, the observed differences would be
due, again, to regression effects.
The final study in Delacatos 1966 book2 is an edited
version of a EdD dissertation by Brian Miracle at the
University of Wyoming.11 Forty fourth- and fifth-grade
students, all reading below grade level, were subjects.
They were divided into 4 groups2 received neurological training (DDPT) and 2 did not. Crossed with
this variable was another in which students did or not receive a remedial reading program2 groups did and 2
did not. In this 2-by-2 research design, the Iowa Test of
Basic Skills was given before and after the 8-week reme-

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dial program. This test yields two relevant measures, vocabulary skill, and reading ability. Miracle reported mean
pre- and post-intervention scores for each of the 4 groups
on these 2 variables. Oddly, neither in Delacatos2 edited
version nor in the original dissertation did Miracle report
doing an overall analysis of variance on his data. Instead, he presents a rather unhelpful table giving 24
Fishers t-values for each of 6 intergroup comparisons for
each of the 4 variables (reading and vocabulary scores,
pre- and post-intervention). Robbins and Glass criticize
this procedure because it capitalizes on the chance significance expected with multiple testing. They apparently did not realize that Miracle (as he stated) was using
Fishers t-test, which (unlike Students t) is a post-hoc
procedure that controls for the effects of multiple comparisons (see Keppel12).
Nonetheless, Miracles table of 24 t-values, of which
7 are significant at the .05 level, is not very informative
because he never reports comparisons of the 4 groups before and after the program. That is, he does not say
whether the crucial within-group changes are significant. For the reading ability data only, Robbins and
Glass9 estimate the variances of the pre- and post-test
means and performed their own analysis of variance.
They found that the scores of the 2 groups that received
neurological training were significantly greater (using
Tukey post-hoc tests) than the scores of the 2 groups that
did not.
The question, of course, then becomes, why was this
the case. Robbins and Glass9 correctly point out that
important details about the experimental methodology
are missing from Miracles reports. Specifically, they say,
One cannot learn from the research report whether the
four groups had the same or different teachers, whether
the groups met at the same or different times of the day,
whether the subjects were treated individually or as intact groups.9(p366) The issue of whether each group had
its own teacher is especially important. If this was the
case, the observed group differences could well be due to
differences between the teachers and not to differences
in the effectiveness of the treatments.
In summary, the studies reported in Delacatos 3
books provide essentially no convincing evidence in
favor of patterning therapy. Robbins and Glass9(p347)
aptly concluded that these studies are
. . . exemplary for their faults. They were naively designed
and clumsily analyzed. They suffer from a multitude of
sources of invalidity. They appear to have been executed
and reported in an atmosphere of relative insensitivity to
basic considerations of empirical, experimental research.

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The present author has found these experiments to


be excellent sources of exam questions in his introductory statistics class. Students must read Delacatos description of a study and then outline its design flaws.
Melvyn Robbins, a critic of the studies reported in
Delacatos books, published his doctoral dissertation in
1966.13 Interestingly, he notes that he spent 2 months
in residence with Carl Delacato.13(p57) at the Institutes
in Philadelphia. In Robbinss experiment, 126 second
graders were divided into 3 groups. For 3 months, an experimental group received 30 minutes of several types of
patterning during the half hour before school. A placebo
group danced, played games, and received nonspecific
patterning for a comparable period. The nontreated controls followed their normal before-school routine. All 3
groups were tested on their reading and arithmetic skills,
intelligence, and laterality (hand, foot, and eye preferences), as well as their creeping ability, before and after
the 3-month program. The creeping test was designed by
individuals trained at the Philadelphia Institutes.
Robbins tested 6 hypotheses based on the Delacato
approach. First, at pretest, creeping ability should correlate positively with reading ability. Three raters rated
the creeping ability of all participants. Interrater reliability was high (average r = .76), but there were no significant correlations between rated creeping ability and
reading scores, even at the .10 level. The average correlation was .03.
The second hypothesis concerned laterality. Subjects who were lateralized should, according to Delacatos perspective, show higher reading scores than those
who are not. This was not the case. The third hypothesis, a variant of the second, stated that the relationship
between reading and creeping should emerge when
creeping ability was statistically controlled for. In fact,
this did not yield any greater relationship between
reading and laterality.
The fourth hypothesis was that the DDPT group
would show greater improvement after training on
reading than would the other groups. Since there had
been significant differences in reading (and arithmetic)
scores between the groups at pretesting, an analysis of
covariance with pretest score as the covariate was used
to test this hypothesis. It was not supported. The fifth
hypothesis was based on the claim that patterning treatment is effective for boosting reading but not math skills.
Analysis of covariance showed this not to be the case. Finally, the sixth hypothesis predicted that there would be
more lateralized experimental subjects after training
than before. Although the primary aim of DDPT is to increase lateralization, this was not found. Robbinss13

