Volume 9, Number 4, 2003

*****
Last Issue of The Sound Connection
This is the last issue of SAIT’s newsletter, The Sound Connection. This issue also marks the ninth complete year of the quarterly publication (i.e., 36 issues). We would like to thank everyone who has contributed to the newsletter as well as those who helped with its distribution (photocopying, folding, labeling, and stamping).

SAIT will continue to publish articles on auditory-based interventions, and these articles will be posted on SAIT’s website (www.sait.org). You can sign up on the website to receive an email announcement whenever the site is updated.

In December, 2001, the Board of Directors decided to change SAIT from a membership-based organization to a non-member, Internet organization. SAIT members continued to receive newsletters in 2002, and they had exclusive access to the ‘Members Only’ section on SAIT’s website. Members will receive one more mailing from SAIT. This will be a full index of all of the past issues. Additionally, all issues of The Sound Connection will be posted on SAIT’s website and will be available to the public.

SAIT will continue its efforts to provide information about various auditory interventions to parents and professionals by posting articles and related information on its website, answering letters via postal mail and email, and distributing information at conferences. In order to continue such efforts, we welcome donations to pay for our expenses.

*****
Dr. Stephen Porges’ Research May Support Berard’s and Tomatis’ Theory on Middle Ear Muscle Dysfunction
Stephen Porges, Ph.D., a professor of Human Development at the University of Maryland, may be closing in on the reason why auditory integration training (AIT) and other similar auditory interventions may be beneficial to children with autism and other related disorders. Dr. Porges’ work has been described in a previous issue of The Sound Connection, but we are learning more about his hypotheses and research findings (see The Sound Connection, Vol. 6, No. 4).

Similar to the works of Drs. Alfred Tomatis and Guy Berard, Dr. Porges’ research has focused on the two muscles in the middle ear–the tensor tympani and the stapedius. Porges has found that the same nerves that control these two muscles also control vocalization, facial expression, heart rate and breathing.

When we experience fear and/or anxiety, the two muscles in the middle ear can no longer diminish low-frequency sounds. Based on an evolutionary perspective, this would allow the individual to attend to all sounds in his/her environment in order to perceive danger rather than attending mostly to higher frequency sounds such as speech.

According to Dr. Porges, many children with developmental disabilities are in a state of high anxiety. As a result, it is difficult for them to attend to only the high frequency sounds such as human speech.

Porges has developed an intervention that is similar to AIT and the Tomatis method. First, the child is encouraged to relax. This may include playing with toys or sitting/resting in a quiet area. This, in itself, should improve the function of the middle ear because the child will be less anxious. The child then listens to specific sounds or music within a narrow frequency range. This is similar to the frequency range of human speech. Gradually, the frequency range is widened which is intended to vigorously exercise the two muscles in the middle ear.

Since the middle ear muscles share the same neural connection with facial expression and vocalization, Dr. Porges expects to see an improvement in communication as a result of an improvement in middle ear function. His 10 years of research on this subject has supported this hypothesis.

Dr. Porges’ line of research is very exciting and may lead to better understanding of some of the AIT effects. However, it does not seem to explain changes in many other areas such as handwriting and drawing, variety in diet, balance and coordination, sensory processing, vision skills, sleep patterns, etc. Some of these changes may result from stimulation of the cerebellar-vestibular system (see The Sound Connection, Vol. 2, No. 2 ). We will keep our readers up-to-date on any new developments.

*****
Listing of AIT Practitioners’ on the Internet
Dr. Guy Berard will soon join the Internet community with his own website => www.drguyberard.com The website will contain many of his thoughts and comments on AIT, several of his published articles, a list of instructors who are approved to teach his method of AIT, and a listing of practitioners who use the Berard method of AIT. The listing will contain names of practitioners who were taught by Dr. Berard or by one of his ‘approved’ instructors.

The International Association of Berard Practitioners (IABP) will also be sponsoring an AIT website in the near future. This website will contain information about AIT and will likely contain a list of AIT practitioners. Currently, the Internet contains two lists of AIT practitioners. The Autism Research Institute’s website (www.AutismResearchInstitute.com) maintains a list of names of all-known AIT practitioners. The Georgiana Institute’s website (www.georgianainstitute.com) contains a list of practitioners trained in the Berard method and practitioners using the DAA equipment, some of whom have not participated in a training course. Both lists do not differentiate the type of training or equipment used.

