Volume 4 Number 2, 1996

Updates
FDA and AIT. No news with respect to the Food and Drug Administration (FDA). The AudioKinetron and the BGC Audio Tone Enhancer/Trainer are still labeled `medical devices,’ and have not yet been approved. The Society for Auditory Integration Training (SAIT) has recently conducted a survey, in cooperation with many AIT practitioners, to investigate possible side-effects during and after receiving AIT. We plan to publish these results in a future issue of The Sound Connection. SAIT hopes to meet formally with FDA representatives in the Spring, 1997, to discuss the possibility of changing the classification of the AIT devices from a Class III to a Class II. This would allow manufacturers to import the devices into the United States as well as ship the devices across state lines. Additionally, investigators would not need to obtain FDA approval to conduct research.

Computerized Language Teaching Program. A promising language teaching program, which has attracted the attention of parents and professionals in the field of developmental disabilities, is currently being studied by researchers. This program was described in two articles by Paula Tallal, Michael Merzenich and their colleagues which appeared in Science earlier this year (January 5, 1996, Vol. 271, pp. 77-84) and which were summarized in a recent issue of The Sound Connection (Vol. 3, No. 3). Computerized programs in the form of games have been designed to help children increase the rate at which their brains can process speech. For children with auditory processing deficits, it helps by retraining the brain to hear words and sounds properly. The program breaks sounds into short sound segments (phonemes) and retrains a child’s brain to distinguish these sounds. The child can then more quickly process speech, making conversational speech more understandable and allowing other language- based skills to improve.

This program is being studied at 30 test sites. Sabra Gelfond, Director of the National Speech/Language Therapy Center in Bethesda, Maryland, says she has seen very encouraging results. Thus far she has used this program with some dyslexic and language impaired children. She is now extending this research to include autistic children.

For more information, please contact: National Speech/Language Therapy Center, Wyngate Medical Park, 5620 Shields Drive, Bethesda, MD 20817, phone: (301) 493-0023.

EASe Compact Disc. Earlier this year, Vision Audio Inc. began distributing a compact disc containing the output of the AudioKinetron. The disc contains only the modulation of the AudioKinetron, and does not include any narrow-band filters. This compact disc is referred to as `Electronic Auditory Stimulation effect’ or EASe disc. Some concerns about the EASe compact disc were discussed in a previous issue of The Sound Connection (Vol. 3, No. 4).

A recent electronic analysis of the disc’s output indicated that the AudioKinetron was working correctly and the music selection was appropriate; however, the variety of the music included on the disc is rather limited.

Over the past year, several parents have described positive effects from the EASe disc on the Internet. Some of the descriptions include a reduction in sound sensitivity and an improvement in speech and social behavior. Currently, there are no controlled studies examining this disc; and there is at least one parent survey underway. For information, phone (410) 679-1605.

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Evidence of Abnormal Processing of Auditory Stimulation Observed in Cerebral Blood Flow Studies
Several studies have documented abnormal levels of blood flow as a response to auditory stimulation in autistic children. In a study published in Developmental Brain Dysfunction, Bernard Garreau and his associates (1994, Vol. 7, pp. 119-128) observed changes in regional cerebral blood flow in response to the presentation of a 750 Hertz tone for 200 milliseconds in both autistic (n=14) and non-autistic (n=6) individuals. Cerebral blood flow was measured using single-photon emission computed tomography. The researchers did not observe any differences between the two groups when the tone was not presented. However, in response to the tone, there was an increase in cerebral blood flow in the left temporo-occipital region for those in the control group. In contrast, there was an increase in cerebral blood flow in the right temporo- occipital region with no activation on the left side for those in the autism group. In general, activation in the left hemisphere is considered normal and is thought to indicate retrieval of acoustic information from memory which may be important for language.

The researchers speculate that activation of “the right hemisphere may be of importance in the elaboration of abnormal and often unexplainable behavioral responses to sounds which are among the most pronounced signs in autistic subjects in early childhood” (pp. 126). This same research group conducted two other studies and obtained corroborative results (Biological Psychiatry, 1992, Vol. 32, pp. 691-699; American Journal of Psychiatry, 1992, Vol. 149, pp. 924-930). Given these findings, we encourage researchers to consider examining cerebral blood flow in relation to auditory integration training.

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Suspected Deafness in Autism: Stimulus Overselectivity Revisited
One common characteristic of autistic children is their characteristic tendency to `tune out’ or ignore stimuli in their environment. This has often been thought of as the result of an extreme form of focused attention, analogous to `tunnel vision.’ Based on an analysis of the E-2 diagnostic checklist collected by the Autism Research Institute, half of all responding parents had suspected their autistic child of being deaf at one time in their child’s life. Consequently, many of these children were tested for a hearing loss; although in most cases, their hearing was found to be normal. One phenomenon which has often been used to describe this focused attention span is `stimulus overselectivity,’ a term first used by Ivar Lovaas, Robert Koegel, and Laura Schriebman (Journal of Abnormal Psychology, 1971, Vol. 77, 211-222). In their experiment, autistic children were taught to press a lever when three stimuli were presented simultaneously. The stimuli included a visual stimulus (a light bulb), an auditory stimulus (a noise), and a tactile stimulus (a cuff around the leg). After the children responded consistently to the three stimuli, they participated in a test phase in which each stimulus was presented separately. Lovaas and his colleagues found that autistic children, unlike non-autistic children, would often respond to just one of the three stimuli during this testing phase, and they concluded that the children were only attending to one of the three stimuli during the initial learning phase.