study stands out in that not only did it test the therapeutic claims of Delacatos method, it also tested specific
theoretical predictions made by the underlying theory.
DDPT was found wanting on all counts.
In his first experiment, Robbins studied normal students. In his second study,14 he used third through ninth
graders who were attending a summer remedial reading
program. A total of 149 students was divided into 3
groups. The experimental group received DDPT and related training, both at home and at school. The placebo
control group took part in nonpatterning physical activities (games, sports, music, dancing, and so on), both
at home and at school, for the same amount of time.
There were no differences between the three groups
in the amount of reading improvement over the course of
the program. Replicating Robbinss13 earlier findings, neither creeping ability nor laterality measures correlated
with reading ability. Robbinss second study was published in the Journal of the American Medical Association.
It was accompanied by a short commentary by Freeman15
pointing out the empirical and theoretical shortcomings
of the Doman-Delacato approach. Robbins16 has also
published a shortened summary of his work.
A study by Kershner, allegedly supporting DDPT,
has appeared in three different versions. The original
was a 1967 masters thesis done at Bucknell University.17
It was published in booklet form the same year by the
State of Pennsylvania Department of Public Instruction.
And finally, it appeared in the scientific literature in
1968.18 I have been unable to obtain the first 2 versions
of this study, but Freeman19 reviewed the Pennsylvania
state publication of it and the following is based on his
review. Kershners study examined 2 groups of children
classified as trainable retarded. Thirteen children were
given DDPT every school day for 74 days. Sixteen control children engaged in normal physical activity during
the same period. At the end of the study, the DDPT
group was found to be better than controls on measures
of perceptual motor proficiency in areas not practiced19(p914) and on the Peabody Picture Vocabulary Test
(an intelligence measure). The DDPT group gained 12
Peabody IQ points while the control group lost 3.
There are two major defects in this study.19 The 2
groups were not equated on pretest IQ scores. The mean
score for the experimental group was 40 and that for the
control group was 62. Thus, the observed changes could
well have been due to regression to the mean. To make
matters worse, it seems that the experimental children
received much more enthusiastic intervention than the
control children. Freeman18 quotes from a local newspaper story about the study in which teachers of the

