Psychomotor PatterningAuthor:Steven Novella, MD- used with permission from The Connecticut Skeptic Vol.1 Issue 4(Fall '96) pg 6The line which sharply demarcates mainstream medicine fromalternative medicine is the line of science. It is possible to crossthat line, however. Any alternative treatment which is tested in arigorous scientific manner and found to be safe and effective, willbe incorporated into mainstream medicine, it will have crossed theline. A therapy, on the other hand, which begins within the halls ofmainstream medicine as a legitimate proposal, and is found, whentested scientifically, to be of no real value, will be discarded.Most such discarded therapies are destined to become forgottenfootnotes in the annals of medical research. Some, however, aresalvaged by practitioners of alternative medicine. These therapieshave crossed the line in the other direction, descending fromscience into pseudoscience.The method of psychomotor patterning for the treatment of mentaldeficiencies is one such therapy. It began 30 years ago as alegitimate, if incorrect, scientific concept for a new treatmentmodality for mental retardation, brain injury, learningdisabilities, and other cognitive maladies. The method was subjectedto controlled trials and found to be of no value. It was debated inthe scientific literature up until the early 1970's, when finallythe medical community arrived at the consensus that patterningshould be discarded as a false concept with no therapeutic role. Useof the techniques of patterning, however, has not died, as we willsee.The concept of patterning was invented by Glenn Doman and C.Delacato in the 1960's, and is therefore often referred to as theDoman-Delacato technique.1 Their theories are primarily an extensionof the older concept that ontogeny (the stages through whichorganisms develop from single cell to maturity) recapitulatesphylogeny (the evolutionary history of the species). Therefore, theneurodevelopmental stages of crawling, creeping, crude walking, andmature walking through which normal children develop is directlyrelated to the amphibian, reptilian, and mammalian evolutionaryhuman ancestors. 2Doman and Delacato's concept of mental retardation is that offailure of the individual to develop through the proper phylogeneticstages. Their treatment modality is therefore designed to stimulatethe proper development of these stages, each of which must bemastered before progress can be made to the next stage. Thisstimulation is achieved through the method known as patterning.The patterning treatment involves the patient moving repeatedly inthe manner of the current stage. In the "homolateral crawling"stage, for instance, the patient crawls by turning his head to oneside while flexing the arm and leg of that side and extending thearm and leg of the opposite side. For patients who are unable toexecute this exercise by themselves, they are passively moved inthis manner by 4-5 adults, alternating back and forth in a smoothmanner. This must be repeated for at least 5 minutes 4 times perday. The purpose of this exercise is to impose the proper "pattern"onto the central nervous system. In the full treatment program, theexercises are combined with sensory stimulation, breathing exerciseswhich are designed to increase oxygen flow to the brain, and aprogram of restriction and facilitation designed to promotehemispheric dominance. 3The claim made for the technique by Doman, Delacato and theirsupporters is that, with this treatment method, mentally retardedand 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 claimsto include the idea that their techniques can promote superiordevelopment in a normal child. 4The theoretical basis of psychomotor patterning is therefore basedon two primary principles, the recapitulationist theory of ontogenyand phylogeny, and the belief that passive movements can influencethe development and structure of the brain. Delacato himselfwrites "Man has evolved phylogenetically in a known pattern. Theontogenetic development of normal humans in general recapitulatesthat phylogenetic process. We have been able to take children whodeviate from normal development (severe brain injured) and throughthe extrinsic imposition of normal patterns of movement and behaviorhave been able to neurologically organize them sufficiently so thatthey can be placed within a human developmental pattern of crawling,creeping, and walking." 