Daily Archives: October 2, 2015

Area of Sensitivity to Acoustic Change Identified in Brains of Autistic Children

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)

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This article appeared in a previous issue of The Sound Connection, 2003, Vol. 9, No. 4, page 6.

If you have any questions about this article please contact us at sait@berardaitwebsite.com.

Why Does Berard AIT Require Intensity and Repetition to be Successful?

Why Does Berard AIT Require Intensity and Repetition to be Successful?

Families and individuals seek auditory integration training (AIT) in hopes of creating some changes in the skills and abilities of the listener. For example, there may be a short attention span, poor auditory discrimination skills, or improvement needed in the ability to follow directions. These are all very desirable outcomes, but the AIT schedule is so rigorously intense that some parents find it difficult to accommodate into their lives. Listeners must complete 10 hours (1 hour/day) of listening to specially processed music within a 12-day period, and the music is carefully selected so it will provide the appropriate type of stimulation. Parents often ask, “why are 10 hours required and why must it be so intense?” The answer actually lies within the brain.

Brain plasticity is the mechanism that allows the brain to be molded or changed. Plasticity is an amazing feature with great power. However, there must be certain controls over it, otherwise, the brain would be constantly subjected to changes that may be beneficial at times, or possibly detrimental at other times. When one area of the brain (cortical map) grows, another area or map often shrinks, due to competition for neurons and synaptic space. To protect against whimsical changes within the brain, three prerequisites must be met. The brain will respond with change when these three conditions occur: attention, repetition and intense exposure. In other words, the individual needs to attend to a specific experience, the experience must be repetitious, and the exposure must be intense. Dr. Berard’s method of AIT meets these parameters, which may be an underlying reason why it has been so successful for so many years.

It is for these reasons that AIT cannot be approached casually. The brain typically does not respond with significant, permanent change to casual exposures. A definitive effort must be made to “convince” the brain that it is the individual’s intention to create a change.

Sally Brockett, M.S.,
Director, IDEA Training Center

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This article appeared in The Sound Connection, Vol. 9, No. 1, 2001. .


If you have any questions about this article please contact us at sait@berardaitwebsite.com.

What’s Before AIT, What’s After AIT?

What’s Before AIT, What’s After AIT?

With such a vast array of interventions now available, parents and professionals are sometimes uncertain as to an appropriate sequence to follow. Due to individual differences and unique needs, it is not possible to set any hard and firm sequence that would be appropriate for all people. However, there are some factors that should be given consideration.

If one considers the hierarchy of development as a guide, it is logical to pursue biological interventions first in order to build a strong foundation for the other developmental areas. When the body is free of toxins and is nutritionally well- balanced, it is likely to respond better to other types of interventions. If the individual has sound sensitivity that is caused by a deficiency in magnesium, yeast overgrowth, mercury toxicity, or use of aspartame (i.e., NutraSweet), the biological treatments may correct the hypersensitive hearing.

Biological treatments vary in the length of time needed to see improvement. While many treatment results may be evident within weeks, some require much more time (i.e., mercury and yeast detoxification may take several months to a year or more). If the child is experiencing sound sensitivity to such a degree that it interferes with daily life activities and/or the child is quite delayed in language development, parents should consider proceeding with AIT in order to improve this situation as quickly as possible. In a case such as this, it is often best to plan another session of AIT after the biological treatments have been completed in order to “fine tune” and stabilize the system. AIT is usually more consistently maintained when the biological dysfunctions have been corrected.

The minimum age for auditory integration training (AIT) is 3 years; and if the child is an appropriate candidate, the only behavioral requirement is that the child accepts headphones. Since AIT may provide such fundamental and comprehensive benefits and sets the stage for further development in many other areas, it is often the first choice by professionals and parents in regard to sound-based interventions.

Some children respond well to AIT following craniosacral or chiropractic treatments since these address some structural problems and may help the sensory defensive child accept the headphones. These treatments may also help reduce problems with chronic ear infections/fluid that can interfere with getting AIT done. Thus, there may be cases where it is best to pursue some of the biological interventions before providing AIT; whereas in other cases, AIT may give the child some immediate benefit that will outweigh reasons for delaying it.

Activities can be done during and after the 10 days of AIT to help the individual integrate and adjust to the changes derived from AIT. Many practitioners recommend participation in sensory integration activities even during the 10-day period of AIT and in the following weeks. This can help reduce any irritability and hyperactivity that may occur and may help reorganize the system more quickly.

A variety of interventions can be provided after AIT to facilitate the development of skills that failed to develop appropriately due to the inefficient auditory system. Computer software programs such as Earobics (www.earobics.com) and SoundSmart by BrainTrain (www.braintrain.com) can be used to help children develop auditory attention and processing skills. Listening to well-structured music such as Mozart and Gregorian Chants (without headphones) can also help reorganize the system. Hemi-Sync (www.hemi-sync.com) music can also be used and does not require listening with headphones.

Interactive Metronome (IM) (www.interactivemetronome.com) is another sound-based intervention that may be used by some individuals after AIT. Since it may take as long as six to nine months for the changes from AIT to be integrated into the system, it is generally recommended that other sound-based interventions not be considered prior to this period. This will allow parents and professionals time to see how the individual has responded to AIT and if there are continuing concerns. Interactive Metronome is designed to help improve motor planning, sequencing and timing capabilities. While these abilities may improve with AIT, some individuals may need more “fine tuning” in these areas; and IM may serve this function. In order to participate in IM, children must be able to participate in a series of coordinated, repetitive movement activities. Although headphones are required for listening to the metronome beats, these soft tones are much less likely to be disruptive to the benefits of AIT than the hours of listening to music and/or speech sounds that are basic to other sound-based interventions.

Currently, there is no data available on the impact of using headphones to listen to the music/speech sounds used in a variety of sound-based interventions. Parents and professionals need to be cautious about this since it is known that listening to music with headphones can have a negative impact on AIT results.

As one can see, many issues must be considered when determining the sequence of interventions. The individual’s needs and differences are a priority and options must take these into account.

Sally Brockett, M.S.,
Director, IDEA Training Center

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This article appeared in The Sound Connection, Vol. 9, No. 3, 2002. .


If you have any questions about this article please contact us at sait@berardaitwebsite.com.

Understanding the Impact of AIT on Reading

Understanding the Impact of AIT on Reading

Two scenarios often present themselves in the practice of auditory integration training (AIT). One involves parents who ask if AIT might help their child who is struggling with reading. The child may read but not comprehend or may not be able to decode the words at all. In some cases, the child reads so slowly that all the required reading can not be completed. The second scenario involves the parent who pursues AIT in hopes of reducing their child’s sound sensitivity, improving language and/or socialization, with no consideration of the impact that it may have on the child’s reading. This parent may report with surprise, that their child’s reading also improved after the AIT. Both parents will want to understand how the AIT process, which impacts on listening skills, can affect the reading process.

We need to examine certain aspects of the reading process in order to see this relationship. The National Institute of Child Health and Human Development along with the U.S. Department of Education’s office of Research and Improvement have been conducting studies and is one of many programs dedicated to understanding reading development and supporting research in reading for the past three years. Based on this cumulative work, much has been learned about how children learn to read and why some struggle with the process. Although there is still much to learn, this research provides important information that can be used to understand and help children develop proficient reading skills. It can also provide insight as to how AIT affects the reading process.

Reading requires the rapid decoding and comprehension of written words. In order to do this, children must be aware that spoken words are composed of small units of sound called ‘phonemes.’ This is referred to as ‘phoneme aware-ness.’ Phoneme awareness is not the same as phonics. When phonemic awareness is evaluated, children are asked to demonstrate their knowledge of the sound structure of words without letters or written words present (i.e., “What would be left if the /p/ sound were taken away from ‘pit’?”). Phonic skills are evaluated by determining the child’s ability to link sounds (phonemes) with letters. The development of phonics skills depends on the development of phonemic awareness.

In order to read an alphabetic language such as English, children must know that written spellings systematically represent spoken sounds. When beginning readers cannot correctly perceive the spoken sounds in words, they will have difficulty sounding out or decoding unfamiliar words. For example, they must hear the /it/ sound in ‘pit’ and ‘fit’ and perceive that the difference is the first sound in order to decode these two words. This auditory perceptual problem will affect reading fluency, resulting in poor comprehension, and limiting reading enjoyment.

