Volume 1 Number 1, 1993

The Society for Auditory Integration Training is Off the Ground
This is the first newsletter of The Society for Auditory Integration Training (SAIT). Applications to join SAIT have been mailed, and practitioners and parents are signing up to become members.

The aim of this newsletter is to present a forum for practitioners and parents to discuss information, questions, concerns, opinions, and share their experiences.

SAIT was founded in St. Louis in January, 1992. Twenty-three practitioners, soon-to-be practitioners, and parents met during a conference on facilitated communication and auditory training to share their enthusiasm as well as concerns about the future of auditory training in the United States. These founding members met three different times during the two-day conference to discuss these issues, and concluded that an organization was much needed to help set policies, standards, and ethics policies for practitioners as well as to distribute objective information about this relatively new intervention. During the meetings, the founding members decided to change the name ‘auditory training’ to ‘auditory integration training’ or AIT. The members felt this name change was necessary since there is another form of treatment called ‘auditory training’ for people with hearing loss. The word ‘integration’ not only distinguishes AIT from AT, but acknowledges its relationship to sensory integration. (Thank you Dr. Rimland for this suggestion.) Rimland also nominated Dr. Stephen Edelson to be the president of SAIT, which was seconded; and he was subsequently elected; the elected co-vice-presidents were Sally and Walt Brockett, the elected secretary was Sabra Gelfond, and the elected treasurer was Lucinda Waddell.

The founding members in St. Louis also wrote a mission statement for SAIT: `The Society for Auditory Integration is dedicated to the enhancement of the quality of life for individuals with special needs through auditory integration training.’

After these January meetings in St. Louis, many of the founding members worked throughout the year on a set of guidelines, standards, and ethics policies; and in December, 1992, we felt ready to incorporate as a non-profit organization (501) (C) (6).

The first Board of Directors includes (in alphabetical order): Sally Brockett (practitioner, CT), Carol Cloud (parent, Idaho), Dr. Margaret Creedon (researcher/practitioner, Illinois), Monica Doben-Stevens (practitioner, Ohio), Lynda Huggens (parent, Louisiana), and Deborah Woodward (practitioner, North Carolina).

It is very important that the membership be active in determining SAIT’s future policies. If you have any suggestions to further SAIT and/or would like to participate on a committee, please write to SAIT at 2207 B Portland Road, Newberg, OR 97132.

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Professional Liability Insurance for SAIT Officers and Board of Directors has been Approved
Professional liability insurance for SAIT’s Officers and Board members was granted by CHUBB, a national professional insurance company. Dr. Edelson spent eight months working with various insurance agencies and brokers to secure this coverage. Coverage for the Officers and Board members of SAIT helps establish AIT as an accepted intervention and will further the acceptance of AIT by other insurance companies and professionals.

We hope this will pave the way for SAIT to arrange for individual liability coverage for its professional members. Edelson is now working closely with an insurance broker to obtain insurance coverage for SAIT’s members.

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Letter from Stephen M. Edelson, Ph.D.
I personally would like to welcome you, enthusiastically, to the first newsletter of the Society for Auditory Integration Training (SAIT). As you know, auditory integration training (AIT) is spreading rapidly and growing acceptance throughout the country.

Although this is an exciting time for everyone involved in this field, many people have been frustrated by the lack of communication between practitioners as well as some procedural inconsistencies across programs. SAIT was established to address these issues by establishing procedures for setting standards and ethics; and providing information about the current state of the art of AIT. Moreover, SAIT encourages researchers to study this relatively new form of treatment for autism and developmental disabilities.

Like all new organizations, SAIT needs your support and encouragement .

The focus of this newsletter is to provide information to AIT practitioners and parents. There are numerous questions and concerns; and we hope to provide a forum for these issues.

Please let us know if you have any suggestions you feel SAIT should address.

Again, welcome to SAIT.

Stephen Edelson, Ph.D. President

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First Annual SAIT Conference to be held in Toronto, Canada
The first SAIT conference will be held on Tuesday, July 13, 1993 from 2 P.M. to 10 P.M. at the Airport Hilton Hotel in Toronto, Canada.

The conference will include talks by various practitioners on current procedural and research issues as they pertain to AIT. Results from the large research study being conducted in Oregon by Drs. Edelson and Rimland will also be presented in the evening session. The research examines many issues in the AIT process, such as the use of filters, comparison of the Audiokinetron with the Audio Tone/Enhancer Trainer (BGC), and changes in the audiogram.

