Volume 4 Number 4, 1997

FDA Update
An official at the Food and Drug Administration (FDA) recently stated that a non-profit organization, such as the Society for Auditory Integration Training, may submit an application to change the classification of auditory integration training (AIT) devices. The FDA had classified AIT devices as Class III `medical devices’ in 1994. A change to a Class II device would lift many of the restrictions on AIT devices. These restrictions involve: importation and distribution of AIT devices in the U.S., inter-state transportation of AIT devices, and prior approval by the FDA to conduct research on the efficacy of AIT devices. Additionally, federal, state, or local government agencies have the jurisdiction to stop the use of AIT devices because of the FDA’s ruling. SAIT is currently requesting specific information from manufacturers of AIT devices in order to submit such an application to the FDA. We will keep SAIT members informed of this process.

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European Chapter of SAIT Established
The Society of Auditory Integration Training (SAIT) has expanded to Europe. SAIT’s Board of Directors approved to have Richard Cubie of Staffordshire, England establish a European SAIT chapter. Mr. Cubie’s office will distribute information about SAIT as well as information about auditory integration training to interested families and professionals. If you would like to contact our European SAIT office, the address is: SAIT c/o Mr. Richard Cubie, Head Teacher; Child Development Centre; Bladon House School; Burton-On-Trent; Staffordshire DE 150TA; England.

Those who are interested in joining SAIT should obtain membership through the U.S. office in Salem, Oregon.

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A Comparison of Auditory Integration Training and `Fast ForWord’
The CD-ROM based language training program distributed by the Scientific Learning Corporation and called `Fast ForWord’ continues to generate interest among professionals and parents of language impaired children. SAIT has been following the `Fast ForWord’ program closely over the past year because of its similarities to auditory integration training (AIT). Additionally, one of SAIT’s Board members, Sabra Gelfond, was involved in a large scale study assessing the efficacy of the `Fast ForWord’ program. Ms. Gelfond was interviewed recently on National Public Radio and in an article in the Washington Post. The large scale study included 500 children with language processing problems. The results indicated that 90% of the participants showed clear benefits over a 6- to 8-week period, with many achieving 1 to 1 1/2 years of improvement in language skills.

There are many similarities as well as differences between the auditory integration training and the `Fast ForWord’ program. Both programs utilize processed sounds as a basis for auditory reorganization.

AIT uses processed music which includes vocals and instrumental pieces, whereas `Fast ForWord’ uses only processed speech, initially just phonemes, then syllables, words and finally full sentences.

Both programs require hours of intensive listening through headphones on a daily basis; however, `Fast ForWord’ requires 1 hour and 40 minutes each day, 5 days a week for 6 to 8 weeks. AIT requires 10 hours, two 30-minute sessions a day for 10 days. Both programs allow for a break over a 2-day weekend.

The minimum age for AIT is 3 years and there is no upper limit. There are no prerequisite skills required other than tolerance for the headphones. The `Fast ForWord’ program is designed for children between 4 and 12 years of age. Prerequisite skills include: attending to task for 20 minutes, tolerance for headphones, use of a mouse or touch window, and comprehension of matching and same/different. In other words, AIT involves a `passive’ form of listening, whereas the `Fast ForWord’ method involves an `active’ form of listening.

It is not clear whether the `Fast ForWord’ program will be beneficial to individuals with moderate to severe forms of autism. Last year’s large scale study included about 30 children with autism, and some of these children had difficulty working with the computer programs. In addition, a recent promotional video distributed by the Scientific Learning Corporation stated that children who improved from the program included: “mild autistics,” “central auditory processing deficits,” “specific language impaired,” and “dyslexia.” Others who may benefit include children with attention deficits and pervasive developmental disorder.

Currently, `Fast ForWord’ is available only on the MacIntosh computer system. A PC version is scheduled to be released in mid- to late-July. The cost of the `Fast ForWord’ program varies, but most practitioners charge between $2,000 to $2,500 for the 6- to 8-week program. If you would like to learn more about the ‘Fast ForWord’ program, you can visit the Scientific Learning Corporation’s web site at http://www.fastforword.com/ Their telephone number is: (415) 296-1470, and their fax number is: (415) 296-1481.

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Auditory Trainers and Auditory Integration Training: What is the Difference?
Most of our readers are quite familiar with the procedure currently referred to as “auditory integration training.” This procedure may be used to address distortions or problems in auditory processing, and/or hypersensitive hearing. The goal is to correct or improve the condition that is contributing to or causing the problem.

