Volume 3 Number 2, 1995

Florida State Agency Returns AIT Devices
As reported in the last issue of The Sound Connection (Vol. 3, No. 1), the Florida Department of Health and Rehabilitative Services (HRS) stopped the practice of auditory integration training (AIT) in three clinics and seized the AIT equipment. The action was taken in response to the Food and Drug Administration’s (FDA) classification of AIT machines as `medical devices.’ Recently, the HRS has returned the AIT devices along with a letter of apology, probably in response to the threat of a major lawsuit by a practitioner.

Because of the action taken by the HRS, most of the practitioners in Florida have decided to discontinue offering AIT until this matter is resolved. When and if the FDA lowers the classification of the BGC Audio Effects Generator (formerly known as the Audio Tone Enhancer/Trainer) to a Class II, the practitioners will offer AIT again.

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FDA Decision Still Pending
We apologize for the delay in sending you the fall, 1995 edition of The Sound Connection. We have been impatiently awaiting the decision from the Food and Drug Administration (FDA) about the status of the Audio Effects Generator. The FDA has reportedly made a decision about the BGC Enterprises’s recent petition to lower the classification of the Audio Effects Generator from Class III to Class II, but they have not yet released this information at the time of printing.

As soon as the FDA has released their decision, SAIT will notify its members.

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SAIT Starts Web Page on Internet
A major purpose of the Society for Auditory Integration Training (SAIT) is to share information about AIT with families and professionals throughout the world. People who have access to the Internet’s World Wide Web can now learn about auditory integration training (AIT) by locating SAIT’s web page at the URL address: http://www.teleport.com/~sait/

Many computer servers offer access to the Internet, including America Online, CompuServe, Delphi, and Prodigy, as well as local Internet servers. There are many discussion groups on autism and related disorders (called newsgroups) offered by these computer servers. Parents as well as professionals often ask questions about AIT which can be answered by someone in the newsgroup. Unfortunately, sometimes misinformation about AIT is posted. We hope that SAIT’s Web page will clarify many issues regarding AIT, and that those with questions will use it as a resource.

One section of the Web page contains information about SAIT. This includes: a brief history; the purpose of SAIT; a listing of SAIT’s Board of Directors, Officers, and Professional Advisory Board; and an application to join SAIT.

Another section of the Web page contains information about AIT. This includes: a general description of the AIT procedure, frequently asked questions (e.g., wearing headphones after AIT, wearing P.E. tubes during AIT), questions to ask when selecting a practitioner, several theories on AIT, and an update on the Food and Drug Administration’s classification of AIT devices. This section also includes articles from The Sound Connection, such as Dr. Guy Berard’s article `Concerning length, frequency, number, and follow-up AIT sessions;’ Dr. Stephen Edelson’s article, `Sound sensitivity: What does it really mean?;’ and Deborah Woodward’s article, `Various interventions to reduce hyeracute hearing.’

Drs. Edelson and Rimland are compiling summaries of research studies which have been published or presented at professional conferences. This paper will be posted on the Web page and will also be included as a SAIT supplement article in the next newsletter.

Please send us suggestions on other information we can include on the Web page. You can mail your suggestions to us or email them to: sait@teleport.com

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Letter from Dr. Temple Grandin
I have been watching the progress of auditory integration training (AIT) with great interest. Studies by Drs. Bernard Rimland and Steve Edelson and reports from parents have indicated clearly to me that AIT is beneficial for many individuals who try it. It can reduce sound sensitivity and in some cases, improve behavior. It is my opinion that AIT is sensory integration for the ears.

Random changes of the sound force the brain to pay attention. It is unknown how it works but both scientific and anecdotal evidence indicates to me that it is a worthwhile procedure for a significant percentage of individuals with autism.

It is important that unless research proves otherwise, practitioners of AIT should follow the standard procedures suggested by its developers. For example, the most beneficial effects can be observed by doing two 30-minute sessions for 10 days. Thoughts to short-cut the procedure by combining sessions into a shorter number of days is not recommended.

A recent article in the New York Times, researched by Dr. Paula Tallal of Rutgers University in Newark, New Jersey, and Dr. Michael Merzenich of the University of California School of Medicine in San Francisco, describes a new form of auditory training for dyslexia that trains the ear to hear hard consonant sounds, such as `d’ and `b.’ This research provides another study indicating that the auditory system can be trained.