Hines: The Doman-Delacato Patterning Treatment for Brain Damage


children in the experimental group extol the wonderful patterning training. Differing zeal of the teachers,
combined with the regression problem already noted, is
sufficient to account for the observed group differences,
negating any support for DDPT.
Kershner admitted as much in a later recounting of
this work,18 noting that the extent to which differential
teaching effects entered into the findings is unknown
and that the increases in IQ after DDPT should be
viewed with caution because of the pretest group differences. Freeman20 notes that the conclusions in this
account were more conservative than those of the
above-mentioned booklet published by the State of
Pennsylvania, which was widely distributed in promotions of the Institutes for the Achievement of Human
Potential.
As implausibly optimistic claims generally do, the
Doman-Delacato technique received much favorable attention in the popular press in the early 1960s.14 Concern for the public prompted the American Academy of
Pediatrics (AAP) to issue a statement, in 1965, condemning DDPT. By the fall of 1968, this statement had
been approved by 9 other professional organizations, including the American Academy of Neurology,4 the
American Academy of Physical Medicine and Rehabilitation, the American Association on Mental Deficiency, and the National Association for Retarded Children. In addition to faulting the theory and empirical
support for DDPT, the AAP was critical of the highpressure tactics used to promote it. The AAP concluded
that these sales methods appear to put parents in a position where they cannot refuse such treatment without
calling into question their adequacy as . . . parents. In
addition, it is asserted [by DDPT promoters] that if
therapy is not carried out as rigidly prescribed, the childs
potential will be damaged. The AAP was also dismayed
that restrictions are often placed upon age-appropriate
activities of which the child is capable, such as walking
or listening to music. An updated version of the AAPs
censure appeared in Pediatrics in 1982.21
Several more studies of DDPT appeared after the
original AAP critique. A 1969 dissertation by Fredericks22 (cited in Foreman and Ward23) showed that a standard 9-week motor training program was more effective
than a patterning program for improving motor control
in children with Downs syndrome.
In 1970, Cohen et al.24 criticized DDPT on theoretical grounds, attacking, for instance, its central tenet that
children must pass through lower stages of a skill to become competent at higher stages (e.g., one must crawl before one can walk). These critics cited, to the contrary, a

87

developmental study of Hopi children.25 Traditionally,


Hopi infants are bound to a carrying board that prevents
crawling for the first year of life. But a comparison of Hopi
children raised in the traditional way with those allowed
to crawl showed no differences between the 2 groups in
walking ability. It appears that the neural systems that
control walking develop in the absence of crawling.
In 1974 Newman et al.26 reported a study using reasonably high-functioning retarded subjects. Excluded
were those with very low IQs and those who were deaf,
blind, or otherwise severely impaired. Sixty-six subjects
were divided into 3 equal groups. The experimental
group received patterning and sensory training for 2
hours a day, 5 days a week, for 2.5 months, and then 7
days a week for another 3.5 months. A placebo group
participated in general physical activity and interacted
with volunteers and supervisors for the same amount of
time. There was a nontreated control group that was
merely tested at the same time as the 2 other groups. All
groups were tested 4 times during the course of the 6month experiment, with the first test being at the outset
of the study. The authors claimed that the experimental
group improved more than either control group on perceptual, motor, and linguistic measures, but not on the
intelligence measures.
Zigler and Seitz27 found serious methodological and
statistical flaws in the design of the Newman study. The
patterning training that the experimental group received
was administered by trainers from the Dallas Academy,
an organization strongly committed to the validity of
DDPT. The physical activity the placebo control group
received was administered by psychology graduate students. There may also have been a failure to blind evaluators as to which group any given child had been in.
The part of the evaluation requiring close physical proximity to the children was carried out by individuals
trained by the Institutes for the Achievement of Human
Potential, individuals with a large stake in proving patterning therapy valid.
There were also statistical problems. Many of the 46
dependent variables had high inter-correlations; i.e.,
they were not independent. Separate univariate analyses
were carried out on each variable. Although an initial
analysis of covariance was done, Zigler and Seitz note
that this does not protect against an inordinately high
likelihood of falsely rejecting the null hypothesis in their
analysis of all 46 measures.27 In fact, while 46 different
dependent measures were examined, many more than 46
tests were done. Zigler and Seitz obtained a copy of the
unpublished report of the full study, of which the published version was a summary. They found in the un-

