Volume 5 Number 3, 1998

Central Auditory Processing Disorder: Deborah Woodward, M.A., CCC/A
There are several issues to discuss when describing central auditory processing (CAP) disorder. From an audiologist’s point of view, the most common problem is difficulty hearing in the presence of background noise. Background noise can range from relatively loud party/classroom noise to a fan from a computer to an outside heat pump. For the verbal child, the diagnosis is straightforward if understanding of words and directions is excellent in quiet surroundings and becomes poor with background noise. For the nonverbal child, identification is more subjective. Potential sources of background noise must be eliminated from the area where the child is learning a task (e.g., fans, fluorescent lights, computer/printer noise as well as radios and TV in adjacent rooms). When the child is compliant and performs consistently at the requested task (e.g., pointing or going to get an object), then background noise can be added. If the child then performs much poorer or is inattentive and distractible, background noise may be the problem.

Auditory memory is another component of CAP. There are several good standardized tests, including the Test of Auditory Perceptual Skills (TAPS), for verbal children. It is important that auditory memory be tested for various types of information. For example, a child may have great auditory memory for random numbers or words, but he/she may not be able to correctly remember two- and three-part directions or a simple sentence. For the nonverbal child who is able to point, an assessment of auditory memory may be obtained using simple objects such as crayons and stacking blocks. For example, ask the child to 1) “Get the red crayon.” 2) “Get the red crayon, make a circle.” 3) “Get the red crayon, make a circle, get the blue crayon,” etc. Another method is to use a family album with several photos on each page. Ideally, the same subjects would be in several of the pictures. Request that the child 1) “Point to the baby.” 2) “Point to the baby and mommy.” 3) “Point to baby and daddy outside,” etc. These tasks can be presented visually only and auditorily only. If the child can perform these tasks visually but not auditorily, this may indicate that the child has CAP problems. It is important to do this in as quiet a space as possible.

If a child has an auditory memory deficit, the issue becomes much more complicated. Is the memory problem physical such as a seizure disorder? attention-based? language-based? or auditorily-based? For the verbal and partially verbal child, there are many auditory tests which may be administered (i.e., phonemic recognition, phonemic synthesis picture test). If the child is able to repeat back sounds, then much information may be obtained. If the child is asked to repeat back “/b/” and says “/m/,” it is possible that the child has an articulation error. However, if the child is able to correctly produce “/b/” in some other context, but repeatedly produces “/m/” when asked to say “/b/,” then a basic phonemic recognition problem may be at the root of higher order auditory memory deficits. This type of problem may be effectively treated with numerous repetitions of the speech sound using live voice or slightly amplified with an assistive listening device. There are many computer software programs that are available to speech pathologists and audiologists who specialize in CAP problems, such as Phonology from Learning Fundamentals, or the Language Bundle, Earobics, Fast ForWord, Train Time or more traditional therapies such as Lindamood’s Auditory Discrimination in Depth. These programs can be used in conjunction with the speech sound repetition program. Additionally, some speech pathologists think that poor phonemic recognition may be an underlying component of oral apraxia.

The important point to realize when considering whether a child has a central auditory processing problem is that hearing is critical to speech and reading. If the perception of a simple speech sound is distorted, it is more difficult to decipher the sounds that have been combined to form words, sentences and thoughts. Impairment in phoneme recognition adversely affects auditory memory, which may result in frustration, not following directions, and appearing inattentive. If the child also has difficulty in background noise, then an auditory memory CAP problem is compounded. Correct identification of the root of the CAP deficit is necessary for effective treatment.

Samonas Sound Therapy: Beverly Hall, M.Ed, CCC/SLP
Samonas is an acronym for Spectral Activated Music of Optimal Natural Structure and is a sound therapy program developed in Germany by physicist Ingo Steinbach. It uses a series of compact discs played through headphones and is relatively inexpensive.

This high technology listening program builds on the knowledge base of Dr. Alfred Tomatis and incorporates many more recent advances in the field of auditory interventions. The effectiveness of this program is attributed to a special treatment of classical music with the newly developed `Envelope Shaped Modulator of the SAMONAS’ principle. The process is called `Spectral Activation.’ A detailed overview of the concepts of the program is provided in Ingo Steinbach’s book, only recently translated into English, entitled Sound Therapy, and is available through Vital Sounds at (608) 831-6673; fax: (608) 231-3946.

Steinbach’s book provides descriptions of the healing effect as well as its historical development and scientific/biological foundation. In his book, Steinbach describes a number of experiments that brought him to the discovery that overtones have a fundamentally different influence on the human mind and body than low tones. He discovered that the overtones are rich in energy and that low tones may have a draining effect on the listener.