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ASA Offers AIT Information Via `Fax-On-Demand’ Service
The Autism Society of America (ASA) provides a 10-page packet of information about auditory integration training (AIT) via fax. This service was made possible, in part, by a grant from the American-Speech-Language-Hearing Association.

Unfortunately, the ASA information is inaccurate and misleading. It states that the Tomatis approach has been “proven effective,” but it has never been empirically tested. The Berard approach is thus far the only AIT method which has been shown empirically to help the symptoms of autism. ASA’s paper, possibly written by a Tomatis practitioner, lists the names and addresses of Tomatis practitioners, but not Berard practitioners.

SAIT has provided ASA with a more accurate document to be used in responding to requests for AIT information. The revised information sheet, which we expect ASA to accept, states that an extensive list of AIT practitioners can be requested from the Autism Research Institute, 4182 Adams Avenue, San Diego, CA 92116, U.S.A.

To access the information about AIT, call 1-800-FAX-0899 or (301) 657-1686; and follow the recorded instructions. The AIT document code is 320. Within 30 minutes, a copy of the AIT packet will be sent to your fax machine. People without a fax machine can obtain a similar information packet by writing to ASA at 7910 Woodmont Avenue, Suite 650, Bethesda, MD 20814, U.S.A.

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Radio Shack Offers a Digital-Display Sound-Level Meter
As mentioned in several previous issues of The Sound Connection, AIT practitioners should measure the sound output levels of their AIT device in order to ensure safe listening levels (see Vol. 1, no. 3, and Vol. 2, no. 1).

Radio Shack is now selling a digital-display sound-level meter ($59.99, catalog no. 33-2055) along with their analog-display sound-level meter ($31.99, catalog no. 33-2050). Radio Shack outlets typically do not carry sound-level meters in stock; however, they can easily be ordered.

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PRACTITIONER’S FORUM
Questions continue to arise about the number of listening sessions in a day and the number of days of listening sessions. The following standard procedures are recommended.

Total number of hours of AIT: The minimum number of hours for AIT to be provided is 9 and the maximum number of hours a person should receive during one series is 10.

Number of sessions in a day: One to two half-hour sessions are recommended per day. If two sessions are given in a day, there should be a minimum of 3 hours between the end of the first session and the beginning of the second session. In addition, under unusual circumstances, it is permissible to have three listening sessions in one day, with at least 3 hours between each session. The listener should not receive three sessions a day more than twice during the entire 10-hour training period. Furthermore, it is best to wait until the person has received at least 5 hours of AIT before providing three sessions in a day. Due to the increased fatigue that may occur with 3 sessions in a day, it may be helpful not to schedule these on consecutive days.

Number of days of AIT: In most cases, AIT is scheduled for a total of 10 days, usually consecutive, although it is acceptable to have a break of 1-2 days midway through the sessions. If a break is scheduled during the listening sessions, it is best that the break occurs after 5 hours of listening.

Repeating Sessions of AIT: AIT may be repeated after 9 to 12 months have elapsed, although it may be repeated after 6 months if AIT did not seem to help the listener after the first set of sessions. When AIT is repeated, it should be administered in its entirety. The effectiveness of shortened time intervals, or “booster sessions” has not been clinically researched.

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Rhythmic Entrainment Intervention: A Drum Rhythm Intervention
The use of Rhythmic Entrainment Intervention (REI) audiotapes is starting to receive attention for use with those with autism and attention-deficits. Jeff Strong developed REI which involves listening to specially-designed drumbeats on a tape recorder for about 40 minutes a day, for at least 6 to 8 weeks. The drumbeats are simply played at a low volume in the background. There is no need to concentrate on the drum rhythm nor actively attend during the listening sessions. The listener can do almost anything during the listening sessions (e.g., play, eat), but there should not be any competing sounds in the background, such as television or people talking.

REI is based on a phenomenon called ‘entrainment’ in which an object’s movements or vibrations become synchronized with the movements of other objects. ‘Sonic’ entrainment refers to sound vibrations influencing the rhythms of objects.

REI is based on the observation that numerous natural rhythms occur throughout the body (e.g., heart beat, brainwaves, respiration). When a person suffers from an illness, a physical disability, or psychological disorder, then his/her internal rhythms may be ‘out of synch.’ By using a form of sonic entrainment, such as REI’s drum rhythms, a person’s natural rhythms are encouraged to reappear.