Another interpretation, suggested by Sally Brockett, is the possibility of `sensory overload.’ Many adults with autism have expressed their difficulty with processing simultaneous sensory input of various types. In the Lovaas et al. experiment, the subjects were stimulated simultaneously with tactile, visual, and auditory input. Perhaps they became overloaded and reacted by shutting down two channels of input. They would then be learning to respond only to the stimulation to which they remained open.

Parents of those who have completed auditory integration training (AIT) report that sensory processing seems improved. Hypersensitivity to taste, touch, smell, auditory, and visual stimuli seem to be reduced; and the individuals are calmer, less irritable, and more cooperative. One theory, also proposed by Sally Brockett, suggests this is due to the cerebellar-vestibular system stimulation that occurs with AIT. Therefore, individuals may be less likely to `tune out’ after AIT because they no longer become overloaded with sensory input.

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PRACTITIONER’S FORUM
Sometimes practitioners are asked about testing for painful hearing when an individual exhibits behaviors that indicate he may have this condition. Is it necessary to do this test?

No, it is not necessary to test for uncomfortable levels of loudness in order to provide AIT, even for those who do have painful hearing. The test results will not change the training procedure, as the procedure generally corrects or improves the problem without any specific steps being taken. Occasionally, some practitioners do this test to document change for research purposes. Since it can be an aversive procedure, there is risk that the individual will become afraid of headphones and noncompliant with the AIT program. Dr. Berard strongly recommends that this test not be used.

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Theories of AIT
Two AIT theories offer different explanations of why AIT might work. They focus primarily on changes with the listener’s ability to change or shift attention.

`Tune In/Tune Out.’ Bill Clark. (Bill Clark is an audio engineer and designer of the BGC Audio Tone Enhancer/Trainer.) Many autistic children are characterized as being deaf at times. This is consistent with the common description of these children as `living in a shell’ and `blocking out’ or `tuning out’ people in their surroundings. A recent analysis of the E-2 data from the Autism Research Institute in San Diego, California indicated that 50% of parents suspected their autistic children of being “very nearly deaf.”

Bill Clark suggests that the modulation of the AIT music may train the listener to `tune in’ to his/her environment. Basically, the listener cannot anticipate the random changes of the music during the listening sessions (i.e., modulation); and thus, he/she cannot `tune out’ or ignore the music. As a result, the person begins to listen (or `tune in’) to the music. By conditioning the person to attend to the music, the person is then able to generalize `tuning in’ to their surroundings.

`Shifting Attention.’ Stephen M. Edelson. Researchers have shown that autistic individuals often have problems shifting their attention from one source to another. Much of this work has been performed by Dr. Eric Courchesne and his colleagues at Children’s Hospital in San Diego, California. For example, a common situation might be: a child is playing with a toy and is asked by a parent to get ready for dinner. Initially, the child’s attention is focused on the toy, and then he/she needs to shift his/her attention to the parent’s instruction. The average non-autistic child can shift his/her attention within one to two seconds. However, an autistic child will continue to perseverate on the toy, and then gradually shift his/her attention to the parent’s instruction. It may take 3 to 5 seconds, or even longer, to shift attention. According to Dr. Courchesne, this inability to shift attention appropriately is a result of structural abnormalities in the cerebellum. Furthermore, Dr. Courchesne proposes that this attention shifting problem may be a critical problem in autism. That is, if a child cannot shift attention in an efficient manner, it will be difficult for him/her to learn about their environment, especially to learn language. For example, if a child shifts attention too slowly, he/she will lose the context of what was said and have difficulty understanding.

Dr. Stephen Edelson suggests that AIT may train or condition the listener to shift his/her attention more rapidly and more efficiently. The modulation during the AIT listening sessions changes the music at random intervals. At one moment, music from the low end of the frequency spectrum is presented; and at another moment, music from the high end of the spectrum is presented. The BGC Audio Tone Enhancer/Trainer also changes the volume level at random intervals. One might argue that the listener is trained or taught to shift his/her attention during the listening sessions since the AIT music is constantly changing from low to high frequencies and from soft to loud music.

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Painful Hearing and Audiogram Peaks: Dr. Guy Berard
It seems that there exists some confusion in the understanding of treating painful hearing through AIT.

PEAKS: The graphic of an audiogram of a person who hears perfectly is a straight horizontal line. This means that this person is hearing all the sounds, all the frequencies, with the same intensity if the sounds reaching his ears have been produced with the same volume.

