Volume 1 Number 2, 1993

Report on the First Annual SAIT Conference
The first annual SAIT conference was held on July 13, 1993 in Toronto, Canada. Over 50 professionals and parents attended the one-day conference. The attendees were from the United States, Canada, Australia, and Switzerland.

Dr. Margaret Creedon of Chicago began the conference with an excellent talk on working with the client during the actual AIT sessions. Since some clients are tense and/or anxious during the sessions, Dr. Creedon gave practical advice on how best to make the client more relaxed during listening.

Sally Brockett, the second speaker, discussed her experience and shared her research findings on providing AIT to children with attention deficit/hyperactivity disorder.

Monica Doben-Stevens then gave an update on the BGC machine and described some of her findings on people with attention deficit / hyperactivity disorder.

After the dinner break, Sally Brockett provided an update on Dr. Berard’s method and the Audiokinetron. The Audiokinetron recently received U.L. Approval. Practitioners who are concerned with obtaining U.L. Approval on their machine(s) should contact their distributor.

Julie Biere and Moira Seyle presented information on aftercare issues and expectations following AIT. They provided suggestions on helping parents understand the period of adjustment that follows AIT and how to assist the individual through this transition period.

Dr. Steve Edelson finished the evening by leading a general discussion on AIT issues, such as P.E. tubes, decibel level, and age. Dr. Edelson also shared some of his recent findings on AIT in a study he is conducting with Dr. Bernard Rimland.

The second annual SAIT conference will again be held prior to the national conference sponsored by the Autism Society of America. This conference will be held July 6 to 9, 1994 in Las Vegas, Nevada.

FDA is Investigating AIT
The Food and Drug Administration is determining whether AIT sound amplifiers should be classified as ‘Medical Devices.’ On August 26, 1993, a representative from the FDA met with Peter and Annabel Stehli to obtain information about AIT and the Audiokinetron.

At this time, Audiokinetrons cannot be imported into the United States until the FDA has made a decision.

The SAPP company in France has hired an attorney to explain their machine to the FDA.

Those involved with this matter are investigating whether there are devices used in a manner similar to AIT which have already been approved by the FDA. If you are aware of any machines like this, please fax a letter to Dr. Steve Edelson at (503) 692-3104, and he will send it to the appropriate people.

What are the implications of the FDA investigation? If the FDA does not classify AIT sound amplifiers as medical devices, then practitioners can continue providing AIT to their clients. If the FDA does classify AIT sound amplifiers as medical devices, then an investigation will be conducted by the FDA to examine the efficacy of AIT. Practitioners may or may not be able to provide AIT during this interim period; it will depend on the FDA’s decision.

It is in the best interest of AIT to assist the legal experts who will then advise us on what steps should be taken. If you would like to participate in this process, write to SAIT; and your name will be forwarded to the lawyers involved.

Letter from Dr. Guy Berard
It’s a great honour for me to be invited to write a few words of introduction in the SAIT Newsletter.

SAIT is, I believe, the most important and effective way to help spread AIT in the United States and all over the world.

All the contacts that I have had with Dr. Stephen Edelson have convinced me of his deep willingness to keep this new approach to autism and other developmental disabilities to an absolutely professional and ethical standard.

To be successful, SAIT needs the help:

— of all the official authorities involved in the area of autism

— of all the practitioners bringing their own experiences, as they have been doing with me during the years, without any competition, but only collaboration.

As a last word to ask these practitioners to be more than prudent if they wish to modify the procedure that I have taught to them; this is not for me a question of pride, (I am too old for that), but my teaching is the result:

— of nearly 30 years of experience,

— of ten thousand patients treated

— of trials to improve the methods, leading unfortunately to some errors that I would like others to avoid.

Good luck to SAIT.

Best Always,

Dr. Guy Berard

Three AIT Talks Presented at the ASA Toronto Conference
Dr. Guy Berard of France, Carole Swick of Texas, and Tina Veale of Ohio presented talks at the ASA conference in Toronto, Canada. Dr. Berard opened the Friday session by giving the keynote presentation to the entire conference audience of nearly 2,000. As expected, his speech was humorous, historical, and informative. Dr. Berard also signed copies of his recently translated book Hearing Equals Behavior.

Later in the day, Tina Veale presented her research findings on AIT; and Carole Swick discussed her observations as well as reports from parents. Both Tina Veale and Carol Swick were among the first practitioners to offer AIT to clients in the United States.