The Samonas Sound Therapy, based on Steinbach’s principles, entails listening regularly to classical music which has been specially recorded for this purpose and is suitable for young children through adulthood. No side-effects are reported. To date, four levels of CD`s are offered which are specially recorded for this therapy, consisting mainly of classical music by Mozart, Hayden, Pleyd, Bach, Handel, Telemann, Couperie, and Satic. Well-known pieces are alternated with some less familiar ones. Level I is available to anyone, whereas levels II through IV are designed for more intensive therapy and are only available to those who have completed therapist training.

Parts of the recording have a unique therapeutic value because of their concentration on the overtones or high extensive regions. All Samonas Sound Therapy recordings include the essential overtones which are mainly lost in ordinary recordings. There are even short sections in which only the essential overtones are recorded; these sections sound quiet or indistinct and, to some people, are just barely audible.

Another effect also depends upon a strategy of sending slightly different signals to each ear and a slightly increased emphasis to the right ear, providing extra stimulation to the left hemisphere – the logical and analytical side of the brain. This is designed to increase attention and awareness. Some researchers believe that the Samonas Sound Therapy works on the whole person by stimulating the ear. Many facets of the body are affected: balance mechanism, emotions, and posture. It is reported that the sound stimulation also works by alternately stimulating and relaxing the tendons and muscles in the middle ear and that the auditory area of the cortex is stimulated, making complex neural connections which spread through the remainder of the body.

In the recommended program, the listener begins listening for only 5 minutes per day; and this time interval is gradually increased. It is advisable to consult with a trained therapist who can individualize and direct the therapeutic listening program. Specifications for compact disc player, headphones, and other supplies are provided by the trained professional.

For additional information on Samonas Sound Therapy, CD’s, trained therapists, and professional training workshops, call Vital Links at (919) 929-0710.

Sound Sensitivity: A Summary of Possible Causes: Sally Brockett, M.S.
Sound sensitivity has been discussed in previous issues of The Sound Connection (Vol. 1, No. 1; Vol. 2, Nos. 1-4; Vol. 3, No. 4) and is a topic of continuing interest since this problem is experienced by many individuals who have developmental disorders. It is also seen in some individuals as an isolated problem with no other disabilities being present. This article will summarize current information about causes. The causes of auditory sensitivity can be classified into two categories: biochemical (which includes nutritional deficiency and drug side-effects) and physiological.

It is well established that nutritional effects may result in hypersensitive hearing. Many individuals who are deficient in magnesium suffer from sound sensitivity, and they often experience an improvement after receiving magnesium supplements. According to the Autism Research Review International (1990, Vol. 4, No. 4), 20 milligrams per each 10 pounds of body weight per day, is an appropriate amount of magnesium. Improvement would occur within a few days if the cause of the sensitivity is a magnesium deficiency.

The use of Nutrasweet (aspartame), a popular artificial sweetener, may also lead to hypersensitive hearing. Many chewable children’s vitamins contain aspartame as well as diet and low calorie foods. Labels must be read in detail, as it may not be easily identified that the product contains aspartame.

Some medications have ototoxic side-effects that may result in auditory hypersensitivity and/or other auditory system problems such as tinnitus and vestibular dysfunction. Dr. Guy Berard cautions against the use of antibiotics in the aminoglycocide family, including erythromycin, gentamicin, garamycin, neomycin, tobramycin, etc. Other medications with known ototoxic side effects include: Advil, aspirin (salicyclates), Benadryl, Beta blockers, Desipramine HCI (Norpramin), Empirin, Imipramine (Tofranil), Motrin (ibuprofen), Naltrexone (Trexan), Sel-dane, Tavist, and Tegretol. Author Elaine Suss reports in her book, When the Hearing Becomes Hard, that diuretics are also known for ototoxicity and must be used with caution.

Other biochemical causes include changes in the system due to stress and anxiety. Many people have reported increased auditory hypersensitivity during periods of stress and anxiety, i.e., exam week at college. Other sensory perceptions, such as tactile, taste or smell, may also be heightened. This may be related to stress-induced biochemical changes. Once the stress-related experience is over, the hypersensitivity usually decreases. Nutritional stress formulas may also be helpful.

The sensory system may also be overaroused by changes in the person’s biochemistry, including increases in toxins produced by an overgrowth of yeast and fungus, and possibly exposures to other toxins (e.g., heavy metals, toxic chemicals). Auditory hypersensitivity may escalate during this exposure and may be restored to more normal levels when the toxins are removed. Other techniques, such as brushing therapy, joint compression and deep pressure, can sometimes be used to help calm the nervous system while seeking appropriate treatment for the toxins.

