The Institutes for the Achievement of Human Potential
|Motto||"The Brain Grows by Use"|
|Purpose||Treatment of "brain injured" children|
The Institutes for The Achievement of Human Potential (IAHP), founded in the 1960s by Glenn Doman and Carl Delacato, teaches and provides literature on a treatment program which it promotes as improving the health and neurological development of "brain injured" and normal children. The claims of the organization do not hold up when subjected to research. The headquarters is located in Philadelphia, Pennsylvania, USA. There are offices and programs offered in several other countries.
Their programs for brain injured children have been widely criticized. According to the American Academy of Pediatrics, the institute's patterning treatment is based on an outmoded and oversimplified theory of brain development, its effectiveness is not supported by evidence-based medicine, and its use is unwarranted. David McGlown has stated that "much professional criticism [of pattern therapy] has tended to be emotive rather than scientific."
The Institutes for the Achievement of Human Potential (IAHP, also known as "The Institutes") was founded in 1955. It practices pattern therapy, which was developed by Doman and educational psychologist Carl Delacato. Pattern therapy drew upon the ideas and work of ideas of neurophysiologist Temple Fay, former head of the Department of Neurosurgery at Temple University School of Medicine and president of the Philadelphia Neurological Society. Fay believed in recapitulation theory, which posits that the infant brain evolves through chronological stages of development similar to first a fish, a reptile, a mammal and finally a human. This theory can be encapsulated as "ontogeny recapitulates phylogeny." Recapitulation theory has been largely discredited in biology. In 1960, Doman and Delacato published an article in the Journal of the American Medical Association (JAMA) detailing pattern therapy. The methodology of their study was later criticized.
The American Academy of Pediatrics and other organizations have criticized the IAHP's claims of effectiveness, theoretical basis and the demands placed on parents by IAHP programs. Early studies originating from IAHP appeared to show some value of their program but were later criticized as significantly flawed. Kenneth Kavale and Mark Mostert have written that later studies they believe to have better design and more objectivity have shown pattern therapy "to be practically without merit."
The Institutes consider brain damage, mental retardation, "mental deficiency," cerebal palsy, epilepsy, austism, athetosis, attention deficit hyperactivity disorder, "developmental delay," and down syndrome as as conditions encompassing "brain injury," the term favored by IAHP. According to a 2007 WPVI television news report, IAHP uses the word "hurt" to describe the children they see "with all kinds of brain injuries and conditions, including cerebral palsy, mental retardation, epilepsy, Down's syndrome, attention deficit hyperactivity disorder, and autism."
IAHP’s program begins with a five day seminar for the parents of "brain injured" children, because the program is carried out by parents at their homes. Following the seminar, IAHP conducts an initial evaluation of the child.
The program described in the 1960 JAMA paper (Doman, et al.) for "brain-injured" children included:
- Patterning – manipulation of limbs and head in a rhythmic fashion
- Creeping – forward bodily movement with the abdomen in contact with the floor
- Crawling – forward bodily movement with the abdomen raised from the floor
- Receptive stimulation – visual, tactile and auditory stimulation
- Expressive activities – e.g. picking up objects
- Masking – breathing into a rebreathing mask to increase the amount of carbon dioxide inhaled, which is purported to increase cerebral blood flow
- Brachiation – swinging from a bar or vertical ladder
- Gravity/Antigravity activities – rolling, somersaulting and hanging upside down.
The IAHP claims that brain injury at a given level of neurological development prevents further progress. This model of childhood development has been criticized in the scientific community.
Other therapies utilized by IAHP include eye exercises for children who have an eye that converges more than the other when looking at an object in the distance and those who have one eye that diverges more than the other when an object is moved slowly toward the bridge of the nose. IAHP also recommends stimulating the eyes of children with amblyopia by flashing a light on and off. For children with poor hearing, IAHP recommends auditory stimulation with loud noises, which may be pre-recorded. Brain-injured children may also be taught to identify by touch alone various objects placed in a bag.
IAHP recommends dietary restrictions, including reduced fluid intake for brain-injured children in an attempt to prevent "the possible overaccumulation of cerebrospinal fluid." Alongside fluid restriction, IAHP recommends a diet low in salt, sweets, and other "thirst provoking" foods.
In their book Controversial Issues in Special Education, Garry Hornby, Jean Howard and Mary Atkinson state the program also includes "gagging" in which the child breathes into a plastic bag until gasping for breath. This is based on the belief that it will cause maximum use of the lungs and thus maximize oxygen circulation to the brain. The book concludes that pattern therapy is ineffective and potentially damaging to families.
The American Academy of Pediatrics Committee on Children With Disabilities issued warnings regarding patterning, one of the IAHP's therapies for brain injured children, as early as 1968 and repeated in 1982. Their latest cautionary policy statement was in 1999, which was reaffirmed in 2002, 2005 and 2010. It stated:
This statement reviews patterning as a treatment for children with neurologic impairments. This treatment is based on an outmoded and oversimplified theory of brain development. Current information does not support the claims of proponents that this treatment is efficacious, and its use continues to be unwarranted.... [T]he demands and expectations placed on families are so great that in some cases their financial resources may be depleted substantially and parental and sibling relationships could be stressed.