88

THE SCIENTIFIC REVIEW OF ALTERNATIVE MEDICINE

published version that 276 statistical tests had been performed, but only 23 (8.2%) reached significance at the
.05 level. Since many of the individual measures were
correlated among themselves, even this 8.2% figure
overstates the case. Newman28 replied to Zigler and
Seitz,27 but his lengthy reply concerns itself largely with
interpretative issues and generally ignores the more damaging statistical criticisms.
In 1978 Sparrow and Zigler29 published their own
study of patterning treatment effectiveness. An experimental group received DDPT for a year. A placebo group
received a matched motivational treatment designed
to increase self-esteem. This included various games and
other activities individual children participated in with
foster grandparents. There was also a nontreated control
group. Over the year, all 3 groups showed some improvement on various measures, but in no case did the
pattern of change of the treatment group differ from that
of its crucial comparison, the motivation group.29(p137)
Although no peer-reviewed experimental research
on patterning has been published since 1978, it has been
mentioned in a few nonexperimental papers. In 1981,
Zigler30 published a plea to end the use of the patterning
treatment for retarded children, calling it useless, expensive, and possibly harmful.30(p389)
In 1979 the National Academy for Child Development (NACD) was founded by Robert Doman in Riverside, California. In 1983 Holm31 reviewed the program
of the NACD (now headquartered in Ogden, Utah) and
concluded that nothing had been added to the old, discredited patterning approach.
In a 1986 review of treatments for Downs syndrome,
Foreman and Ward23 mentioned patterning, but only to
emphasize the lack of evidence for its effectiveness. They
reiterated the condemnation of DDPT by the American
Academy of Pediatrics. Foreman and Ward32 also surveyed pediatricians regarding their preferred therapies
for Downs syndrome. Of the 204 respondents, 97.5%
said that they never recommended patterning and
92.2% reported that they advised parents against using
it. Only 2.9% said that they were sometimes in favor
of patterning and the remaining 4.9% were unaware of
its existence.

CONCLUSION
Although no research on patterning therapy has been
published in the medical or psychological literature for
over 10 years, it has not disappeared. Discredited treatments rarely do. Instead, they are perpetuated by testi-

monials and uncritical media reports that fuel the marketing efforts of profit-driven promoters. True to fashion,
Domans 1994 book1 was essentially a republication of an
identical book from 1974.33 The only difference was that
the word Downs was added to the title, broadening
the potential clientele. The Institutes for the Achievement of Human Potential continue to promote patterning therapy in their publications and courses, all
listed on the IAHP Web site (www.iahp.org). One of
their courses is titled What to Do About Your BrainInjured Child and uses Domans book as the text.

REFERENCES
11. Doman G. 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, Downs Child. Garden City Park, NY:
Avery; 1994.
12. Delacato C. Neurological Organization and Reading.
Springfield, Ill: Thomas; 1966.
13. Hines T. Pseudoscience and the Paranormal: A Critical
Examination of the Evidence. Amherst, NY: Prometheus Books;
1988.
14. American Academy of Neurology. The Doman-Delacato treatment of neurologically handicapped children. Neurology. 1968;18:12141216.
15. Doman RJ, Spitz EB, Zucman E, Delacato CH,
Doman G. Children with severe brain injuries. JAMA 1960;
174:257262.
16. Delacato C. The Treatment and Prevention of Reading
Problems. Springfield, Ill: Thomas; 1959.
17. Delacato C. The Diagnosis and Treatment of Speech and
Reading Problems. Springfield, Ill: Thomas; 1963.
18. Glass GV, Robbins MP. A critique of experiments on
the role of neurological organization in reading performance.
Reading Research Quarterly. 1967;3:551.
19. Robbins MP, Glass GV. The Doman-Delacato rationale: a critical analysis. In: Hellmuth J, ed. Educational
Therapy. Vol. 2. Seattle, Wash: Special Child Publications;
1969:321377.
10. Winer BJ, Brown DR, Michels KM. Statistical Principles in Experimental Design. 3rd ed. New York, NY: McGraw
Hill; 1991.
11. Miracle BF. The Linguistic Effects of NeuropsychoLogical
Techniques in Treating a Selected Group of Retarded Readers [dissertation]. Laramie, Wyo: University of Wyoming; 1964.
12. Keppel G. Design and Analysis. 2d ed. Englewood
Cliffs, NJ: Prentice-Hall; 1982.
13. Robbins MP. The Delacato interpretation of neurological organization. Reading Research Quarterly. 1966;1:5778.
14. Robbins MP. Test of the Doman-Delacato rationale
with retarded readers. JAMA. 1967;202:389393.

