Volume 2 Number 3, 1995

Dancing In The Rain Available Soon!
Dancing In The Rain: Stories of Exceptional Progress by Parents of Children with Special Needs will be published soon and available through the Georgiana Organization. Annabel Stehli, author of The Sound of a Miracle, has collected and edited personal stories of more than twenty families who have struggled to help their children overcome disabilities of many types. The stories are about children diagnosed with disorders such as attention deficit/hyperactivity disorder, learning disabilities, autism, pervasive developmental disorder, dyslexia, fetal alcohol syndrome and hyperlexia. Parents describe their experiences with auditory integration training, vision therapy, nutritional therapy, behavior therapy, the TEACCH program and Options Institute, sensory integration and occupational therapy.

Dancing In The Rain is available for $20.00. This price includes shipping. To order Dancing in the Rain, contact The Georgiana Organization at P.O. Box 2607, Westport, CT 06880. Telephone: 203-454-1221. FAX: 203-454-3788. Those interested in large orders should call or fax for discount prices.

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FDA Developments: The BGC Device
The Food and Drug Administration (FDA) has recently registered BGC Enterprises and their auditory training device, the Audio Tone Enhancer/Trainer. This does not mean that the FDA has approved the device, but rather, the FDA has formally recognized the company and their device. BGC also submitted the FDA application papers, which, if approved, will allow them to market the Audio Tone Enhancer/Trainer. D.A. George of BGC Enterprises believes approval will take place soon.

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Auditory Processing Problems Linked to Dyslexia
Dyslexia is often thought as a visual disorder since children with dyslexia are often described as having reading and spelling problems. However, recent physiological findings indicate that the auditory processing system may be the primary cause of or major contributor to dyslexia.

Dr. Glenn Rosen at Beth Israel Hospital in Boston and Drs. Albert Galaburda and Matthew Menard at Harvard Medical School conducted post-mortem examinations of the brains of five dyslexic subjects and seven non-dyslexic, control subjects. Those with dyslexia had a decrease in neurons on the left-side of the medial geniculate nucleus, an auditory relay station which receives sound signals from the ear, encodes them, and then sends them to the auditory cortex. Interestingly, the left side of the medial geniculate nucleus processes fast- changing sounds, such as “stop consonant” sounds. Such sounds include: ba, da, ka, and ta. The duration of stop consonant sounds is about 1/25 of a second whereas the duration of vowel sounds is approximately 1/10 of a second. It is argued that children with dyslexia do not appear to perceive stop consonant sounds appropriately and have difficulty distinguishing among various sounds. As a result, they will not be able to form a mental lexicon which would allow them to associate letters and words to specific sounds.

Dr. Guy Berard, a French physician and the developer of auditory integration training, has treated hundreds of children with dyslexia; and according to Dr. Berard, most of them improved dramatically from his treatment. Similar to the findings reported above, Dr. Berard has always argued that the underlying cause of dyslexia and other disorders, such as autism, is a dysfunctional auditory processing system.

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Concerning Length, Frequency, Number, and Follow-Up AIT Sessions: Dr. Guy Berard
When I was treating my own deafness, more than 40 years ago with the Tomatis device under the direction of Tomatis himself, there were absolutely no rules, neither for me nor for the other patients. Each session could last 1, 2, or 3 hours, and this could be everyday, every 2 days, every week, 2 or 3 times a day, for a total of 50, 100, 150, 300 sessions.

After I built my first auditory integration training (AIT) device, and because of the lack of uniformity with Tomatis’ method, I decided to determine the best way to obtain the optimal results, in the minimum amount of time, while considering the various aspects of the problem. Yet, I was always concerned with the efficiency.

I had to consider: the minimum amount of time that my patients or their parents would have to stay in a hotel; the minimum amount of time they would spend in my office; the minimum amount of tiredness and stress from the treatment itself; the minimum amount of money that they would have to spend for my treatment, lodging, etc. But, of course, my true aim was to obtain the best results for my patients.

My procedure was determined through systematic analysis of the changes in my patients’ audiograms. I can say that I tried nearly every possibility, according to their age and diagnosis and the fact that some patients lived close to my office in Annecy whereas others lived 30 kilometers or more from Annecy.