When we listen to spoken words (e.g., ‘bag’) we do not perceive each unit of sound in the word (/b//a//g/). We perceive bag as an overlapping bundle of sound that seems to be a single unit rather than three distinct sounds. This facilitates the listening process and oral communication. Since the individual sounds (phonemes) within words are not consciously heard by the listener, no one receives natural practice in understanding that words are composed of smaller distinct sound units. Thus, the early stages of reading instruction must focus on phoneme awareness and phonics skills and providing practice with these skills in text is critical.

Since readers have a limit on their attention span and memory, it is essential to develop fluency and automaticity in decoding and word recognition. When decoding is laborious and inefficient, the reader cannot remember what he has read and bring meaning to the content. There are additional components involved in the development of good readers. Good comprehension requires the reader to link the written ideas to their own experiences and to have the necessary vocabulary to make sense of the content. Good syntactic and grammatical skills and the ability to sequence also impact on reading development.

Given this understanding of reading development, it is easier to see how AIT can impact upon this skill. AIT often enhances listening skills and the ability to perceive sounds more accurately. This may enable the child to perceive the spoken sounds in words so phonemic awareness can develop and phonics can be taught. Thus, the basic auditory perceptual skills involved in reading may be improved through AIT.

Many parents also comment on how AIT improves their child’s listening comprehension. They understand spoken language better. This improvement in listening comprehension may also extend to the ability to listen to one’s own inner language or thoughts, including the thoughts perceived through the process of reading.

The ability to sequence at many different levels impacts on reading and is affected by AIT. The child must be able to sequence the phonemes in words in order to sound out or decode new words. Words in sentences must be correctly sequenced in order to be meaningful and sentences within paragraphs must flow in an organized sequence. The sequence must be retained by the reader if the content is to be logical. When AIT enhances the child’s ability to organize and sequence, it may help with this component of the reading process.

AIT practitioners should understand these relationships so they can respond to parents questions about the impact of AIT on their child’s reading abilities.

Sally Brockett, M.S.,
Director, IDEA Training Center

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This article appeared in a previous issue of The Sound Connection, 2000, Vol. 7, No. 4, pages 2, 3, & 6.

If you have any questions about this article please contact us at sait@berardaitwebsite.com.

Autism Research Institute

Autism Research Institute

4182 Adams Avenue

San Diego, California  92116

 

The Efficacy of Auditory Integration Training:

 

Summaries and Critiques of 28 Reports

(January, 1993 – August, 2004)

 

Stephen M. Edelson, Ph.D. and Bernard Rimland, Ph.D.

 

Auditory integration training (AIT), as developed by French otolaryngologist Guy Berard and based on the work of his predecessor, Alfred Tomatis, typically consists of 20 half-hour sessions of listening to specially modulated music over a 10- to 20-day period.  AIT has been reported to be beneficial in several conditions, including AD/HD, autism, dyslexia, and hypersensitive hearing at certain frequencies.

 

The present review covers 28 reports on AIT.  Twenty-three reports concluded that AIT benefits various population subgroups, three studies claim to show no benefit (or no benefit over that seen in a control group), and two studies reported rather ambiguous or contradictory results.  Considering the great difficulties in both providing a credible placebo treatment and assessing improvement in the subject populations, these results are quite encouraging. The balance of the evidence clearly favors AIT as a useful intervention, especially in autism.

 

Following are summaries of all research studies known to us that have investigated the efficacy of AIT.  These studies were published between January, 1993 and May, 2001 and have appeared in peer-reviewed journals, professional newsletters, and/or were presented at professional conferences.  Twenty-six of the studies utilized subjects with autism, attention deficit/hyper-activity disorder, central auditory processing disorder, and/or mental retardation.  Two

of the studies evaluated the physiological effects of AIT on animals.

 

Section A of the paper summarizes those studies supporting the efficacy of AIT; Section B summaries those studies that claim to have found no support for its efficacy; and Section C summarizes the results of two studies which we have classified ‘ambiguous, contradictory, or controversial.’  Following these three sections, Section D, we discuss two additional reports in a Discussion section, followed by our Conclusions.

 

The summaries are listed chronologically within each disorder.  All used Berard-type equipment and procedures.  (We are not aware of any relevant research using the Tomatis approach during the time period covered.)

 

The following abbreviations are used for the tests/checklists utilized most often in the studies:  Aberrant Behavior Checklist (ABC-1), Autism Behavior Checklist (ABC-2), Behavior Summarized Evaluation (BSE), Childhood Autism Rating Scale (CARS), Clinical Evaluation of Language Fundamentals–Revised (CELF-R), Conner’s Parent Rating Scales (CPRS), Fisher’s Auditory Problems Checklist (FAPC), Screening Test for Auditory Processing Disorders (SCAN), Self-Injurious Behavior Questionnaire (SIBQ), Staggered Spondaic Word (SSW), and the Test of Nonverbal Intelligence (TONI).

 

Section A — Studies Reporting Positive Effects of AIT (N=23)

                  

 

AUTISM STUDIES

 

(1) Ocular Movements Among Individuals with Autism Pre- and Post-Auditory Integration Training

Margaret P. Creedon in collaboration with Stephen M. Edelson and Janice E. Scharre

Easter Seals Therapeutic Day School, Autism Research Institute, and Illinois College of Optometry

Paper presented at the Annual Conference of the Association for the Advancement of Behavioral Therapy, New York, 1993.

 

In an open-clinical study, visual tracking movements and optokinetic nystagmus (a visual reflex) were assessed in 22 autistic individuals, ages 6 to 13 years, prior to, immediately following, and three months after AIT.  Significant improvements were seen in horizontal tracking immediately following AIT and in both horizontal and vertical tracking three months post AIT.  No changes were seen in optokinetic nystagmus.

 

Parents completed the FAPC and the ABC-1. The FAPC indicated significant improvement at 3 months post-AIT, and the ABC-1 indicated significant improvement both immediately following and 3 months post-AIT.

 

Comment.  This was an open-clinical study with no control group for comparison.

 

(2)  Study of the Effects of AIT in Autism

Dawn Cortez-McKee and Jaak Panksepp

Bowling Green State University, Ohio

Paper presented at the Annual NW Ohio Autism Society Conference, 1993.

 

This open-trial clinical study utilized 33 autistic individuals.  Participants were assessed using multiple measures prior to (two baseline measures), and at 1-week, 1-month, and 3 months following AIT. The measures included: ABC-1, BSE, CARS, CPRS, FAPC, and SIBQ.  Significant improvement was seen on all of the measures, except the FAPC, at the one- and three-month follow-up assessment periods.

 

Comment. This study was also an open-clinical trial with no control group for comparison.

 

(3 & 4) Two Studies of the Effects of Auditory Integration Training in Autism

Tina K. Veale

Comprehensive Concepts in Speech and Hearing, Cincinnati, Ohio

Paper Presented at the International ASA Conference on Autism, Toronto, Canada, 1993.

 

Study I.  In a double-blind placebo pilot study, five autistic subjects participated in the experimental group and five in the control group.  Parents completed three different evaluation forms–the ABC-1, the CPRC, and the FAPC.   These instruments were completed prior to, one month following, and three months following AIT.  There were no initial differences between the experimental and control groups, but positive trends indicating improvement in the experimental group were seen at three months following AIT for all three evaluation forms.

 

Study II.  This was an open clinical study involving 46 autistic participants.  Parents completed the ABC-1, CPRS, FAPC as well as the Autistic Behavior Composite Checklist and Profile.  Significant improvements were observed at one month and six months following AIT.  Some of the behavioral changes included: reductions in hyperactivity, social withdrawal, auditory problems, restlessness, and anxiety.

 

Comment.  Study I included a control-placebo group, but there were only five subjects in each group.  Given this small number, it is not surprising that, despite the benefits seen, there were no significant differences between the two groups.  Study II which did find significant pre- and post-treatment differences was an open-clinical trial and did not include a placebo-group.

 

(5)  The Effects of Auditory Integration Training in Autism

Bernard Rimland and Stephen M. Edelson

Autism Research Institute, San Diego, California

American Journal of Speech-Language Pathology, 1994, 5, 16-24.

 

This study involved an open-clinical research design which included several experimental control measures.  There were 445 autistic subjects in the study, with ages ranging from 4 to 41 years.  A significant reduction in sound sensitivity was found, based on the presentation of pure tones prior to and immediately following the AIT sessions. Analyses of the hearing tests conducted prior to, after 5 hours of listening, and after 10 hours of listening, showed hearing acuity to have improved slightly while the amount of variability within the audiogram decreased.   Subjects were also assigned at random to one of several filtering conditions (e.g., filter auditory peaks, no filters, filter painful frequencies). No differences in the efficacy of the AIT were found among the filtering conditions.

 

Parents completed several different questionnaires on a monthly basis for 9 months.  These included the ABC-1, CPRS, and the FAPC.  The responses to these behavioral measures indicated a sharp reduction in problem behaviors, starting one month following the AIT listening sessions.  These changes remained stable throughout the entire 9 months of post-AIT evaluations.

 

Participants were assigned at random to one of three different AIT devices.  No differences were found in the efficacy of the devices.

 

Correlational analyses were employed to attempt to develop a profile of those individuals who may benefit from AIT. Lower functioning individuals displayed significantly greater improvement, as indicated by the ABC-1 and the CPRS.

 

No significant relationships were found between behavioral improvement and age, degree of sound sensitivity, and the amount of variability in the pre-AIT audiogram.

 

Comment.  Although a placebo group was not employed in this research project, the study did include several experimental controls, such as videotape raters who were ‘blind’ to before/after conditions, and random assignment to filter conditions and to AIT devices.

 

(6) Positron Emission Tomography Measure of Modified Auditory Integration Therapy: 

A Case Study

Jacqueline M. Cimorelli and Melanie K. Highfill

University of North Carolina at Greensboro & Center for the Dev. of Comm. and Learning, Winston-Salem, NC

Presented at the ASA National Conference, Las Vegas, 1994.

Reported in ADVANCE for Speech-Language Pathologists and Audiologists, June 26, 1995.

 

A single-subject research design investigated changes in brain functioning following AIT using Positron Emissions Test (PET) Scan technology.  The research subject was an 8-year old male with mental retardation and autism.  PET scans were conducted prior to a second set of AIT listening sessions (baseline), one day after the listening sessions, and  six months later. The results at both the one-day and six-month follow-up evaluations indicated a normalization of brain wave activity, including a decrease in hyper-metabolism in the frontal lobe and an increase in activity in the occipital lobe.

 

Comment.  Although these results are encouraging, this study involved only one subject; and there was no control subject for comparison.  Additionally, a PET scan had not been given prior to the first set of AIT sessions; thus, the baseline information used in the research study may not be an appropriate measure for comparison.

 

(7)  Changes in Unilateral and Bilateral Sound Sensitivity as a Result of AIT

Deborah Woodward

Woodward Audiology, McLeansville, NC

The Sound Connection, 1994, 2, p.4.

 

Loudness tolerance was investigated in 60 children with autism and related disorders.  Uncomfortable loudness level (UCL) measurements were performed prior to and immediately following AIT.  Prior to AIT, the results from the left and right monaural presentations (to each ear independently) as well as the binaural presentation (to both ears simultaneously) were much lower than 90 dBHTL, where 90 dBHTL is considered a normal lower limit of UCL.  Furthermore, the binaural tolerance to the speech noise was 9 to 11 dBHTL less than the monaural tolerance level, where 3 to 6 dBHTL is considered normal.  Following AIT, the monaural tolerance level to each ear 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.  In addition, the binaural tolerance level was only 5 dBHTL lower than the monaural sound presentations, indicating a more normal response.

 

Comment.  This study involved a relatively large number of subjects; however, the study did not employ a control group.

 

(8) Parental Perceptions of Change Following AIT for Autism

Dana Monville and Nickola Nelson

Western Michigan University

Paper presented at the American Speech-Language-Hearing Conference, New Orleans, 1994.

 

A survey was mailed to 150 parents of children diagnosed with either autism or pervasive developmental disorder whose children had received AIT between 1991 and 1993.  Forty parents (27%) responded to the survey.  Of those who responded, 25 (63%) reported an increase in attention span; 25 (63%) reported a decrease in sound sensitivity; and 12 (30%) reported an increase in language.  Four parents (10%) reported an increase in tantrums and aggression.

 

Comment. Although the survey was sent to 150 families, only 27% responded to the survey. It is possible that those who observed positive changes in their children were more likely to complete the survey than those who did not observe any changes.

 

(9)  Auditory Integration Training

Jane R. Madell and Darrell E. Rose

Long Island College Hospital, Brooklyn, NY; and Mayo Clinic, Jacksonville, FL

American Journal of Audiology, March, 1994, 14-18.

 

This study involved an open clinical trial of AIT on four children.  Their diagnoses included: autism, PDD, and learning disabilities.  Audiograms of all four children showed improvement following AIT (i.e., a decrease in variability).  Behavioral improvement was observed in three of the four children.  The benefits reported were: increased calmness, decreased sound sensitivity,   and improvements in speech/language and word recognition in noise.

 

Comment.  Although this report included a great deal of clinical detail, only four subjects participated in the study; and there was no control group.

 

(10)  Auditory Integration Training: A Pilot Study

Bernard Rimland and Stephen M. Edelson

Autism Research Institute, San Diego, California

Journal of Autism and Developmental Disorders, 1995, 25, 61-70.

 

The study utilized a blind-placebo controlled experimental design.  Eight subjects were assigned at random to the experimental (AIT) group, and 9 were assigned to the placebo group. The placebo group listened to the same, but unprocessed, music. Three months following AIT, significant improvements were observed on the ABC-1 and the FAPC. Although there were no changes in sound sensitivity nor changes in the audiogram, the majority of subjects had not been reported to be sound sensitive, nor were they able to be tested audiometrically.

 

Comment. Although the subjects were assigned at random to the AIT and placebo groups, there were initial differences between the two groups.  Regression analysis suggested the effects observed were not artifacts of the initial differences.

 

(11)  Epileptic Activity in Autism and Acquired Aphasia: A Study Using Magneto-Encephalography

Jeffrey D. Lewine, Sherri L. Provencal, John T. Davis, and William W. Orrison, Jr.

Department of Radiology, School of Medicine, University of Utah Medical School

Paper presented at the Autism Society of America National Conference, Orlando, Florida, 1997

 

Magnetoencephalography and EEG recordings were used to measure electrical activity in the brain in one child with dyslexia and one high-functioning autistic adult.  Baseline recordings demonstrated larger than normal responses in the areas associated with hyperacusis.  Following AIT, a more normalized balance or symmetry in electrical activity was observed.

 

Comment.  These findings document physiological changes due to AIT; however, there were only two subjects in the study and no control group.

 

(12) Auditory Integration Training:  A Double-Blind Study of Behavioral, Electro-physiological, and Audiometric Effects in Autistic Subjects

Stephen M. Edelson, Deborah Arin, Margaret Bauman, Scott E. Lukas, Jane H. Rudy, Michelle Sholar, and Bernard Rimland

Autism Research Institute, San Diego, CA;  Massachusetts General Hospital, Boston, MA; McLean Hospital, Belmont, MA; and Upper Valley Medical Centers, Troy, OH

Focus on Autism and Other Developmental Disabilities, 1999, 14, 73-81.

 

Nineteen autistic subjects were assigned at random to either the experimental group (n=9), which listened to AIT-processed music, or a placebo group (n=10), which listened to the same, but unprocessed, music.  All evaluations were ‘blind’ to group assignment. Behavioral, electro-physiological, and audiometric measures were assessed prior to and following AIT.  Behavioral:  A significant improvement was observed in behavioral problems (using the ABC-1) in the experimental group at the 3-month follow-up assessment. Electrophysiological:  Of the 19 subjects, three experimental group and two placebo group subjects were able to cooperate with the auditory P300 Event Related Potential (ERP) task.  All five subjects showed abnormal P300 ERPs prior to the AIT listening sessions. Three months following AIT, all three subjects showed a dramatic improvement in their auditory P300 ERP.  No improvement was seen in the placebo group.  Audiometric:  The subjects’ poor communication and attention skills precluded formal statistical evaluation of the data from a battery of audiometric tests; however, an audiologist was able to assign correctly 10 of the 15 subjects for whom partial data were available to the treated and non-treated groups, on a ‘blind’ basis.

 

Comment.  AIT was reported to produce both behavioral improvement and normalization of brain wave activity. The behavioral changes on the ABC-1 are consistent with those obtained in a previous study (Rimland & Edelson, 1995, Section A, #10).  Although the electrophysiological findings are encouraging, they are based on a total of only five subjects.

 

(13) Auditory Integration Training and Autism: Two Case Studies

Mark Morgan Brown

Private Practitioner, Republic of Ireland

British Journal of Occupational Therapy, 1999, 62, 13-18.

 

This is a clinical study of two autistic siblings, a 5-year old male and a 3 1/2-year old female. Observations were made at three and six months following AIT.  Improvements were reported in attention, arousal and sensory modulation, balance and movement perception, praxis and sequencing, speech and language, social and emotional maturity, and eye control.

 

Comment.  Although this study provided detailed descriptions of subjects prior to and after AIT, it involved only two subjects and no control group for comparison.

 

Attention Deficit/Hyperactivity Disorder Reports

 

(14) Non-Pharmacological Techniques in the Treatment of Brain Dysfunction

Jeffrey M. Gerth, Steve A. Barton, Harold F. Engler, Alyne C. Heller, David Freides, and

Jane Blalock

Georgia Institute of Technology, Emory University, and the Atlanta Speech School

Technical Report prepared for the GTRI Fellows Council, Georgie Tech Research Institute, Georgia Institute of Technology, June, 1994.

 

This study evaluated the effectiveness of AIT on 10 children with auditory-based learning deficits.  Eight of the ten had also been diagnosed as having Attention Deficit Disorder.  Subjects were given a series of diagnostic tests, and parents were requested to complete several questionnaires. Two subscales from the Woodcock-Johnson Psycho-Educational Battery test were used to evaluate changes in auditory processing.  These subscales, the Sound Blending scale and the Incomplete Words scale, indicated an improvement of one standard deviation or more in 4 of the 10 subjects, and moderate improvement in two other subjects.  Performance on other criteria (e.g., CPRS and the FAPC) “could not be meaningfully evaluated, given the amount of missing data.”

 

Comment.  Although improvement was reported in 6 of the 10 subjects, there was no control group.

 

(15)  Auditory Processing Skills and Auditory Integration Training in Children with ADD 

Donna Geffner, Jay R. Lucker, Ann Gordon and Dolores A.  DiStasio

St. John’s University, Jamaica, NY and Ann Gordon Associates, Stony Brook, NY

Paper Presented at the Annual Convention of the American-Speech-Language Hearing Association, New Orleans, 1994

 

This study investigated changes in audition and language in 16 children with AD/HD.  A large number of tests were employed to evaluate possible changes as a result of AIT.  The measures included:  standard audiometric threshold testing, tolerance for tones and speech, speech recognition in quiet and noise conditions, and the Goldman-Fristoe-Woodcock (GFW) Test of Auditory Selective Attention.  Post-assessments were conducted within 3 months following AIT.  Significant improvement was observed in the subjects’ tolerance to tones and speech, speech recognition in the noise condition, and in listening skills as measured by the GFW Auditory Selective Attention Test and several subscales from the Detroit Test of Learning Aptitude (oral commissions, attention span for unrelated words, and attention span for related words).

 

Comment.  No control group was utilized in this study.

 

(16) Long-Term Effects of AIT Comparing Treated and Non-Treated Children

Donna Geffner, Jay R. Lucker, and Ann Gordon

St. John’s University, Jamaica, NY; and Ann Gordon Associates, Commack, NY

Paper Presented at the Annual Convention of the American Speech-Language-Hearing Association, Seattle, 1996.

 

The study involved a one-year follow-up evaluation of children with Attention Deficit Disorder.  Those receiving AIT (n=10) were compared to a control group (n=10) which did not receive AIT.  Using a tolerance testing procedure for ‘uncomfortable’ listening levels, improvement of 6 dB in the left ear was observed for the AIT group, but no change was observed in those in the control group. No differences were found between the two groups with respect to listening to ‘comfortable’ speech.  Additionally, tests evaluating speech recognition in noise and auditory-language processing showed improvement for those in the AIT group but not for those in the control group.

 

Comment.  Although a control group was used in this study, those in the control group did not receive a placebo treatment that would have controlled for the possibility of a ‘placebo effect.’

 

(17) The Effects of Auditory Integration Training on Children Diagnosed with Attention Deficit/Hyperactivity Disorder: A Pilot Study

Wayne J. Kirby

University of North Carolina at Asheville

Paper presented at the First Annual Congress of International Association of Berard Practitioners, Antwerp, Belgium, 2000.

The Sound Connection, 2000, Vol. 7, pp. 4 & 5.

 

This study employed a placebo-control design in which five children listened to AIT-processed music and five children listened to the same, but unprocessed, music.  Subjects were assessed using the Auditory Continuous Performance Test (ACPT) prior to and three months following the experimental/placebo listening sessions. The ACPT provides measures for impulsivity and inattention and also includes a ‘total number of errors’ score.  Comparison of the two groups at three months post-AIT indicated a statistically significant reduction in the total number of errors for those in the AIT group.  Improvement was also observed on the impulsivity and inattention scores for the AIT group, but these results were not significantly different from the results obtained from the placebo group.

 

Comment. Although a placebo group was utilized in this study, there were only five subjects in each group.

 

Central Auditory Processing Disorder (CAPD) Reports

 

(18)  The Effects of Auditory Integration Therapy on Central Auditory Processing

Brenda Huskey, Kathryn Barnett, and Jacqueline M. Cimorelli

University of North Carolina at Greensboro

Paper presented at the American Speech-Language-Hearing Conference, New Orleans, 1994.

 

In an experimental study, two auditory processing tasks were administered to six subjects in the AIT treatment group and six subjects in a control group.  These tasks included the SSW test and the Phonemic Synthesis Test (PST).  Pre- and post-tests were given prior to, and at 4 to 6 weeks, and at 8 to 12 weeks following AIT.  For the SSW test, there were no improvements in the subjects 4 to 6 weeks following AIT, but there were improvements on the total score and on the left competing condition at 8 to 12 weeks following AIT. There were no changes in the results from the PST.

 

Comment.  Although a control group was employed, there were only six subjects in each group.  Additionally, the control group did not receive a placebo treatment to permit evaluation of the possibility of a ‘placebo-effect.’

 

(19)  Clinical Outcome Evaluation: Auditory Integration Training

Jane H. Rudy, Sharon S. Morgan, and Marianne Shepard

Upper Valley Medical Centers, Troy, Ohio

Paper presented at the Ohio Speech-Language-Hearing Conference, 1994.

 

In an open-clinical study, 13 subjects diagnosed with attention deficit/hyperactivity disorder (ADHD) and/or central auditory processing dysfunction (CAPD) were given a variety of assessments prior to, immediately following, and three months post-AIT.  These tests examined hearing acuity, central auditory processing (SSW, SCAN), auditory evoked potentials (i.e., brain waveforms–P200 and P300), language function (CELF-R), and intelligence (TONI).  Immediately following AIT, there were significant improvements in the SSW, SCAN, and CELF-R, and no change in the TONI.  Three-months post-AIT, there was additional improvements in the SSW and CELF-R, but no further change in the SCAN.  There was also a significant improvement in the TONI.  An analysis of the P200 waveform indicated a significant change in amplitude but no change in the P300 waveform latency. No significant changes in hearing acuity were detected during any of the assessments.

 

Comment. This was an open-clinical study, and there was no control group.

 

Studies Investigating Mixed Populations

 

(20) Auditory Integration Training: One Clinician’s View

Jane R. Madell

Long Island College Hospital and State University of New York, Brooklyn

 Language, Speech, and Hearing Services in Schools, 1999, 30, 371-377.

 

Changes in speech perception were evaluated in several disorders prior to and following AIT.  The populations included: autism, pervasive developmental disorder (PDD), multisystem developmental disorder (n=46), attention deficit disorder or attention deficit/hyperactivity disorder (n=26), and central auditory processing disorder with  leaning disabilities  (CAPD/LD, n=46).  Subjects’ speech perception was assessed by asking them to  recognize words in both quiet and competing noise environments.  Improvement in speech perception was documented in both the quiet and noise conditions following AIT.  In a second part of this study, uncomfortable loudness thresholds (UCLS) were evaluated  in individuals diagnosed with autism (n=24), PDD (n=26), and CAPD (n=10).  UCLs also improved in these children following AIT.

 

Comment.  This is an excellent clinical study with many subjects and multiple measures of change.  However, a control group was not used for comparison.

 

(21)  A Comparative Study of the Earducator and the AudioKinetron

Sally Brockett

IDEA Training Center, North Haven, Connecticut

The Sound Connection, 2001, 8, 1 & 6.

