Volume 5 Number 1, 1997
Georgie resides in Corvallis, Oregon where she works as an artist and is writing an autobiography.
Our congratulations to Georgie and her husband, Tom (also, see related article on page 7).
A child with dyslexia and an adult with high functioning autism were tested pre and post AIT. The first recording demonstrated relatively large responses in the areas in the brain associated with hyperacusis. Following AIT, the responses were normalized which indicated a restoration of balance or symmetry. Dr. Lewine is hoping to track such differences over a more extended time period.
In a talk entitled ‘Review of Autism Treatments,’ Luke Tsai, M.D. briefly commented on auditory integration training. He referenced only one study, conducted by Sue Bettison in Australia. Her study involved 80 subjects, with 40 receiving AIT and 40 receiving unfiltered music. Since the results of this study did not show a significant difference between the two groups, he concluded that it may be as effective as simply presenting unfiltered music to the child in a home setting.
Dr. Tsai did not mention some of the short-comings of the Bettison AIT study (see The Sound Connection, Vol. 4, No. 1, 1996). Since Dr. Tsai stressed the importance of studies with a large number of subjects to assure statistical significance, it is surprising that he did not also comment on the Rimland and Edelson study with 445 subjects, published in 1994, which yielded positive results.
Barry Gordon, M.D., Ph.D. presented a seminar entitled `Improving Auditory Comprehension through Auditory Attention Training.’ Dr. Gordon described a 4 1/2 year old boy who failed to comprehend spoken words due to an apparent disregard for auditory stimuli.
A discrete trial teaching format was used to teach the child to imitate a visually presented activity (sit down). The same activity was then taught as a verbal command which requires auditory comprehension. The child could not learn the activity when auditory comprehension was required. Auditory attention was trained successfully by requiring the child to point to a wooden block immediately after hearing a tone. Reinforcement was provided when the child delayed his response until the tone was presented, and responded within 3 seconds after the end of the tone. The results suggest that auditory attention can be effectively trained through the discrete trial format and that this is an important factor in teaching auditory comprehension. The auditory attention training only required a few days of training.
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Methods. Nine children, age ranging from 3 to 16 years, participated in this study. This included 8 males and 1 female. Assessment measures included two diagnostic checklists–the Childhood Autism Rating Scale (CARS) and the Autism Behavior Checklist (ABC). Subjects were evaluated prior to and nine months following AIT listening sessions.
Results. Gillberg et al. compared differences between pre- and post-assessment measures for the subscales on these two checklists. Eight of nine children did better on the ABC total score after AIT, and 7 of 9 did better on the ABC sensory subscale. Using standard statistical procedures on the data , which was reported in the article, showed significant, favorable results. However, Gillberg et al., using the inappropriate Berferonni statistical procedure, reported the results to be negligible. Strange!
Comments. There are several shortcomings of this study, and these are listed below.
1. There were no control groups for comparison.
2. Gillberg et al. assessed behavioral change using two diagnostic checklists- the CARS and the ABC. The authors of these checklists, Eric Schopler and David Krug, have stated that they were not designed to evaluate treatment outcomes.
3. Although the significance level was set at 0.005 to compensate for a relatively large number of pairwise comparisons, 20, this significance level is typically not recommended when analyzing the data of such a small sample size.
4. Arnold Barnett, Ph.D., Professor of Operations Research at MIT, noted that “in 15 of the 17 pre-post comparisons in which the child’s score changed, it declined after AIT.” Thus, another interpretation of the findings would be that the participants improved following AIT.
SAIT’s Board of Directors elected officers for the 1997 – 1998 term. The officers and positions are: Stephen M. Edelson, Ph.D., President; Sally Brockett, M.S., Vice-President; Rose Marie Davis, M.A., CCC/A, Treasurer; and Cherri Saltzman, Secretary.
Dr. Geffner is a professor at St. John’s University and the Director of the Speech and Hearing Center in Jamaica, New York. She and her colleagues have conducted several studies on the efficacy of auditory integration training (AIT) on children with Attention Deficit/Hyperactivity Disorder. Their findings have consistently shown positive improvements as a result of AIT.
SE: Would you like to discuss some of your work on AIT?
JP: Yes. I obviously got into AIT on yours and Bernie Rimland’s coat- tails. We also were coaxed into it by the parents in this region [Northwest Ohio] who wanted to have the treatment available for their children. We were able to organize a free clinic for them. We conducted several evaluations that were not too cost intensive and did not require too much time. Basically, we found essentially what you did–using the same scales you used, a broad spectrum of improvements was evident. As a result, we became more interested in trying to develop an animal model to explain the changes. We exposed young newborn birds to music for 10 days, giving them the classic AIT treatment (modulation only) using the BGC system; and every study has yielded statistically reliable changes in both behaviors and neurochemistries. Typically however, the animals receiving the unmodulated control music have exhibited comparable effects. In any event, the changes could be interpreted as positive behaviorally as well as chemically. For instance, the neurochemical change resemble what would be expected for an anti-depressant effect.