The idea that rhythms may affect one’s health is not a novel one. Primitive civilizations in Africa and other places throughout the world have used rhythms, such as drumbeats, as a healing power. Researchers at the Monroe Institute in Virginia have documented positive effects on sleeping, learning/memory, physical health, and mental health in people who listened to various sound frequencies.

The REI Institute recently completed an open-trial clinical study on the effects of their REI audiotapes on 16 autistic children in four different classrooms. Teachers were instructed to rate various behaviors during an 8-week period. After 8 weeks, 15 of the 16 students were reported to be calmer. One student became agitated and dropped out of the study after 6 weeks. An analysis of other behavior changes after 8 weeks indicated that 11 of the 16 children were observed to have mild to dramatic changes. Some of the changes included: decrease in agitation and aggression, improvements in eye contact, and improved listening.

If you would like to obtain additional information about REI, you can write to: The REI Institute, Inc., 2285 Stewart Avenue #1420, St. Paul, MN 55116, U.S.A. Their telephone number is 1-800-659-6644, and their email is REIInst@aol.com.

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New Edition of Autism Treatment Guide Available in Jan. ’96
A revised edition of the popular reference book, Autism Treatment Guide, written by Elizabeth Gerlach, will be available next month from Four Leaf Press. The book contains descriptions, references, and contact numbers for a variety of interventions for children and adults with autism. Some of the topics include: vitamin therapy, dietary interventions, and sensory integration therapy. Important information regarding diagnosis, education, and assessment are also addressed in the book.

This revised edition contains updated resources for all interventions including auditory integration training. A section on autism and autism- related Internet Web sites was also added to the book, including SAIT’s new Web page.

The book can be ordered from Four Leaf Press, 2020 Garfield Street, Eugene, OR 97405, U.S.A. The cost of the book is $9.99 plus $2.00 for shipping and handling ($3.50 for orders outside the U.S.).

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“Input” From Dr. Guy Berard
After leaving France for Cambodia in 1947, in order to open an office in Phnom- Penh, my first act was to find premises, have them set up to become a place where I could examine and treat my patients, make X-rays, and operate on minor surgery cases.

During the three months time that this required, I had to find an interpreter able to speak all of the languages used in this country: Cambodian, Vietnamese, several Chinese dialects, Japanese, Phillipino, Thai, and of course, French and English.

Mr. Men, this was his name, was warmly recommended to me. He was a wonderful, wise, 30-year old man; and I asked him to use the three months to teach me how to speak Cambodian, Vietnamese and the three principle Chinese dialects in the usual narrow vocabulary necessary to interview patients.

Then, my office finally opened; and I had my first patient, a Chinese man, suffering from stomach ulcers. As I had lots of time, and was proud to parade my vocabulary and my medical knowledge, and with the help of my translator, the Chinese man had to endure me for 1 hour and a half:

      – my interview,

 

      – the examination of his body,

 

      – X-ray of his stomach, before, during and after drinking a nauseous mixture

 

      – the precise technical diagnosis of his sickness, with graphics,

 

      – and a prescription for drugs which should be bought at the chemist.

 

The Chinese man left, and Mr. Men asked me, “What are you supposed to do in Cambodia, make money, or not?”

My answer…? “Why this question? How much did you charge this patient?”

Mr. Men replied, “Nothing of course!! What have you done? Talk and talk during 1 1/2 hours, in a language that he cannot understand, and was not at all interested in, as he is only a rice seller. You have given a photo without any life likeness to him, and finally signed a paper which costs only one piaster for a thousand. With this paper, he has to go to the chemist who will really do something for him by selling some medications. This is not serious.”

I asked, “Well, … what should I have done?”

Mr. Men responded, “First, tell him if you can cure him, or not. Second, how long that will take. Third, how much it will cost. And fourth, give him one or two or three injections “that he will pay for.” But don’t ask him to pay for a piece of paper!”

This story is absolutely true. Mr. Men had given me an excellent lesson, and as soon as I opened my clinic, I followed the systematic rule of informing the patient:

      – Yes, I can treat, (or not)

 

      – Number of days at the clinic

 

      – Total price

 

The diagnosis was of less importance.

Do you think that things were very, very different when I returned to practice in France? Not in my opinion, and I think that all over the world, individuals have a similar approach to the problem, even though with slight variations. This is why, EFFICIENCY has become my absolute priority, in the development of my successive devices, in their use, in the reduction of the number of sessions, in the way I worked in my office, and the teaching of my method.

My feeling is that efficiency and simplification are good rules, ….and not only in AIT!