AIT practitioners are encouraged to visit these websites to make sure the contact information is correct.

*****
News and Notes
We are sad to report that Dr. Alfred Tomatis died last month (December, 2001). Dr. Tomatis was one of the pioneers in the area of auditory interventions. Dr. Tomatis’ health had been declining for the past few years. In addition, his son, Christian Tomatis, died of a heart attack earlier in the year. Christian was in charge of the worldwide Tomatis organization.

***
The International Association of Berard Practitioners (IABP) is planning a Fall 2003 or Spring 2004 conference on auditory integration training (AIT). Their last conference was held in Antwerp, Belgium and received high praise from its attendees. The upcoming conference will be held in the United States, most likely on the east coast. If you are interested in learning more about the conference and/or would like to participate, please contact Sally Brockett at: ideasb@cshore.com

***
Dr. John Unruh recently stepped down as the Chairman of IABP. Dr. Stephen M. Edelson of the Center for the Study of Autism in Salem, Oregon was selected to replace him. IABP will continue to be housed at Voluntas in Antwerp, Belgium. More details about this transition will be published in the upcoming issue of IABP’s newsletter.

***
A discussion group dedicated to auditory interventions is now available on Yahoo.com. The description is as follows: “This group is to share information, ideas, successes, and opinions about the various forms of listening therapy that exist. It is primarily designed for people interested in Sheila Frick’s Therapeutic Listening and Samonas Therapy but also open to thoughts on AIT (auditory integration training), The Listening Program, The Tomatis Method and Listening Fitness. It is overseen by a speech therapist trained in Therapeutic Listening.”

To subscribe to the discussion group, simply visit www.yahoogroups.com and conduct a search on the phrase: listeningtherapy.

***
Sheila Frick recently published a book titled Learning with the Whole Body and a booklet with a compact disc titled No Worries. These items can be purchased from Developmental Delay Resources (DDR), phone: 301-652-2263, fax: 301-652-9133, website: www.devdelay.org Note: DDR publishes an excellent quarterly newsletter and sells many books and other publications.

***
The Autism Research Institute will publish a CD-Rom containing previous issues of their newsletter, the Autism Research Review International. This will include every issue from 1987 to 2001, Volumes 1 to 15. An index will also be available on the CD-Rom. The CD-Rom will be available in February. Its availability will be announced on ARI’s website: www.AutismResearchInstitute.com

*****
Situations In Which a Filter May Be Helpful
Stephen M. Edelson, Ph.D. and Sally Brockett have both had situations in which they found that the use of a filter or two filters made a significant difference in the clients’ ability to tolerate listening to the AIT music.

Dr. Edelson experienced the first situation when a client’s filters (2 KHz and 8 KHz) were inadvertently switched off during an AIT session. In a short time, the client became pale and nauseous while listening without the filters. As soon as it was discovered that the filters were off, the correction was made and this client immediately became more comfortable. He was able to resume listening without the physical distress.

Sally Brockett had a young child whose audio test results did not indicate the need for any filters, though there was a peak at 4000 Hz that did not meet the criteria for filtering. During the first two days, this child had on-going complaints about the music, though the volume was set quite low. Any attempt to raise the volume even by one level produced more complaints. On the morning of the third day, the child was still not accepting the music well. Sally recalled Steve’s experience with the filters being switched off for his client and the resulting discomfort. Since this child’s audio test showed the peak at 4000 Hz, this filter was turned on even though the peak did not quite qualify for filtering. Although the child did not know that any adjustment was being made on the device, she immediately said “Oh, that’s much better” when the filter was switched on. Her sessions continued with the 4000 Hz filter, and she was quite happy.

After an additional two more experiences similar to that described above, Sally and Steve believe that it may be appropriate in certain cases to try setting a filter to enable the listener to accept the music more comfortably. This should only be considered when a client is clearly having significant difficulty tolerating the music without filters. The three young children all responded well with a 4000 Hz filter. The adult required the 2-8, which had been identified on the audio test. Using a filter not previously identified through the audio test may occur in cases where the client has not been able to cooperate with the Berard protocol for audio tests, so no filters were set. Or, it may occur when the audio test does not indicate the need to filter. If peaks are present, it is suggested that the filtering rules be used to determine which peak or peaks come closest to meeting the criteria for filtering. Using that filter/s should be tried first. If that does not make a difference, try the next most significant peak/s. In our experiences, turning the filter/s on made an immediate, definite difference. If this does not occur, then no filters should be used.

