Volume 2 Number 2, 1994

ASHA Publishes Report on AIT
A long-awaited report by the American Speech and Hearing Association (ASHA) was recently published on auditory integration training (AIT). The report, published in ASHA, (November, 1994), was written by the Subcommittee on Auditory Integration Training of the Ad Hoc Committee on Auditory Integration and Facilitated Communication. The report includes: a brief review of methodology, practitioner education, equipment, and research considerations as well as the Subcommittee’s concerns related to the practice of AIT.

Some of the concerns addressed in the report were: candidacy (e.g., who will benefit from AIT), personnel (i.e., non-audiologists performing audiograms), equipment calibration (i.e., decibel level), and varying treatment procedures (e.g., length of listening sessions).

The report “… recommended that consumers be informed that AIT is experimental in nature before they participate in treatment” and that “… ASHA develop a position statement and guidelines regarding these procedures as more research findings become available.”

This report provides the reader with much information and SAIT members are encouraged to read this report. A copy of the report can be obtained from ASHA by calling (301) 897-5700 and ask for either Maureen Thompson (ext. 320) or Evelyn Cherow (ext. 135).


Corrections to ASHA Report

Some of the issues raised in the November ASHA report are incorrect or out-of- date. They are:

Page 56 (col. 1, para. 2). LP’s are not considered an appropriate music source, and audiotapes are not recommended for AIT.

Page 57 (col. 1, para. 3). As of September 1, 1994, the Food and Drug Administration has classified the Audio Tone Enhancer/Trainer as a ‘medical device.’

Page 57 (col. 1, para. 7). The report states: “To date, no evidence has been published in refereed journals that shows benefit with any specific population.” Rimland and Edelson (1994) published a study showing that children and adults with autism benefit from AIT. This article is cited in several places throughout this ASHA report, and it was published in an ASHA journal (American Journal of Speech-Language Pathology, May, 1994).

Page 58 (col. 3, under Resources) As of April, 1994, the address for the Society for Auditory Integration Training is 9725 SW Beaverton-Hillsdale Hwy., Suite 230, Beaverton, OR 97005.

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BGC’s Audio Tone Enhancer/Trainer Labeled a ‘Medical Device’
On September 1, 1994, the Food and Drug Administration (FDA) classified the Audio Tone Enhancer/Trainer as a ‘medical device.’ A device is labeled a ‘medical device’ by the FDA if there are claims that it will improve a condition. (Eye glasses are also considered medical devices.) This classification does not mean that the Audio Tone Enhancer/Trainer is harmful.

Earlier this year, the FDA classified the Audiokinetron as a ‘medical device;’ and as part of their ruling, they stated that the Audiokinetron can no longer be imported into the United States and that it cannot be transported across state lines (for more information, see The SAIT Newsletter, Vol. 1, Nos. 3 & 4).

At the present time, the Audio Tone Enhancer/Trainer is considered a ‘non- approved’ medical device because it has not been approved by the FDA. Once ample research is conducted as to its efficacy, BGC Enterprises will submit an application to obtain FDA approval.

The FDA has not made any decision with respect to the manufacturing, distribution, and use of the Audio Tone Enhancer/Trainer. BGC Enterprises has submitted a form to obtain approval to continue manufacturing and distributing their machine.

AIT practitioners who use the Audio Tone Enhancer/Trainer should be aware that their professional liability insurance company may no longer provide coverage since the device is a ‘medical device’ and has not yet received FDA approval.

SAIT will keep its members informed of any new information with regard to this issue.

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A Letter from Sally Brockett, M.S.
Dear SAIT Members,

January, 1995 marks the third anniversary of our society. It is an important milestone for several reasons. One, it proves that our mission statement, “The Society for Auditory Integration Training (SAIT) is dedicated to the enhancement of the quality of life for individuals with special needs through auditory integration training,” is well founded and serves to motivate and guide us toward our goals. Two, it signifies that we have successfully faced and conquered many obstacles inherent in the founding of any organization that might have crumbled a weaker, less determined group. And three, it points out how young our society really is when compared to other organizations that may be celebrating their 20th or 25th anniversary! So, while we can be justified in giving ourselves a congratulatory pat on the back, we must also recognize and accept the fact that a lot of hard work lies ahead if we are to be able to celebrate a 5th and 10th anniversary in the years ahead.

Members should ask themselves, “What should be the focus of our work now, and what can I do as an individual, either parent or professional, to help with this work?” FDA approved research to validate the efficacy of AIT is crucial to the survival of this intervention. We must find ways to get this type of research done as soon as possible. Professional members can take an active role in the effort by obtaining procedural information and working with others to start research projects. Parents can assist by sharing information they may have on sources of funding or contacts that might facilitate the studies. Networking with each other to share whatever we learn as we proceed along the path will assist others and eliminate the need for each of us to “recreate the wheel.”

