Dr. Berard Says

I am often asked about the difference between my method of AIT and the Tomatis listening center program. Dr. Tomatis was practicing his method in France before I developed my method. I learned the Tomatis program from him, and then determined that a more efficient method could be devised. My goal was to develop a program that would be as effective or even more effective, while requiring fewer hours of listening, and therefore, less cost for the families. Since my medical degree was in the field of general surgery, I went back to medical school and received my degree as an ENT (ear, nose and throat surgeon). This training provided the background necessary for pursuing my goal of developing a more efficient ear retraining program. 

Over many years of clinical practice with a variety of patients, I perfected my method so that the music stimulation was sufficiently powerful to reorganize the auditory system with a total of 10 hours of listening, provided over a period of 10 to 12 days (in two 30 minute sessions per day). This provided a method of auditory reorganization that was practical and cost effective for most families. 

An important difference between the Tomatis program and my method is the fact there is little research to document the effectiveness of the Tomatis program. While there are anecdotal reports of progress following the Tomatis program, clinical reports are not available to provide data on measured improvements. My method and equipment has been well researched for many years. In more recent years, after my method became available and well publicized, the Tomatis Centres reduced the number of hours required for listening, though it still requires 30 or more hours. No reasons or studies were provided for this sudden shift to fewer hours.

Now, to clarify some current misunderstandings. The terms “auditory integration training” and “AIT” were coined in response to the introduction of my method into the U.S. in the early 1990’s. The Tomatis program had never been referred to as ”auditory integration training” or “AIT” prior to 1992. The Tomatis method is not AIT and parents should not feel that they have “done AIT for their child” if they have only provided the Tomatis program. It is different from my method in theory and practice.

In recent years Tomatis practitioners have stated that Berard AIT is useful for reducing hypersensitive hearing and then should be followed by the Tomatis program to improve listening, processing, and communication skills. Some Tomatis Centres even begin their program within a few days/weeks of completion of Berard AIT. My method is effective not only for reducing hypersensitive hearing but also for retraining the listening, attention, processing, and communication skills. 

In recent years, my practitioners have provided clinical studies that document the improvement in communication, attention, and processing skills achieved by my method. Berard Practitioners use standard tests to measure progress. These tests demonstrate statistically significant improvements following Berard AIT. Therefore, it should not be assumed that the Tomatis method must be used after Berard AIT to achieve this progress. In fact, it would be prudent to allow time for the Berard AIT to be integrated and stabilized in order to evaluate progress and decide whether more intervention is even necessary. This would also be helpful for families who try to carefully manage their resources so they can get the most benefit for their individuals with special needs. After all, it was for this reason that I developed my method of AIT. 

From the moment I became interested in the problems of hearing, I have been aware of the studies by the health organizations concerning hearing deficiencies caused by wearing headphones for certain occupations. 

The statistics were related to telephone operators, translators, and musicians, and even though I cannot exactly quote the results now, I remember that the people whose hearing had been impaired through occupationally-related causes could obtain an official pension. Thus, it was officially recognized that wearing headphones to listen to speech or music could lead to some hearing damage. Afterwards I was asked by several lawyers to evaluate the percentage of hearing loss of these individuals. This percentage was very different for each person, probably because of differences in the physiological and physical resistance of each person. 

If it was admitted that wearing headphones to listen to speech or music could lead to some damage to normal individuals, it is obvious that someone who had been treated with AIT, who had some problem of hearing, would be more sensitive to all hearing aggressions, including wearing headphones. This is the reason why I forbid the use of headphones, or at least, if people have to do this because of their work, to minimize the amount of time for this use. 

What causes this hearing problem when headphones are used? 

I have never read any official explanation, if one even exists, and have to suggest my own opinion. 

Normally, when you hear sounds, such as music, talking, noises from your own behavior, songs of the birds, as well as thunderclaps, any kinds of engines or of explosions, they reach your tympanic drums after passing through a large quantity of atmosphere. This air works as a shock absorber to diminish the intensity of the impact on the eardrum. 

However, when you are hearing sounds coming directly from the membrane of the headphone to your tympanic membrane, through the one square centimeter of air included in your outer ear canal, the impact is practically direct, without any possibility of easing this aggression. 

This constant aggression is transmitted to the ossicles, then to the inner ear. This explains why many of people working with headphones have a trough, or drop on 4000 Hertz on their audiogram, similar to that of people working in noisy factories. 

On the other hand, wearing headphones eliminates all the sounds coming from outside, increasing the sounds coming from your own body, your own voice, creating a sort of echo. This aspect of the problem is more important for people wearing earplugs placed directly in the outer ear canal close to the eardrum. Then there is no more air to help the vibration of the tympanic drum and all your own sounds lead directly to the cochlea and the brain, which is not satisfactory, physiologically or psychologically. 

As soon as I became aware of the existence of the Walkman, I warned officials of the danger of this type of device, for the same reason … in vain. Now the same officials are discovering this danger and giving precautions. 

It is important to mention that the AIT processed music is therapeutic; and thus, wearing headphones during the listening sessions will not cause any harm. 

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

Sometimes parents, and even practitioners become confused when they read or hear different information about my AIT method. This information will provide important guidelines that should be followed in a Berard AIT program.