There is no charge for members and a $10 charge for non-members. There will be a no-host dinner-break from 5:30 to 7:00 P.M.

The SAIT conference date is the day prior to the Autism Society of America (ASA) conference (July 14 to 17) in Toronto.

Please complete the form on the last page if you are planning to attend this one-day conference. We hope to see you there.

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SAIT Board of Directors Elections
Four of the seven seats on the Board of Directors will be up for election this summer. Initially, the elections had been planned for mid-June.

The Board feels that it is important for Professional members as well as non- practitioners, (Associate members), to be involved in the election process. Since the SAIT examination will not be administered until the fall, the Board decided to allow practitioners who have passed the initial review process to be able to vote for Board members. However, the letters of references for many of the AIT practitioners who have applied to SAIT are being sent to SAIT at a slow rate, and it was felt best to wait until more applications from practitioners are reviewed so practitioners can be well-represented in the voting process. (Practitioners were asked for three letters of references when applying for professional membership.)

The election ballots will be sent to SAIT members about August 1, 1993; and the deadline to receive the completed ballots is September 1. If you would like to nominate a practitioner, other professional, and/or parent to be on the Board of Directors, please send your nomination to: Board Nominations, SAIT, 2207 B Portland Road, Newberg, OR 97132. The deadline for nominations is July 15, 1993.

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AIT Conference in Stamford, CT
A two-day conference celebrating the breakthrough of AIT in the country was sponsored by the Georgiana Organization on May 7th and 8th. Practitioners, parents, and listeners themselves shared their heart-warming experiences with AIT to an audience of almost 500 people. Besides AIT, there were presentations on visual training, vitamin therapy, Landau-Kleffner syndrome, and facilitated communication.

On the evening of the first day, many AIT practitioners gathered at dinner to share their enthusiasm as well as their concerns about SAIT. It was a very productive meeting, and there were many good ideas. Peter Stehli announced during the meeting that the Georgiana Organization will work together with SAIT.

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Australian Research on AIT
Dr. Sue Bettison, psychologist at the Autism Research Institute in New South Wales, Australia, has completed a placebo-control study on the efficacy of AIT for autistic individuals in which half received AIT and half did not receive AIT. None of the evaluators knew to which group any subject belonged. There was a total of 40 subjects in each condition.

Dr. Bettison is using the BGC Audio Tone/Enhancer Trainer, and Drs. Rimland and Edelson are consultants on this study.

If you are conducting an empirical study on the efficacy of AIT, please tell us about it.

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Why Not Headphones After Receiving AIT?
Dr. Guy Berard says that people should not wear headphones to listen to music after receiving AIT. He argues that the ear cannot defend itself against very loud sounds. Basically, sound is energy; and when a lot of energy (i.e., music) is placed in a short and narrow tube (i.e., the ear canal), it will work the ear drum, middle ear, and inner ear excessively.

According to Berard, AIT improves one’s auditory sensory system. If a person wears headphones to listen to music after receiving AIT, a person’s hearing may return to where it was prior to receiving AIT. Berard believes that it is acceptable to listen to spoken words at a low to moderate level using headphones.

Berard states that using headphones to listen to AIT music is therapeutic and is not harmful to the listener’s hearing system.

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ASHA Reviewing AIT
The American Speech and Hearing Association has formed a committee to examine the efficacy of both facilitated communication and AIT. The committee chair for AIT, Dr. Jane Madell, is also an AIT practitioner and was the audiologist who tested Georgie’s hearing before Georgie traveled to France to receive AIT. There are three peer consultants for this committee who are also practitioners: Tina Veale, Monica Doben-Stevens (SAIT Board member), and Deborah Woodward (SAIT Board member). We will keep you posted on developments.

Loud Concert Halls Post-AIT: A Matter of Concern?

There have been three reports of people who attended loud concerts after receiving AIT whose behavior regressed to what is was prior to AIT.

If you know of a similar case, please let us know so we can share this information. Send us as much documentation as possible, such as age of listener; environment, degree of sound sensitivity before AIT, after AIT, and after the loud sound exposure.

If there are other issues you would like to share with SAIT members, please write.

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Why Not Transfer AIT Output to Audiotape?
There are two major reasons for not having AIT placed on audiotapes.

1. Dr. Berard tells us that AIT requires filtering certain peaks present in a person’s audiogram. This kind of individualization precludes the use of standard tapes. In addition, after five hours of listening, one’s hearing needs to be reassessed. If new peaks become evident, then audiotapes with new filter settings would need to be used.

