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 1955 by Glenn Doman and Carl Delacato, provide literature on and teaches patterning therapy (motor learning), which the Institutes promote as improving the "neurologic organization" of "brain injured" and healthy children through a variety of programs, including diet and exercise. It is headquartered in Philadelphia, Pennsylvania with offices and programs offered in several other countries. Pattern therapy for patients with neuromuscular disorders was first developed by acclaimed Philadelphia neurosurgeon Temple Fay, MD in the 1940s. While patterning has been widely criticized and multiple studies have found the therapy ineffective, other more recent studies suggest the methods may have merit and reference the work of the Institutes. While theories behind Fay Reflex Therapy (the "Doman-Delacato Method") are contested, techniques resulting from the theory are used in conventional physical or occupational therapy today that were not used prior, and the techniques are well understood in terms of motor learning.
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. 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 by some, but is referenced by others more recently.
The philosophy of the Institutes consists of several interrelated beliefs: that every child has genius potential, stimulation is the key to unlocking a child's potential, teaching should commence at birth, the younger the child, the easier the learning process, children naturally love to learn, parents are their child's best teacher, teaching and learning should be joyous and teaching and learning should never involve testing. This philosophy follows very closely to the Japanese Suzuki method for violin, which is also taught at the institute in addition to the Japanese language itself. The Institutes consider brain damage, intellectual impairment, "mental deficiency", cerebral palsy, epilepsy, autism, athetosis, attention deficit hyperactivity disorder, "developmental delay", and Down syndrome 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". Glenn Doman described his own personal philosophy for treating patients as stemming from his WWII veteran officer motto: "Leave no injured behind."
Programs for brain-injured children
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.
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.
Scientific evaluation and criticism
The Institutes model of childhood development has been criticized in the scientific community.
American Academy of Pediatrics position statement
According to the American Academy of Pediatrics, patterning treatment is based on an oversimplified theory of brain development and its effectiveness is not supported by evidence-based medicine, making its use unwarranted. 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 2010 states:
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.
Some of the text in the position statement from the AAP differs from the medical literature of today, however, even though it has been retained. The statement suggests "Some of the cases dramatically publicized by the Institutes have been children with traumatic brain damage or postencephalitis, who may make substantial gains without any special treatment". It is widely accepted today that patients with traumatic brain damage (including cerebral palsy) will fail to make gains without "special treatment" with urgency or early intervention, much less "substantial gains". It is known today that the brain develops in an experience-dependent process. If certain experiences are not triggered, the pathways in the brain relating to this experience will not be activated. If these pathways are not activated, they will be eliminated. The AAP statement regarding postencephalitis also conflicts in that patients with symptoms following the reduction of inflammation of the brain is a considered postencephalitic parkinsonism, a disease that triggers degeneration of the nerve cells in the substantia nigra, leading to clinical parkinsonism, an incurable disease still today. While certain standard drugs and therapies may help delay the progression of the disease, such treatment is typically only considered "delays of progression", not gains.
The AAP statement, while a statement opposed to patterning without further evidence, is in fact in agreement with The Institutes in the manner at which the patients make improvements, stating that these improvements are due to "the basis of growth and development" (according to the Institutes the "brain grows with use"), "the intensive practice of certain isolated skills" and "the nonspecific effects of intensive stimulation". And the AAP considers this method to "differ substantially from other groups treating developmental problems". In their summary, the AAP does acknowledge "improvement observed in patients undergoing this method of treatment" but considers said observations as "poorly documented claims for cure" and thus "an unproven technique".
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.
A 15 patient 2012 Norwegian cost analysis of an unproven intensive training treatment for brain damage that included 11 patients treated by IAHP found the treatment regimen not cost effective. The authors expressed doubt that the treatments could achieve adequate benefits to be cost effective and concluded that health care services should only fund these treatments for clinical trials. A 2013 study found the claims of superior results of treatment by the IAHP were not substantiated.
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".
