The Institutes for the Achievement of Human Potential
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.
The IAHP was criticized by Herman H. Spitz in his 1986 book, The Raising of Intelligence who said, "The wasted money and shattered marriages are undocumented in the information provided to its potential customers by the Institutes for the Achievement of Human Potential, which must take its place in the long list of pseudoscientific impressive sounding remedies sold by self-righteous advocates who feed on human anguish."
The IAHP website gives a founding date of 1955 and lists only Glenn Doman as founder other sources give dates in the 1960s and also credit Carl Delacato with co-founding the IAHP. The Institutes for The Achievement of Human Potential (IAHP, also known as "The Institutes") is located in Wyndmoor, Pa., a suburb of Philadelphia, Pennsylvania. Glenn Doman (a physical therapist), together with Carl Delacato (an educational psychologist), developed an approach to treating children with brain injury, published in 1960 in the Journal of the American Medical Association (JAMA). The methodology of this study has been criticized. Their work drew heavily on the ideas of Temple Fay (a neurophysiologist), who was head of the Department of Neurosurgery at Temple University Medical School and president of the Philadelphia Neurological Society. Fay believed that the infant brain evolves (as with evolution of the species) through stages of development similar to a fish, a reptile, a mammal and finally a human. This idea, encapsulated as "ontogeny recapitulates phylogeny", is also known as the recapitulation theory. Recapitulation theory has been largely discredited in biology. The IAHP claim that brain injury at a given level of neurological development prevents further progress. This model of childhood development has been rejected by science.
Since 1968 the American Academy of Pediatrics and other organizations have severely criticized the IHAP's claims of effectiveness, theoretical basis and the demands placed on parents by the IHAP programs. Early studies originating from IAHP appeared to show some value of their program but were found to have significant flaws in methodology and analysis. Following studies with better designs and more objectivity showed the program of IAHP to essentially have no merit.
Glenn Doman published the book What To Do About Your Brain-Injured Child in 1974, which describes the ideas and techniques used by IAHP. The subtitle of the book or your Brain-damaged, Mentally Retarded, Mentally Deficient, Cerebral-Palsied, Epileptic, Autistic, Athetoid, Hyperactive, Attention Deficit Disordered, Developmentally Delayed, Down’s Child lists the many conditions the author regards as being encompassed by "brain injured" – the term favoured by IAHP. According to a 2007 WPVI television news report the 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."
Programs for brain-injured children
The five day seminar that IAHP calls the "What To Do About Your Brain-Injured Child Course" costs at least $1,600 per couple and must be completed before the IAHP will conduct their initial evaluation of the child, which costs an additional $3,000.
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.
Hornby, Howard and 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.
Hornby et al. conclude their discussion of the IAHP program with the statement, "Therefore, the conclusion must be that this programme is not only ineffective with brain-injured children but also potentially damaging to the functioning of their 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 IHAP has asserted that it was willing and interested in participating in controlled scientific studies, in contradiction of this the IHAP 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.
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