Auditory trainers are devices that amplify sounds and may be used by people who have hearing loss and/or auditory processing disorders in order to help them function. The device is not intended to correct the cause of the dysfunction, but may help the person process auditory information more efficiently. The types of auditory trainers used in school can be classified into two categories. The first is similar to a walkman headset, with a microphone which amplifies all sounds. The second is more sophisticated and consists of an FM transmitter (a microphone) and a receiver (a headphone, or a device attached to the child’s hearing aids). The teacher or therapist wears the transmitter, which sends the auditory signal (that person’s voice) to the receiver. The child wears the receiver, which brings the target signal (teacher’s voice) directly to that child’s ear. This system may help individuals with auditory filter/ground problems. A filter/ground problem means that the child has difficulty filtering out background noise in order to concentrate on a target stimulus.

Although the auditory trainer may be helpful in many circumstances, there are some drawbacks. The child may feel conspicuous if he/she is the only child wearing such a device. Therefore, issues of self-esteem must be addressed. Digital cellular phones or FM systems sharing the same frequency channel may create interference rendering the auditory training system useless.

In some cases, children who have been using auditory trainers to assist their ability to process auditory information have been able to discontinue their use after participating in AIT. If the AIT procedure is successful in addressing the cause of the dysfunction, the auditory trainer may no longer be needed.

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Practitioner’s Forum
I am hearing conflicting reports on whether or not to use narrow-band filters during the AIT listening sessions. Please clarify.

The AIT devices utilize two types of filtering systems. The first uses wide- band filters, also termed ‘modulation,’ which treats all music emanating from the AIT device. The second uses narrow-band filters, which are activated on an optional basis by the AIT practitioner to fit the individual client. The narrow-band filters are set to correspond to frequencies which the person hears too well (i.e., auditory peaks). In some cases, it is difficult to obtain a valid audiogram from a person; and for these individuals, one does not use narrow-band filters. As Dr. Guy Berard has stated, “It is better to use no filters than the wrong filters.”

Several research studies conducted by Drs. Bernard Rimland and Stephen M. Edelson have indicated that narrow-band filters may not be necessary for AIT to be effective. However, these studies included only subjects diagnosed with autism. Even though sound sensitivity and behavior were evaluated, other parameters, such as speech/language and central auditory processing, were not. Investigating other possible changes may have indicated the advisability of using narrow-band filters.

Case Study. We would like to illustrate the importance of using narrow-band filters for one individual who received AIT at the Center for the Study of Autism. This person is a high-functioning autistic adult who is married and has two children. The configuration of his audiogram indicated that he needed two narrow-band filters–3000 Hz and 8000 Hz. This person felt calm and relaxed during the first six AIT listening sessions. He also was sleeping better at night. During the first ten minutes of his seventh listening session, one of his children went into the equipment room and deactivated the narrow-band filters on the AIT device. For these 10 minutes, the man felt nauseous. He then reported his feelings to the practitioner who consequently checked the AIT device and reactivated the two filters. Within a few minutes, the man reported feeling much better. Since this person was able to describe his feelings, the Center performed additional testing the next day to determine which filter was having a greater impact on him. Basically, the 3000 Hz filter had the biggest effect, whereas the 8000 Hz filter had a mild-to-moderate effect.

Although this illustration is based just on one case, it does suggest that, for some people, narrow-band filters may be important.

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Otoacoustic Emissions Testing: Nicholas J. Berg, M.D.
SAIT has received numerous inquiries from parents and professionals about using otoacoustic emissions testing to determine candidacy and filter settings on auditory integration training (AIT) devices. We have asked Dr. Nicholas Berg, an Ear, Nose and Throat Specialist, to describe this testing procedure and to discuss whether it is appropriate to use this procedure for AIT.

I am an ear, nose and throat doctor and a parent of a child with autism. I assist a psychologist who performs AIT. Several parents of children planning to start AIT had questions about the role of otoacoustic emissions testing. I will explain otoacoustic emissions testing in general, its role in autism, and its role in AIT.

Otoacoustic emissions are sounds made by the ear. This is different than ringing in the ear. When someone has ringing in the ear, that person is the only one who can hear the noise. When other people can hear the ringing coming from someone’s ear, it is called an `otoacoustic emission.’ When I was training in the mid 1980’s we read about a man in Japan who had otoacoustic emissions loud enough to be heard standing next to him. Most of us laughed at the idea, but now we know that 60% of people’s ears will make sounds detectable with sensitive microphones. Nearly everyone with normal hearing will make an otoacoustic emission very soon after hearing special sounds. Otoacoustic emissions testing works by presenting a sound that includes low tones and high tones in someone’s ear and listening for what sound comes out. If someone is deaf, no sound will come out because healthy nerve endings have to react to sound and make a reflex change in size to send a new sound out. Some people with good hearing will not make an otoacoustic emission and we don’t know why. When otoacoustic emissions testing shows no sound coming out, more testing is needed to see if the person is deaf. The test can be done by a nurse or a technician. Basically a ‘yes’ or ‘no’ answer is required to see if the person can hear. Since otoacoustic emissions testing listens for a very soft sound coming from the ear, the person tested and the room needs to be quiet. The National Institute of Health has recommended otoacoustic emissions testing as one way to test the hearing of newborn babies because it is a quick and easy test to do, and it does not bother most babies. I know of no dangers to the baby. Not all hospitals are testing every newborn because of the cost of the test.

