Psychomotor Patterning
Steven Novella, MD
In the 1960s, psychomotor patterning was proposed as a new treatment modality f
or people with mental retardation, brain injury, learning disabilities, and oth
er 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 ear
ly 1970s, when the scientific medical community arrived at the consensus that i
s should be discarded as a false concept with no therapeutic role. Its use, how
ever, has not stopped.
The concept of patterning was invented by Glenn Doman and C. Delacato and is th
erefore often referred to as the Doman-Delacato technique [1]. Their theories a
re primarily an extension of the outdated concept that ontogeny (the stages thr
ough which organisms develop from single cell to maturity) recapitulates phylog
eny (the evolutionary history of the species). Thus the neurodevelopmental stag
es of crawling, creeping, crude walking, and mature walking through which norma
l children develop is directly related to the amphibian, reptilian, and mammali
an evolutionary human ancestors [2].
Doman and Delacato postulated that mental retardation represents a failure of t
he individual to develop through the proper phylogenetic stages. Their treatmen
t modality supposedly stimulates proper development of these stages, each of wh
ich must be mastered before progress can be made to the next stage. This stimul
ation is done through what they call "patterning," in which the patient moves r
epeatedly in the manner of the current stage. In the "homolateral crawling" sta
ge, for instance, patients crawl by turning their head to one side while flexin
g the arm and leg of that side and extending the arm and leg of the opposite si
de. Patients who are unable to execute this exercise by themselves are passivel
y moved in this manner by 4-5 adults, alternating back and forth in a smooth ma
nner. This must be repeated for at least 5 minutes, 4 times per day. This exerc
ise is intended to impose the proper "pattern" onto the central nervous system.
 In the full treatment program, the exercises are combined with sensory stimula
tion, breathing exercises intended to increase oxygen flow to the brain, and a 
program of restriction and facilitation intended to promote hemispheric dominan
ce [3]. Advocates claim that patterning enables mentally retarded and brain inj
ured children to achieve improved, and even normal, development in the areas of
 visuo-spatial tasks, motor coordination, social skills, and intellect. They al
so claim to promote superior development in a normal child [4].
The theoretical basis of psychomotor patterning vements can influence the development and structure of th
e brain. As Delacato stated in 1963:
Man has evolved phylogenetically in a known pattern. The ontogenetic developmen
t of normal humans in general recapitulates that phylogenetic process. We have 
been able to take children who deviate from normal development (severe brain in
jured) and through the extrinsic imposition of normal patterns of movement and 
behavior have been able to neurologically organize them sufficiently so that th
ey can be placed within a human developmental pattern of crawling, creeping, an
d walking [3].
Medical treatments are evaluated on two criteria, their theoretical basis and t
heir empirical value. The scientific community has rejected patterning on both 
counts. By the 1960s, it became clear that recapitulation it is based on an inc
orrect linear concept of evolution. Evolutionary lines continuously branch and 
deviate, forming a complex bush of relationships, not a linear ladder of descen
t. Embryological development does not reflect the mature stages of other distan
t branches of this evolutionary bush. Studying the embryology of the developing
 fetus also does not reveal any evidence of successive stages reflecting past e
volutionary ancestors.
There is also no theoretical basis for the belief that patterns can be impresse
d upon the developing cortex. Brain development is genetically driven and invol
ves a complex sequence of cell growth, migration, organization, and even progra
mmed cell death. Abnormalities in this process can be caused by genetic flaws, 
toxic insults, infection, or biochemical abnormalities. There is no model by wh
ich any of these disparate causes can be influenced by passive, or even active,
 movement of the neck and limbs. Thirty years of subsequent neurological, embry
ological, and medical progress have failed to lend any theoretical or clinical 
support for Doman and Delacato's principles.
Their use of breathing exercises to promote oxygen delivery to the brain also l
acks an acceptable theoretical basis. The brain and the cardiovascular system a
re designed to give highest priority to oxygen flow to the brain cells. Elabora
te and powerful feedback mechanisms ensure adequate delivery. It is true that c
arbon dioxide retention, in this case achieved through breathing techniques, do
es increase blood flow to the brain. There is absolutely no reason to believe, 
however, that this helps the developing brain.