1. The practitioner is using an approved Berard AIT device.  As of October 1, 2022, there are ONLY three devices approved for Berard AIT: the Auditory Integration Modulator (AIM) the Earducator™ the Audiokinetron.
2. The minimum age for the listener is 3 years old. There is no upper age limit.
3. The listener should be examined by a health care practitioner prior to the start of the listening sessions to assure that there is no ear infection, excessive wax and/or fluid present that will interfere with the transmission of the sounds through the auditory system. If an ear infection should develop at any time during the AIT program, the training must stop and cannot resume until the individual is clear of infection and excessive fluid.
4. The optimal schedule provides for 20 listening sessions lasting for 30 minutes, over a 10-day period. In most cases, the listener has two sessions a day for 10 days. At some AIT clinics, the listening sessions are given for 10 consecutive days; however, it is also acceptable to have a 1- or 2-day break, but only after the first 5 days of listening. The number of sessions and length of them are not subject to change until formal research procedures determine that such changes are beneficial.
5. Additional AIT programs may be administered until there is no more improvement. The additional AIT programs should not occur until at least three months (six months for those with autism) after the previous AIT program.
6. Each additional program must include the complete 10-hour program of listening and “booster” sessions (sessions under the 10 hours) are not considered Berard AIT.
7. There is no research or clinical data that supports the provision of “booster” (a few days of AIT) sessions. If it appears that the individual may benefit from more AIT, the entire 10 days should be done. Berard AIT can be provided until there is no more benefit seen.
8. Audiotests are typically obtained prior to, at the midpoint, and at the end of the 10 hours of listening. The first and mid-point tests are used to determine whether any narrow-band filters will be used. The first test should be obtained not more than two weeks before beginning AIT.
9. Filtering peaks is optional for those with developmental disabilities who may not be able to cooperate with the audiotest procedure. Studies have shown that improvement occurs even without narrow-band filters due to the modulation of the music. In fact, the protocol for selecting filters is complex and there are only specific cases when filters are necessary. Not all peaks in the audiotest are filtered.
10. The intensity level (volume) during the AIT listening sessions should not exceed an average maximum output of 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.
11. Once the AIT program has been started, headphones should not be used for recreational music and other listening. It is well documented that use of headphones has reversed the benefits obtained from AIT. For computer and language labs at school, or for watching a movie on a plane, place the headphones around the neck and adjust the volume so it can be quietly heard from the ear pieces near the neck.

Concerning Length, Frequency, Number,
and Follow-Up AIT Sessions 

When I was treating my own deafness, more than 40 years ago with the Tomatis device under the direction of Tomatis himself, there were absolutely no rules, neither for me nor for the other patients. Each session could last 1, 2, or 3 hours, and this could be every day, every 2 days, every week, 2 or 3 times a day, for a total of 50, 100, 150, 300 sessions. 

After I built my first auditory integration training (AIT) device, and because of the lack of uniformity with Tomatis’s method, I decided to determine the best way to obtain the optimal results, in the minimum amount of time, while considering the various aspects of the problem. Yet, I was always concerned with the efficiency.

I had to consider: the minimum amount of time that my patients or their parents would have to stay in a hotel; the minimum amount of time they would spend in my office; the minimum amount of tiredness and stress from the treatment itself; the minimum amount of money that they would have to spend for my treatment, lodging, etc. But, of course, my true aim was to obtain the best results for my patients. 

My procedure was determined through systematic analysis of the changes in my patients’ audiograms. I can say that I tried nearly every possibility, according to their age and diagnosis and the fact that some patients lived close to my office in Annecy whereas others lived 30 kilometers or more from Annecy. 

What should be done? One session, two sessions, three sessions in a day? Separated from each other, 1, 2, 3, 4 hours? Sessions of 1/2 an hour or 1 hour? Sessions every day, or every 2 days, or every 3 days? I first began by giving my patients a total of 50, then 30, then 25, then 20 sessions, in order to decrease the cost of the treatment itself and other expenses. 

After 5 years of testing, I had ascertained that the best results were: two sessions a day, with each session being a half-hour in length, separated by a minimum of 3 hours, and for 10 consecutive working days; the maximum interruption being the 2-day weekend. 

Even when applying to these rules strictly, special circumstances (e.g., patients traveling from out of town, family problems) sometimes required that I change my procedure in order to accommodate these individuals. I can say that in doing so, it has always led to a worsening of their condition. The problems: 

— shorter treatments resulted in a relapse afterwards 

— increasing the frequency, the number, the space of time of sessions often resulted in a worsening of their audiograms; that is, their auditory system appeared to be saturated. 

I have been informed, by either my trainees themselves or by some of their patients who wrote me for advice, that some users of my method have changed my procedure by increasing or decreasing the number of listening sessions, the length of the sessions, by including monthly or bimonthly “booster sessions,” or other modifications. 

Please be aware, I have absolutely no personal gain in writing this article. My method is based on thousands of patients and determined by the analysis of thousands of audiograms. Thus, I could, myself, assume the problems above were brought about by some modifications. I state this because of the importance of my clients to me, and of my reputation. 

In contrast, users of AIT who try to modify these rules, certainly with an honest willingness to obtain better results or to accommodate their patients, will damage their reputation as well as their “own” method.