3Medical treatments are evaluated on two criteria, their theoreticalbasis and their empirical value. Patterning has been rejected by thescientific community on both accounts. The theory of recapitulationhas never been fully accepted, and even by the 1960's had been allbut discarded by evolutionary and biological scientists.The essential flaw in the theory of recapitulation is that it isbased on an incorrect linear concept of evolution. Evolutionarylines continuously branch and deviate, forming a complex bush ofrelationships, not a linear ladder of descent. Embryologicaldevelopment does not reflect the mature stages of other distantbranches of this evolutionary bush. Studying the embryology of thedeveloping fetus also does not reveal any evidence of successivestages reflecting past evolutionary ancestors.There is also no theoretical basis for the belief that patterns canbe impressed upon the developing cortex. Brain development isgenetically 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, toxicinsults, infection, or biochemical abnormalities. There is no modelby which any of these disparate causes can be influenced by passive,or even active, movement of the neck and limbs. Thirty years ofsubsequent neurological, embryological, and medical progress havefailed to lend any theoretical support for Doman and Delacato'sprinciples.Their practice of using breathing exercises to promote oxygendelivery to the brain also lacks an accepted theoretical basis. Thebrain and the cardiovascular system are designed to give highestpriority to oxygen flow to the brain cells. Elaborate and powerfulfeedback mechanisms ensure adequate delivery. It is true that carbondioxide retention, in this case achieved through breathingtechniques, does increase blood flow to the brain. There isabsolutely no reason to believe, however, that such increased flowis at all helpful to the developing brain.Despite the fact that patterning is theoretically bankrupt, ifempirical evidence existed which demonstrated that patterningimproves neurological development, it would be accepted and used.There are many mainstream interventions which are employed in modernmedicine that lack a fully understood theoretical basis. Physiciansare, at their heart, practical individuals, and if something works,it works. They require proof, however, that an intervention doesindeed work and is safe.On this score, patterning has just not delivered. Over a period ofapproximately ten years in the late 60's and early 70's there weredozens of clinical trials comparing improvement in groups ofdevelopmentally delayed children given patterning treatment comparedto controls who were given no treatment but similar amounts ofattention. 2,5-7 Although most of the studies had significantmethodological flaws, some were fairly well designed. None wereperfect. More importantly, none confirmed the claims of Doman andDelacato. Some of the studies did show modest improvement in motorskills or visuo-spatial skills over controls. None showed improvedintellectual development. The few positive results found were notimpressive or reproducible. Eventually, such clinical trialsstopped, as the technique was abandoned as a blind alley. This pointmarked the unequivocal crossing over of patterning from science topseudoscience.The tragedy of this story does not stem from the fact thatpatterning is a failed theory. It is regrettable that patterning didnot deliver as promised, for any legitimate treatment for braininjured and retarded children would be most welcome. The realtragedy began, however, when Doman and Delacato released theirclaims for a new dramatic treatment before their theories had beenscientifically validated.This behavior, reminiscent of the cold fusion fiasco, is more thanjust professionally irresponsible. In physics, such behavior ismerely bad form; when dealing with the desperate parents of braininjured children, it can be considered cruel. Doman and Delacatowere widely criticized for publicizing their unsubstantiated claims,giving false hope to vulnerable parents and their afflictedchildren.The saga, however, did not end with the scientific death ofpatterning. Doman, Delacato and their associates began incorporatingthe patterning technique into their Institutes for the Achievementof Human Potential (IAHP), which was established in Philadelphia inthe 1950's. They continued to advertise and use patterninguninterrupted right through the scientific controversy, past thescientific condemnation, and on into the present day.I was also able to locate one other institution, the NationalAcademy of Child Development (NACD), located in