[tri-med] NACD Article from a Sceptic

Hey all!  I found the following article while searching for more info on 
NACD.  I hope you guys will find it useful.  I became wary of NACD when they 
changed their policy regarding payment.  They now require payment for one 
year up front ($1600) as opposed to paying every 3 months when you come back 
for the re evaluation.

It's kind of a long article, but worth $1600 to me :-)!

Psychomotor Patterning
by Steven Novella, MD
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.

References:

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 Prob lems. 
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-http://www.nacd.org/articles/food.html





_________________________________________________________________
Get your FREE download of MSN Explorer at http://explorer.msn.com/intl.asp

                  Building ___ooOOoo__ Rainbows
                       www.trisomyonline.org
                  Families Helping Families On-line

Other related posts: