Volume 7 Number 1, 1999

News and Notes
SAIT is offering its members a new service. Members can now receive The Sound Connection through the postal mail, e-mail, or both. If you have not already contacted us and you would like to receive the newsletter via e-mail, please send us an e-mail at: sait@teleport.com Members will receive the newsletter via postal mail unless we hear otherwise.

SAIT recently developed a one-page brochure describing SAIT’s mission to potential members. We would appreciate it if members could help distribute these brochures at seminars, conferences and workshops. Please contact us if you would like to help us out with this.

At the 1999 DAN! Conference, Sidney Baker, M.D., mentioned that he has observed a loss of benefits from AIT in clients who received secretin afterwards. Please contact SAIT if you have also observed similar responses to secretin.

The Scientific Learning Corporation (SLC) now offers new educational software, ‘Away We Go.’ The software provides practice in: phonological awareness; rhyming; letter-name association; colors, shapes, sizes, relational differences; following directions; working memory and mouse-motor skills. Professional and parent versions of ‘Away We Go’ are available.

SLC also offers a new CD-ROM software product, called ‘Reading Edge,’ which measures various pre- reading skills of children in kindergarten to second grade. These skills include: phonological awareness, phonological memory, letter identification and decoding. To learn more about these products, visit their web site at: www.fastforword.com

Earobics has also developed a new product, ‘Earobics 1 for Adolescents and Adults.’ This software program is designed to help readers 12 years and older to spell better, read faster, and comprehend better. The program may also be useful for people who are learning English as a second language.

Advanced Brain Technologies is now offering training courses on ‘The Listening Program,’ a music and sound stimulation method designed to re-train the auditory system. (See The Sound Connection, 1999, Vol. 6, No. 4, for a description of this program.) To obtain general information from Advanced Brain Technologies, call 1-888-228-1798; or visit their web site at: www.advancedbrain.com

Georgiana Thomas, daughter of Annabel Stehli, recently finished writing her autobiography. Georgie describes her early life with autism and how religion played a role in her recovery. She is looking for an agent or publisher. If you know of someone who may be able to help her, write to her in care of SAIT; and we will forward your letter to her.

SAMONAS Sound Therapy: Sheila Frick, OTR
Use of sound as therapy has grown in popularity in recent years, resulting in an increasing number of auditory intervention techniques becoming available. SAMONAS is one such auditory intervention that has recently gained attention as it begins to be used widely throughout the United States, by occupational therapists, speech and language pathologists, psychologists, teachers, and other professionals.

The SAMONAS system includes several specially recorded and activated compact discs and a number of sophisticated pieces of equipment which were designed to enhance the quality and the energetic contents of sound for greater effectiveness when used in a therapeutic context.

Ingo Steinbach developed this unique form of auditory intervention in Germany. Steinbach is a sound engineer with a broad background in music, physics, and electronics. All of the recordings used for SAMONAS are based on the SONAS Principle, the system of optimal natural structure, which makes it possible to maintain the valuable elements and structure of natural sounds throughout the entire process of recording, processing and reproduction. The choice of music is based on the principles of music therapy. Most selections are classical music, and some include nature sounds. A special device called the ‘envelope shape modulator’ enhances the upper frequency range, which activates the recordings. (Thus the acronym SAMONAS: spectrally activated sounds of optimal natural structure.)

Using his strong background in music and physics, Steinbach takes extreme care in every step of the recording process from the selection of the music to the selection of the instruments, musicians, and the location of the recordings. He uses only natural instruments that produce rich harmonic sounds, noting the difference in structure of the sound patterns between electronic and natural sounds. Electronic instruments produce sounds that have a relatively simple structure when compared to acoustical instruments. These sound patterns do not have the same ability to trigger attention and hold our interest in the same way that natural sounds do. Steinbach believes that natural sound is also more effective in energizing the body. All recordings are recorded live in places known for their acoustic qualities. Many of his pieces are recorded in cathedrals throughout Europe and preserve the spatial essence of the recording space.

Steinbach also pays close attention to the emotional state of the musicians. Again, using the guiding principles of physics and his own musical background, he points out that sound is the “carrier wave of intention.” He will only record the musicians when they are playing from “joy.” Although the technical skills of the musicians are apparent, Steinbach believes that the joyful nature of the musicians and their ability to play and communicate together is critically important for music that is used for therapeutic purposes.

The spectral activation and filtering of these uniquely spatial and realistic recordings has been done in a way designed to keep the natural structure of the music intact. When listening to a SAMONAS recording, one would not notice any distortions in the music (this is very different from other auditory interventions that use filtered sound).

Steinbach processes the music on special equipment that has been designed to intensify the high frequencies in the sound structure. These frequencies provide information about directional distance of sounds as well other detailed information about the sound source. In addition to the spectral activation, there are also short passages in the CDs with intensive filtering during which almost nothing but the overtones are heard. This trains the ear to pay attention to these upper ranges in the sound spectrum. Again, the higher tones are the parts of the sound spectrum that captivate our attention and hold our interest. Imagine trying to listen to a lecturer who holds one hand in front of his mouth, dampening the highest frequencies. After a short time it becomes very tiresome and difficult to keep listening. The upper frequencies of the sound spectrum also contain finer detailed qualities about the sound source such as differentiating one voice from another and detecting the emotional qualities that one uses for social cues.

There are several levels of CDs varying in music selections as well as degree of activation. These levels range from SONAS recordings with no additional activation, SAMONAS A which is mildly activated, with SAMONAS levels I and II having increased intensity of spectral activation as well as filtering. The therapist first chooses the appropriate music based on the difficulties of the client and then decides on the level of activation. Not all levels of activation are appropriate for all clients. For example, an intensive level of activation would be an inappropriate choice for an individual who has a history of sound sensitivity. However, this might be a good choice in cases of poor auditory discrimination.

Listening times and protocols are highly individualized. Individual protocols are established through clinical reasoning based on a number of factors including, but not limited to, age, past history, presenting problems, and current assessment data. The daily listening times may also vary greatly from a few minutes per day, up to half an hour. Listening times of longer than an hour per day would be highly unusual. The entire duration of a listening program might also vary greatly from several weeks to several months. Many individuals may also maintain some level of listening as part of an ongoing sensory diet, a planned schedule of sensory activities that one uses to maintain overall self regulation.

SAMONAS has a broad base as far as clinical effectiveness. Through training the ear it sharpens attention and perception, as well as assisting the body in balancing and regulating itself. SAMONAS does not aim to treat specific disorders, rather it is very effective in reducing a number of difficulties in conditions which often have associated sensory processing and perceptual, attention, learning and social difficulties that underlie function. At this time there are a number of ongoing case studies that have been documented and a few formalized research projects that are underway.

These CDs are used in a variety of ways depending on the training and the background of the therapist. The SONAS and SAMONAS A CDs are freely available. SONAS CDs are not spectrally activated, and SAMONAS A CDs are slightly spectrally activated. These CDs are to be used without any special training; however, one should be careful in their use without some background in the use of music therapy and the use of sound as a therapeutic tool. All other levels of CDs are more intensely activated and require advanced training.

At the present time there is one entry module course, Listening with the Whole Body, taught by Sheila Frick, OTR. Steinbach teaches five-day core training along with other therapists who have a number of years of experience working with SAMONAS. The entire process of becoming trained in SAMONAS requires the entry module or other preconditions such as prior work with other sound techniques or self study, the completion of a five-day course, one year of practical work with SAMONAS, and written presentation of several case studies that demonstrate a sufficient level of understanding and competency.

Those interested in becoming trained in the use of SAMONAS should contact SAMONAS International at 608-278-7075 or Fax at 212-898-0177. More information is also available online at www. Samonas.com.

Impedance Level and Headphones
Although several articles on impedance level have appeared in previous issues of The Sound Connection, we still receive questions regarding this topic. Basically, a mismatch between the impedance level of the AIT device and the headphones can lead to a significant change in the sound output level as well as a reduction in the quality of the output.

A case in point. The maximum sound level of the Audio Tone Enhancer/Trainer is 80 dB SPL at 1 milliWatt using 100 ohm impedance level headphones (page 12, BGC Enterprises, 1991). Their manual states: “Warning: Changing headphones to other than those recommended will change output sound pressure level (SPL)” (page 2, BGC Enterprises, 1991). In a recently published study, Zollweg, Palm, and Vance (American Journal of Audiology, 1997, Vol. 6, pp. 39-47) used Realistic PRO-60 headphones. The impedance level of the Realistic headphones is 92 ohms at 1 milliWatt, and this reduction in impedance markedly increased the sound level of the AIT device. The difference between the impedance level recommended by BGC Enterprises and the Realistic headphones used in the Zollweg et al. study translates into a 400% increase in the sound pressure level. In fact, Zollweg et al. reported average output levels much higher than the recommended 80 dB SPL, ranging from 103 dB SPL to 115 dB SPL for the “most commonly used volume settings” in their study. Zollweg et al. stated “The highest level recorded for any track was 122 dB SPL on the linear scale and 120 on the dBA scale” (page 43).

In their study, Zollweg and his colleagues found no difference between subjects who received AIT and subjects who received a placebo (both groups improved following the AIT listening sessions). The extremely high volume level may have affected their results, and it could also have put the participants in their study at unnecessary risk for noise-induced hearing loss.

It is critical that all AIT practitioners use the correct impedance level.

The impedance level for the AudioKinetron is 50 ohms. SAPP recommends using Beyerdynamic’s headphones, Model DT-100. You can contact Beyerdynamics at: 56 Central Avenue, Farmingdale, NY 11735; telephone: (516) 293-3200; fax: (516) 293- 3288. The impedance level for the Audio Tone Enhancer/Trainer is 100 ohms. There are several companies which sell headphones with a 100 ohm impedance level. BGC Enterprises recommends using KOSS headphones, Model HV/PRO. KOSS also makes another headphone set, Model SB-30, that has a 100 ohm impedance. Contact 1- 800-USA-KOSS to locate a KOSS dealer in your area. Please note: these headphones come with a lifetime warranty.

Another Look at Narrow Band Filtering: Critical or Helpful?
Stephen M. Edelson and Sally Brockett
There is some confusion in the field of auditory integration training (AIT) about whether narrow band filters are necessary. Basically, the standard procedure for AIT is to follow a specific protocol in activating narrow band filters for those frequencies to which the person is hypersensitive. These frequencies can be determined by looking for peaks in a person’s hearing test. These peaks do not necessarily correspond to frequencies which are perceived as painful, but they appear to correspond to frequencies which a person hears too well (see The Sound Connection, 1996, Vol. 4, No. 1; 1996, Vol. 4, No. 2 ).

Although Dr. Guy Berard and many practitioners feel strongly that narrow band filters are critical for the success of AIT, two studies conducted by Drs. Rimland and Edelson have shown that narrow band filters may not be needed for AIT to be effective, at least with those on the autism spectrum. (Note: that when narrow band filters are not utilized, the listener still hears modulated music.) Furthermore, if modulation is the critical factor during the AIT listening sessions, then activating narrow band filters will decrease the amount of auditory stimulation because filters produce gaps in the modulated music. Thus, AIT listening sessions may actually be less effective.

In a previous issue of The Sound Connection (1997, Vol. 4, No. 4), we reported a case in which an autistic adult was hypersensitive to two frequencies, as evident in his audiogram. When filters were activated at 2,000 and 8,000 Hz, he felt fine and enjoyed listening to the AIT music. However, when the filters were removed, he felt quite ill.

This case may provide us with insight into the usefulness of narrow band filtering. Perhaps narrow band filters may be necessary during the AIT listening sessions because they may increase comfort while listening. That is, if a person hears one or more frequencies too well, the AIT music may be overwhelming, especially if these frequencies are presented rather intensely during the listening sessions.

One implication of this hypothesis can be applied to individuals who are unable to complete the hearing test. When a person’s hearing cannot be assessed, the standard AIT procedure is not to use narrow band filters. However, in some cases, these individuals may not be comfortable during the listening sessions. Perhaps they are hearing certain frequencies too well. It may be advantageous to try single as well as combinations of narrow band filters to see if the person’s distress can be reduced or eliminated during the early listening sessions. After a few sessions, the listener may be comfortable and able to continue without the filters. This proved successful in the case of a young, nonverbal child with autism who was initially very restless and resistant to listening. After three sessions with 2,000 and 8,000 filters, he was able to continue listening happily without the filters.

It is also important to remember that Dr. Berard’s experience was primarily with learning disabled individuals as opposed to those on the autism spectrum. It may be that filters help in fine tuning the auditory system for those with less severe disabilities. A clinical study based on the use of filters versus no filters with the learning disabled population would be useful.

If AIT practitioners try this new procedure, we would be very interested in hearing how the sessions progressed and how the individuals later responded to AIT.

AIT: Behavioral, Brain Changes Seen
In auditory integration training (AIT), participants listen through headphones to electronically filtered and modulated music for 20 half-hour sessions. A new study supports earlier research showing that AIT can be effective in reducing behavior problems in autistic individuals, and also indicates that AIT may improve the brain’s ability to process [auditory] stimuli.

Stephen M. Edelson and colleagues divided 19 children and adults into two groups, one which received AIT, and another which listened to unmodified music through headphones. Both study participants and evaluators were ‘blind’ as to which children were receiving the real treatment.

The researchers asked parents to evaluate their children’s behavior prior to and for three consecutive months after receiving the therapy. (Previous research indicates that gains from AIT appear three months after the therapy.) Parents were asked not to begin any new therapies during the three-month period following the intervention.

“A significant decrease in Aberrant Behavior Checklist scores was observed in the experimental group at the three-month follow-up assessment,” Edelson et al. say. Two other behavioral checklists did not show significant changes.

Of the study participants, three who received AIT and two in the placebo group were able to participate in a brainwave measurement test called the P300 ERP (Event Related Potential), which is used to evaluate the brain’s ability to process stimuli. Prior to the beginning of the study, all participants had abnormal P300 ERPs. “Three months following AIT, all three treated participants showed a dramatic improvement in their auditory P300 ERP,” the researchers say, “whereas none of the participants in the placebo group showed change.”

Edelson and colleagues note that AIT, originally believed to benefit only sound-sensitive autistic individuals, appears to beneficial for many who are not sound-sensitive as well.

Auditory Integration Training: A double-blind study of behavioral and electrophysiological effects in people with autism,” Stephen M. Edelson, Deborah Arin, Margaret Bauman, Scott E. Lukas, Jane H. Rudy, Michelle Sholar, and Bernard Rimland, Focus on Autism and Other Developmental Disabilities, Vol. 14, No. 2, pp. 73- 81.

This summary appeared in the Autism Research Review International (ARRI), 1999, Vol. 13, No. 3, p. 5. The ARRI is published quarterly by the Autism Research Institute (4182 Adams Ave., San Diego, CA 92116).

[Editor’s note: Narrow band filters were not employed in this study. Participants listened to only modulated AIT music.]

Auditory Integration Training for Autism: Effects on Harmful and Stigmatising Behaviours
Research study conducted by: Chris Cullen and Oliver Mudford of Keele University, Staffordshire, England; and Lorna Wing and Richard Millis of the National Autistic Society,London, England

Objective: To assess behavioural, cognitive, social/adaptive, and audiological changes following auditory integration training (AIT).

Design and Subjects: Repeated measures crossover design with subjects receiving both AIT and a control (placebo) therapy. All persons involved in obtaining [outcome] measures were blind to treatment order. Sixteen children with autism who attended special needs educational services aged 5;09 to 13;11 completed the study. All had parent-and teacher-reported problem behaviours.

Main Outcome Measures: Parent- and teacher-completed rating scales of behaviour problems; direct observational recordings of behaviour; standardised tests of IQ, language, and social/adaptive behaviour; audiometrics; parents’ anecdotal reports concerning behaviour changes following treatment.