What should be done? One session, two sessions, three sessions in a day? Separated from each other, 1, 2, 3, 4 hours? Sessions of 1/2 an hour or 1 hour? Sessions everyday, or every 2 days, or every 3 days? I first began by giving my patients a total of 50, then 30, then 25, then 20 sessions, in order to decrease the cost of the treatment itself and other expenses.

After 5 years of testing, I had ascertained that the best results were: two sessions a day, with each session being a half-hour in length, separated by a minimum of 3 hours, and for 10 consecutive working days; the maximum interruption being the 2-day weekend.

Even when applying to these rules strictly, special circumstances (e.g., patients traveling from out of town, family problems) sometimes required that I change my procedure in order to accommodate these individuals. I can say that in doing so, it has always led to a worsening of their condition. The problems:

— shorter treatments resulted in a relapse afterwards

— increasing the frequency, the number, the space of time of sessions often resulted in a worsening of their audiograms; that is, their auditory system appeared to be saturated.

I have been informed, by either my trainees themselves or by some of their patients who wrote me for advice, that some users of my method have changed my procedure by increasing or decreasing the number of listening sessions, the length of the sessions, by including monthly or bimonthly “booster sessions,” or other modifications.

Please be aware, I have absolutely no personal gain in writing this article. My method is based on thousands of patients and determined by the analysis of thousands of audiograms. Thus, I could, myself, assume the problems above were brought about by some modifications. I state this because of the importance of my clients to me, and of my reputation.

In contrast, users of AIT who try to modify these rules, certainly with an honest willingness to obtain better results or to accommodate their patients, will damage their reputation as well as their “own” method.

As for receiving AIT more than once, follow these suggested guidelines: Deafness–one series every 6 months to 1 year, until the audiogram seems stabilized, then stop and verify annually; Dyslexia, Depression, Suicidal ideation– check after 3 months, 6 months, 1 year; and repeat AIT only if the audiogram is not normal; and Autism– every 6 months to 1 year, until there is no more improvement of the behavior, and then stop. This means that the patient’s hearing problem has been solved and he/she doesn’t need any more help in this area.

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Auditory Integrative Training From a Sensory Integrative Perspective
The December, 1994 issue of Sensory Integration: Special Interest Section Newsletter, included an article by Sheila Frick, OTR, and Nancy Lawton-Shirley, OTR which explained some of the effects of auditory integration training (AIT) from the perspective of sensory integration theory. The publication of this article happened to coincide with The Sound Connection’s publication of the Cerebellar-Vestibular System Theory submitted by Sally Brockett. M.S. Frick and Lawton-Shirley present a similar theory and provide some more technical details to support the clinical observations.

Frick and Shirley-Lawton report that in their experience with over 300 individuals, those with known vestibular processing dysfunctions appear to make the greatest gains from AIT. These improvements may occur in the areas of movement perception and security, overall arousal, organization and social- emotional response. This may occur since the vestibular system helps modulate neural activity and acts as a central reference point from which all other sensory information is composed (Frick, 1994).

Discussion also focuses on the reticular activating system which receives input from the auditory and vestibular systems. According to A. Jean Ayres, the reticular activating system helps the brain focus on one sensory input or type of sensory input by inhibiting other types. The unpredictable, modulated music used in AIT would stimulate a particular area of the reticular activating system which is activated by novel sensory input. Therefore, the unique sounds used in AIT may be capable of producing changes not only in the auditory processing of sound, but also in posture, balance and spatial orientation.

The reticular activating system also depends heavily upon the neurotransmitter norepinephrine which plays a role in alerting, motivation, emotion and arousal. According to Cool and Farber (1990), this may function as “keys to nervous system development and organization, learning, memory and reorganization.” The temporary periods of irritability, emotional lability and hyperactivity that are sometimes seen after AIT may be related to an increase in norepinephrine production.

The article concludes with a presentation of two case studies and a statement emphasizing the need for more research to clarify the functional changes which occur with AIT. If you would like to receive a copy of the complete article, please send a written request to Nancy Shirley-Lawton at The Special Children’s Center, 1810 Crestview, Hudson, WI 54016.