In addition to the American Academy of Pediatrics, a number of other organizations have issued cautionary statements about claims for efficacy of this therapy. These include the executive committee of the American Academy for Cerebral Palsy, the United Cerebral Palsy Association of Texas, the Canadian Association for Retarded Children the executive board of the American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation. Hornby et al. call R.A. Cummins 1988 book The Neurologically Impaired-child: Doman-Delacato Techniques Reappraised (Croom Helm, ISBN 9780709948599), "The most comprehensive analysis of the rationale and effectiveness of the Doman-Delacato programme to date" and state Cummins uses neuroanatomy and neurophysiology to demonstrate that there is no sound scientific basis for the techniques used by the IAHP and concludes any benefit is likely due to increased activity and attention. Hornby et al. conclude, "It is now clear that the only results supporting the effectiveness of the programme come from a handful of early, poorly controlled studies." Kavale and Mostert and others also identified serious problems with the early research on the IAHP program. An analysis of higher quality studies found that students not receiving the treatment had better outcomes than those who were treated by the IAHP.
The IAHP has asserted that it was willing and interested in participating in controlled scientific studies, in contradiction of this the IAHP has instructed parents of children in their program not to take part in any independent studies designed to evaluate the program's effectiveness. Also in contradiction of these assertions the IAHP withdrew its agreement to participate in a "carefully designed study supported by federal and private agencies" when the study was in its final planning stages. According to Herman Spitz, "The IAHP no longer appears to be interested in a scientific evaluation of their techniques; they have grown large, wealthy, and independent, and their staff is satisfied to provide case histories and propaganda tracts in support of their claims." Similarly Terrence M. Hines stated that they "have shown very little interest in providing empirical support for their methods."
A 2013 study found the claims of superior results of treatment by the IAHP were not substantiated.
A small (15 patients) 2012 Norwegian cost analysis of non proven intensive training treatment for brain damage which included 11 patients treated by IAHP found such treatments were not cost effective and the authors expressed doubt that these treatments could achieve adequate benefits to be cost effective. The papers conclusion was that health care services should not fund these treatments other than for clinical trials.
A 2006 retrospective study of 21 children by the IAHP and others of children with cortical visual impairment found significant improvement after use of the program the study had no control group. Norum et al. stated regarding this study, "...any proof of effectiveness cannot be obtained from a non-randomized study."
Kathleen Ann Quill, in her book Teaching Children with Autism: What Parents Want, says "thousands of families have wasted time and money to follow Doman's methods." She goes on to say "Professionals have nothing to learn from Doman's pseudoscientific treatments, but they have plenty to learn from his marketing strategy", which is aimed at parent's "hopes and fantasies". In The Neurology of Autism (2005, Coleman, M., ed.) Pavone and Ruggieri found no support for Doman / Delacato patterning having an important role in treatment.
Martha Farrell Erickson and Karen Marie Kurz-Riemer discuss early intervention with "normal infants and toddlers" in their book "Infants Toddlers and Families". They claim Doman "capitalized on the desires of members of the "baby boom" generation to maximise their children's intellectual potential" and "encouraged parents to push their infants to develop maximum brain power". However his programs were "based on shaky or nonexistent research evidence" and "most child development experts at the time described many aspects of the program as useless and perhaps even harmful."
Martin Robards also cites widespread criticism in his book Running a Team for Disabled Children and Their Families but concedes that Doman and Delacato caused paediatricians and therapists to recognize that early intervention programs are needed.
The Doman-Delacato patterning technique is premised on a bankrupt and discarded theory and has failed when tested under controlled conditions. Its promotion with 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 further disappointment, guilt, and feelings of inadequacy. The process can also waste their time, energy, emotion, and money. These resources may be taken away from their children. Parents can also be 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. Parents are encouraged, in fact, to remain in a state of denial while they are pursuing a false cure.
- "About Us". iahp.org. The Institutes for the Achievement of Human Potential.
- Hornby, Garry; Howard, Jean; Atkinson, Mary (2013). Controversial Issues in Special Education. Routledge. pp. 5–7. ISBN 9781134094387.
- Kavale, Kenneth A.; Mostert, Mark P. (2004). The Positive Side of Special Education: Minimizing Its Fads, Fancies, and Follies. Rowman & Littlefield Education. pp. 146–57. ISBN 9781578860975.
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- von Tetzchner, S.; Verdel, M; Barstad, B.G.; Gravås, E.M. et al. (2013). "The effect of interventions based on the programs of The Institutes for the Achievement of Human Potential and Family Hope Center". Developmental Neurorehabilitation 16 (4): 217–29. doi:10.3109/17518423.2012.739211. PMID 23834196.
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Eventually, the Biogenetic Law had become scientifically untenable.
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