Volume 6 Number 4, 1999

The Listening Project: Stephen W. Porges, Ph.D.
During the past three years our research team, directed by Dr. Olga Bazhenova, has been testing a new biologically-based intervention that uses acoustic stimulation to enhance social interaction and communication behaviors. Our initial research protocol applied the intervention to children between the ages of three and five who had a diagnosis of autism. We have tested more than 65 children in a double-blind randomized control experimental design. Most children experienced noticeable improvements in social behavior and communication skills immediately following the intervention. The improvements persisted when assessed during a three-month follow-up. The intervention consists of five 45- minute sessions. We believe that although the intervention was initially tested with children diagnosed with autism, it will be useful for other populations with difficulties in listening, communicating and organizing social behavior. While our technique shares several features with other forms of auditory intervention techniques, it differs in theory and practice.

Theoretically, the intervention is based on the Polyvagal Theory (see references), a theory derived from my 30+ years of research on the relation between the neural regulation of the autonomic nervous system and social-emotional processes. The Polyvagal Theory explains how the structural and functional organization of the autonomic nervous system has changed during evolution. The theory emphasizes that during various states of challenge the control of autonomic function shifts from the phylogenetically newer systems to the older systems. The theory owes its name to the vagus, a large cranial nerve that exits the brainstem and communicates with many of our visceral organs. The theory emphasizes that there are two functionally distinct and phylogenetically determined vagal systems, an older system innervating our gut and a newer system controlling our heart and bronchi that is linked to the neural regulation of the muscles of the head. The Polyvagal Theory provides three points that led us to use acoustic stimulation in our protocol to improve social behavior and communications skills.

First, the area of the brainstem that regulates the heart (i.e., via the new vagus) alsoregulates the muscles of the head including those of the face, middle ear, mouth, larynx, and pharynx. When we studied the general function of these muscles, we realized that collectively these muscles provide an integrated Social Engagement System that controls looking, listening, vocalizing, and facial gesturing. In fact, if the neural regulation of this group of muscles were dysfunctional, we would observe a face that did not work in social settings. Interestingly, these facial features reflect common behavioral symptoms that have been used to describe several psychopathologies (e.g., autism, depression, aggressive disorders, and post traumatic stress disorders) or emotional states during severe challenge (e.g., grief, rage, anger, loneliness) or medical illness (e.g., senility, AIDs, fever).

Second, the middle ear muscles play an important role in extracting human voice from our complex acoustic environment. When the neural tone to the middle ear muscles is low, the middle ear structures do not actively filter out the low frequency sounds that dominate the acoustic environment of our modern industrial world and do not amplify the frequencies associated with human voice. This difficulty in “listening” to human voice might occur even in an individual who has normal “hearing” (i.e., normal function of the cochlea, the auditory nerve, and the brain areas processing acoustic information).

Third, the neural regulation of the middle ear muscles is linked to the neural regulation of the other muscles of the face, which control facial expression and vocal intonation. Thus, stimulation improving neural regulation of the middle ear muscles should integrate and stimulate the neural regulation of facial expression, looking, listening, and vocalizing.

The area of the brain that contains the “lower” motor neurons for the Social Engagement System is near the lower portion of the brainstem. During periods of appropriate social communication (e.g., facial expressivity, vocal intonation), the “lower” motor neurons are regulated by the “upper” motor neurons in the frontal cortex. During periods characterized by fight-flight behaviors and fear-induced shut down or immobilization, the theory proposes that cortical regulation of these “lower” motor neurons is displaced by phylogeneically more primitive systems. The more primitive systems are dependent upon subcortical structures that evolved to negotiate survival by managing metabolic resources to promote mobilization (i.e., fight-flight behaviors) or to conserve metabolic resources by immobilizing (e.g., freezing or death feigning). Thus, a critical feature of whether an individual appropriately communicates with the social environment, or engages in a strategy of fight-flight or freezing behaviors is determined by the individual’s perception of the environment. Does the individual perceive the environment as safe or dangerous? The theory states that there is a degrading of the function of the Social Engagement System when the individual perceives the environment as dangerous. Conversely, if the individual perceives the environment as safe, there is the neurophysiological possibility that the cortex could regulate the “lower” motor neurons of the Social Engagement System to promote communication and social behavior. Thus, the perception of safety is the primary requirement for our intervention. In fact, we first called our intervention project, “Making the world safe for our children.”