I want to encourage all members to consider what they have to offer on behalf of this effort. Remember that the load is lighter and moves more rapidly with the help of many. Completing FDA approved research will help assure that SAIT and AIT will be able to celebrate future anniversaries.

Best regards,

Sally Brockett, M.S. Editor, The Sound Connection

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Is there any advice about the maintenance of the AIT device?
Since the AIT devices are quite expensive, great care should be taken to insure that the device works properly and has a relatively long life-span. There are several issues which are discussed below to help practitioners maintain their AIT device.

Static electricity. We have heard reports about both the Audiokinetron and the Audio Tone Enhancer/Trainer (BGC) malfunctioning because of static electricity. It is recommended that the practitioner stand on a plastic mat when operating the machine. In addition, some practitioners touch a grounded piece of metal prior to touching the AIT device in order to neutralize any electricity in their body, such as touching the screw securing a light switch plate, or a metal water or steam pipe.

Surge protector. A high-quality surge protector (available at computer stores) will protect the AIT device from power surges which may destroy the machine. In addition, many practitioners turn the power on and off using a power strip switch rather than the power switch on the device. Since power switches on the AIT devices may break, this ounce of caution may avoid a future headache.

Overheating. Occasionally we hear about an Audiokinetron overheating. One reason for its susceptibility to overheating is its conversion from European (230 V) to U.S. standard voltage (115 V). To counter this problem, some practitioners have had a technician install a small cooling fan in their Audiokinetron.

Periodic checks of loudness level. As stressed in previous issues of The Sound Connection, it is important that the practitioner calibrate the loudness level of their AIT device on a regular basis, preferably once a week, using a sound level meter (see The SAIT Newsletter, Volume 1, No. 2).

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SAIT Establishes Professional Advisory Committee
The Board of Directors has established an Advisory Committee to provide the Board with advice and feedback about SAIT’s policies and guidelines. Members on the Advisory Committee are elected for 2-year terms, and they are encouraged and expected to have an active role in SAIT.

The initial members elected to the Advisory Board are (in alphabetical order): Dr. Guy Berard (developer of AIT and the Audiokinetron), Lois Blackwell (founding SAIT member), Bill Clark (developer of the Audio Tone Enhancer/Trainer, BGC), Carol Cloud and Lynda Huggens (founding SAIT Board members, both were parent representatives), and Dr. Bernard Rimland (founding SAIT member and early AIT proponent).

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SAIT Board Elects New Officers
SAIT’s Board of Directors has selected its new officers for the 1995 term. Dr. Stephen Edelson was re-elected as President, Dr. Jon Kaunitz was elected Vice- President, Sally Brockett was elected Secretary, and Candace Timpson was re- elected Treasurer.

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New Guidelines Issued on Treatment of Middle Ear Fluid
According to recently issued guidelines from the Agency for Health Care Policy and Research (AHCPR), drugs and surgery are greatly overused in the treatment of middle ear fluid (otitis media with effusion, OME) in children under the age of five. The new guidelines tell parents and doctors that time, rather than antibiotics and surgery, may heal this all too common childhood problem.

According to these guidelines, based on extensive review of the scientific evidence, the preferred approach is to observe the condition for the first three months in children one to three years old, unless the child has other conditions, such as nervous system abnormalities, or acute otitis media (ear infection) which is usually accompanied by sharp pain and fever. These conditions require prompt attention.

Parents and doctors are advised to watch for signs of hearing loss, or drainage of fluid, and should try to eliminate factors which have been linked to OME. Washington D.C.-based pediatrician Russell Bunai observed that in regions where dairy products are not consumed, certain diseases and conditions such as allergies, ear infections, and sinusitis were not prevalent. Dr. Mark Eisen, of Chapel Hill, N.C., uses elimination of all dairy products and processed sugar as a first line of defense against ear infections, and nasal and ear congestion. Eisen states, “There’s not a parent I’ve dealt with who hasn’t seen a profound difference in their child’s congestion and fluid when they follow this.”

With the increased concern about antibiotic resistant bacteria, prevention of otitis media becomes an even more important issue. According to Dr. Michael Schmidt, author of Childhood Ear Infections, and Beyond Antibiotics, the four main causes of ear infections are allergy (including allergy to dairy), infection, mechanical obstruction and nutritional deficiencies. In a study of 100 allergic children by W. Leonard Draper, M.D., approximately 50% had fluid in their ears. Parents and doctors need to explore ways to prevent recurrent fluid and infections by identifying the causes, rather than just treating the symptoms.