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Theories of Auditory Integration Training
In this section of The Sound Connection, we describe various theories on why auditory integration training (AIT) works for some individuals. The theories can be classified in different ways, such as those explaining a reduction in auditory peaks, a reduction in sound sensitivity, and an increase in attention as well as postulating change in the middle ear, inner ear, and mid-brain. This issue contains a description of theories postulating biochemical changes as a result of AIT.

Jaak Panksepp. `Opioid hypothesis of AIT.’ There is growing evidence that some individuals with autism have elevated levels of brain opioid activity, and some assays have suggested the presence of an uncharacterized variant of beta- endorphin. This is supported by analysis of opioid-like activity in their cerebral spinal fluid and the positive responsiveness to drugs that block the action of opioids in the brain. Brain opioids, such as beta-endorphins, are endogenous opiate-like substances in the brain; and elevated levels of these substances are associated with either pleasurable or anesthetic effects.

The beta-endorphin hypothesis of AIT suggests that the modulated music stimulates, and possibly normalizes, certain areas of the brain which release endogenous opioids. It is established that listening to music activates endogenous opioids. One possible area in the brain involved in the release of beta-endorphins is the inferior colliculus of the midbrain which receives sound input and is rich in opioid receptors.

At the present time, there is no empirical support for this hypothesis. However, it is interesting to note that naltrexone, which blocks the action of beta-endorphins, is not recommended for schizophrenic individuals because it may intensify abnormal social behaviors even though it can reduce auditory hallucinations in some. Similarly, Dr. Guy Berard has always stated that AIT should not be given to schizophrenic individuals because AIT may make their condition worse.

Since brain-opioid activity is hard to measure, this hypothesis is presently hard to test. However, Dr. Panksepp is currently exposing newborn chickens to AIT music and is examining possible biochemical changes in their brain. Preliminary results suggest that 10 days of exposure to both normal and modulated music can have significant effects on certain brain neurochemical systems, especially brain serotonin activity. These results were presented at the 25th Annual Society for Neuroscience Convention in San Diego on November 13, 1995 (see the current issue of the Autism Research Review International, 1995, Vol. 9 (4) for a summary description).

Lisa Boswell. `Melanin hypothesis of AIT.’ Recent studies indicate that autistic individuals do not have normal circadian rhythms of the pineal hormone melatonin. Melatonin helps regulate a host of neuroendocrine functions including sleep patterns and autoimmunity-both of which are abnormal in autism. Researchers have been able to worsen autoimmune symptoms in lab animals by altering melatonin rhythms. This hypothesis suggests that auditory integration training (AIT) improves autism by helping to normalize pineal function and melatonin rhythms which would improve autoimmune symptoms. This would explain why Dr. Guy Berard noted an improvement in allergic disorders such as eczema, hay fever, and asthma after AIT, and would support work by Drs. Reed Warren, V.K. Singh, and others who believe that autism may be related to autoimmune system dysfunction.

Boswell further speculates that AIT reduces sound sensitivity and improves pineal function by increasing melanin in the stria vascularis in the middle ear. The stria is the “battery” of the cochlea. Additional melanin in the stria would result in changes in the endolymph and hair cell function. Melanin has many functions, from aiding neural development to increasing neural transmission. Melanin in the inner ear can absorb acoustic energy much as melanin in the skin absorbs photic energy. Research has demonstrated increased strial melanin in response to impulse noise. Increased melanin through AIT might help normalize audiograms and mitigate the effects of hyperacusis on the pineal gland, which responds to environmental stimuli. AIT could then improve pineal function, normalize circadian rhythms, and decrease autoimmune symptoms.

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“Quiet-Eared” Women
Although we are unaware of it, our ears produce continuous, inaudible tones throughout the day, much like the feedback from a microphone. These tones, called spontaneous otoacoustic emissions, are emitted by hair cells located in the inner ear. Interestingly, people with sensitive hearing seem to generate a greater number of different tones at once; and left ears tend to emit fewer tones than right ears. In addition, men produce fewer tones than women. However, if a female shares the same uterine environment as a male, such as the case of twins, the tones in her ears are similar to the tones in a man’s ears.

Dennis McFadden of the University of Texas at Austin, who has conducted research on twins and non-twins to study differences in otoacoustic emissions, speculates that women with twin brothers are exposed to male hormones in the womb, which causes the nerves leading from the hindbrain to the cochlea to develop in a similar manner to men’s nerves. As a result, these nerves become more active inhibitors of otoacoustic emissions.