Our approach was theoretically designed to recruit specifically the cortical regulation of the Social Engagement System to promote the voluntary prosocial behaviors that are missing in autistic children. The model is an optimistic model, because it assumes that for many children with social behavior and communication difficulties the Social Engagement System is neuroanatomically and neurophysiologically intact. The problem is conceptualized as a functional deficit. Thus, to obtain the desired behavior, our task is to stimulate the cortical regulation of the brainstem system that regulates the muscles of the head. The theory predicts that once the cortical regulation of this brainstem system is engaged, social behavior and communication will spontaneously occur as the natural emergent properties this biological system. Thus, the intervention is seen as “stimulation” and “exercise” of a corticobulbar neural system (i.e., nerves that connect the cortex to the brainstem) that regulates the muscles of the head.

The intervention is based on two primary principles: 1) cortical control of “listening” and the other components of the Social Engagement System via the corticobulbar pathways requires the environment to be perceived as “safe,” and 2) exposure to acoustic stimulation within the frequency band of human voice is capable of stimulating and exercising the neural regulation of the middle ear muscles and other components of the Social Engagement System. Thus, the intervention attempts to engage the active cortical control of the middle ear muscles as a portal to the Social Engagement System.

Our intervention model is theoretically driven and differs from other auditory intervention techniques. Our model emphasizes the importance of extracting human voice in social settings via the cortical neural regulation of the middle ear muscles. The intervention uses a relatively narrow frequency band that focuses on the frequencies of human voice. The acoustic stimuli are computer- altered by applying digital filters to extract specific frequencies. These filters are part of a complex algorithm that modulates the width of the frequency to “exercise” and “stimulate” the neural regulation of the middle ear muscles and to integrate the components of the Social Engagement System. In our model, tempo is only relevant in promoting positive affective states associated with safety. We do not use classical music, although the frequency band of many classical composers such as Mozart is similar to that of human voice. We focus on human voice, because the processing of the human voice is neurobiologically different from the processing of other acoustic signals and according to our model the processing of human voice is a component of a human social communication system, the Social Engagement System.

Our program has been called the Listening Project and it is actively being conducted at the University of Maryland in the Laboratory of Developmental Assessment and Intervention within the Institute for Child Study. We are continuing to solicit support for and participation in our research protocol. If you are interested in contributing to or participating in our research program, please email my laboratory to request information (pr36@umail.umd.edu).

References

A more detailed description of the research is reported as a preliminary report on the Webpage of the Unicorn Children Foundation www.saveachild.com/porges.html)

Porges, S.W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A Polyvagal Theory.Psychophysiology, 32, 301-318.

Porges, S.W., Doussard-Roosevelt, J.A., Portales, A.L., & Greenspan, S.I. (1996).Infant regulation of the vagal “brake” predicts child behavior problems: A psychobiological model of social behavior. Developmental Psychobiology, 29, 697-712.

Porges, S.W. (1997). Emotion: An evolutionary by-product of the neural regulation of the autonomic nervous system. In C. S. Carter, B. Kirkpatrick, & I.I. Lederhendler (eds.), The Integrative Neurobiology of Affiliation, Annals of the New York Academy of Sciences, 807, 62-77.

Porges, S.W. (1998). Love and the Evolution of the Autonomic Nervous System: The Polyvagal Theory of Intimacy.Psychoneuroendocrinology, 23, 837-861.

Dr. Porges address is the Chair of the Department of Human Development and the Director of the Institute for Child Study at the University of Maryland, College Park, MD 20742; e-mail:sp37@ umail.umd.edu

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AIT: Viewed As an Educationally Related Service
The recent shift in the FDA policy regarding auditory integration training (AIT) devices requires that practitioners and parents understand the procedure as a component of the educational process. Rather than asking whether it is covered by health insurance (which generally implies a medically related service), we need to direct our attention to helping parents, school staff and administrators recognize the important relationships between AIT and learning.

There can be a variety of causes that contribute to learning difficulties and each must be considered when working with children who are struggling in school. However, one that is of prime importance, and is often overlooked, is the children’s ability to listen. By listen, we are referring to the desire to pick up the message and actively, correctly, and quickly, interpret the meaning. The first step of listening depends upon the ability to hear, or receive the sounds. This is a passive process. With a small number of exceptions, most children with learning difficulties have hearing abilities within the normal range. They are not hearing impaired and do not require hearing aides. In fact, a surprisingly large number of these children actually hear with great acuity. So much so that their ability to listen is compromised by the fact that they hear too much, and can not easily tune in to the target message.

One way to recognize the relationship between listening and success in school is to understand the connection between listening, reading and spelling. As children learn to read, they must coordinate recognizing letters and their associated sounds. The written symbols only represent sounds, and the actual meaning appears as the readers express the sounds, either internally or externally, as words. In order to achieve this, the audio-visual-verbal coordination must be perfectly timed.

When children slowly and laboriously decode a word or series of words, they lose the meaning and simply name words, but can not understand the message. Fluent readers, who easily coordinate the temporal and spatial aspects of analyzing and synthesizing the information, will quickly and accurately comprehend the message intended by the written symbols. Reading and writing difficulties occur when groups of sounds are not perceived accurately and rapidly, in other words, when children have a problem with listening.