Audiocassettes of Dr. Berard’s talk (code 930713-410) and Tina Veale’s talk (code 930713-470) can be purchased from Audio Archives International (100 West Beaver Creek, Unit 18; Richmond Hill, Ontario L4B 1H4; Canada) for $7.00 per tape and $4 postage. (Carole Swick’s talk is not available through Archives International.) A two-page listing of all of the audiocassette tapes from the ASA conference is available from SAIT; please enclose a self-addressed stamped envelope.

New President and Location For the Autism Society of America (ASA)
The new President of the ASA is Jackie Rosen. SAIT wishes Ms. Rosen the best of luck in her new position and will be happy to assist ASA on issues involving AIT.

The main headquarters of ASA has recently moved to: 7910 Woodmont Ave., Suite 650, Bethesda, MA 20814. Their telephone number is: (301) 657-0881. A toll-free number has also been established to provide information and referrals. The number is 1-800-3-AUTISM.

SAIT’s New Board of Directors
The votes have been tallied, and SAIT is happy to announce two re-elected members and two newly elected members to the Board of Directors. They are: Monica Doben-Stevens (re-elected, AIT practitioner), Deborah Woodward (re- elected, AIT practi-tioner), Margaret Bauman, M.D. (professional, non-AIT practitioner), and Jon Kaunitz, M.D. (parent).

Three of the seven Board members will remain on the Board for one more year. They are: Sally Brockett, Carol Cloud, and Margaret Creedon, Ph.D. Their positions will be up for election next year.

During the next month, the Board will select a President, Vice-President, Secretary, and Treasurer. These officers will be announced in the next SAIT newsletter.

Why Should the Impedance Level of the Headphones Match the Impedance Level of the AIT Device?
Manufacturers of both the Audiokinetron and the Audio Tone/Enhancer Trainer (BGC) state that the impedance level of the headphones must match the impedance level of the device. The impedance level of the Audiokinetron is 50 Ohms, and the impedance level of the Audio Tone/Enhancer Trainer is 100 Ohms. There are at least three good reasons why the impedance levels should match:

1. A mismatch between the headphones and the devices may lead to an uneven current flow and could cause over-heating and permanent damage to the equipment.

2. The volume level could be affected resulting in the output being louder or softer than desired. (See SAIT President’s comments on pages 5 and 7.)

3. The quality of the output may be distorted.

Music Selection for AIT Machines
There has been some confusion as to what constitutes appropriate music for the Audiokinetron. According to some sources, any music that makes the ‘Efficiency’ lights bounce back-and-forth on the Audiokinetron is appropriate for AIT. However, Dr. Guy Berard recently discussed this matter with Mr. Pierre Suire of SAPP, the manufacturer of the Audiokinetron; and they both agreed that relying solely on this criterion for music selection is inappropriate for AIT and may lead to a less efficient set of listening sessions.

The music used for AIT should cover a wide range of frequencies; but most contemporary music today covers only a narrow range of frequencies. In the Audiokinetron, modulation occurs when the music source contains frequencies below and above 1000 Hz. This triggers the random number generator, which then modulates the output at random between low and high frequencies. Thus, when the music source contains frequencies below 1000 Hz, the Audiokinetron output will be primarily low frequencies (no modulation); and when the sound source contains frequencies below and above 1000 Hz, the Audiokinetron output alternates between low and high frequencies (modulation).

Many contemporary recordings contain only a narrow range of frequencies, mostly between 750 Hz and 3000 Hz. Thus, when music below and above 1000 Hz are presented (e.g., between 750 Hz and 3000 Hz), the ‘Efficiency’ lights will bounce back-and-forth yet the music only covers a narrow range of frequencies.

According to Dr. Guy Berard, Pierre Suire, and Bill Clark (developer of the Audio Tone/Enhancer Trainer (BGC) method), AIT will be most effective when the music covers a wide range of frequencies; thus it should also include frequencies below 750 Hz as well as frequencies above 3000 Hz.

One way to determine whether a music selection covers a wide frequency range is to examine the music using a spectrum analyzer. Some spectrum analyzers can be purchased for $100 to $500. However, the music should be examined on a more powerful device. The cost of such a device starts at about $80,000.

Basically, the less expensive spectrum analyzers can only measure frequencies which occur for a relatively long duration, whereas the expensive devices can measure frequencies for shorter durations. Music containing frequencies which last only a short duration is felt to be best for AIT.

SAIT is compiling a list of some of the more appropriate compact discs for AIT. This list will be distributed to its members as soon as it is completed.