Physiological causes may include: damage to the auditory system through exposure to loud noise, traumas such as whiplash, and abnormalities in function of the brainstem or higher cortical areas. A study by Deborah Woodward of Woodward Audiology in McLeansville, NC revealed that in children with autism, the binaural tolerance to speech noise, prior to AIT, was 9 to 11 dBHTL less than the monaural tolerance level (see The Sound Connection, 1994, Vol. 2, No. 2). This may indicate abnormal amplification in the brainstem or lack of bilateral inhibition. A study by Collett et al., published in The Lancet (1993, Vol. 342, pages 923-924), produced results that may indicate an alteration in the functioning of the medial olivocochlear (MOC) bundle which is located in the brainstem, and may explain sound sensitivity in autistic people.

There is also speculation about a possible link between hypersensitive hearing and the amygdala, located in the limbic system of the brain. Dr. Margaret Bauman’s research found that some neurons in the amygdala are abnormal. There are auditory pathways to the amygdala responsible for fear conditioning to sounds. It is possible that the abnormal functioning in the amygdala plays a role in the development of a dysfunctional fear response to sounds. Perhaps AIT stimulates the amygdala in some way that reduces this fear.

It is clear that there are many possible causes of hypersensitive hearing. One must learn about these causes and try to determine what might be the cause for a particular individual. If that can be determined, an appropriate intervention can be selected. When certain things that are possible to control have been ruled out, AIT may be an appropriate intervention to use for decreasing sound sensitivity.

Advice Regarding Computerized Learning Games: Attention and Flexibility
Attention is an important issue when working on computerized educational games. To be effective, a game must activate the frontal lobe in addition to other areas of the brain.

The function of the frontal lobe is to attend and initiate responses, integrate all new information, categorize and sort, problem solve and reason. The frontal lobe can be thought of as the executive of a company. All new information must be sent through the frontal lobe before it can be sent along to the more specialized area of the brain. Furthermore, an immature nervous system has a weakened ability to process new information and associate information. (As you are assisting the learner to develop attention skills, you must consider the levels of interdependence and independence.)

In the beginning stages of computerized cognitive therapy, some individuals require a great deal of assistance with processing and initiation of response to the stimuli. As skill and familiarity with the tasks increases, less assistance is generally required. Some individuals demonstrate independent functioning after initial instruction.

Inflexibility is typically a predominant characteristic of autistic children. Therefore, it is suggested that you become familiar with one way to play the games before you and the child play together. Introduce your preferred method of interacting with the stimulus first, then observe how your child prefers to interact with the stimulus. Compromise once you understand how your child wants to interact with the program by designing a lesson plan that will allow both methods of interaction. I usually alternate games with a `my choice/your choice’ format and allow the student to play on the video games for the reward periods. Train Time is an interactive computerized educational program which I developed and is produced and distributed by LocuTour (800-777-3166; see The Sound Connection, 1997, Vol. 5, No. 2). Reward schedules in Train Time are quite individualized. I actually use tactile rewards more than verbal praises, such as “good job!” I found that if there was going to be echolalia and perseveration, it was going to be on the auditory reward. I do not think it is very functional to have a child say, “You did it!” after every utterance. In general, the children have shown a remarkable preference to the intrinsic reward of completing the task correctly and being allowed to move on to the next stimulus. This makes some sense since a reward actually requires the child to shift attention to the reward, then back to the stimulus. For some children, this is too distracting.

If a child is echolalic, should he/she play computerized games to improve auditory memory? Yes, I think echolalia is a natural expressive language stage that develops auditory memory. It does last too long in some children and is no substitute for interactive language. I also find that there are ways to move a child beyond echolalia, but it can be useful to use their ability to copy what they are hearing when you are trying to teach auditory comprehension.

Some Possible Causes and Treatments for Tinnitus
Exposure to excessively loud noise is a common cause of tinnitus, or ringing in the ears. It may also be caused by wax buildup, aspirin and other ototoxic medications (see related article, pages 4 & 5), temporomandibular joint disorder (TMJ), whiplash or other trauma to the head/neck area, tumors or other injury to the auditory nerve. Tinnitus may also be an early sign of anemia, diabetes and atherosclerosis. Elevated blood cholesterol and triglyceride levels are associated with tinnitus, which frequently improves when these levels become normal. Improvement in blood circulation may decrease tinnitus, so use of circulation boosters such as Ginkgo biloba may be helpful. Interestingly, a study in Israel found a vitamin B12 deficiency in soldiers suffering from tinnitus. When these soldiers were given vitamin B12 supplements, their tinnitus diminished. Daily doses of 1000 mg. of niacinamide, a B-vitamin, two or three times a day are often helpful. Other approaches seek to mask the tinnitus with `white noise’ or calming music. There are devices that produce sounds of nature or background sounds that will mask the irritation produced by tinnitus. In some cases, biofeedback, deep breathing and visualization may be helpful in relieving the stress and anxiety associated with tinnitus.