Doctors Martha Farrell Erickson and Karen Marie Kurz-Riemer wrote that IAHP "capitalized on the desires of members of the 'baby boom' generation to maximize their children's intellectual potential" and "encouraged parents to push their infants to develop maximum brain power". But most contemporary child development experts "described many aspects of the program as useless and perhaps even harmful". Kathleen Quill concluded that that "professionals" have nothing to learn from pattern therapy. Pavone and Ruggieri have written that pattern therapy does not have an important role in treatment. Neurologist Steven Novella has characterized pattern therapy as being based on a discarded theory and a "false cure". He also wrote that IAHP's unsubstantiated claims can cause both financial and emotional damage. While detailing criticism of pattern therapy, Robards also wrote that the therapy caused pediatricians and therapists to recognize that early intervention programs are necessary.
Much of the work at The Institutes follows from Dr. Temple Fay who 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.
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".
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 the functioning of families.
Opposition to a control group
The IAHP has asserted in the past that it was willing and interested in participating in controlled scientific studies. Such studies require a control group, in that half the patients receive the treatment and the other half receive placebo treatment over time. A control group in this manner, where children are not being treated, was in direct opposition to Glenn Doman's personal philosophy: "leave no injured behind". Additionally, since Doman taught that "time is the enemy of the brain-injured child" (in that each day they are not getting better, they are getting worse), the months or years that the control group would not be treated, he would be doing "harm" in participation. According to his philosophy, this would be in conflict with the Hippocratic oath, namely first do no harm. The IAHP then instructed parents of children in their program not to take part in any independent studies designed to evaluate the program's effectiveness. 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." Terrence M. Hines then stated that they "have shown very little interest in providing empirical support for their methods".
Funding and contributors
The Institutes receive funding from a variety of sources, some of which include patient care/therapy, book sales, events, courses, as well as private/public funders and foundations. Their public list of contributors is diverse: Ametek Foundation, Arcadia Foundation, Mrs. Elizabeth G. Bain, Five B Family Foundation, Helen D. G. Beatty Trust, Bell & Howell, Bethlehem Steel Foundation, Boeing, Vertol Good Neighbor Fund, Brith Sholom Foundation, Fred J. Brunner Foundation, Louis N. Cassett Foundation, Sol Cohn Foundation, Connelly Foundation, Crane Fund, Mr. & Mrs. Glenn Doman, Downs Foundation, DuPont, 88th Infantry, Division Association, Charles Robert Evenson Foundation, Samuel Fels Fund, Federal Express, Freeman Foundation, French Benevolent Society, General Electric Employees Community Service Fund, Given Foundation, Seymour & Doris, Greenberg Foundation, Philip S. Harper Foundation, Heinz Foundation, Hoyt Foundation, Hutton Trust, Ite Foundation, Christian Johnson Endowment Fund, Ken Foundation, Kerby Foundation, DJ Kernott Memorial Fund, William A. Klopman Foundation, Kirchner, Moore & Co., Leeds & Northrup Foundation, Lewt Foundation, Lil Maur Foundation, Lions Club, John McShain Charities, Mr. & Mrs. Michael Maltzoff, Hale Matthews Foundation, Charles E. Merrill Trust, Montgomery County Federation of Women’s Clubs, Morgan Foundation, Henry & Lucy Moses Fund, Inc., O’Keefe Family Foundation, Inc., Order of the Golden Chain, Ms. Victoria Perez, Pew Memorial Trust, Mr. & Mrs. Humberto Portillo, T. Rowe Price Associates, Inc., Renee & Ted’s Big Heart Foundation, Republic Steel Corporation, Mr. & Mrs. Javier Romero, Damon Runyon Memorial Fund, Scholler Foundation, Mary E. Smith Foundation, Ethel Sergeant Clark Smith Foundation, Sony Corporation of America Foundation, Union Central Insurance Co. Foundation, United Airlines Foundation, United Steelworkers of America, Tasty Baking Foundation, The Jett Travolta Foundation, Mrs. Miriam Van Gelderen, Vollmer Foundation, Wilkie Brothers Foundation, Wiremold Foundation, Henrietta Tower Wurts Memorial, Youth Development Fund, E. Matilda Zeigler Foundation "and others".
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