Spelling is another area that poses difficulties for many children who have listening problems. It requires many of the skills used in reading, however it could be viewed as the reverse process. Writers start by choosing the word they wish to spell, analyzing the sounds within the word and selecting the associated letters that make the sounds. Just as with reading, this process involves listening to the sounds, either voiced internally, or externally, but also includes visualizing the letters in the proper spatial sequence.

AIT is a procedure that trains children to listen more accurately. Dynamic music with a wide range of frequencies is processed through a system of filters in the AIT device. The volume and tone of the melody are constantly and randomly modulated, but the rhythm and phrasing are unchanged. This auditory stimulus activates the listening abilities, which then open up to the whole sound spectrum in a coordinated and efficient manner. Children who are learning to read and write will integrate verbal and written messages more easily. Self- confidence will grow as the children become competent learners.

As children develop efficient listening abilities, it will be reflected in other educationally related areas as well. Verbal directions given by teachers will be understood more easily and rapidly, allowing the children to respond without further questions. Children, who appear to be more cooperative and obedient, may actually be more able to comprehend what they have been asked to do. It is difficult to cooperate if you don’t understand the directions.

Efficient listening skills will also impact on the consistency of children’s work performance. Children with learning difficulties often demonstrate extreme fluctuations in the quality of their work, from high quality to poor. These variations may arise due to the level of fatigue at the time the work is done. Poor listening abilities mean that the children must work much harder than typical children in order to interpret their world. It would be similar to constantly translating a foreign language! The listener becomes tired and may “tune out” for a while in order to rest. Efficient listeners know what the speaker is saying as he says it, without having to think about it.

Children with good listening abilities also have an advantage socially. They will not be overwhelmed by the sounds of the social environment. Many socially isolated individuals withdraw due to the problems created by their inability to focus on the conversation and tune out background noises. Their sensory system may be overloaded, causing anxiety and stress that may only be relieved by seeking a less stimulating, confusing environment. When listening skills are trained to be efficient, the children often demonstrate more appropriate social relationships.

These examples illustrate the important connection between success in school and optimal listening abilities. AIT practitioners need to understand and focus on this aspect of the training procedure in order to facilitate the development of AIT as an educationally related service.

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Advanced Brain Technologies
(This information is based on promotional ABT information)
Advanced Brain Technologies, (ABT) develops products and methodologies for therapeutic, educational, and self-improvement application. ABT products currently include; The Sound Health SeriesT psychoacoustically-refined classical music to improve the home, school and work sound environment The Listening ProgramT, specially-treated classical music and nature sounds for auditory stimulation and Brain BuilderT software for the development of auditory and visual sequential processing and short-term memory. ABT is currently in development of visual media for early child brain development and is presently recording several hours of new classical music with the Arcangelos Chamber Ensemble for various applications. ABT also begins two-day professional training courses in psychoacoustics and sound therapy in Europe this September with US courses beginning in October.

ABT is an outgrowth of the National Academy for Child Development (NACD). Robert J. Doman Jr. founded NACD in 1979. Robert Doman and the NACD staff have a long history in the use of therapeutic sound, having overseen and utilized virtually every method developed, with thousands of children since discovering the work of Dr. Alfred Tomatis in the early 1970’s

ABT brings together experts in symbiotic fields, with co-creators spanning backgrounds in medicine, neurodevelopment, education, speech/language pathology, sound therapy, music, audio engineering, and psychoacoustics.

The Sound HealthT Series is a line of specially designed baroque/classical music CDs. This series contains six application-specific titles: Concentration, Thinking, Learning, Productivity, Relax, and De-Stress. Featuring psychoacoustically-refined masterworks, The Sound Health Series creates a positive soundscape for home, school, or work environment.

The Listening ProgramT is currently in clinical testing and will be released later this year. This is one of the most advanced sound stimulation applications in the world. Highly effective filtration/gating protocols and complementary sound tracks are based on the work of Dr. Alfred Tomatis. This program is the first to have Dr. Tomatis’ groundbreaking theories integrated into each aspect of therapeutic and creative production.

The Listening Program’s eight CDs contain specially treated classical music and nature sounds. A companion booklet of listening protocols, adaptable to multiple situations, is included. Each CD consists of 4 fifteen-minute sound tracks, sequentially treated with proven technologies, to gently exercise and re-train the auditory mechanism. This helps the brain process a full spectrum of sound. The Listening Program provides a safe, easy to use and accessible sound stimulation program to families, schools and clinics. With only a CD player and pair of quality headphones required for use, it will serve well by itself or as a complement to educational, therapeutic and other sound stimulation programs.

