Volume 7 Number 4, 2000
Eric Courchesne of the University of California at San Diego has found significant impairments in auditory processing in autistic individuals using P300 brain wave technology (see Courchesne, 1987 for a review). The P300 brain wave occurs 300 milliseconds after the presentation of a stimulus. (The ‘P’ refers to the positive polarity of the brain wave.) The P300 is associated with cognitive processing, and this brain wave is considered an indication of long-term memory retrieval (Donchin, Ritter, & McCallum, 1978). Edelson et al. (1999) examined auditory P300 activity prior to and three months following auditory integration training (AIT). Three autistic individuals participated in the experimental AIT group and two autistic individuals participated in a placebo group. Prior to AIT, all five individuals had abnormal auditory P300 activity, indicating an auditory processing problem. Three months following AIT, the results showed dramatic improvement in P300 activity for those who received AIT (i.e., a normalization of P300 activity) and found no change in those who received the placebo.
We do not know the underlying reason for auditory processing problems in autism; however, autopsy research by Drs. Bauman and Kemper have shown that an area in the limbic system, the hippocampus, is neurologically immature in autistic individuals (Bauman & Kemper, 1994). The hippocampus is responsible for sensory input as well as learning and memory. Basically, information is transferred from the senses to the hippocampus, where it is processed and then transferred to areas of the cerebral cortex for long-term storage. Since auditory information is processed in the hippocampus, the information may not be properly transferred to long-term memory in autistic individuals.
Auditory processing problems may also be linked to several autistic characteristics. Autism is sometimes described as a social-communication problem. Processing auditory information is a critical component of social-communication. Other characteristics that may be associated with auditory processing problems include: anxiety or confusion in social situations, inattentiveness, and poor speech comprehension.
Interestingly, those individuals who do not have auditory processing problems are often ‘auditory learners.’ These children do very well using the Applied Behavior Analysis (ABA) approach, whereas those who are visual learners do not do as well with this approach (McEachin, Smith & Lovaas, 1993). Given this, one might suspect that many visual learners have auditory processing problems and that visual learners will do quite well with a visual communication/instruction approach. It is also possible to provide visual support with ABA programs that have an auditory component. In this way, the visual learner can process the auditory information more easily.
The better autistic children understand auditory information, the better they can comprehend their environment, both socially and academically. The better we understand the autistic child, the better we can develop ways to intervene in an effective manner.
Bauman, M.L., & Kemper, T.L. (1994). Neuroanatomic observations of the brain in autism. In M.L. Bauman & T.L. Kemper (Eds.), The neurobiology of autism. Baltimore: Johns Hopkins UP.
Courchesne, E. (1987). A neurophysiological view of autism. In E. Schopler & G.B. Mesibov (Eds.), Neurological issues in autism. New York: Plenum Press.
Donchin, E., Ritter, W., & McCallum, W.C. (1978). Cognitive psychophysiology: The endogenous components of the ERP. In E. Callaway, P. Tueting, & S. Koslow (Eds.), Event-related brain potentials in man. New York: Academic Press.
Edelson, S.M., Arin, D., Bauman, M., Lukas, S.E., Rudy, J.H., Sholar, M., & Rimland, B. (1999). Auditory integration training: A double-blind study of behavioral, electrophysiological, and audiometric effects in autistic subjects. Focus on Autism and Other Developmental Disabilities, 14, 31-62.
McEachin, J.J., Smith, T., & Lovaas, O.I. (1993). Long-term outcome for children with autism who received early intensive behavioral treatment. American Journal of Mental Retardation, 97, 359-372.
Bettison (1996). This large-scale study involved 80 children who were diagnosed with autism or Asperger syndrome. The study involved a placebo-control experimental design, and follow-up measures were obtained over a 12-month period. The results indicated improvement in both the experimental (AIT) and placebo groups, but there were no differences between the two groups.
Shortcomings: One of the primary measures used to investigate changes in sound sensitivity was a modified version of the Hearing Sensitivity Questionnaire designed by Rimland and Edelson (1991). The checklist was designed only as a survey of sound sensitivity in the autism population and not a checklist to evaluate treatment effectiveness. Additionally, Bettison developed a scoring method for this checklist that was designed to provide a measure of the person’s degree of sound sensitivity. Unfortunately, this scoring method did not even have 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 used as 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 not designed to measure treatment effectiveness. When evaluating the efficacy of an intervention, it is important that the proper measurement tools are used; otherwise, the findings will be invalid.
Zollweg, Vance and Palm (1997). Zollweg et al. studied the effects of AIT on 30 subjects who were diagnosed as having either mental retardation or autism. Follow-up measures were conducted 3, 6 and 9 months post-AIT. Both groups improved over the 9- month assessment period, but there were no differences between the two groups.
Shortcomings. There are several problems with this study. First, fewer than a third of the subjects had autism; thus one cannot generalize these findings to the autism population. There are no claims made in the scientific literature that AIT will be effective for mentally retarded individuals. 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, one should not even generalize these findings to the mental retardation population.
Gillberg, Johansson, Steffenburg, & Berlin (1997). Nine autistic children were evaluated over a 9-month period. A control group was not employed in this study. Gillberg concluded that there were no changes as a result of AIT in these children.
Shortcomings. This study has several serious problems. Gillberg relied on two diagnostic checklists to measure changes as a result of AIT, the Childhood Autism Rating Scale (CARS) and the Autism Behavior Checklist (ABC). Neither checklist was designed to evaluate treatment effectiveness. Additionally, Gillberg et al. used 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 virtually guarantees that no treatment will be found effective. A reanalysis of the data by Rimland and Edelson (1998) indicated a statistically significant difference for the ABC total score at the .01 level and for the ABC sensory subscale at the .02 level. Gillberg et al. (1998) later stated “… a moderate reduction in sensory problems may have occurred” (p. 94). Seven of the nine children showed improvement. Thus, contrary to what Gillberg et al. say, the results were definitely positive.
Howlin (1997). Howlin criticized a controlled-placebo AIT study (Rimland and Edelson, 1995) by stating that the statistically significant differences on two measures were clinically not important.
Shortcomings. Howlin (1997) criticisms were based on her misunderstanding. 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 Aberrant Behavior Checklist (ABC) 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 Fisher Auditory Problems Checklist (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.
Mudford et al. (2000). Mudford et al. conducted an AIT study involving a double-blind crossover design. A total of 16 autistic children participated in the study, and their behaviors were evaluated over a 4-month period. Significant improvement was documented on two measures for those in the placebo group—a decrease in hyperactivity and a decrease in ear-occlusion.
Shortcomings. The significant improvements for those in the placebo condition were dismissed by the authors, but it is quite possible that these improvements may have been due to receiving 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 improvements in the placebo group are consistent with findings associated with AIT; and (b) Rimland and Edelson (1994) and Gillberg et al. (1997) documented improvement up to 9 months following AIT. In their study, Mudford et al. did not consider the possibility that the improvement in the placebo condition may have been due to receiving AIT eight months earlier. The authors refused to analyze their data to evaluate this hypothesis, claiming that additional analyses of their data will increase the likelihood of error. Their conclusion is unwarranted. Reanalysis of their data could very well decrease the likelihood of error. One cannot unequivocally state that AIT was ineffective in this study unless the data are examined to see if the significant improvements observed in the placebo condition were due to receiving AIT earlier. Here again we see an eagerness to declare AIT ineffective when the data do not support such a conclusion.
Bettison, S. (1996). The long-term effects of auditory training on children with autism. Journal of Autism and Developmental Disorders, 26, 361-374.
Gillberg, C., Johansson, M., Steffenburg, S., & Berlin, O. (1997). Auditory integration training in children with autism: Brief report of an open pilot study. Autism, 1, 97-100.
Gillberg, C., Johansson, M., Steffenburg, S., & Berlin, O. (1997). Auditory integration training in children with autism: reply to Rimland and Edelson [Letter to the Editor]. Autism, 2, 93-94.