*****
Age Issue and AIT Revisited – Once Again
In the last issue of The Sound Connection, Guy Berard, M.D. wrote an article in which he stated that the minimum age to receive AIT should be 3-years old. Subsequently, John Unruh, Ph.D., Chairman of the International Association for Berard Practitioners (IABP), wrote a similar article for the IABP newsletter; and he also agreed with Dr. Berard’s position. Following these two articles, Jane Madell, Ph.D. submitted a ‘Letter to the Editor’ to SAIT in which she suggested that children under age 3 years, under some circumstances, may also benefit from AIT. We have published her letter below. We have also included an ‘Editor’s Reply,’ written by Stephen M. Edelson, Ph.D.

***
To the Editor:

I read with interest Dr Berard’s letter suggesting that AIT should not be performed prior to age 3 years. I certainly do not have the number of years of experience of Dr. Berard, but I have been doing AIT for ten years and have seen more than 1400 children of which about 20-25% are under 3 years. It is my opinion that AIT can be successfully performed on children as young as 14 months under some circumstances. In fact, it is generally believed that young brains are more plastic and adaptable to change.

Based on my experience, no child should ever receive AIT treatment unless it can be demonstrated that the child has an auditory function disorder as determined by an audiologic evaluation. As Dr. Berard has stated, AIT can only deal with the auditory component of the disorder. Therefore, it is essential that the auditory component be measured. Dr. Berard is correct that there can be medical causes which can appear as “hypersensitivity” but which are not truly “hypersensitivity.” In addition to the causes he mentioned, ear infections can cause it to appear that a child is hypersensitive.

Dr. Berard expresses concern about possible damage to the ears of a young child. If the equipment is calibrated on a regular basis (every 3 months) as audiologic equipment is, and if the output is monitored by a knowledgeable person, there should be no reason for concern about damage to hearing. I think the quality of the auditory stimulus will also be a significant factor in how the child responds to treatment. Not all the AIT programs are the same.

In summary, I believe that young children can successfully receive AIT if 1) an audiologic evaluation by a pediatric audiologist identifies auditory function problems, 2) the equipment is calibrated and monitored regularly, and 3) there is a system in place for monitoring progress during and after treatment.

Sincerely,

Jane R. Madell, Ph.D.; CCC A/SLP, ABA, Cert AVT
Director, Hearing and Learning Center
Beth Israel Medical Center and
Professor, Clinical Otolaryngology
Albert Einstein College of Medicine

***
Reply to Dr. Madell:

First, I would like to say that Dr. Madell is a well-respected audiologist; and she is one of the pioneers in the field of AIT. Second, I want to mention that Dr. Madell does not offer the Berard method of AIT. Over the years she has developed her own AIT method. One cannot assume that the results from her work, using her method, can be applied to the Berard method of AIT. When Drs. Berard and Unruh strongly urged a minimum age of 3 years, they were referring to the Berard method of AIT.

As many practitioners know, Dr. Berard states that the volume level should be relatively loud in order for AIT to be effective. The concern regarding the age issue is: how loud is a safe level for young children? Research has estimated the loudness levels and length of exposure for adults, but the safe loudness level for young children is not known. Is it reasonable to generalize the findings from adults to young children? I don’t think so.

Some practitioners say that they simply play the music at a lower level for young children. Should AIT practitioners presume what is a safe level? In other words, should we take a chance on causing permanent hearing damage (a problem which will last a lifetime) by guessing what level is safe? I don’t think so.

A few people have argued that some children may have a much better prognosis if they are given AIT at a very young age. AIT has been popular in the U.S. for over 10 years–Where is the comparative data? Additionally, we are learning that sound sensitivity may be caused by some biomedical problems; and these problems have been discussed in past issues of The Sound Connection. For example, I know of one girl who received AIT four different times to reduce her sound sensitivity over an eight-year period. Each set of AIT sessions helped her, but the effects would wear off within a year or two. After receiving a chelation treatment for mercury toxicity, her sound sensitivity went away permanently! We are also hearing reports of a reduction in sound sensitivity soon after receiving secretin as well as being on a gluten-free/casein-free diet.