For more in-depth information on this topic parents and professionals can order “Otitis Media with Effusion in Young Children: Clinical Practice Guidelines” by calling AHCPR at (800) 358-9295. Recommended Reading: Childhood Ear Infections and Beyond Antibiotics by Dr. Michael Schmidt, published by North Atlantic Books, 2800 Woolsey Street, Berkeley, CA 94705.

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Changes in Unilateral and Bilateral Sound Sensitivity as a Result of AIT
A recent study completed by Deborah Woodward of Woodward Audiology in McLeansville, North Carolina, in collaboration with the Center for the Study of Autism in Beaverton, Oregon, provides further evidence of a reduction in sound sensitivity as a result of AIT. Loudness tolerance in each ear independently and both ears simultaneously was examined in 60 children with autism and related disorders. Uncomfortable loudness level (UCL) measurements were performed; these measurements are used in hearing aid evaluations.

Procedure. Speech noise was presented to each ear, and the loudness level was slowly increased until the child indicated, either verbally or nonverbally, that the sound was uncomfortable. A level of 90 dBHTL would be considered a lower limit of UCL. The sounds were then presented in both ears simultaneously (binaurally). Since the brainstem amplifies binaurally presented sounds by 3 to 6 decibels over monaurally presented sounds, it was expected that the UCL would be lower for binaurally presented sounds. This test was presented prior to and soon after receiving AIT.

Results. Prior to AIT, the results from the left and right monaural (independent) presentations as well as the binaural presentation were much lower than 90 dBHTL. Interestingly, the binaural tolerance to the speech noise was 9 to 11 dBHTL less than the monaural tolerance level. This may indicate abnormal amplification in the brainstem or possibly lack of bilateral inhibition (see Collett et al. 1993, described in The Sound Connection, Vol. 2, No. 1). Following AIT, the monaural tolerance level increased 13 to 15 dBHTL, but overall, the monaural and binaural tolerance levels were lower than normal. This increased tolerance to speech noise was statistically significant (p<.01). In addition, the binaural tolerance level was only 5 dBHTL lower than the monaural sound presentations, indicating a more normal response.

Implications. The results support the idea that AIT can reduce sound sensitivity in some individuals. Furthermore, sound sensitivity may be due to a problem in the brainstem or higher cortical areas rather than due to a problem in the cochlea.

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“Input” from Dr. Guy Berard
When I was practicing medicine in Cambodia, my patients didn’t care of the method that I could apply to treat them: they only asked to be cured, as quickly as possible, for the lowest expense. So, the only aim of my work was “efficiency.”

When I came back to France, keeping the same concept, I won the reputation among my colleagues of being able to find a solution in abnormal cases. Particularly, Dr. Jarricot of Lyon, a well known professor, used to ask for my opinion every time when he had to care for ENT’s difficult cases.

Twelve years ago, he phoned me to ask if I could treat a friend of his, professor of cardiology, 70 years old, suffering of such painful hearing that he had to retire. This man couldn’t stand the telephone ringing, nor his house- bell, the television, people talking too strong, etc. He was living the life of a recluse in his house. All the ENT’s whose advice he had taken had told him that it was probably a very severe “recruitment” and that nothing could be done.

I responded to Dr. Jarricot that I could give advice only after making an audiogram. Dr. Jarricot told me that his friend would not accept the torture of hearing some sounds through an earphone. I asked him to convince his friend that my way of making the test would be so soft that, in any case, it couldn’t be painful.

An appointment was made, and it would take pages to describe how anxious the man was, waiting for the sounds that I would send, increasing slowly by 5 decibels from zero. He was always raising his hand, and when I asked:

“So you really hear that sound?,” the answer was, with a frown, “No, but I will!”

The graphic showed a severe deafness on the high frequencies. I explained to him that he had to be treated with my method to stop the worsening of his hearing, and as he first didn’t accept the principle of listening to some strong music through the device, I promised to treat him myself, without the help of my nurse.

To my question concerning his way of life, he answered that his only activities were reading books and collecting post-marks (stamps). He came for the treatment, still more than anxious. I explained to him that I would send the music from “no sound,” progressively increasing the intensity until the moment when he informed me that he was hearing something.

I started applying AIT, and, at the moment when he was hearing, I began talking with him about his post-marks. While he was talking, very interested by the subject, I was increasing the intensity. He was then talking louder and louder. After a few moments, I asked him: Q: Do you know how to read numbers?
A: Of course, yes, he answered, laughing!
Q: What is this?
A: Seventy.
Q: Seventy what?
A: I don’t know.
Me: Seventy decibels!
Him: But it’s not at all painful!!!