Howlin, P. (1997). When is a significant change not significant? [Letter to the Editor]. Journal of Autism and Developmental Disorders, 27, 347-348.
Mudford, O.C., Cross, B.A., Breen, S., Cullen, C., Reeves, D., Gould, J., & Douglas, J. (2000). Auditory integration training for children with autism: no behavioral benefits detected. American Journal Mental Retardation, 105, 118-129.
Rimland, B., & Edelson, S.M. (1994). The effects of auditory integration training in autism. American Journal of Speech- Language Pathology, 5, 16-24.
Rimland, B., & Edelson, S.M. (1995). Auditory Integration Training: A Pilot Study. Journal of Autism and Developmental Disorders, 25, 61-70.
Rimland, B., & Edelson, S.M. (1998). Response to Howlin on the value of auditory integration training [Letter to the Editor]. Journal of Autism and Developmental Disorders, 28, 153-154.
Rimland, B., & Edelson, S.M. (1998). Auditory integration training in children with autism [Letter to the Editor]. Autism, 2, 91-92.
Zollweg, W., Vance, V., & Palm, D. (1997). The efficacy of auditory integration training: A double blind study. American Journal of Audiology, 6, 39-47.
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.
Introduction. Virtually all forms of therapy involving auditory stimuli require an understanding of frequency spectrum analysis concepts and techniques. The purpose of this article is to present a brief overview of what spectrum analysis is, how it is done, and where to find some appropriate software.
Spectral content of music and sound. According to the 19th Century French mathematician, Jean Baptist Fourier, all sounds comprised of periodic sound waves can be recreated by adding a series of sine waves together at varying amplitudes (what we perceive as “intensity” or “loudness”). Spectrum analysis is a method of identifying the frequencies (and their corresponding amplitudes) present in a sound by performing a computational process known as a Fast Fourier Transform.
The importance of spectral analysis. Practitioners of auditory intervention techniques should be aware of the spectral content of the stimuli they are delivering to the auditory systems of their clients, students, or trainees. This is particularly important for professionals who practice the Bérard and Kirby Methods of Auditory Integration Training (AIT) as well as many other sound- and music-based interventions.
It has been theorized that broad spectrum sound is particularly important in creating AIT stimuli for several reasons. Modulating sound by dynamically modifying the relative amplitude of key spectral components of music appears to stimulate the entire auditory system, including the conductive, sensorineural and retrocochlear mechanisms. Additionally, insuring the presence of the appropriate spectral content allows for effective notch-filtering of masking frequencies. This filtering procedure facilitates the subject’s perception of the otherwise masked (and therefore unperceived) stimuli. Masking phenomena may account for the auditory perception anomalies of some subjects. For example, a person who has a significant hypersensitivity to a particular frequency may be unable to perceive neighboring frequencies within the corresponding critical band due to amplitude masking. Without ascertaining, through spectral analysis, that the appropriate spectral content is contained in the music, the potential benefits gained from notch- filtering hyper-sensitive frequencies can not be realized.
Spectral analysis techniques. Real Time Analyzers (RTAs): These devices are commonly used by professionals in the audio industry. They are dedicated hardware- based digital audio processors. The KAM PC-based auditory delivery system I developed for AIT practitioners includes the capability of viewing spectral content in real time using this kind of digital audio processor.
Non-real time analyzers: These systems are generally computer-based. In essence, they are data acquisition systems that can perform very complex mathematical processes on the acquired audio data. Usually, the sound to be analyzed is recorded into the computer by connecting the output of the CD player, AIT device or other audio component directly to the input of the computer’s sound card using the appropriate audio adaptors. The signal is recorded onto the hard drive of the PC. The stereo signal can then be viewed on the computer screen as a waveform graph representing the varying overall intensity of the sound over a specific period of time (FIGURE 1). [Figures located on www.seriouscomposer.com/Spectrum_Analysis.htm/]
The user may select a portion of the waveform he/she wishes to analyze. The computer then performs the mathematically complex Fast Fourier Transform (FFT) operation on the selected waveform region. This process converts the visible waveform graph representing sound in the time domain to either a spectrum graph (FIGURE 2) or a sonogram (FIGURE 3). Both types of graphs represent the waveform graph’s conversion into the frequency domain. The resulting graphs depict the intensity of each frequency over a specific time period.
