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INTRODUCTION
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
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
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
82
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-
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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-
85
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.
86
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
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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.
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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