 

This study compared the effects of two Berard AIT devices–the Earducator and the AudioKinetron.  A total of 19 children diagnosed with  autism, learning disabilities and attention deficit disorder participated in this study. The children were assigned at random to either the Earducator or the AudioKinetron; and the evaluators, the parents, were ‘blind’ to group assignment. The ABC-1 and the Attention Deficit Disorders Evaluation Scale were used to assess changes.  The results showed improvement in both groups of children and no differences between the two AIT devices.

 

Comment.  Although the aim of this study was to compare two Berard AIT devices, a placebo group would have also provided additional information regarding the effectiveness of the two AIT devices.

 

 

Reports of Animal Studies

 

(22)  An Animal Model of Auditory Integration Training

  1. Waldhoer, J. Panksepp, D. Pruitt, M. Vaningan, D. McKee, J. Rossi III, and J. Lindsey

Bowling Green State University & Toxicology, Wright-Patterson Air Force Base

Paper presented at the Annual Society for Neuroscience Convention, San Diego, 1995.

 

This study was undertaken to follow up the positive findings seen in an earlier study on autistic children conducted by these authors (see Section A, #2).  AIT was administered to newborn domestic chicks, selected as the species of choice because of their responsivity to sounds.  Starting at two days of age, subjects were included in one of three groups–AIT (experimental), music (control 1, same music as the AIT group but not processed), and silence (control 2).  Following AIT, those in the experimental group exhibited an increase in growth and a reduced inhibition to separation-induced vocalizations in response to music.  Post-mortem analysis of the brain tissue indicated a reduction in serotonin and 5-HIAA levels in the two music groups (experimental and control 1).  In addition, an analysis of the behavioral effect of cyproheptadine, a general serotonin antagonist, yielded comparable behavioral effects.  The data suggest that AIT may modify serotonergic tone in the brain.

 

Comment. Although behavior changes were observed in chicks who received AIT, neurochemical changes were found both in the AIT and placebo-music groups (control 1).

 

(23) Biochemical Changes As a Result of AIT-type Modulated and Unmodulated Music

Jaak Panksepp, John Ross III, and T.K. Narayanan

Bowling Green State University, Ohio

Lost & Found: Perspectives on Brain, Emotion, and Culture, 1996/7, Vol. 2, p. 1 & 4.

 

This experiment involved four conditions in which groups of chicks were exposed to either AIT-type modulated music (using the EASe Disc 1, produced by Vision Audio, Inc., Joppa, MD); unmodulated music (the same music source but not processed); human voices (male and female); or no sound.  For both the modulated and unmodulated conditions, neurochemical assays indicated a dramatic increase in norepinephrine and its principle metabolite, MHPG.  The researchers also found increases in brain dopamine and its metabolite (HVA), but these changes were not as large.  No clear changes were observed in brain serotonin and epinephrine.  Very little change was observed for those included in the ‘human voice’ and ‘no sound’ conditions.

 

Comment.  Changes were not observed in the human voice condition  (placebo group) and no sound conditions, but neurochemical changes were found in the modulated condition (AIT group) and the unmodulated condition (placebo group).  These findings indicate that listening to music produced neurochemical changes.

 

Section B — Studies Purporting AIT to be Ineffective (N=3)

 

Autism Reports

 

(1) Auditory Integration Training for Children with Autism: No Behavioral Effects Detected

Oliver C. Mudford, Barbara A. Cross, S. Breen, Chris Cullen, David Reeves, Judith Gould,

and Jo Douglas

Keele University, University of Manchester, and UK National Autistic Society

American Journal of Mental Retardation, 2000, 105, 118-129.

 

In a double-blind crossover design, 16 autistic children were evaluated for a 4-month period.  Several measures were used in this study including: parent and teacher rating scales (ABC-1, Nisonger Child Behavior Rating Form), direct observations (stereotypy, object obsessive, disruptive behaviors, stigmatising behaviors, vocal stereotypy), intelligence/cognitive testing (Leiter International Performance Scale), speech-language evaluation (Reynell Developmental Language Scales III), social/adaptive behavior (Vineland Adaptive Behavior Composite), standard audiometric testing, and parent reports.  Improvements were observed in both the AIT group and the placebo group on adaptive/social behavior and expressive language.  Statistically significant improvements in hyperactivity and ear occlusion were observed in the  subjects who participated in the placebo condition.

 

Comment. Although the significant improvements seen in those in the placebo condition were dismissed by the authors, it is quite possible that these improvements may have been due to the subjects having received AIT eight months earlier (i.e., they may have participated in the AIT group prior to the crossover).  This is a real possibility given:  (a) the two areas of improvement in the placebo group are consistent with findings associated with AIT; and (b) Rimland and Edelson (1994, see Section A, #5) and Gillberg et al. (1997, see Section C, #2) documented improvement up to 9 months following AIT.  The present authors called this possibility to Mudford’s attention and suggested that the data be reanalyzed to test it.  Mudford refused, claiming that additional analyses of the data would increase the likelihood of error. On the contrary, reanalysis of the data would have decreased the likelihood of error.  Here we see an eagerness to declare AIT ineffective when the data do not necessarily support such a conclusion.

 

Central Auditory Processing Problems (CAPD) Reports

 

(2) The Effects of Auditory Integration Training for Children with Central Auditory Processing Disorder (CAPD)

Karen A. Yencer

State University of New York at Buffalo

Doctoral Dissertation, 1996; American Journal of Audiology, 1998, 7, 32-44.

 

Thirty-six children diagnosed with central auditory processing disorder participated in an experimental condition (i.e., listened to AIT music), a placebo condition (i.e., listened to unmodulated music), or a control condition (i.e., did not listen to music).  Children with autism, pervasive developmental disorder (PDD), and multiple-handicaps were excluded from the study.  A battery of tests were administered to the subjects prior to and one month following the listening sessions.  These included: standard audiometric testing, the SSW test, the Phonemic Synthesis test, the Standard Progressive Matrices test, FAPC, auditory brainstem response (ABR), event-related potential (P300), and a speech-in-noise test.  The P300 analyses indicated some improvement in the AIT condition (mean latency from 366.2 msec. to 348.5 msec.) versus a slight worsening in the placebo condition (mean latency from 400.8 msec. to 402.2 msec.).  Significant improvements were found for the three conditions on all measures except the speech-in-noise test.

 

Comment.  Yencer examined changes following AIT after only four weeks following the AIT sessions.  Stephen M. Edelson, who consulted on this study, noting that Berard and others had stated a need for at least 3 months of follow-up, insisted that she examine changes for at least three months following the AIT sessions.  However, Yencer chose to conduct follow-up measures for only one-month because of her dissertation schedule.  Cutting corners may be acceptable in meeting academic requirements, but not acceptable where decisions affecting the welfare of handicapped children are concerned.  Note that Huskey, Barnett, and Cimorelli (1994) investigated AIT on a similar population (i.e., CAPD) and found no improvement at 4 to 6 weeks following AIT, but did observe improvement at 6 to 8 weeks post-AIT (see Section A, #18).

 

Studies Investigating Mixed Populations

 

(3) The Efficacy of Auditory Integration Training: A Double Blind Study

William Zollweg, Vere Vance, and David Palm

University of Wisconsin at La Crosse; Research Associates, Inc.; and Gundersen Lutheran Hospital

American Journal of Audiology, 1997, 6, 39-47

The study involved a double-blind research design involving 30 participants who were assigned at random to either an experimental (AIT) group or a placebo-control group. The participants were 7 to 24 years old, and the majority carried diagnoses of mild to profound mental retardation. Some of the participants were diagnosed as having autism. Evaluations were conducted using audiometric tests, a Loudness Discomfort Level test, and the ABC-1 at 3, 6, and 9 months following AIT.  Although no differences were found between the AIT and control groups with respect to hearing and behavioral changes, both groups showed improvements. The results from the Loudness Discomfort Level test indicated that the control group had a higher tolerance for the frequency 250 Hertz than the AIT group at the 9-month post-assessment measure.

 

Comment.  There are several severe problems with this study.  First, the title should have stated “… in a Mixed Population” since fewer than a third of the subjects were autistic; thus one cannot generalize these findings to the autism population.  Neither Berard, nor any other responsible investigator, has proposed AIT as a treatment for mental retardation.  Second, the volume level was much higher than recommended.  The recommended volume level is 80 dB SPL or lower.  The decibel level in the Zollweg et al. study was measured as high as 122 dB SPL.  Finally, an analysis of the audiograms indicated that 27% were given the wrong narrow band filters.  Given the methodological flaws, these findings are not applicable even to the mentally retarded population.

 

 

Section C: Studies Presenting Ambiguous, Controversial,

 and/or Contradictory Findings (N=2)

 

(1) The Long-Term Effects of Auditory Training on Children with Autism

Sue Bettison

Autism Research Institute, Sydney, Australia

Journal of Autism and Developmental Disorders, 1996, 26, 361-374.

 

“Eighty children, 3-17 years of age, with autism or Asperger syndrome and mild to severe distress in the presence of some sounds, were randomly allocated to two groups.  The experimental group received auditory training and the control group listened to the same unmodified music under the same conditions.  Significant improvements in behavior and severity of autism were maintained for 12 months by both groups.  Informal data suggested that a range of abnormal responses to sound and other sensory abnormalities may also have improved.  Verbal and performance IQ increased significantly 3 to 12 months after interventions.  Findings suggest that some aspect of both auditory training and listening to selected unmodified music may have a beneficial effect on children with autism and sound sensitivity, …”  [Author Abstract]

 

Comment: The results indicated significant improvement in both the experimental (AIT) and placebo groups, but there were no differences between the two groups.   Bettison attributed these improvements to listening to music in a structured environment. However, critics have interpreted these findings as evidence of ‘no benefits’ associated with AIT, which is a debatable point.

 

While this is an exemplary study in many respects, the instruments used to assess changes associated with AIT had severe shortcomings.  One of the primary measures used to investigate changes in sound sensitivity was a modified version of the Hearing Sensitivity Questionnaire (HSQ) designed by Rimland and Edelson (1991). The HSQ was designed only as a survey of sound sensitivity in the autism population and not an instrument to evaluate treatment effectiveness.  Rimland and Edelson did not use it as an assessment measure in any of their three studies on AIT.  Additionally, Bettison employed a scoring method for the HSQ that was said to provide a measure of the person’s degree of sound sensitivity. This scoring method lacks even face validity (i.e., the appearance that the checklist is valid).  For example, if a parent agreed with the item: ‘Have there been certain sounds which the person does not seem to hear?,’ this response was considered an indication of hypersensitivity to sounds rather than hyposensitivity to sounds.

 

Another measure used in the study, the Developmental Behavior Checklist, had been used previously in clinical settings, but it was also not designed to measure treatment effectiveness.  When evaluating the efficacy of an intervention, it is crucial that the appropriate measurement tools be used.

 

(2) Auditory Integration Training in Children with Autism: Brief Report of an

Open Pilot Study

Christopher Gillberg, Maria Johansson, Suzanne Steffenberg, and Orjan Berlin

Autism, 1997, 1, 97-100

 

Nine children with “an autistic disorder” were given AIT for 10 days, in accordance with the procedure recommended by Guy Berard.  No control group nor control procedure was used.  At the end of the 9-month follow-up period, 8 of the 9 children showed improvement on the Autism Behavior Checklist (ABC) total score, and 7 of 9 children showed improvement on the ABC sensory subscale.  Rimland and Edelson calculated the significance level of the differences, using standard matched paired t-tests and derived ap<.01 level for the ABC total score and p<.02 for the sensory score (“Auditory integration training in children with autism [Letter to the Editor],” 1998, Autism, 2, 91-92).

 

Comment.  This study has several serious problems.  Gillberg relied on two diagnostic checklists to measure changes as a result of AIT, the CARS and the ABC-2.  Neither checklist was designed to evaluate treatment effectiveness.  Additionally, despite the small sample size (only 9 cases), Gillberg et al. required an alpha level of .005 to test for statistical significance instead of the usual .05 and .01 level.  This extremely low, very conservative alpha level is uncommon in research. Its use in a small sample study virtually guarantees that no treatment will be found effective.  As a result, Gillberg et al. (1997) erroneously concluded that no benefits were seen in their study on AIT.  In response to Rimland and Edelson’s (1998) ‘Letter to the Editor,’ protesting Gillberg et al.’s statistical analyses, Gillberg et al. (1998) stated  “… a moderate reduction in sensory problems may have occurred” (p. 94; “Auditory integration training in children with autism: reply to Rimland and Edelson [Letter to the Editor],” Autism, 1998, 2, 93-94).  Contrary to what Gillberg et al. concluded, the results were definitely positive.  The failure to include a control group is unfortunate, but should not result in understating the value of AIT.

 

Section D: Tabulation of Studies, Discussion and Conclusion

 

Table 1: Tabulation of Studies

(Number of Studies)

 

 

 

Disorders

 

Positive Findings

Ambiguous, Controversial, &/or Contradictory  

Results Unclear/

Questionable

 

 

No Effectsa

Autism 13 1 (Bettison)

1 (Gillberg)

1 (Mudford et al.) 0
ADHD 4 0 0 0
CAPD 2 0 1  (Yencer) 0
Several Populations 2 0 1 (Zollweg et al.) 0
Animals (chicks) 2 0 0 0

 

a Note that none of the studies failed to show discernible benefits.

 

Of the 28 research studies that evaluated physiological, behavioral, and cognitive changes in the subjects, the authors of 23 (82%) studies concluded that their data supported the efficacy of AIT, three (11%) claimed to have found no evidence of efficacy, and two (7%) report ambiguous, contradictory results.

 

Discussion

 

Negative Bias

 

We recognize at the outset that no research study is perfect–all have flaws and shortcomings of various kinds.  However, the 23 studies with positive outcomes, by and large, exhibited fewer and less serious shortcomings than the subset of three supposedly negative studies.  All three of these studies demonstrated an alarming bias favoring negative results [Mudford et al. (Section B, #1), Yencer (Section B, #2); and Zollweg et al. (Section B, #3)].

 

Two additional published reports clearly show a negative bias regarding AIT by some researchers.  In a ‘Letter to the Editor’ entitled “When is a significant change not significant?,”  Patricia Howlin criticized a controlled-placebo AIT study (Rimland and Edelson, 1995, Section A, #10) by stating that the statistically significant differences on two measures were clinically not important (Journal of Autism and Developmental Disorders, 1997, 27, 347-348).  Howlin’s criticisms were based on her misunderstandings. She stated “Thus, the mean fall in the ABC score was less than 0.4 points; hardly a dramatic change in a scale of 58 items” (page 348).  Howlin assumed that the maximum possible score on the ABC-1 was 58; however, the maximum possible score was only 3.  Thus, the difference of almost 0.4 points is a meaningful proportion of the 0 to 3 range and is clinically significant.  Regarding another measure, Howlin stated that a 12-point difference on the 93-item FAPC was also not clinically important.  Howlin was wrong again.  The FAPC contains 25 items, not 93 items; thus, an average change on 12 of 25 items is quite dramatic and clinically significant.  Again, the results were positive, not negative.

 

In another report, Rankovic, Rabinowitz, and Lof (1996) measured the sound output levels of a single AudioKinetron, as reportedly used by a local AIT practitioner (American Journal of Speech-Language Pathology, 5, 68-72).  The highest output level used by the practitioner was measured at 110 dB SPL, and the maximum output level of the AIT device was measured at 118 dB SPL.  The authors concluded that these output levels can be harmful to hearing, and warned that AIT is potentially dangerous.  However, an AIT device, like any radio, compact disc or audiocassette player, can be set to play too loudly.  Should all be banned as potentially dangerous?  Every practitioner is aware of his/her responsibility to make sure that the device is played at an appropriate level. Basing conclusions on a single, very probably atypical case, is a poor practice—the authors’ conclusions are not justified.

 

A good deal of what has been written about AIT is excessively skeptical, negative or derogatory, permeated with the assumption that AIT is ineffective.  Our review of all the research on the efficacy of AIT that we have been able to find refutes this negative view.

 

Probably because AIT lacks a plausible rationale and is counter-intuitive, it has become the target of skepticism and of negatively biased research.  One’s opinion about an intervention, like one’s opinion about an individual, should be based on evidence rather than prejudice.  The present authors were themselves skeptical when first learning about AIT.  Their interest was stimulated, despite their initial skepticism, by a number of almost-too-good-to-be-true clinical reports from parents of autistic children who had been treated at Dr. Guy Berard’s clinic in Annecy, France.  There is a place for skepticism, but there is also a place for safe, non-intrusive, short-term and relatively inexpensive therapies with reasonably good track records.

 

Physiological Findings

 

It is of interest that all seven studies that sought evidence of physiological change (e.g., electrophysiological, biochemical) as a result of AIT, including the two animal studies, reported positive findings (Section A, #s 6, 11, 12, 19, 22, 23; Section B, #2).  This is an area where further research is indicated, in our opinion.

 

‘Placebo’ Music — Less Inert Than We Think?

 

Five studies described in this paper utilized a placebo group and found significant improvements in both the AIT group and the placebo group (Bettison, 1996, Section C, #1; Panksepp et al., 1996/7, Section A, #23; Waldhoer et al., 1995, Section A, #22; Yencer, 1998, Section B, #2; Zollweg et al., 1997, Section B, #3).  While such findings are typically construed to indicate ‘no benefits’ from AIT, we believe there may be more to the story than that.

 

Jaak Panksepp has raised the intriguing possibility (personal communication) that the presumably inert ‘placebo’ music may have had, contrary to expectation, a significant beneficial effect.  Guy Berard specified that the music used in his version of AIT must have (1) a good tempo/beat, (2) a large variation in frequency within short intervals, and (3) a strong unpredictability component.  Bill Clark, an audio engineer and developer of a popular AIT device, after analyzing the output of over one thousand compact discs, identified about 70 discs that best meet Berard’s specifications.  Most AIT practitioners use the music from Clark’s list   As Panksepp points out, this small subset of carefully selected, attention-arousing music is not a random sample of available music and may, in fact, confer benefits that disqualify it from placebo status.  Panksepp suggests such music arouses and activates attentional circuits in the brain (Panksepp, 1996/7, See Section A, #23).

 

Future Research on AIT

 

Based on our monitoring of AIT research, we offer the following suggestions for consideration in future research studies.

 

___            Diagnostic instruments are inappropriate for evaluating treatment efficacy.  Assessment

instruments designed specifically for evaluating treatment efficacy should be utilized.

 

___      An assessment follow-up period of at least three months is necessary.

 

___      In a mixed population, separate statistical analyses should be conducted to assess specific

populations (e.g., AD/HD, autism, CAPD, dyslexia).

 

___      When describing the AIT procedure, specify the filter settings, loudness levels, etc. to

permit assessment and replication of the research.

 

___      The consistent findings of better than expected outcomes for the placebo groups in a number of studies, as well as evidence from other sources, suggests that certain kinds of music may stimulate significant improvement in attention and learning in some individuals, even without filtering and/or modulation of the music.  Additional research in this area is clearly needed.

 

___      All seven of the studies in this review that have measured electrophysiological or biochemical responses have reported such changes in the subjects given AIT. Further study of physiological responses to AIT is indicated.

 

Conclusion

 

Our review of the available literature on AIT has produced 23 studies with positive results and only 3 claiming no benefits from AIT.  While none of the research done thus far on AIT is of Nobel Prize quality, the positive studies are far more credible than those with negative results.  As we point out in our comments, the 3 studies that claim no benefits are deeply flawed, with conclusions that are not supported by the research procedures nor the research data.

 

AIT does, in fact, appear to be a worthwhile, frequently beneficial intervention which confers improvement in a number of symptoms, in a significant proportion of disorders on the autism spectrum.

 

*****

 

The Autism Research Institute does not offer AIT nor any other form of treatment.

If you have any questions about this article please contact us at sait@berardaitwebsite.com.

Questions to Ask AIT Practitioners

Questions to Ask AIT Practitioners

Carol Cloud, Moscow, Idaho

As a parent of a twenty-year old son with autism, who has gone through AIT, I understand the concerns and apprehension a parent has in choosing a professional to conduct this training.

In order to make the best informed decision possible in selecting an AIT specialist, I would want to know the following about the specialist I was considering:

1. What is the person’s educational background?

2. What experience has the person had working with special needs children?

3. What is the total number of children this person has conducted AIT on?

4. What percentage of this total were autistic children?

5. How long has the person been doing AIT?

6. Who trained the specialist? Is this person an “approved” instructor? How extensive was the training program?

7. What is the highest intensity level of decibels that the listener is exposed to during the listening sessions?

8. What machine is the practitioner using for the AIT sessions? Is it the same type of machine that the practitioner received training on?

9. Is the practitioner using compact discs which meet the criteria considered appropriate for AIT? (A list of these compact discs is presented below.)

10. What is the total fee charged? How does this fee compare to what others charge for AIT?

11. Is the person a member of the Society for Auditory Integration Training?

12. Ask for three references– parents of children — inquire about their experiences — were they satisfied?

13. Ask to see an informed consent form pertaining to the practitioner.

.

————————————
This article appeared in a previous issue of The Sound Connection, 1993, Vol. 1, No. 2, page 6.

If you have any questions about this article please contact us at sait@berardaitwebsite.com.

Letter from Dr. Guy Berard

Letter from Dr. Guy Berard

Last Considerations Concerning AIT and Minimum Age of Children

Since the beginning of my work, I have placed a great deal of thought into these issues, in order to avoid wrong ways.

I first used:

  • my understanding of AIT
  • my own experience with AIT

Then gradually I had to add:

  • the reports sent to me by practitioners and parents, –
  • my correspondences with other professionals in Audiology and Autism

These contacts with professionals taught me that there could be some underlying conditions, different than the usual ENT area, such as mercury toxicity, magnesium deficiency, the possible need for secretin, which could lead to sound sensitivity found in autism or other behaviour anomalies.

Being aware of this information, practitioners should discuss these possibilities with parents before applying AIT with my method. The parents will realize that the practitioner is informed of different sound sensitivity issues.

AIT can be appropriate for sound sensitivity, particularly when other underlying conditions have been ruled out or treated. AIT may also be appropriate for enhancing skills and abilities such as attention, language, socialization, etc. depending upon the individual.

Now, as for the minimum age for applying AIT, all my trainees are aware of the different rules that I have successfully taught, according to my own past experience. The first paragraph of this article explains that, little by little, I have had to take into consideration all of the advices which were provided to me by these numerous correspondents.

I shall now conclude that:

  • in the interest of children,
  • for eliminating any possibilities of damage of the ears, even if very very rare,
  • for suppressing the criticism of audiologists or other ENTs,

the minimum will be imperatively 3 years old, never less, even if parents are insisting for obtaining a younger age.

April 13, 2002, Annecy, France

———-
This article appeared in The Sound Connection, Vol. 9, No. 3, 2002.


If you have any questions about this article please contact us at sait@berardaitwebsite.com.

Inaccurate Information on AIT Published

Inaccurate Information on AIT Published
by the National Research Council

The National Research Council (NRC) recently published a book, Educating Children with Autism (2001), which contains disgracefully inaccurate information about auditory integration training (AIT). The book can also be read, free-of-charge, on the Internet (www.nap.edu and search the word ‘autism’). The section on AIT is located on pages 99 and 100.

The book falsely states regarding AIT: “… in general studies have not supported either its theoretical basis or the specificity of its effectiveness” (page 100). Edelson and Rimland recently wrote a review paper on AIT. The review paper found 23 studies to have reported improvement, 3 studies to have reported no improvement, and 2 studies to have reported equivocal results.

There are many other problems with this very biased NRC report. A 1994 paper by Gravel is falsely cited: “A recent review noted that for children treated with auditory integration therapy, objective electrophysiologic measures failed to demonstrate differences in hearing sensitivity between children with autism and controls, thereby questioning the overall premise of auditory integration therapy” (p. 100). Gravel’s paper was actually an “opinion” paper; she did not report any research data nor did she review any studies using electrophysiologic measures to examine hearing sensitivity. Gravel did cite studies investigating other auditory issues, such as deafness, distortions in hearing and auditory processing. However, the statement that she cited studies showing no differences in hearing sensitivity in autism was simply not true.

The chapter also states “More recent studies noted no differences in responses to auditory integration training therapy in children with autism or controls (Best and Miln, 1997; Gillberg et al., 1997)” (page 100). The Best and Miln (1997) report was actually an unpublished review paper on AIT and contained no research data. The Gillberg et al. (1997) study was an open-clinical trial study of only 9 children, with no control group. Gillberg et al. (1998) acknowledged one year later that there may have been improvement as a result of AIT in their 1997 study. This was not mentioned in the NRC report. A study by Bettison (1996) was also discussed, but there was no mention of the many inherent problems with this study.

The book mentioned only one published study supporting AIT (Rimland & Edelson, 1995) and ignored the Rimland and Edelson (1994) paper involving 445 autistic children and the double-blind placebo study involving electrophysiological measures (Edelson et al., 1999). All three of these studies were among the 23 which showed positive results. The Edelson et al. (1999) study documented dramatic improvements using electrophysiological measures as well as significant improvements in behavior. The other 20 studies showing positive results were also ignored.