I treated, cured him definitively, and thanked him because he had given to me one of the keys concerning my theory on autism. At the beginning of his problems, he had an infection of the ears. During this sickness, his hearing became so harmful that, in order to avoid this pain, he had blocked the mobility of the 3 ossicles of the middle ear, the same way one will no more use the painful joint of an elbow, using the other side. So, psychologically afraid of the possibility of having to be confronted by harmful noises, he had carried on blocking his ossicles, convinced that all sounds would be painful.

Right away, I was led to the comparison with autistic children, who, certainly in addition to other etiologies, (because all the children having suffered from otitis didn’t become autistic), at a moment of their life had: suffered from painful hearing, blocked their hearing, felt comfortable in living their own life, without constraints of obeying orders of parents or teachers, and then remaining with the same behavior.

Of course, as I am always indicating, this symptom of painful hearing in the autistic syndrome is just a part of it, less or more important for each case, this explaining the difference of the positive results for each individual.

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Music Soothes Surgeons
Music has been used in surgery for many years, but a recent study found that surgeons may be less stressed and perform better when listening to music they select. Researchers at the State University of New York at Buffalo used a series of stress tests, measuring blood pressure and pulse rates, to determine what impact selecting one’s preferred music would have on the performance of surgeons.

When listening to their choice of music, the surgeons had lower blood pressure and pulse rates. They were able to concentrate on the task and perform better. They were also less influenced by external factors. The doctors selected music from 50 different instrumental pieces. Classical music was favored by 46 surgeons, two doctors chose jazz, and two chose Celtic harp music. Favorable responses and improved performance were not associated with any particular music category.

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CEREBELLAR-VESTIBULAR SYSTEM THEORY: Sally Brockett, M.S.
The cerebellar-vestibular system (CVS) is the sensory-motor processing center of the brain. It consists of the vestibular system or inner ear system, and the cerebellum or “old brain”, which is connected to the inner ear by the vestibular nerve. The CVS is responsible for sensory processing (including hearing and vision), coordinating voluntary and involuntary motor movements, (including eye movements), and controlling the sense of balance, direction, time and rhythm. It also regulates anxiety. (Dr. H. Levinson), (S. Goddard).

A dysfunction of the CVS can produce an assortment of symptoms and behaviors. Some of these include: problems with hearing and vision, balance, coordination, abnormal responses to motion, problems with sense of time and direction, poor concentration and memory, hyperactivity, obsessive-compulsive behaviors, difficulty with academic performance and increased anxiety. These are problems which characterize disorders such as autism, pervasive developmental disorder, learning disabilities, and dyslexia.

Auditory integration training may be one method of providing stimulation to the CVS to help reorganize a dysfunctional system. However, with AIT the stimulation is through specially designed, vibrating sound waves, rather than motion, or deep pressure massage, etc. AIT practitioners and parents are reporting changes in symptoms and behaviors that appear to indicate that the cerebellar-vestibular system is affected by the AIT procedure. (T. Veale),(S. Brockett).

The CVS theory provides a reason as to why so many changes occur with AIT that on the surface do not appear to be related to the auditory system, or specifically, the flattening of the audiogram pattern. It explains why individuals report that they can taste and smell things better, and are no longer tactilely defensive. It also supports parents’ and teachers’ claims that the child has better balance, motor coordination and handwriting. The accounts of improved eye contact, eye-hand coordination, and eye alignment are also explained by this theory. The observations that some people could suddenly tell time, while others could understand left/right directionality are also justified by this concept.

It seems that a combination of theories, such as peak reduction and acoustic reflex, may best explain all of the results of AIT, and this combination would have to include the cerebellar-vestibular system theory.


REFERENCES

Ayres, A. Jean, Ph.D., Sensory Integration and the Child, Western Psychological Services, 1989.

Brockett, Sally, M.S. “AIT Results with the ADD Population”, First Annual Society for Auditory Integration Training Conference, Toronto, Canada, 1993.

Goddard, Sally, “A Developmental Basis for Learning Difficulties and Language Disorders”, Institute for Neuro-Physiological Psychology Monograph Series. No. 1, 1990.

King, Lorna Jean, OTR. “Sensory integration: an effective approach to therapy and education. Autism Research Review International, Guest Editorial, Vol. (?), 1993.

Levinson, Harold, M.D., Phobia Free, M. Evans & Co., Inc., NY, 1986.

Levinson, Harold, M.D., Smart, But Feeling Dumb. Warner Books, NY, NY, 1984.

Veale, Tina, M.A., “Auditory Integration Training: Where Are We Now?”, 1993 World of Options International Autism Conference, Toronto, Canada. 1993.