Huntsville, Utah,that offers patterning as part of their treatment program. The NACDis run by Robert Doman, the nephew of Glenn Doman, although bothinstitutions are eager to point out that there is currently noassociation between the two.On August 8, 1996, NBC aired a program titled "Miracle Babies",hosted by Kathy Lee Gifford. The program included a segmentportraying an apparent "miracle cure" of a child suffering frommoderate mental retardation. As is all too typical of the lay press,Kathy Lee provided an emotionally appealing yet completelyuncritical presentation of the patterning technique, touting itsvirtues without even a hint of skepticism. There was no evidencethat NBC did any investigative reporting into the background andvalidity 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, asany parents would be, by the need to finally accept that their childwas not developing normally. In their desperation, they sought anypossible hope, and it was offered to them by the IAHP. The hope thatthey purchased, however, came at a heavy price, both financial andemotional.Both the IAHP and the NACD rely heavily on the family as the primarydeliverers of the patterning treatment method. In order to evenreach the stage where their child can be enrolled into theaggressive treatment program, they must first complete a trainingand evaluation course which begin for both institutions withpurchasing and listening to a set of audio tapes. The IAHP states intheir literature that only the most dedicated and capable parentswill make it to the final stage of treatment. The NACD appears lessdemanding, but they follow the same principle.The end result is that the parents and other family members of thepatient must alter their lives to institute a daily program ofpatterning exercises, breathing exercises, and programs of sensorystimulation. The mother interviewed by Kathy Lee stated that theprogram was so demanding that it dominated her life, resulting inemotional and physical exhaustion. The exceptional demands of thepatterning method is the primary reason cited in the medicalliterature for caution in evaluating patterning, for the obviousharm that would ensue if the method were recommended prematurely,without good proof that it is effective.The program also illuminated another important feature of thepatterning phenomenon, the difference between anecdotal andscientific evaluation of its effectiveness. One important fact tounderstand is that most children, even severely mentally retardedchildren, still grow and develop, although on a slower curve thanaverage. Therefore, any child admitted into any treatment programwill make some progress as an inevitable consequence of time andtheir natural development, even if that treatment program iscompletely worthless. Without adequate controls, it is thereforeimpossible to evaluate any such treatment. Of course, Kathy Lee andthe parents of the child on the program reported remarkableprogress. Whether or not the treatments played any role, however,cannot be known. The viewers, however, were meant to come away withthe sense that they had witnessed a miracle cure.The NACD and IAHP literature both caution that individual resultswill vary. By emphasizing the need for dedicated capable parents,they also create a situation in which, if a patient fails to makesignificant progress, the parents are the ones to blame. Theseparents now have the added guilt of feeling inadequate to havehelped their injured child.Most practitioners of alternative medicine either practice or are atleast accepting of many different forms of alternative cures. Thisresults from the fact that if one has a casual, or even anti,science attitude regarding one alternative modality, then they willlikely have a similar attitude towards other modalities. It is notsurprising, therefore, that the NACD embraces other scientificallyquestionable practices.For instance, the NACD advertises on their web site that they alsoevaluate and treat for food sensitivities. Although there is not thespace here to adequately address this complex issue, suffice to saythat food sensitivities are controversial at best, and certainlylack scientific acceptance. The excerpt in the box below is quiterevealing. 