P.E. Tubes and AIT: A Debate
Patchless eustachian (P.E.) tubes are often inserted into a person’s tympanic membrane (ear drum) to drain fluid as well as ventilate the middle ear. This procedure is typically used for children who have recurrent ear infections and children who have fluid build-up due to allergies. A debate has begun over whether children with P.E. tubes should receive AIT.

One side. Dr. Guy Berard has recently stated that AIT should not be conducted on individuals who have P.E. tubes for several reasons. He states that 1) some of the AIT music may travel through the P.E. tube rather than strike the ear drum, and may thus be less effective. 2) the ear drum is not as flexible with a P.E. tube, and the ear drum does not move in an optimal manner for AIT to be effective.

Another side. Some audiologists have questioned this rule of ‘no P.E. tubes while receiving AIT.’ P.E. tubes are usually inserted into a solid, non- flexible part of the ear drum; thus it may have little effect on its movement. In addition, many AIT practitioners around the country who were not aware of this issue have observed improvement in clients who had P.E. tubes.

SAIT recommends that practitioners refer clients to a physician if they suspect any problem and to advise full disclosure to parents about the possibilities of problems with P.E. tubes in place.

If you have given AIT to people with P.E. tubes, please send us information regarding their outcome.

Selecting an AIT Practitioner by 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 back- ground?

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

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

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

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

It has been over two and a half years since my son first received AIT. Changes are slowly occurring. He has gradually become more social. This year he sought interaction with other students in his physical education class, initiated greetings with students, participated fully in class activities, and ‘hung out’ with other students in the commons area during lunch time.

He has demonstrated a sense of humor to teachers and students and even told a couple of jokes.

We have seen an increased willingness to participate in different activities. He is more patient and accepts changes in schedules with no problems.

He now wants to go to the mall, the movies, pot luck dinners, his brother’s boy scout awards dinners, etc. He is more aware of what others are doing as he listens more closely and usually has to read anything he sees us writing. He is more affectionate.

Finally, our son is now employed twenty hours a week, in the mail room at the county court house. This is a paid position with benefits! He has a strong work ethic and should be completely independent at the job within six months.

Update on ASHLA Committee on AIT
The American Speech-Hearing- Language Association (ASHLA) has organized an Ad Hoc committee on auditory integration training (AIT) which will have its first face-to-face meeting in Washington D.C. on September 11, 1993. This committee is a part of the original Ad Hoc Committee on AIT and Facilitated Communication; however, after the first conference call, the amount of information to be considered made it necessary to split the members in charge of this committee into two sub-committees. The chairperson overseeing both committees is David Fabry, Ph.D. from Mayo Clinic in Rochester, Minnesota. The AIT chairperson is Anne Marie Tharpe, an audiologist at Vanderbilt University in Nashville, Tennessee. In addition to Dr. Fabry and Ms. Tharpe, AIT committee members responsible for the preparation of the Ad Hoc report include: Evelyn Cherow, Cathleen Del Polito, Jane R. Madell, Tina K. Veale, and Deborah L. Woodward.

The purpose of the AIT sub-committee is to prepare a technical report on AIT’s impact on audiologists’ and speech-language pathologists’ scope of practice, standards, education, research, and ethics. The technical report will also prepare background resource materials to be used at a later date for the development of preferred practice patterns for AIT for the treatment of autism and other communication disorders. The purpose of this committee does not currently include the development of guidelines for the practice of AIT.

The report hopes to provide general information about AIT, the types of individuals currently involved in AIT, education/training required, the type of equipment used, equipment calibration recommendations as well as AIT candidacy and consumer considerations. The technical report may also include a discussion of AIT practice for Speech-Language Pathologists and Audiologists including the following 1993 Code of Ethics statements:

Individuals shall evaluate the effectiveness of services rendered and of products dispensed and shall provide services or dispense products only when benefit can reasonably be expected.

Individuals shall not guarantee the results of any treatment or procedure, directly or by implication; however, they may make a reasonable statement of prognosis.

The Ad Hoc Committee technical report on AIT is expected to be available late- 1993 or early-1994.

AIT Listeners Speak Out
Comments from AIT listeners can help us understand the effects of AIT and the difference it can make for people:

“I can read longer now because I don’t have to reread the words again to understand them. I know what they mean right away.”

“I feel calmer, less agitated, less irritated, like I don’t have to argue and be angry too much. I can concentrate better. Voices in the background don’t interfere so much.”

“I can do two things at once now, like listen to my teacher and write. I can do my work faster and not act up with the kids easier now.”