In 1982, the American Academy of Pediatrics issued a position statement conclud
ing that "patterning" has no special merit, that its proponents' claims are unp
roven, and that the demands on families are so great that in some cassite [5].
Of course, if clinical evidence could demonstrate that patterning improves neur
ological development, it would be still accepted and used. Many mainstream inte
rventions lack a fully understood theoretical basis. Physicians are, at their h
eart, practical individuals, and if something works, it works. They require pro
of, however, that an intervention does indeed work and is safe.
On this score, patterning has just not delivered. Duringf approximately ten yea
rs in the late 60s and early 70s, dozens of clinical trials compared groups of 
developmentally delayed children given patterning treatment to comparable who r
eceived no treatment but similar amounts of attention [2,6-8]. None confirmed t
he claims of Doman and Delacato. Some found modest improvements in motor or vis
uo-spatial skills, but none showed improved intellectual development. The few p
ositive studies were neither impressive nor reproducible. Eventually, such clin
ical trials stopped and the scientific community abandoned the technique as a b
lind alley.
The tragedy of this story does not stem from the fact that patterning is a fail
ed theory. It is regrettable that patterning did not deliver as promised, for a
ny legitimate treatment for brain injured and retarded children would be mr theories had been scientifica
lly validated. This behavior, similar to the "cold fusion" fiasco, is more than
 just professionally irresponsible. In physics, such behavior is merely bad for
m; when dealing with the desperate parents of brain injured children, it should
 be considered cruel. Doman and Delacato were widely criticized for publicizing
 their unsubstantiated claims and giving false hope to vulnerable parents and t
heir afflicted children.
The saga, however, did not end with the scientific death of patterning. Doman, 
Delacato, and their associates began incorporating the patterning technique int
o their Institutes for the Achievement of Human Potential (IAHP), which was est
ablished in Philadelphia in the 1950s and still operates today. A second facili
ty, the National Academy of Child Development (NACD) 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 state that there 
is 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 cu
re" of a child suffering from moderate mental retardation. As is typical of the
 lay media, Kathy Lee provided an emotionally appealing view of patterning with
out even a hint of skepticism. The segment did bring out the desperateness of t
he 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 desper
ation, they sought any possible hope, and it was offered to them by the IAHP. T
he hope that they purchased, however, came at a heavy price, both financial and
 emotional.
The IAHP and the NACD both rely heavily on the family as the primary deliverers
 of the patterning treatment. In order to even reach the stage where their chil
d can be enrolled into the aggressive treatment program, they must first comple
te a training and evaluation course that begin with purchasing and listening to
 a set of audiotapes. The IAHP states in their literature that only the most de
dicated and capable parents will make it to the final stage of treatment. The N
ACD appears less demanding, but follows the same principle. The program require
s families to alter their lives to institute a daily program of patterning exer
cises, breathing exercises, and 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 program also illuminated another important feature of the s
, food sensitivities must be considered as one of the most likely [9]. 
Food sensitivies have no proven relationship to behavior, and most of the above
 symptoms are not related to food sensitivity. The NACD also offers a consultat
ion with an "orthomolecular physician." Such practitioners are clearly outside 
of the scientific mainstream.
Conclusion
The Doman-Delacato patterning technique is premised on a bankrupt and discarded
 theory and has failed when tested under controlled conditions. Its promotion w
ith unsubstantiated claims can cause significant financial and emotional damage
. Such claims can instill false hope in many people who are already plagued by 
guilt and depression, setting them up for a futher disappointment, guilt, and f
eelings of inadequacy. The process can also waste their time, energy, emotion, 
and money. These resources may be taken away from their children. Parents can a
lso be distracted from dealing with the situation in other practical ways and c
oping psychologically as a family with the reality of having a brain-injured or
 mentally retarded child. Parents are encouraged, in fact, to remain in a state
 of denial while they are pursuing a false cure.

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