2. A second reason was given by Bill Clark, the inventor of the BGC device. Audiocassette tape recorders/players have built-in circuits to minimize sound distortion, and these circuits would diminish the modulation that is essential to the AIT process.

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Ear Infections and AIT
A number of parents report concern about ear infections and changes in their child’s behavior. Some parents have noticed that after their child has experienced an ear infection, the improvement in behavior stops or reverts back to the way the child behaved prior to AIT. In one case, this occurred with fluid present but no infection. Once the fluid was eliminated, the positive behaviors returned.

These reports support Dr. Berard’s principle that “hearing equals behavior.” That is, the infection (or just fluid) interferes with the transmission of auditory signals, which in turn, affects the way the child behaves.

More importantly, it gives rise to concerns about the impact of ear infections on behavior, and the potential reversal of the benefits of AIT. If there is a relationship between ear infections and loss of AIT benefits, it becomes more important to learn what is causing the infections and to treat the cause in order to prevent future illness. In general, the present procedure is to simply diagnose and to treat the infection. However, the question arises: Does the infection cause auditory dysfunction and can it “undo” the AIT results? Research is needed in this area to reach a conclusion.

Meanwhile, what should parents do? If your child has a history of recurrent ear infections, you should learn about causes of infections and how to prevent them. An excellent resource is a book titled Childhood Ear Infections by Dr. Michael Schmidt. It can be ordered for $12.95 by calling 1-800-359-9051. Books by William Crook, such as The Yeast Connection, may also be helpful. If your child has improved after AIT and loses these gains following ear infections, the training can be repeated to correct auditory dysfunctions again.

Dr. Berard has recently stated that if a person with tubes has AIT, there may be some risk of an ear infection. This is only a theory and needs further investigation. At this time, it is recommended that AIT not be not done until the tubes come out and the ear drum is healed. Editor’s Note: Antibiotics are frequently prescribed for viral infections such as ear infections. While many individuals appear to respond well to these drugs, many others do not. Two articles follow which detail some possible risks associated with antibiotic use.

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Antibiotic Use for Ear Problem Questioned
The antibiotic amoxicillin “is not effective for the treatment of persistent asymptomatic middle-ear effusions,” Erdem Cantekin and colleagues state, in a report that has touched off a heated debate over the politics of scientific research.

Cantekin’s paper, based on a study of the effects of amoxicillin treatment on secretory otitis media (painless accumulation of fluid in the middle ear, resulting from obstruction of the eustachian tube), was a dissenting opinion written after his co-researchers– who were funded by the pharmaceutical industry– had interpreted their data as favorable to amoxicillin, and had published their conclusions in the Journal of the American Medical Association (JAMA) in 1987. JAMA originally rejected Cantekin’s dissenting paper, but — in a surprising turn-around — published it in 1991, saying that the journal had erred in rejecting it earlier.

Cantekin criticized the diagnostic and statistical methods used by his co- researchers, and said objective measures showed that at four-week follow-up, “only 30.7% of the children treated with amoxicillin or amoxicillin with decongestant – antihistamine had improved hearing, compared with 32.8% of those in the placebo group.” Further, while fluid accumulation decreased in children treated with amoxicillin and decongestants, Cantekin et al. note, “four weeks after treatment … the recurrence of effusion in children treated with the antibiotic treatment was two to six times higher than in children treated with placebo.” They add that side effects such as diarrhea, rashes, irritability or sedation were much more common among those receiving antibiotics (especially when combined with decongestants and antihistamines) than in the placebo group.

Cantekin et al. note that another large scale study found that the antibiotics Pediazole and cefaclor also were ineffective in treating secretory otitis media.

Cantekin notes in the June 1992 issue of JAMA that while his findings related only to non-acute otitis media, “several recent studies (Dutch, Danish, Swedish, Israeli, and multinational) show that antibiotic treatment for acute otitis media is not effective.” In addition, he says, “the acute otitis media study conducted at the Otitis Media Research Center in Pittsburgh showed that amoxicillin was not effective in clearing severe episodes of acute otitis media.”

In a letter in JAMA, John Wilson, Jr., says that “Cantekin confirm what many of us in primary care have observed: namely, that chronic and recurrent otitis media does not respond to antibiotics.” He cites studies indicating that children with chronic secretory otitis media who were treated for food and inhalant allergies showed significant improvement, and suggests that “the common practice of prescribing antibiotics freely for children … be replaced by a more thoughtful approach that addresses and treats the initial environmental triggers causing this condition.”