Available software There are a number of computer programs available for spectrum analysis. I often use the spectrum analyzer function in Sound Forge, a professional audio software package manufactured by Sonic Foundry, Inc. However, there are a number of other programs available over the internet that are either shareware or freeware. You can find links to a number of these programs at http://www.hitsquad.com/smm/cat/SPECTRUM_ANALYZERS. This site provides download links to a wide variety of spectrum analysis programs for MacIntosh, Windows, Linux, Atari and other operating systems. One popular software program that contains a spectrum analysis function is Cool Edit. You can download an early shareware version of Cool Edit ’96 at http://www.seriouscomposer.com. This program is designed to be run under Windows 9x. This software will allow you to record the music you wish to analyze on your hard drive via your sound card directly from your CD player, AIT device or other audio component. You can then analyze various sections of the sound sample by clicking on the desired points in time represented on the waveform graph. You can also set the software to show the fluctuating amplitudes of the spectral content in real time (as the sound sample is playing). If you find this demonstration program useful, you can obtain additional information on a fully functional version of the software from Syntrillium Software Corporation at http://www.syntrillium.com.
Conclusion Knowledge of spectrum analysis theory and practice is essential to the effective application of the many varieties of auditory intervention techniques currently being practiced. I hope that this article will help to convey the value of objective measurement and analysis of the auditory stimuli that form the basis of this continually-evolving music technology.
About the Author Wayne J. Kirby is the creator of the KAM System, an upgradeable software- based auditory delivery system for AIT and other stimuli. He can be contacted at The AIT Center, 383 Merrimon Avenue Asheville, NC 28801. Telephone: 828-254-7160; fax: 828-253-4573; email: email@example.com; website: http://www.seriouscomposer.com
Copyright © 2000 Wayne J. Kirby.
All Rights Reserved Worldwide.
No part of this publication may be reproduced in any form or by any means without prior written permission of the copyright owner. International
The clinical trials involve assigning individuals with autism or other disabilities, such as ADD or language disorders, at random to either the AudioKinetron or the Earucator. Parents do not know to which device their son/daughter is assigned. After all of the assessments are completed, audiological and behavioral comparisons will be made between the two groups. These trials are being conducted in Connecticut, Texas, and California. A clinical trial may be conducted in Missouri this fall.
At the present time, we are not aware of any ongoing or completed research assessing the efficacy of the Electronic Ear (Tomatis method), the AudioScion, or Digital Auditory Aerobics.
The Program is unique in three ways:
1. Unique Philosophy.
2. Learning Lab. MAP features a Learning Lab, which contains over 100 different learning programs. The parent or therapist starts by teaching the child to learn basic skills, such as how to imitate, listen and follow simple directions. And the best part is that MAP will tell you what to teach at every point along the way because it is designed to introduce each program in developmental sequence. This means that the child can move at his/her own pace without you worrying about whether or not he/she is on track. The computer will do it for you!
3. Video Section. Video clips allow you to observe speech/language pathologists teaching children. By watching the video clips parents and therapists are coached on how to teach each child to focus their attention, to comply with a request and to use language. The video clips also allow you to observe how to use the right tone of voice when directing a child to follow a direction, to gesture appropriately when prompting a child’s response, to appear calm when the sessions are not going well and to avoid using body language that may signal the wrong message.
This is a user-friendly program that can be easily implemented and incorporated into the home, school or therapy environment.
To find out more about MAP, contact National Speech/Language Therapy Center at 301- 493-0023 or visit their web site at: www.NationalSpeech.com.
Georgie resides in Corvallis, Oregon; she is married and the mother of Rebecca, a healthy 3-year old girl. Georgie also lectures throughout the world about her life, autism, and her experiences with AIT.
The next issue of The Sound Connection will include excerpts from her new book. If you would like to purchase a copy of Overcoming Autism, you can send an email to Georgie at: firstname.lastname@example.org