8 I doubt there are many children who do not have threeor more of these symptoms, especially since many are vague orqualified enough to apply to anyone. The NACD also offers aconsultation with an "orthomolecular physician." Again, I will notdelve into this issue here, but suffice to say such "physicians" areclearly outside of the mainstream.Unproved therapies can be harmful in many ways, not always by directtoxicity or physical harm. The promotion of psychomotor patterningby institutions which make bold unsubstantiated claims about itseffectiveness may cause significant financial and emotional damage.Such claims instill false hope in people who are likely alreadyplagued by guilt and depression. By doing so, these desperateparents are being set up for a crushing disappointment or furtherguilt of inadequacy. In the process they must spend a great deal oftheir resources of time, energy, emotion, and money. These resourcesare taken away from their other children and other important facetsof their lives, resources they might not be willing to spend if notfor the fantastic claims which have lured them to this path. Theyare also distracted from dealing with the situation in otherpractical ways and coping psychologically as a family with thereality of having a brain injured or mentally retarded child. Theyare encouraged, in fact, to remain in a state of denial while theyare pursuing a false cure.The Doman-Delacato patterning technique is pseudoscience because itis premised on a bankrupt and discarded theory and, moreimportantly, has failed to demonstrate any significant effectivenessunder controlled conditions, and yet it is being purveyed as aninnovative and effective treatment, and even possibly a cure. TheIAHP and NACD cannot support the claims that they make, and aretherefore guilty of fraud. Current regulations should prevent suchabuse, but unfortunately such institutions as the FDA lack themanpower and the teeth to properly enforce such regulations andfulfill their role to protect the public from the snake-oilsalesman, dressed up in the modern clothes of alternative medicine,that increasingly prey upon the vulnerable, the sick, and thedesperate.ReferencesDoman RJ, Spitz EB, Zucman E, Delacato CH, and Doman G: Childrenwith severe brain injuries, Neurologic organization in terms ofmobility. JAMA, 174:257, 1960Cohen HJ, Birch HG, Taft LT: Some considerations for evaluating theDoman-Delacato "Patterning" method. Pediatrics, 45:302- 14, 1970Delacato CH: The Diagnosis and Treatment of Speech and ReadingProblems. Springfield, Illinois: Charles C Thomas, 1963.Doman G, Delacato CH: Train Your Baby to be a Genius. McCall's Magazine, p. 65, March 1965Neman R, Roos P, McCann BM, Menolascino FJ, Heal LW: Experimen talEvaluation of Sensorimotor Patterning used with Mentally RetardedChildren. Am J Mental Deficiency, 79:372-84, 1975Ziegler E, Victoria S: On "An Experimental Evaluation ofSensorimotor Patterning": A Critique. Am J Mental Deficiency, 79:483-92, 1975Freeman RD: Controversy Over "Patterning" as a Treatment for BrainDamage in Children. JAMA, 202:83-86, 1967NACD website, URL-http://www.nacd.org/articles/food.html--------------------------------------------------------------------------------The American Academy of Pediatrics has a position statement (Nov1999) condemning "Patterning" as a "treatment" of neurologicallyhandicapped children:The Treatment of Neurologically Impaired Children Using PatterningAMERICAN ACADEMY OF PEDIATRICSCommittee on Children With DisabilitiesABSTRACT. This statement reviews patterning as a treatment forchildren with neurologic impairments. This treatment is based on anoutmoded and oversimplified theory of brain development. Currentinformation does not support the claims of proponents that thistreatment is efficacious, and its use continues to be unwarranted.ABBREVIATION. AAP, American Academy of Pediatrics.Patterning has been advocated for more than 40 years for treatingchildren with brain damage and other disorders, such as learningdisabilities, Down syndrome, cerebral palsy, and autism.1-5 A numberof organizations have issued cautionary statements about claims forefficacy of this therapy,6-10 including the American Academy ofPediatrics (AAP) in 1968 and 1982.3,11 Media coverage,12 inquiriesfrom parents and public officials, the use of alternative forms oftreatment by parents for their children,13 and the existence of anew generation of pediatricians who may be unaware of the programsthat involve patterning have prompted the AAP to review the currentstatus of this controversial treatment.Patterning is a series of exercises designed to improvethe "neurologic organization" of a child's neurologic impairments.It requires that these exercises be performed over many hours duringthe day by several persons who manipulate a child's head