SE: This is quite interesting.
JP: It really is. We are now planning a study to evaluate music as an anti-depressant. Perhaps an unfortunate pattern, at least for those who are strong AIT proponents, is that music alone has typically had as much affect as AIT. My suspicion is that the extra frills that are added to music using the AIT variables contribute rather little to the overall benefits. The biggest benefit may simply be systematic exposure to attention-grabbing music in a systematic well-controlled manner.
SE: This would be consistent with Sue Bettison’s work.
SE: How soon after AIT exposure did you assess behavioral and biochemical changes in the chicks?
JP: All of behavior was done at mid-treatment and within 48 hrs of the end of the treatment.
SE: Is it possible that a 3-month post assessment may have provided additional results or possibly no results?
JP: Perhaps, but we were not set up to keep a chicken farm running in the animal facility; and we really did not expect to find such striking changes. Lots of follow-up is needed, but we really do not have the resources to do much more on that right now.
SE: Given that the studies involved normal hearing chicks, is it possible that those with abnormal hearing (chicks and people) may show additional benefits? Also, could this possibly explain why you found positive changes in both the modulated and non-modulated groups?
JP: Those are possibilities, but without data I could not hazard more than a guess, and at this point my opinion would be not worth much more than a coin toss.
SE: Is it possible that the modulation used in AIT makes the whole experience more intense?
JP: Certainly, and more attention-grabbing. There is no doubt some variability as to which children respond best to what type of music. I think that simply listening to music through headphones makes the music attention- grabbing. If you do not wear headphones, then the music is simply in the background–it is not actively attended to.
SE: Since the chicks did not wear headphones in your studies, is it possible that you could have observed greater changes as a result of AIT? and is it possible that you might have found a difference between the modulated and non-modulated groups?
JP: It is possible, but headphones for the chicks would have been an incredible nuisance.
SE: I guess another way to look at this idea of `attention-grabbing’ is that autistic individuals often have attention deficits. By having them listen to attention-grabbing music for 30 minutes sessions, they are being conditioned to attend for relatively long periods of time.
JP: Yes, and this might be an important component. If the sound just gets into your attention systems, some important brain systems are more vigorously exercised. I know that you collect AIT theories, which one is your favorite?
SE: Those theories that deal with attention.
JP: Those are my favorite too.
SE: In Sue Bettison’s study, she found no difference between an experimental (AIT) group and a placebo group. The placebo group heard the same music as the experimental group, but the music was unmodulated. Some people do not realize that the music given to the placebo group was not your ‘ordinary, everyday’ type of music. It was carefully selected to enhance the effects of AIT. The music had a very good tempo and involved frequencies over a wide spectrum. This criterion fits only approximately 5% of the music available on the market. Can you describe to us the results of your most recent study?
JP: In our last chick study, we used the EASe discs which were produced by Bill Mueller. He also sent us the same music but unmodulated. Interestingly, the unmodulated music had a larger affect than the modulated version. Overall, both the unmodulated and modulated versions had rather spectacular effects on whole brain neurochemistries. The biggest effects were on brain norepinephrine which is clearly involved in brain attentional processes. We had two additional groups–one involved listening to an audiotape of male and female voices and the other one did not involve listening to any sounds. We did not see any chemical changes in birds that simply listened to human voices.
I used to ask my patients to give me a detailed report of their condition three months after the end of their treatment. I was sometimes surprised to be informed, in addition to the concerns relevant to the problems for which they had been treated, that some unexpected responses had occurred:
— Sight: Several patients told me that their sight had changed, generally improved, and that they had to change their glasses, by reducing the necessary diopters. An explanation can be proposed in thinking that with the brain cells of sight begin very close to those of hearing. AIT may increase the blood circulation in this area. The vision cells could take advantage of this physiological situation. This is just an opinion, not scientific assertion.
— Hand dominance: Left-hand dominance changing to right handedness was sometimes indicated; and the opinion expressed previously can be suggested for this change as well. I used to tell my trainees the story of a mother who was anxious because her daughter was left-handed. I was treating this girl for her learning disabilities, and her mother used to inform me of the improvement at school; but she continually complained about the persistence of the left-hand dominance. All of a sudden, six months after the end of AIT, she phoned me, excited and enthusiastic: “Dr. Berard, my daughter has become right- handed during the night! She asked me why I had put her teacup with the handle on the left side, and this seemed wrong for her!” Maybe the connections between the billions of synapses was modifying everyday, according to the different sounds of the environment, until the moment when the last contact was established at the place for the left brain to control the right hand.
As I have always indicated, the aim of AIT is to correct hearing problems. AIT should not be considered to change conditions such as vision, hand dominance, or other problems. Practitioners of AIT will observe some other responses at times; and if these are noted frequently, it would be good to share these observations with SAIT.
Editor’s Note: These are fascinating observations. The Sound Connection welcomes related input from our readers.