Hines: The Doman-Delacato Patterning Treatment for Brain Damage


15. Freeman RD. Controversy over patterning as a
treatment for brain damage in children. JAMA. 1967;202:
385388.
16. Robbins MP. Creeping, laterality, and reading. Academic Therapy Quarterly. 1966;1:200206.
17. Kershner JR. An Investigation of the Doman-Delacato
Theory of Neuropsychology As It Applied to Trainable Mentally
Retarded Children in Public Schools [masters thesis]. Lewisburg,
Pa: Bucknell University; 1967.
18. Kershner JR. Doman-Delacatos theory of neurological organization applied with retarded children. Exceptional
Children. 1968;34:441450.
19. Freeman RD. Review of Kershner JR, An Investigation
of the Doman-Delacato Theory of Neuropsychology As It Applies
to Trainable Mentally Retarded Children in Public Schools. J Pediat. 1967;71:914915.
20. Freeman RD. Letter. Exceptional Children. 1968;35:
9495.
21. American Academy of Pediatrics. The Doman-Delacato treatment of neurologically handicapped children. Pediatrics. 1982;70:810812.
22. Fredericks, H. A Comparison of the Doman-Delacato
Method and Behavior Modification upon the Coordination of Mongoloids [dissertation]. Eugene, Ore: University of Oregon; 1969.
23. Foreman PJ, Ward J. Treatment approaches in Downs
syndrome: A review. Aust N Z J Dev Disabilities. 1986;12:
111121.
24. Cohen HJ, Birch HG, Taft LT. Some considerations

89

for evaluating the Doman-Delacato patterning method. Pediatrics. 1970;45:302314.


25. Dennis W, Dennis MG. The effects of cradling practices upon the onset of walking in Hopi children. J Genet Psychol. 1940;56:7786.
26. Newman R, Roos P, McCaan BM, Menolascino FJ,
Heal LW. Experimental evaluation of sensorimotor patterning
used with mentally retarded children. Am J Ment Defic.
1974;79:372384.
27. Zigler E, Seitz V. On An experimental evaluation of
sensorimotor patterning: a critique. Am J Ment Defic. 1975;
79:483492.
28. Newman R. A reply to Zigler and Seitz. Am J Ment
Defic. 1975;79:493505.
29. Sparrow S, Zigler E. Evaluation of a patterning treatment for retarded children. Pediatrics. 1978;62:137150.
30. Zigler E. A plea to end the use of patterning treatment
for retarded children. Am J Orthopsychiatry. 1981;51:388390.
31. Holm VA. A western version of the Doman-Delacato
treatment of patterning for developmental disabilities. West J
Med. 1983;139:553556.
32. Foreman PJ, Ward J. A survey of pediatric management practices in Downs syndrome. Aust Pediatr J. 1986;22:
171176.
33. Doman G. 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. Garden City Park, NY: Avery; 1974.

IN BRIEF
When Nonsense Equals Common Sense
PARISAccording to a January 29, 2001, Reuters report, French health authorities have issued a report recommending that radio emissions used for mobile telephones be reduced to the lowest levels possible to avoid
health risks. The report also recommends against excessive use of mobile telephones by children.
According to the US Food and Drug Administration, the radio frequency energy or radiation emitted at
low levels by mobile phones can, at high exposure levels,
cause biological damage. Amid speculation that these
radio emissions may cause brain cancer or other illnesses

in immoderate users, the reports authors insisted they


have no proof for these theories.
The general attitude of prudence recommended by
no means amounts to proof of the theories about health
risks, the report said. This is good sense advice justified
by the reasonable doubts that exist while we wait for future scientific information.
There is no evidence for biological damage from prolonged
use of microwave devices. The only production is heat. Prudence in this case indicates unrestricted use.Ed.