"Patterning" Under Attack

"Patterning" is a rigid physical treatment for children handicapped by brain damage, mental retardation or reading disabilities. It has received widespread publicity, and is now being used to treat 10,000 children in the U.S. and abroad. Some of them appear to have responded to the treatment. But while the parents involved have become ardent disciples, medical men have seriously questioned the theory underlying the method. This month, ten major medical and health organizations* stated categorically that patterning was "without merit" and chided its inventors for claiming cures without documentation.

Regimen of Recapitulation. The patterning method was devised in the early 1950s by Physical Therapist Glenn J. Doman and Psychologist Carl Delacato. To apply the novel technique, they organized Philadelphia's Institutes for the Achievement of Human Potential. The therapy is based on a highly disputed hypothesis. According to the Doman-Delacato theory, impairment of speech, vision and manual skills can be caused by the interruption of a child's normal progress from creeping to crawling to walking. Discarding standard evaluation systems and using an elaborate diagnostic scheme of their own, Doman and Delacato classify retarded children in three questionable "profile" groups: 1) truly brain-injured. 2) psychotic, 3) genetically brain-deficient. They treat children in any of these groups who have presumably skipped one or more of the creep-crawl-walk stages by prescribing a compulsory retracing of the process. No matter how old they are, the children are painstakingly retaught to creep, then crawl, then walk.

Sessions begin under the strict supervision of a physical therapist, then must be rigorously continued at home for daily periods ranging up to twelve hours--between follow-up visits to the I.A.H.P. at 30-to 90-day intervals. In more severe cases of mental and physical retardation, treatment begins with physical manipulation of the limbs by therapists, then parents and family friends, to simulate creep-crawl-walk movements. Usually, at least three people are needed to put the child through his paces, and the therapy must be carried out in five-minute sessions, four times a day, seven days a week.

Punctured Profile. Doman and Delacato demand strict adherence to the format of their program, insisting that anything less may result in failure. Such time-consuming effort is justified, they claim, since it patterns those functions that the child's brain has somehow failed to develop.

The dissenting medical groups denounce the Institutes for the Achievement of Human Potential for "the excessive nature of their undocumented claims." The medical organizations point out that there has been no scientifically sound evidence to support the theory or practice of patterning. Doman and Delacato withdrew from one comprehensive, Government-supported study designed to test their theory. Independent tests conducted by Dr. Melvyn P. Robbins at the University of Chicago failed to substantiate the validity of the treatment.

In the A.M.A. Journal, Philadelphia Child Psychiatrist Roger D. Freeman pointed out some other shortcomings of the Doman-Delacato theory. It ignores the fact that some children with severe brain damage recover without any treatment at all, he wrote, and it overlooks the fact that intense attention and love can often stimulate improvement. Forcing parents to become practically full-time therapists, he added, could easily cause neglect of other members of the family and feelings of guilt if a session were ever missed. Freeman also questioned the Doman-Delacato notion that the use of playpens may inhibit mental development, and punctured their oversimplified diagnostic profile for retarded children.

"By themselves," said Freeman last week, "testimonials and case histories may impress laymen, but unfortunately they prove nothing." Calling the Philadelphia team's sweeping claims for cure and extreme demand on parents unjustified by present evidence, he said, "There are alternatives to the Doman-Delacato methods, and we intend to increase public and professional awareness to these."

*The American Academy for Cerebral Palsy, the American Academy of Physical Medicine and Rehabilitation, the American Congress of Rehabilitation Medicine, the Canadian Association for Children with Learning Disabilities, the Canadian Association for Retarded Children, the Canadian Rehabilitation Council for the Disabled and the National Association for Retarded Children.

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