(This article was reprinted from the Autism Research Review International, 1992, Volume 6, Number 4, published by the Autism Research Institute, 4182 Adams Ave., San Diego, CA 92116.)

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Possible Ototoxic Effects of Antibiotics
Ototoxic means that a substance is toxic to the auditory system. Certain antibiotics may be ototoxic causing hearing loss, ringing or ear noises, and/or other auditory problems.

If a child is prescribed an antibiotic for an ear infection, parents may want to ask their physician, pharmacist, or use the Physicians Desk Reference to find out if the drug is ototoxic.

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AIT and My Son by Lynda Huggens
My youngest son, Jon, received AIT in October, 1991. Many things led me to pursue AIT for him. At the beginning of the school year in 1990, Jon’s teacher had asked me if I had ever noticed that Jon heard things before I did. She had noticed that he heard planes, trains, etc. before she could, as they traveled in the community. I had, of course, noticed Jon’s unusual reactions to various noises over the years. As an infant, he would almost literally jump out of my arms and cover his ears when startled by a loud noise, such as a vacuum cleaner, the mixer, lawn mower, barking dogs, and sirens. He could not tolerate fireworks, and we finally had to drop out of Special Olympics because of the noise of the starting gun. But I never thought about his hearing things ‘differently.’

In November, 1990, I heard Ruth Sullivan speak; and she said that some very interesting research was being done on how persons with autism actually hear. In December, a family friend brought me an article in Reader’s Digest called ‘Fighting for Georgie.’ The article was an excerpt from a soon-to-be published book by Annabel Stehli titled The Sound of a Miracle. The article read like fiction but curiosity led me to read the book. I even called Annabel on the telephone, and she put me in contact with other parents who had traveled to France to obtain AIT for their autistic children.

When Jon received AIT, I decided to keep a diary of any changes noted in his behavior. Since receiving AIT, the most significant change has been an overall calm in Jon’s demeanor. His father and teacher both first noted this after speaking with him by telephone during the 10 days of listening sessions. Since receiving AIT, I have noticed many changes in his style of communication. Jon is not so anxious in his conversations, and he interrupts other’s conversations less frequently. Jon completes sentences for others; before he did not seem to understand another person’s thoughts well enough to do that! Previously, most of his conversation was echolalic and pertained to what he had just heard. He began to comment on things said an hour earlier.

Sounds that he previously did not like are now often amusing to him. Jon did not like to be near our dog and hated for him to bark. He now goes to the patio door and asks Spot to “Speak”! In the past, he would cover his ears and say “turn it off” when his choir teacher rewound a tape recorder used to record class practice. After AIT, Jon thought the high-pitched screech of the rewinding was amusing. His singing in choir is now in correct volume and mostly on key.

Some of the other changes I noticed in Jon are: less distracted by noise, less incessant talking, less pronoun reversals, responds more appropriately and more spontaneously, his thought processes appear to becoming clearer and more complicated, increased vocabulary, laughs more appropriately, and handles disappointment better.

Like many parents who pursue AIT for their child, I secretly prayed for a major miracle for my son as a result of the training. But as I told Lucinda Waddell before Jon ever received AIT, if it did nothing but increase his attention span so that he could learn better, I would consider it successful. AIT did not result in that prayed-for miracle, but it has made significant and positive changes in Jon’s life. Would I do it again? You bet I would.

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The Issue of Age and AIT
What is the minimum age to receive AIT? At the present time, SAIT has taken a rather conservative approach and urges that the minimum age should be 4 years since very little is known about the effects of auditory stimulation on a developing hearing system.

Dr. Guy Berard has, for some time, insisted that AIT not be given to children under 4 years of age. There is reason for this limit, since the very sensitive auditory system is not yet matured before age 4.

We asked Dr. Binet, the first person to offer AIT in North America, about this age issue. In general, he prefers seeing clients 4 years of age and older; however, he will give AIT to a younger child if his/her autism is getting worse, such as the case when a child appears to be withdrawing further.

There is much support for the effectiveness of early intervention on children with developmental disabilities; and some practitioners feel that AIT should be given to children as young as possible. However, it is not clear at this time whether AIT should be classified as a form of early intervention. Many young children around the country have received AIT, and some parents have reported positive findings; however, the long-term effects are not known at this time.

We are now contacting some of the top researchers who study auditory stimulation and its effects on development, and we are asking them for their opinion on this issue. Please let us hear from you about your experiences.