I have found only one article about otoacoustic emissions testing in children with autism. Six children had both ears tested, and only 9 of the 12 ears tested passed because the children made too much noise or otherwise did not cooperate. It is important to be sure that a child with autism is not deaf because when a deaf child reaches 2 years old without special help, many of the ways the deaf child will act are similar to the behavior of some autistic children. If a hearing test or otoacoustic emissions test cannot be completed with autistic children, many times an auditory brainstem response test is necessary. This is a harder test because wires need to be taped to the skin of the head and the child has to be still and quiet for 20 minutes. If otoacoustic emissions testing works in an autistic child, we are sure the child is not deaf; and he does not have to go through a much more difficult test.

I could find no articles about otoacoustic emissions testing for AIT. Otoacoustic emissions testing uses many high and low tones at the same time before listening for a sound to come from the ear. It cannot be used to find out if a person hears one tone better than another. The hearing test performed before AIT tries to find special tones that an ear is very sensitive to so that filters can be set to change how loud those special tones are heard during the therapy. Otoacoustic emissions testing gives no useful information for setting filters. The only value in otoacoustic emissions testing with AIT is to make sure that a child can hear because it makes no sense to do AIT on a deaf person. The only reason to do more than one otoacoustic emissions test on the same person is to see if someone who could once hear is now deaf. This is a good idea after a bout of meningitis, many ear infections, a head injury, or exposure to certain poisons or medicines. The only reason to repeat otoacoustic emissions testing after AIT is to show that AIT did not make someone deaf. There is no research yet to show that otoacoustic emissions testing will predict that someone needs AIT or is responding to AIT. In conclusion, otoacoustic emissions are sounds made by hearing ears that can be tested to see if someone can hear. People with autism may be tested to see if they can hear with otoacoustic emissions testing but it is limited to give us a “yes/no” answer about hearing and has no special use in AIT.

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Considerations About the Use of AIT by My Trainees: Dr. Guy Berard
I don’t know if I should begin right now with my congratulations for my trainees or wait until the end of this article!

Since the time I began teaching my method first in France in 1985, and afterwards in the USA, and then in other countries of the world, I have been wonderfully surprised by the interest that my trainees are showing:

      – in doing their best to correctly apply the method through my device,

 

      – in keeping in constant contact with me to ask my opinion on special cases

 

      – and to suggest different possibilities for modifying the technique (amount of time of the sessions, time between sessions, total number of sessions, etc.)

 

The answers to all these questions have already been the subject of my former articles in SAIT’s newsletter, The Sound Connection.

I have not figured the exact statistics on the hundreds of faxes that I have received, but I can say that this number is very high and has led me to often change the rolls on my fax machine, and to work hours each day answering them.

Is it because I had personally experimented during my practice with nearly all the different ways to approach the problem of training individuals through the different devices, modified from the first one, in order to obtain the best, quickest results? Is it because I had studied ten thousand audiograms? Be that as it may, no particular new considerations have developed from these contacts with my trainees, but only the confirmation that AIT is working well, and the listeners appear satisfied. In rare cases, this was not the case. Basically, the problem was the trainee who, in order to please some client, had agreed to increase the number or length of the session.

The only important modification of my teaching since the beginning has been that trying to obtain an audiogram from an autistic child at all costs, as I was doing before, was an error. This may disturb and tense up the individual, and does not modify the setting of the Audiokinetron.

Sometimes a practitioner suggests a discovery in which a special symptom or disorder appears to correspond to a special configuration on the audiogram. Generally, these ‘discoveries’ concern only one case.

In conclusion, the teaching that I continue applying has not been, nor in my opinion, has not needed to be modified through recent years. This, of course, is true for the moment, but I continue to listen to all serious suggestions sent by my correspondents to consider including them in my teaching and to broadcast them, after verification.

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SAIT’s Annual Meeting
SAIT will hold its 5th annual meeting in Orlando, Florida during the Autism Society of America’s (ASA) national conference (July 8 to 12, 1997). For information about the ASA conference, call 1-888-648-2033. For those who will not be able to attend the conference, we will summarize those talks which are related to AIT in the next issue of The Sound Connection.

At press time, we did not have a date and room scheduled for the annual meeting. If you are planning to attend the ASA conference as well as SAIT’s annual meeting, please contact our main office in late-June or early-July to obtain more specific information about the meeting. The best way to contact us is either by fax (503-363-9110) or by email (sait@ teleport.com).