andextremities in patterns purporting to simulate prenatal andpostnatal movements of nonimpaired children.14 Concern aboutpatterning has been raised because promotional methods have made itdifficult for parents to refuse treatment for their children withoutquestioning their motivation and adequacy as parents.3 Moreover,dire health consequences for children are implied if parents do notmake arrangements to have their child begin patterning.Several treatment options are offered, ranging from a home programto an intensive treatment program, which states that each succeedingoption "offers greater chance of success." Participation in theintensive treatment program requires completion of 3 of the 5preceding programs, is by invitation only for the "most capablefamilies," and potentially could deplete substantially a family'sfinancial resources. The regimens prescribed can be so demanding,time-consuming, and inflexible that they may place considerablestress on parents and lead them to neglect other family members.15,16(pp251-252)Patterning programs use a developmental profile designed by theInstitute for the Achievement of Human Potential both to assess achild's neurologic functioning and to document change over time.16(p40)17 However, the validity of using this profile for thesedomains has not been demonstrated, nor has it been compared withcurrently accepted methods of measuring a child's development. Inaddition to making claims that a number of conditions may beimproved or cured by patterning, proponents of the program assertthat patterning can make healthy children superior in physical andcognitive skills.18-22The aims of treatment programs include attainment of normality ofphysical, intellectual, and social growth in children with braininjuries. According to providers of patterning therapy,1 themajority of children treated are claimed to achieve at least 1 ofthose goals. To our knowledge, however, no new data have beenpresented to support the use of patterning since the AAP reissuedits policy statement in 1982. The lack of supporting evidence forthe use of this therapy brings into question once again itseffectiveness in neurologically impaired children.THE THEORYNeurologic organization, the principle central to the patterningtheory of brain functioning, is an oversimplified concept ofhemispheric dominance and the relationship of individual sequentialphylogenetic development.16,23-25 This theory also states thatfailure to complete properly any stage of neurologic organizationadversely affects all subsequent stages and that the best way totreat a damaged nervous system is "to regress to more primitivemodes of function and to practice them."17 According to this theory,the majority of cases of mental retardation, learning problems, andbehavior disorders are caused by brain damage or improper neurologicorganization, and these problems lie on a single continuum of braindamage, for which the most effective treatments are those advocatedby patterning.3,16Current information does not support these contentions. Inparticular, the lack of dominance or sidedness probably is not animportant factor in the cause of, or the therapy for, theseconditions.3,16,17 Several careful reviews of the theory haveconcluded that it is unsupported, contradicted, or without meritbased on scientific study.16,17,23,25 Others have described thehypothesis of neurologic organization to be without merit23 andconcluded that the theoretical rationale for the treatment isinconsistent with accepted views of neurologic development.24,27(pp207-235)28(pp207-247)STATUS OF CLAIMED THERAPEUTIC RESULTSResults published on patterning have been inconclusive.29-31Although reports of improvement in reading ability after treatmenthave been heralded as support for the theory,32,33 statisticalanalysis revealed few demonstrable benefits.34,35 Controlled studiesof reading skills have shown little or no benefit from treatment.16(pp333-352)36-38Some disabled children who purportedly benefited from treatment hadbeen given a misdiagnosis or an unduly pessimistic prognosis. Thecourse of maturation in children with neurologic impairments varies,which leads to unwarranted claims that improvements in theirconditions were the result of a specific form of treatment.17,39Some of the cases publicized involved children with traumatic braininjury or encephalitis, who may make substantial health improvementswithout special treatment.A well-controlled investigation40 compared 3 groups of children, allof whom were severely mentally