If instead of this straight line, the graphic shows a “peak,” which is a point situated 5, 10, 15 or more decibels higher than the two neighboring frequencies, (i.e., if the graphic of all the frequencies is at the level of 15 dBs except 1000 Hz heard at 5 dBs), then 1000 Hz is called a peak.

This peak means that 1000 Hz is heard better than all the other sounds, that it covers them, leading to some difficulties:

– it may lead to learning disabilities, the child hearing the sounds of this area better, corresponding to some vowels and diphthongs, will make mistakes as the hearing of these vowels and diphthongs will “hide” the hearing of the consonants.

– according to my theories, it may represent, or even be responsible for, some sicknesses as allergies, depression,… but this opinion would need several pages of explanations. So anyway, in order to help individuals, these peaks have to be suppressed, which is the work of the filters of the AudioKinetron.

PAINFUL HEARING: Here the problem is absolutely different. Some individuals, autistic or not, cannot stand some sounds heard at an intensity which seems absolutely normal to everybody else.

Opposite of what happens with peaks, when an audiogram can be obtained, it is principally the frequencies which are poorly heard which are painful. The most simple example is old people becoming deaf to high frequencies. They cannot stand children squealing and all the sounds of high frequencies. On their audiogram, painful hearing corresponds to troughs, and not to peaks.

It is easy to determine which are the painful frequencies for the individuals whom we are training. When making an audiogram, you increase the intensity of each frequency until the moment when the individual says “It’s painful.”

This technique should not be used:

– because it is of no interest for setting the device,

– because it consequently bothers the individual for no purpose, and autistic children submitted to this test will make an association between the test and wearing headphones for AIT,

– because individuals may become anxious about the training,

– and because they may block the ossicles instead of listening to the music.

To conclude, though the research of peaks is important for the diagnosis of some hearing abnormalities, the search for painful hearing is forbidden.

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History of SAIT
The history of the Society for Auditory Integration Training follows an interesting course. In early 1991, Annabel Stehli’s book, The Sound of a Miracle, was published and immediately created a great wave of interest in auditory integration training (AIT). At about this same time, Drs. Bernard Rimland and Stephen M. Edelson conducted the first clinical study of the AIT procedure, and a small number of individuals interested in AIT traveled to France to learn the procedure from Dr. Guy Berard.

In January, 1992 a conference was held in St. Louis, Missouri that focused attention on AIT. Many attendees were enthusiastic about AIT, but shared mutual concerns about its future. Very late one evening, twenty-three individuals crowded into one of the hotel rooms and discussed the issues. In the early morning hours, when the meeting ended, it was concluded that an organization was needed to help set policies, to establish ethical standards and to distribute objective information. Two additional meetings were scheduled before or after the regular conference workshop sessions. By the end of the conference, these founding members had developed a mission statement, elected its first officers and settled on the organization’s name, The Society for Auditory Integration Training, abbreviated to SAIT.

Throughout the remainder of 1992, many of the founding members collaborated in developing the guidelines, standards and ethics policies for SAIT. Under the sponsorship of Annabel and Peter Stehli and their newly formed Georgiana Foundation, Dr. Berard began training seminars in the U.S. to teach people his procedure. By December, 1992 SAIT incorporated as a non-profit organization and elected its first Board of Directors. Parents and professionals interested in the development of AIT joined SAIT in order to obtain information and share ideas.

Early in 1993, SAIT began work on publishing a quarterly newsletter. Initially, the newsletter was simply called The SAIT Newsletter, however, members soon selected The Sound Connection as its title. Currently, The Sound Connection is mailed to members throughout the U.S. and in foreign countries. Membership in SAIT is open to professionals who practice AIT, parents of individuals with special needs, and interested others. Membership policies have changed with the changing needs and situations in the field of AIT.

SAIT has played an instrumental role in the development of AIT in this country. There are still hurdles to be cleared which will require much effort, however the mission and objectives of SAIT are still as valid as they were when the founding members established them nearly 5 years ago. Obviously, the future of SAIT and AIT is unknown at this time, however, if members continue to make progress toward furthering the understanding and recognition of AIT, the society will have more pages to write in the coming years.

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ASA’s AIT Package Available on the Internet
The Autism Society of America (ASA) has recently included their auditory integration training (AIT) packet on the Internet. The URL address is: http://www.autism-society.com/ This is the same AIT packet which is available through the mail from ASA and through fax-on-demand (tele.: 1-800-FAX-0899) As mentioned in a previous article of The Sound Connection (Vol. 3, No. 2), this packet contains inaccurate information about AIT and is geared toward the Tomatis approach. For example, the packet lists Tomatis practitioners around the country, but it only provides names of organizations which provide a list of Berard AIT practitioners (i.e., the Autism Research Institute and the Georgiana Organization). Drs. Rimland and Edelson wrote to ASA to correct many of the problems with the AIT packet but were told that the packet is reviewed every two years. Minnie Rouse, ASA’s Information and Referral Director, said recently that the packet will likely be reviewed sometime in 1997.