References
Ayres, A.J. (1972). Sensory integration and learning disorders. Los Angeles: Western Psychological Services.
Cool, S.J., & Farber, S. (1990). Functional neurochemistry. In C.B. Royeen (Ed.), American Occupational Therapy Association (AOTA) Self-Study Series: Neuroscience foundation of human performance, (pp.13-14). Rockville, MD: AOTA.
Frick, S.M., & Lawton-Shirley, N. (1994, December). Auditory Integrative Training From a Sensory Integrative Perspective. Sensory Integration: Special Interest Newsletter, pp. 1-3.

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Sound Sensitivity: What Does It Really Mean? Stephen M. Edelson, Ph.D.
Although attention in the field of autism has recently been focused on sound sensitivity, only a handful of researchers have examined or commented on this phenomenon. Most of the reports in the literature have simply listed sound sensitivity as one of the many characteristics exhibited by autistic children. Common descriptions include covering one’s ears, running away from a sound source, crying, and in some cases, throwing severe temper tantrums. The book,

The Sound of a Miracle, by Annabel Stehli brought to light the problem of sound sensitivity and called attention to how it may impede the maturation of some people afflicted with autism.

One question is: Do the reactions to certain sounds in one’s environment necessarily mean that the person is experiencing pain? Based on my research with Dr. Bernard Rimland, Director of the Autism Research Institute in San Diego, and discussions with many professionals as well as people with autism, I feel that some individuals may experience pain; but in others, sounds are simply heard too loudly and may cause a fear response.

Painful hearing: Many adults with painful hearing have described certain sounds as “hitting a nerve” or cutting into their ear.” Some therapists who work with self-injurious autistic individuals feel that severe ear/head banging may be a reaction to painful sounds in the environment.

Although some people may display a physical reaction to sounds, others may react to painful sounds by ‘tuning out’ or ‘ignoring’ the sounds. This may be why autistic children are often described as ‘living in a shell’ and why many parents suspect their child of being deaf. If some, or possible many, sounds are perceived as painful, a child may revert to focusing his/her attention inward rather than outward. We do not know why some individuals have painful hearing. Interestingly, low levels of magnesium, an essential mineral, have been associated with sound sensitivity. We know that many autistic children respond quite well to vitamin B6 and magnesium. Furthermore, researchers have found that damage to the brainstem may lead to sound sensitivity.

Hearing too well: Another form of hypersensitivity is hyperacuity–hearing sounds too well. That is, sounds are not perceived as painful; but rather, they are perceived too loudly. I have heard any reports from parents who claim their child can hear sirens or hear airplanes in the distance before other people can hear them. I have also witnessed this phenomenon. Two other possible reasons for hearing too well is the brainstem’s inability to provide inhibition within the auditory pathway (see article describing Collett et al.’s 1993 study in The Sound Connection, Vol. 2, No. 1) and over-amplification of bilateral input (see article describing Woodward’s 1994 study in The Sound Connection,Vol. 2, No. 2).

Another aspect of hearing too well may be an emotional fear response to certain sounds. Annabel Stehli’s daughter, Georgiana, described herself as having ‘bionic’ hearing. It is important to mention that she had many fears associated with sounds. She described rain as sounding like machine gun fire. She could hear water rushing through pipes in the wall, and she was scared that the pipes would burst through the walls and hurt her. After receiving auditory integration training from Dr. Guy Berard, she no longer feared these sounds because she could no longer hear the water rushing through the pipes. There has been some speculation on a possible link between hypersensitive hearing, fear, and a part of the limbic system–the amygdala. Recent brain autopsies of autistic individuals, conducted by Dr. Margaret Bauman and her associates at Harvard Medical School, indicate that some neurons in the amygdala are abnormal and may not be working properly. The amygdala is responsible for many functions, including emotions and fear. Interestingly, there are auditory pathways connected to the amygdala; and researchers, such as Joseph E. LeDoux at New York State University, have found that these pathways are responsible for fear conditioning to sounds. This raises the question: Does AIT stimulate the amygdala in some way which reduces fear to sounds?

It is important that researchers attempt to separate these two possible types of sound sensitivity. They may involve different brain structures and imply different treatment strategies.