Unfortunately, the publication of the book may serve to dissuade parents from trying a very safe, non-intrusive and potentially effective intervention with their autistic children.

We hope our readers will inform parents and professionals about the NRC’s false statements regarding AIT if they are asked about it.

 

– – – – – – – – – – – –
This article appeared in a previous issue of The Sound Connection, 2002, Vol. 9, No. 2, pages 1 & 2.

If you have any questions about this article please contact us at sait@berardaitwebsite.com.

How AIT Got Its Name

How AIT Got Its Name
In his practice, Dr. Guy Berard used the terms ‘auditory training’ and sometimes ‘auditory re-training’ to refer to his method of auditory stimulation. As most readers know, Berard’s method involves the use of modulation and narrow band filters. Soon after this intervention was introduced in the United States (in the early 1990’s), there was much confusion between Berard’s method and another method which was also termed ‘auditory training.’ The latter method involves the use of an FM device used to transmit a teacher’s voice to a student who wears a small receiver in his/her ear.

Dr. Bernard Rimland felt that a better term was needed to describe Berard’s method. He realized that Berard’s method could be considered a form of sensory integration; and after much thought, he coined the phrase ‘Auditory Integration Training’ or ‘AIT.’ At the same time, a few practitioners started using the term ‘Auditory Enhancement Training’ to differentiate Berard’s method from the other form of ‘auditory training.’ This term is still used by some people today. Since the term ‘AIT’ is used by most professionals and families, we recommend that all practitioners use this term to avoid confusion.

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This article appeared in a previous issue of The Sound Connection, 1996, Vol. 4, No. 1, page 7.

If you have any questions about this article please contact us at sait@berardaitwebsite.com.

Frequently Asked Questions Concerning Auditory Integration Training

Frequently Asked Questions Concerning Auditory Integration Training

Following are frequently asked questions about auditory integration training (AIT), along with SAIT’s response to each one. Please let us know if there are additional questions you would like answered.

Who is a good candidate for AIT?
We do not yet have a profile of those individuals who would benefit most from AIT. We initially thought people similar to Annabel Stehli’s daughter, Georgie, would be most likely to benefit. Ms. Stehli’s book, The Sound of a Miracle, detailed how Georgie benefited from receiving AIT. Georgie was high-functioning, verbal, and very sound-sensitive. After receiving AIT, her sensitivity was eliminated; and her overall behavior improved. However, several research studies as well as many reports from parents show that people who are not similar to Georgie also do benefit from AIT.

Drs. Rimland and Edelson (1994) studied the effects of AIT on 445 autistic children and adults. They used a variety of statistical techniques to determine a profile of those who improved as a result of AIT. Although these researchers documented a reduction in sound sensitivity and an improvement in behavior, they did not see any relationship between age, language ability, configuration of the audiogram, and degree of autism. They did find that low functioning individuals improved behaviorally more than high functioning individuals.

Given these findings, the current answer to the question, “Who is a good candidate for AIT?” seems to be “we don’t know.” As with most interventions, not everyone benefits from AIT. However, given the noninvasiveness of this intervention, it may be worthwhile for interested individuals to see if AIT may be beneficial.

If a Person Cannot Be Tested Audiometrically, Can He/She Still Receive AIT?
The AIT music is processed in two ways. In one way, termed ‘modulation,’ low and high frequency portions of the sound spectrum are attenuated at random. The second way involves using narrow-band filters to dampen specific frequencies in the sound spectrum. These frequencies, referred to as ‘auditory peaks,’ are those which are heard much better than their adjacent frequencies. An audiotest is often given to an individual prior to AIT to determine if he/she has auditory peaks in his/her hearing. If one or more peaks are evident, then narrow-band filters may be used during the AIT listening sessions to lower the volume of sound at those frequencies. In cases in which a person cannot perform reliably on an audiotest, filters are not recommended, but the music is still modulated throughout the 10 hours of listening. Dr. Guy Berard, the pioneer of AIT, has often stated that it is better to use no filters than the wrong filters. He states that narrow-band filters are often not necessary for people with autism and related disorders.

The use of behavioral observations and sound field testing to obtain an audiogram for AIT is also not recommended by Dr. Berard. Behavioral observations may not be sufficiently reliable to determine the precise point at which the person begins to hear sounds, and this minimal threshold level is the point that needs to be measured. Sound field testing provides the results for only the better ear.

There are a few practitioners who feel they can determine the necessary filters by analyzing a person’s speech patterns, and others who feel they can determine filters by using an Otoacoustic Emissions Test. At the present time, there is no scientific support for either of these two methods.

What is the Minimum Age to Receive AIT?
How old is old enough to begin AIT? In the past, Guy Berard’s position has been that, to be on the safe and conservative side, AIT should not ordinarily be given before age 4 years. Some authorities on hearing and child development agree, suggesting that the auditory system is too immature in younger children. Additionally, there is concern that young children may not effectively protest if the music is inadvertently played too loudly.

Pressure toward dropping the age limit to 3 years has been mounting from both parents and practitioners, who point to the potential advantages of early intervention. Some have used AIT with children as young as 2 years of age. After he learned of apparent positive results with some 3 year olds with no known negative or adverse results, Dr. Berard has reconsidered; and he now feels that 3 years may be a suitable age (personal communication, 5/4/95).

Whatever the trainee’s age, extreme care should be taken to ensure that the volume is well below the EPA and OSHA noise exposure limits-in all cases-and that AIT devices be checked frequently to prevent excessive loudness. The output should never go above 85 dB. This caution is especially important for young children, since EPA and OSHA limits have been determined for adults and not for children.

Until a safe age limit and volume level are established, practitioners who give AIT to young children should proceed very cautiously.

Why Should the Listener Not Wear Headphones After Receiving AIT?
Dr. Guy Berard states that people should not wear headphones to listen to music after receiving AIT. He argues that the ear cannot defend itself against very loud sounds. Basically, sound is energy; and when a lot of energy (i.e., music) is placed in a short and narrow tube (i.e., the ear canal), it will work the ear drum, middle ear, and inner ear excessively.

According to Berard, if a person wears headphones to listen to music after receiving AIT, his/her hearing may return to where it was prior to receiving AIT. There have also been several clinical case reports of individuals who experienced a sudden loss of gain after wearing headphones. Berard believes that it is acceptable to listen to speech at a low to moderate level using headphones.

Why are people offering AIT when there is no research to support its efficacy?
There is research on AIT which supports its efficacy. We are aware of 28 studies which have investigated the effectiveness of AIT. Twenty three of these studies have indicated improvement in people with autism and learning disabilities after receiving AIT. The Autism Research Institute in San Diego distributes a summary of these research studies. Click here to visit their web site.

 

Does AIT reduce sound sensitivity by causing some form of hearing damage?
There is no evidence at all to support the idea that AIT is effective by inducing hearing damage. In fact, Drs. Bernard Rimland and Stephen Edelson analyzed the audiograms from 199 people who received AIT. They documented a significant decrease in sound sensitivity and a slight improvement in hearing. (The slight improvement in hearing may have been due to familiarity with the testing situation and/or the audiologist.) Of course, AIT devices, like any other devices using audiotape or compact discs, can be misused by adjusting them to play too loudly. The Society for Auditory Integration Training has often urged AIT practitioners to calibrate their equipment to make sure that the output level of these devices does not exceed 85 dBA.

How can a person be sure that an AIT practitioner is following the standard AIT procedure developed by Dr. Guy Berard?
Some practitioners have chosen to depart from the basic procedure developed by Dr. Guy Berard during his several decades of clinical experience. Some do tell parents of the changes while others do not. SAIT advises parents to do their `homework,’ by learning as much as they can about the procedure. SAIT provides parents and professionals a list of questions to ask practitioners as well as information about the basic procedure. Most of this information on this website and through the Internet at https://berardait.wpengine.com. Parents can obtain a list of Berard AIT Practitioners at https://berardait.wpengine.com/PracList.htm.

Has the Food and Drug Administration (FDA) classified the AIT devices as harmful?
No, the FDA has not classified AIT devices as harmful. Any device for which there are claims that it will improve or cure a condition is automatically labeled a `medical device’ by the FDA. Recently, the FDA clarified their position regarding AIT devices. That is, as long as AIT devices are not promoted as ‘medical devices,’ then the FDA does not have jurisdiction over them.

If you have any questions about this article please contact us at sait@berardaitwebsite.com.