The Listening Program will be available exclusively through qualified and trained professionals. Training courses will begin in Cambridge, England and Cologne, Germany in September `99, followed by courses throughout the United States beginning 10/99.

Brain BuilderT is a fun and easy to use computer program to assess and develop auditory and visual sequential processing and short-term memory.

Brain Builder provides a systematic workout for the brain, helping you to actually improve the two most fundamental building blocks of all cognitive processes: auditory and visual sequential processing skills. Strengthening these fundamentals improves one’s ability to conceptualize and visualize, the basic thinking skills. It also results in faster cognitive processing.

Brain Builder is currently available on PC CD-ROM for Windows 95, 98 and NT, with a Home Edition and special site licenses for schools and clinics. A MAC version is in development and is anticipated to be released later this year. Brain Builder is appropriate for adults and children as young as age four with guidance.

Advanced Brain Technologies can be contacted by: Phone: (801) 622-5676; Fax: (801) 627-4505; e-mail: info@advancedbrain.com; Post: P.O.Box 1088, Ogden, Utah 84402. USA. Web: www.advancedbrain.com.

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Computer-based Treatment for Auditorily Based Language-Learning Disorders
Marna Scarry-Larkin, M.A., CCC/SLP
There are three primary types of reading disability. A specific problem in processing phonological information can cause “dyslexia.” More generalized problems in language based processing are typical of the second group of poor readers. These children have difficulty with phonological processing as well as semantic and syntactic language processing. The third group have precocious decoding skills, hyperlexia. They may learn to read at three, but have little understanding of what is read.

Therapy approaches to improve reading or comprehension skills need to focus on improving the area of weakness. Treatment for phonological awareness will need to establish accurate, consistent ability to discriminate sounds in isolation, sequence and in words. The sound to symbol correlation is the bridge between the auditorily processed language that the child first learned and written language. A weakness in understanding the phoneme/grapheme system will most certainly result in poor reading and spelling. Essential Literacy is a three part program designed first to improve phonemic awareness, second to teach the rules of English and third, to practice rapid reading and spelling of the most essential words for reading.

Children with syntactic and semantic errors in their oral language can be expected to have similar difficulty with written language. Learning to ask and respond to “Who, What, When, Where and Why” questions help with the formulation of questions and answers. Rapid automatic naming has also been shown to be beneficial for children with generalized language-learning disorders. The game Match Ups! provides both visual and auditory cues for naming and an option to remove cues as naming improves. Train Time includes all of these areas for language processing.

The ability to see and name common and less common items in the environment stimulate the receptive-expressive naming loop necessary for fluid speech in context. “It’s a …. food” presents 100 stimulus items in an uncluttered background for confrontation naming and syntactic and semantic practice. The extra buttons on the screen allow for individualization of each stimulus item. The text can be shortened or expanded using these buttons and the child’s or parent’s speech can be recorded for future sessions.

Reading without understanding is not functional. Children with hyperlexia typically have some connection with written word to meaning, but it is not well developed. They may sometimes get one or two ideas from the more visual nouns in the sentence, but not understand the action or cause/effect statements. Making a strong connection between word and image is the most effective treatment for comprehension problems. “It’s a … Mixed” provides an opportunity to connect the picture to sentences that you write and record. The Articulation Series has over 2,500 different stimulus photographs. Each photo has a word, phrase and sentence associated with the picture. Vocabulary development and sentence structure can be practiced with interesting picture stimuli.

LocuTour Multimedia has been at the forefront in developing new software programs for children with language and communication disorders. All the games are developed by speech-language pathologists and pre-market tested with children with a variety of abilities. They now make 19 products. A free software demo is available by calling 800-777-3166. The website is www.locutour.com

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Have You Heard About Tummy Tunes?
A couple from Montgomery, Alabama, Kevin and Wynne Harrison, recently developed `Tummy Tunes.’ This is a prenatal music system which is designed to present music to a developing fetus. This patented device is modeled after the `Mozart Effect,’ which has found that exposing a child to music may develop cognitive skills, such as spatial perception (see The Sound Connection, Vol. 6, No. 2). Tummy Tunes consists of two tiny speakers which are strapped around the belly of a pregnant woman. The speakers are attached to a small audiocassette player, and the speakers can be moved to any position on the belt.

Tummy Tunes is based on the premise (supported by research) that since one’s hearing develops between the 26th and 28th week of gestation, auditory stimulation presented to a newly formed sensory system may promote brain development especially in the area of sound/speech perception.

Note of caution: Some critics believe that presenting excessive sound stimulation to a developing fetus will affect their sleeping habits while in the womb. This would then impede rather than encourage brain development. (Editor’s note: Excessive anything should be avoided.)

For more information about Tummy Tunes, contact Wynneko Enterprises at 1-888- 583-3404 or visit their web site at: www.tummytunes.net