“I feel better now. It is easier to be good now.” “I can focus better. I can think better. I can smell things better. I can hear better. My whole body feels differently now. I can see better now. The sound of guns going off in my head has left now.”

“I feel bigger– like I can control myself better.”

“I like auditory training. It helped me and my headaches. It helped the hammering go away. I feel better.”

“There’s something different about me but you can’t see it. I hear differently.”

Sound Level Meters Are Essential: A Comment by Stephen Edelson, SAIT President
In talking with AIT practitioners around the country, I was surprised to learn that some practitioners are not making periodic checks on the decibel level output of their Audiokinetron or Audio Tone/Enhancer Trainer (BGC). Although the devices are designed to prevent, or at least minimize, auditory output above 85 dBA, we feel output testing is essential to protect the listener (as well as the prudent practitioner, from the legal standpoint).

At the Center for the Study of Autism in Newberg, Oregon, we make weekly checks of the equipment and record the results in a log book.

To estimate the output level, the sound level meter should be set at ‘slow response’ on the ‘A’ scale. The receiving end of the meter is placed between the two headphones, and the headphones are then squeezed as much as possible. Several music selections should be tested in order to get an estimate of the dBA output range.

We use a sound level meter (catalogue #332050) from Radio Shack which sells for $35.00, although there are other good inexpensive instruments available.

If you are not using a sound level meter to test the output level of your AIT machine, I strongly urge you to do so.

Basic Information About Auditory Integration Training (AIT)
Based on many of the telephone calls I have received at my research center, it is apparent that confusion exists about AIT. I am writing this letter to provide basic information about AIT as well as to clarify many of these issues.

1. A health care professional should examine the individual’s ears prior to AIT to ensure there is not excessive wax and/or fluid. Excessive wax or fluid may reduce the volume of the AIT input. It is the responsibility of the practitioner to ensure that this has been done prior to AIT.

2. The listener receives 18 to 20 listening sessions, and each listening session lasts for 1/2 hour. In most cases, the listener has two sessions a day for 10 days. The number of sessions and length of the sessions are not subject to change until formal research procedures determine that such changes are beneficial.

3. During the listening sessions, the person listens to processed music. That is, the AIT sound amplifier deletes low and high frequencies at random from the compact discs, and then sends this modified music through headphones to the listener. This random selection of frequencies is termed ‘modulation.’

4. The intensity level (volume) during the AIT listening sessions should not exceed 85 dBA (slow scale) and may be set at much lower intensities depending on the individual’s comfort level. Basically, the music is played at a moderately loud, but not uncomfortable, level. The 85 dBA level for a total of one-hour per day is well below the Occupational Safety and Health Act (OSHA) guidelines for non-hazardous noise levels. The OSHA Noise Standard permits exposure to an average noise exposure of 85 dBA for eight continuous hours. For reference, 85 dBA is approximately as loud as standing 5 feet from a vacuum cleaner, with 92- 94 dBA as loud as wind noise in a car with the window down. It is also important to note that the perception of intensity varies considerably depending on the pitch of the sound. For example, a high-pitched song sung by Carly Simon may be perceived as louder than one sung by a male vocalist such as Gordon Lightfoot even though both may have the same dBA measurement.

5. Audiograms are typically obtained prior to, at the mid-point, and at the completion of the AIT listening session. The first and the mid-point audiograms are used to set filters on the AIT machines. These filters are used to dampen (40 dBA or more) those frequencies which the person hears too well (peaks).

6. Dr. Guy Berard, developer of Berard method of AIT, and Bill Clark, developer of the BGC method of AIT, state that filtering peaks is optional for the developmentally disabled population. In addition, Dr. Bernard Rimland, Director of the Autism Research Institute in San Diego, and I have conducted an empirical study on 350 individuals with various degrees of autism and have found that filtering peaks in one’s hearing is not related to one’s level of improvement using various post-assessment measures. The music is modulated throughout the 10 hours of listening, whether or not peaks are filtered.

7. AIT involves several components including some audiological work, behavior analysis and management, educational issues, and after-care counseling for the client and family. The most satisfactory results can be obtained when a multi- disciplinary team approach is used for the administration of the AIT program. SAIT recommends a multi-disciplinary team which could include (but is not limited to) specialists in the fields of audiology, psychology, special education, and speech/language.

If you should have any questions about AIT, please do not hesitate to contact me or a member of the SAIT Board of Directors.

Stephen Edelson, Ph.D. President