In many cases, the best, long-term results will be achieved by identifying and treating the underlying causes of sound sensitivity, be it toxicities, side effects of medications and/or additives, or nutritional deficiencies. Identification of these problems and treatment can be started at very young ages, as soon as the problem arises. If the child continues to be sound sensitive by the age of 3 years, Berard AIT can be provided to reduce the hyper-sensitivity in a short period of time. Treatment to resolve the underlying cause should continue until a biomedical cause is ruled out or corrected.

Berard AIT may also be appropriate for children with delays in speech/language and auditory processing, with or without issues of sound sensitivity. AIT can be provided once the child turns 3 years and is best when used in conjunction with other appropriate interventions based on the child’s unique needs.

Sincerely,

Stephen M. Edelson, Ph.D.
Co-Editor, The Sound Connection
SAIT, P.O. Box 4538, Salem, OR 97302, USA

*****
Hearing Test Simulates Real World Sounds
Ruth Litovsky, a researcher at the University of Wisconsin-Madison, has developed a new hearing test which simulates hearing in the real world. In contrast to traditional assessment measures, Dr. Litovsky’s test reproduces many of the sounds found in the child’s environment, such as different competing voices as well as sounds they may hear on the playground and at home.

The test involves presenting voices and sounds from loud speakers positioned in a semi-circle around the child. Children play a “game” in which they are instructed to follow the directions of only one voice, and this voice tells them which picture to select on a computer monitor. Sometimes voices/sounds are presented from one direction; whereas at other times, the voices/sounds are presented from different directions. Dr. Litovsky’s test can assess how well children hear when presented with competing voices/sounds as well as how children hear in noisy situations.

The assessment of hearing in a simulated ‘natural’ environment is welcome news. Dr. Guy Berard has always argued that to understand how people hear, you need to understand how they hear in their normal surroundings. This is why he recommends that listening tests be performed in a sound-quiet room.

*****
Area of Sensitivity to Acoustic Change Identified in Brains of Autistic Children
French researchers Gomot, Giard, Adrien, Barthelemy, and Bruneau have identified an abnormality in the brain of autistic individuals that is associated with auditory sensitivity.

The researchers examined the electrophysiological changes that occur during the ‘automatic’ detection of a change in auditory frequency. Fifteen autistic children and 15 normal children (controls) participated in this study. The electrophysiological measures included: scalp potential and scalp current density (SCD).

Although detection of the frequency change occurred in both hemispheres, the results indicated that the brains of autistic children responded much faster to the change than those in the control group. Additionally, detection of frequency change was fastest in the left frontal cortex.

Gomot and his colleagues concluded that the abnormal activity in the left frontal cortex could affect cognitive and behavior impairment. This study is one of many that have documented dysfunctional auditory processing in autistic children.

Psychophysiology, 2002, Vol. 39, pp. 577-584. (PMID: 12236323)

*****
Music Training and Brain Growth
German researchers Gottfried Schlaug and Gaser Christian found many differences in the brain structure of professional musicians and non-musicians. Using magnetic resonance imaging sequence, they compared the imaging results of 15 professional musicians with 15 age and sex matched non-musicians.

The comparison indicated more gray matter volume in several areas including: the left and right primary sensorimotor regions, the left intraparietal sulcus region, the left basal ganglia region, and the left posterior perisylvian region. There were also differences in the bilaterality of the cerebellum.

These findings suggest that brain growth may be a response to intense stimulation of music during childhood. Furthermore, the authors suggest that such growth may occur only at a critical period of brain maturation. For example, this type of brain development may occur at an early age but may not occur in older children and adults.

Note: Although musicians typically begin their music training during childhood, the results do not necessarily prove a causal relationship between music training and brain growth. It is possible that these differences in gray matter were apparent at birth, and this ‘advantage’ provided them with the talent needed to pursue a career in music.

Paper presented at the 53rd Annual American Academy of Neurology meeting (May, 2002) in Philadelphia, Pennsylvania.