Results: No results favoured AIT over control. To the contrary, significant differences (p<.10, 2-tailed) tended to show that the control condition was superior on parent-rated measures of hyperactivity and on direct observational measures of ear-occlusion. No differences were detected on teacher-rated measures or on audiological measures. Across the whole study, children’s IQs and language comprehension did not increase, but adaptive/social behavioural scores and expressive language quotients decreased. The majority (56%) of parents were unable to report in retrospect when their child had received AIT. No individual child was identified as benefiting clinically or educationally from AIT

Conclusion: Previous claims for the benefits of AIT in reduction of problem behaviours and increases in IQ and adaptive/social skills were not supported by the results. AIT may divert parents’ and service providers’ resources from better-validated interventions.

This summary was posted on the Internet at: http://www.epi.bris.ac.uk/rd/national/pcd/funded/completed/a1232es.htm

Editor’s Note: These results are quite puzzling for several reasons: (1) The results contradict those of prior AIT studies; (2) No change was noted in those participants who received AIT; and (3) those in the placebo group improved significantly (not by chance) on two outcome measures. :

SAPP Corporation Will Manufacture Three New AIT Devices
SAPP Corporation recently announced plans for their new auditory integration training device, the INTEGRAL Learning System. SAPP Corporation will be manufacturing three different models: one without narrow band filters (Model SC200), one with narrow band filters (Model SC250), and one with narrow band filters and a microphone (Model SC300). All three models will have an upper limit volume setting of 80 dB.

SAPP Corporation recently obtained UL approval for their three devices. Sally Brockett, Director of IDEA Training Center, Inc. will conduct training seminars in the Berard method for these devices. The INTEGRAL Learning System is for educational purposes and does not fall under FDA regulation. These devices are updated versions of the French-made Berard device manufactured by SAPP. The sale of devices will be restricted to qualified professionals who receive training in this method. The devices will be available in the U.S. from Walt Brockett. Contact Sally Brockett for information on the training seminars at 203-234-7401 or ideasb@cshore.com.

More Music for the Mind
In a previous issue of The Sound Connection, we reviewed the research on the ‘Mozart Effect’ (1999, Vol. 6, No. 2). In general, the research findings were mixed; and the ‘Mozart Effect’ has been documented to last for only a short time following a presentation of Mozart’s music, about 15 minutes. These research findings have sparked great deal of interest in the use of classical music to stimulate the brain in babies, children and adults.

Apparently as a result, Philips Classics, a division of PolyGram records, has delved into their vaults of classical music and has repackaged many of their old classical recordings. Some of their releases along with the packaging descriptions include:

Bach for Babies — fun and games for budding brains

Beethoven for Babies — brain training for little ones Beethoven at Bedtime — a gentle prelude to sleep

Mozart for Mother-to-be — tender lullabies for mother and child

Mozart for Your Mind — boost your brain power

Baroque at Bathtime — a relaxing serenade to wash your cares away

Bach at Bedtime — lullabies for the still of the night

We counted a total of 41 different CDs. Whether or not these recordings can make a significant difference in cognitive development, future generations may develop appreciation for the great classical composers and may care little for the Beatles, Bob Dylan, and the Rolling Stones.

International Association of Berard Practitioners: January, 2000 Conference Planned
The first conference sponsored by the International Association of Berard Practitioners will be held in Antwerp, Belgium on January 27, 2000. Speakers will include: Dr. Guy Berard, “Foundation of the method, its evolution, and its actual status;” Dr. John F. Unruh, “The influence of AIT on the practice of rehabilitation of the brain injured: A historical perspective;” Dr. Paul Deltenre, “Physiological mechanisms of auditory perception;” Dr. Wayne Kirby, “The effects of AIT on children diagnosed with attention deficit/hyperactivity disorder;” and Sally Brockett, “Aftercare: Often overlooked and misunderstood.”

Several SAIT members will be in attendance, and we will summarize the highlights of the conference in the Spring, 2000 issue of The Sound Connection.