Several days ago I commented on some "alternative" treatments for autism that may be attractive to concerned parents but have not been supported by systematic research evidence. Looking at a list of these treatments prepared by Tristram Smith ("Empirically supported and unsupported treatments for Autism Spectrum Disorders", Scientific Review of Mental Health Practice, 2008, Vol.6(10, pp. 3-20), I was concerned to see a reference to "patterning". I suppose I hoped it had gone away.
"Patterning" has been around for a long time-- long enough to have had the American Academy of Pediatrics twice release policy statements rejecting the practice. Basically, "patterning" involves practices such as making older children use movements like crawling that are characteristic of earlier development, or, for children who are very seriously handicapped, having adults move the passive child's head and limbs through patterns that resemble early reflex movements.
In either case, proponents of "patterning" believe two things: 1. That a child's problems, whether obvious physical handicaps, cerebral palsy, or autism, are caused by damage to the brain; and 2. That because early brain development and aspects of both movement and development occur at the same time, repeating the early movements will cause early steps in brain development to repeat themselves. Causing the child to re-experience earlier events is thus expected to cause a modified recapitulation of early stages in development and therefore to replace damaged parts of the brain with new, healthy brain tissue.
The first belief can certainly have much truth to it, as physical handicaps and movement problems may well be caused by brain damage. Cerebral palsy is by definition a condition caused by brain damage due to oxygen deprivation or other factors. Whether or not autism should be considered as due to brain damage is arguable, although there are some differences between typical children's brains and those of autistic children, with the latter tending to be larger. But it isn't clear whether we should say that genetically-caused differences are really "damage" in the same sense that physical trauma to the brain is damage.
The second assumption, that re-experiencing old events can cause development to be recapitulated, is completely illogical. The fact that early brain development was accompanied by characteristic infant reflexes-- movement patterns different from the ones we see displayed by older children and by adults--- does not mean that the movement patterns did cause, or could now cause a repetition of, brain development. To claim this relationship is rather like saying that because a car rolls along when there is gas in the tank, pushing the car will refill an empty tank. As usual, it is a mistake to assume that because two events are correlated, one causes the other AND we can easily tell which is the cause and which the effect.
It is hard to imagine that anything but magical thinking could be behind the claim that "patterning" causes recapitulation of development and thus cures all brain-related disorders. Unfortunately, this kind of magical thinking is not uncommon, and we see the same beliefs in claims that "age regression techniques" like diapering and bottle-feeding older children or adults will somehow make them return or regress to infancy and then re-develop in the ways we'd prefer.
Gentle reader, are you saying that there can be no harm in "patterning"? Why be so critical, why not let people try whatever treatments they please? Well, the reason I'm critical is that I believe these practices do cause harm to the families that use them. "Patterning" that involves moving a child's head and limbs is hard work, time-consuming (it's done 5 or 6 times a day), and destructive of social capital (friends and neighbors must be called in to help regularly, as five adults are needed each time). Other children and other family needs may be neglected in order to follow the "patterning" schedule. Other, possibly effective treatments may be avoided if parents are committed to the "patterning" approach. These things are harmful, in light of the fact that there is no evidence that "patterning" is effective, or even any logical argument to show that it should be. The day that someone shows evidence from randomized controlled trials, supporting the effectiveness of "patterning" for autism or other problems, will be the day that I stop criticizing.
I do understand, though, that parents who despair of help for their children may choose to do the most far-fetched things in the hope of a miracle. I don't criticize those parents, but I have nothing but criticism for those who make their livings by selling ineffective or harmful methods to families who are too distressed to think clearly.