disabled and institutionalized. Onegroup received patterning, a second was treated by motivationaltechniques, and a third received routine care. Using a wide varietyof behavioral measures, the investigators found no significantdifferences among the 3 groups. On the basis of this study, theinvestigators found nothing to recommend patterning treatment overroutine care.40 They concluded that patterning cannot be consideredsuperior to any other method of treatment for institutionalizedmentally disabled children.Other less well-designed studies41,42 also investigated the effectof patterning therapy on children with a heterogeneous range ofdisabilities. One showed a significant, but short-term, effect ondevelopmental progress in comparison with that attained by childrenreceiving traditional programs in New Zealand.41 The investigatorsdisclosed that the relative success of the program was linked to thefamilies' desire to take greater responsibility for their children'seducation. Another investigation demonstrated no significantprogress in the development of mentally disabled children who hadundergone patterning therapy.42 A review of the use of patterning toarouse children in a coma and for sensory stimulation in brain-injured children and adults also gave no scientific evidence ortheoretical rationale for its use.43CONCLUSION AND RECOMMENDATIONPediatricians need to work closely with the families of theirpatients with neurologic disabilities and ensure that they haveaccess to all standard services available in their communities.After the proper diagnosis is made, physicians should discusscontroversial treatments as part of the child's initial managementplan. Pediatricians, therefore, need to be acquainted with routineand controversial treatments, schedule ample time for theirdiscussion, and explain to parents the placebo effect and theimportance of basing treatment decisions on controlled researchtrials.Treatment programs that offer patterning remain unfounded; ie, theyare based on oversimplified theories, are claimed to be effectivefor a variety of unrelated conditions, and are supported by casereports or anecdotal data and not by carefully designed researchstudies. In most cases, improvement observed in patients undergoingthis method of treatment can be accounted for based on growth anddevelopment, the intensive practice of certain isolated skills, orthe nonspecific effects of intensive stimulation.Physicians and therapists need to remain aware of the issues in thecontroversy over this specific treatment and the available evidence.On the basis of past and current analyses, studies, and reports, theAAP concludes that patterning treatment continues to offer nospecial merit, that the claims of its advocates remain unproved, andthat the demands and expectations placed on families are so greatthat in some cases their financial resources may be depletedsubstantially and parental and sibling relationships could bestressed.REFERENCESInstitutes for the Achievement of Human Potential. InformationalBulletin. Available at: http://www.iahp.org. Accessed August 8, 1999Golden GS. Nonstandard therapies in the developmental disabilities.Am J Dis Child. 1980;134:487-491American Academy of Pediatrics, Committee on Children WithDisabilities. The Doman-Delacato treatment of neurologicallyhandicapped children. Pediatrics. 1982;70:810-812Landman GB. Alternative therapies. In: Levine MD, Carey WB, CrockerAC, eds. Developmental/Behavioral Pediatrics. Philadelphia, PA: WBSaunders Co; 1992:754-758Nickel RE. Controversial therapies in young children withdevelopmental disabilities. Infants and Young Children. 1996;8:29-40American Academy for Cerebral Palsy. Doman-Delacato treatment ofneurologically handicapped children. Statement of ExecutiveCommittee. Rosemont, IL: American Academy for Cerebral Palsy;February 15, 1965United Cerebral Palsy Association of Texas. The Doman-DelacatoTreatment of Neurologically Handicapped Children [informationbulletin, undated]. Austin, TX: United Cerebral Palsy Association ofTexasCanadian Association for Retarded Children. Institutes for theAchievement of Human Potential. Ment Retard. Fall 1965:27-28American Academy of Neurology and American Academy of Pediatrics.Joint Executive Board Statement. The Doman-Delacato treatment ofneurologically handicapped children. Neurology. 1967;17:637American Academy of Physical Medicine and Rehabilitation. Doman-Delacato treatment of neurologically handicapped children. Arch PhysMed Rehabil. 1968;49:183-186American Academy of Pediatrics. Doman-Delacato treatment ofneurologically handicapped children. AAP Newsletter. June 1, 1968(suppl)Sharpe R. Better babies. Wall Street Journal. July 18, 1994;col 1, p1, sec ASpigelblatt L, Laine-Ammara G, Pless IB, Guyver A. The use ofalternative medicine by children. Pediatrics. 1994;94:811-814Zigler E. A plea to end the use of the patterning treatment forretarded children. Am J Orthopsychiatry. 1981;51:388-390Freeman RD. Controversy over "patterning" as treatment for braindamage in children. JAMA. 1967;202:385-388Cummins RA. The Neurologically Impaired Child: Doman-DelacatoTechniques Reappraised. New York, NY: Croom Helm; 1988Chapanis NP. The patterning method of therapy: a critique. In: BlackP, ed. Brain Dysfunction in Children: Etiology, Diagnosis, andManagement. New York, NY: Raven Press; 1982:265-280Doman G. How to Teach Your Baby to Read: The Gentle Revolution.Garden City Park, NY: Avery Publishing Group; 1994Doman GJ. Teach Your Baby Math. New York, NY: Simon and Schuster;1979Doman G, Doman J. How to Multiply Your Baby's Intelligence. GardenCity Park, NY: Avery Publishing Group; 1994Doman G, Doman J, Aisen S. How to Give Your Baby EncyclopedicKnowledge. Garden City Park, NY: Avery Publishing Group; 1994Doman G, Doman D, Hagy B. How to Teach Your Baby To Be PhysicallySuperb: More Gentle Revolution. New York, NY: Doubleday; 1988Robbins MP, Glass GV. The Doman-Delacato rationale: a criticalanalysis. In: Hellmuth J, ed. Educational Therapy. Seattle, WA:Special Child Publications; 1968Cohen HJ, Birch HG, Taft LT. Some considerations for evaluating theDoman-Delacato "patterning" method. Pediatrics. 1970;45:302-314Silver LB. Controversial therapies. J Child Neurol. 1995;(suppl1):S96-S100Zigler E, Seitz V. On "an experimental evaluation of sensorimotorpatterning": a critique. Am J Ment Defic. 1975;79:483-492Molfese DL, Segalowitz SJ. Brain Lateralization in Children:Developmental Implications. New York, NY: Guilford Press; 1988Springer SP, Deutsch G. Left Brain, Right Brain. New York: WHFreeman; 1989Institutes for the Achievement of Human Potential. A Summary ofConcepts, Procedures, and Organization. Philadelphia, PA. Institutesfor the Achievement of Human Potential; 1964Doman RJ, Spitz ER, Zucman E, Delacato CH, Doman G. Children withsevere brain injuries: neurological organization in terms ofmobility. JAMA. 1960;174:257-262Freeman RD. An investigation of the Doman-Delacato theory ofneuropsychology as it applies to trainable mentally retardedchildren in public schools. J Pediatr. 1967;71:914-915. Book reviewDelacato CH. The Diagnosis and Treatment of Speech and ReadingProblems. Springfield, IL: Charles C. Thomas Publishers; 1963Delacato CH. Neurological Organization and Reading. Springfield, IL:Charles C. Thomas Publishers; 1966Neman R, Roos P, McCann RM, Menolascino FJ, Heal LW. Experimentalevaluation of sensorimotor patterning used with mentally retardedchildren. Am J Ment Defic. 1975;79:372Money J. Reading disorders in children. In: Brenneman-Kelly Practiceof Pediatrics, IV. Hagerstown, MD: Paul B. Hoeber Inc; 1967;chap14A:1-14Robbins MP. A study of the validity of Delacato's theory ofneurological organization. Except Child. 1966;32:517-523Robbins MP. Creeping, laterality and reading. Acad Ther Q.1966;1:200-206Robbins MP. Test of the Doman-Delacato rationale with retardedreaders. JAMA. 1967;202:389-393Masland RL. Unproven methods of treatment. Pediatrics. 1966;37:713-714Sparrow S, Zigler E. Evaluation of a patterning treatment forretarded children. Pediatrics. 1978;62:137-150Bridgman GD, Cushen W, Cooper DM, Williams RJ. The evaluation ofsensorimotor-patterning and the persistence of belief. Br J MentSubnormality. 1985;31:67-79MacKay DN, Gollogly J, McDonald G. The Doman-Delacato methods, I:the principles of neurological organization. Br J Ment Subnormality.1986;32:3-19Cummins RA. Coma arousal and sensory stimulation: an evaluation ofthe Doman-Delacato approach. Aust Psychol. 1992;27:71-77The recommendations in this statement do not indicate an exclusivecourse of treatment or serve as a standard of medical care.Variations, taking into account individual circumstances, may beappropriate.Copyright © 1999 by the American Academy of Pediatrics. No part ofthis statement may be reproduced in any form or by any means withoutprior written permission from the American Academy of Pediatricsexcept for one copy for personal use.Resource Archive hosted by The Scientific Review of Mental HealthPractice (SRMHP)http://www.srmhp.org/archives/patterning.html