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Auditory integration training

 
Medical Encyclopedia: Auditory Integration Training
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More about Auditory Integration Training:
Origins
Purpose
Research and general acceptance
Resources

Definition

Auditory integration training, or AIT, is one specific type of music/auditory therapy based upon the work of French otolaryngologists Dr. Alfred Tomatis and Dr. Guy Berard.

Description

A quartet of CAP defects have been identified that can unfavorably alter how each person processes sound. Among these are:

  • Phonetic decoding, a problem that occurs when the brain incorrectly decodes what is being heard. Sounds are unrecognizable, often because the person speaking talks too fast.
  • Tolerance-fading memory, a condition with little or poor tolerance for background sounds.
  • Auditory integration involves a person's ability to put together things heard with things seen. Characteristically there are long response delays and trouble with phonics, or recognizing the symbols for sounds.
  • The fourth problem area, often called auditory organization, overlaps the previous three. It is characterized by disorganization in handling auditory and other information.

Certain audiological tests are carried out to see if the person has a CAP problem, and if so, how severe it is. Other tests give more specific information regarding the nature of the CAP problem. They include:

  • Puretone air-conduction threshold testing, which measures peripheral hearing loss. If loss is found, then bone-conduction testing, or evaluation of the vibration of small bones in the inner ear, is also carried out.
  • Word discrimination scores (WDS) determines a person's clarity in hearing ideal speech. This is done by presenting 25–50 words at 40 decibels above the person's average sound threshold in each ear. Test scores equal the percentage of words heard correctly.
  • Immittance testing is made up of two parts, assessing the status of, and the protective mechanisms of the middle ear.
  • Staggered sporadic word (SSW) testing delivers 40 compound words in an overlapping way at 50 decibels above threshold to each ear of the person being tested. This test provides expanded information that makes it possible to break down CAP problems into the four basic types.
  • Speech in noise discrimination (SN) testing is similar to Staggered Sporadic Word testing except that other noise is also added and the percentage correct in quiet is compared with that correct when there is added noise.
  • Phonemic synthesis (PS) determines serious learning problems. The types of errors made in sounding out written words or associating written letters with the sounds they represent help in determining the type and severity of CAP problems.

— Joan Schonbeck


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Alternative Medicine Encyclopedia: Auditory Integration Training
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Home > Library > Health > Alternative Medicine Encyclopedia

Definition

Auditory integration training (AIT), is one specific type of music/auditory therapy based upon the work of French otolaryngologists Dr. Alfred Tomatis and Dr. Guy Berard.

Origins

The premise upon which most auditory integration programs are based is that distortion in how things are heard contributes to commonly seen behavioral or learning disorders in children. Some of these disorders include attention deficit/hyperactive disorder (ADHD), autism, dyslexia, and central auditory processing disorders (CAPD). Training the patient to listen can stimulate central and cortical organization.

Auditory integration is one facet of what audiologists call central auditory processing. The simplest definition of central auditory processing, or CAP, is University of Buffalo Professor of Audiology Jack Katz's, which is: "What we do with what we hear." Central auditory integration is actually the perception of sound, including the ability to attend to sound, to remember it, retaining it in both the long- and short-term memory, to be able to listen to sound selectively, and to localize it.

Guy Berard developed one of the programs commonly used. Berard's auditory integration training consists of twenty half-hour sessions spent listening to musical sounds via a stereophonic system. The music is random, with filtered frequencies, and the person listens through earphones. These sound waves vibrate and exercise structures in the middle ear. This is normally done in sessions twice a day for 10 days.

Alfred Tomatis is also the inventor of the Electronic Ear. This device operates through a series of filters, and reestablishes the dominance of the right ear in hearing. The basis of Tomatis' work is a series of principles that follow:

  • The most important purpose of the ear is to adapt sound waves into signals that charge the brain.
  • Sound is conducted via both air and bone. It can be considered something that nourishes the nervous system, either stimulating or destimulating it.
  • Just as seeing is not the same as looking, hearing is not the same as listening. Hearing is passive. Listening is active.
  • A person's ability to listen affects all language development for that person. This process influences every aspect of self-image and social development.
  • The capacity to listen can be changed or improved through auditory stimulation using musical and vocal sounds at high frequencies.
  • Communication begins in the womb. As early as the beginning of the second trimester, fetuses can hear sounds. These sounds literally cause the brain and nervous system of the baby to develop.

Description

A quartet of CAP defects have been identified that can unfavorably alter how each person processes sound. Among these are:

  • Phonetic decoding, a problem that occurs when the brain incorrectly decodes what is being heard. Sounds are unrecognizable, often because the person speaking talks too fast.
  • Tolerance-fading memory, a condition with little or poor tolerance for background sounds.
  • Auditory integration involves a person's ability to put together things heard with things seen. Characteristically there are long response delays and trouble with phonics, or recognizing the symbols for sounds.
  • The fourth problem area, often called auditory organization, overlaps the previous three. It is characterized by disorganization in handling auditory and other information.

Certain audiological tests are carried out to see if the person has a CAP problem, and if so, how severe it is. Other tests give more specific information regarding the nature of the CAP problem. They include:

  • Puretone air-conduction threshold testing, which measures peripheral hearing loss. If loss is found, then bone-conduction testing, or evaluation of the vibration of small bones in the inner ear, is also carried out.
  • Word discrimination scores (WDS) determines a person's clarity in hearing ideal speech. This is done by presenting 25–50 words at 40 decibels above the person's average sound threshold in each ear. Test scores equal the percentage of words heard correctly.
  • Immittance testing is made up of two parts, assessing the status of, and the protective mechanisms of the middle ear.
  • Staggered sporadic word (SSW) testing delivers 40 compound words in an overlapping way at 50 decibels above threshold to each ear of the person being tested. This test provides expanded information that makes it possible to break down CAP problems into the four basic types.
  • Speech in noise discrimination (SN) testing is similar to Staggered Sporadic Word testing except that other noise is also added and the percentage correct in quiet is compared with that correct when there is added noise.
  • Phonemic synthesis (PS) determines serious learning problems. The types of errors made in sounding out written words or associating written letters with the sounds they represent help in determining the type and severity of CAP problems.

Benefits

Upon completion of an auditory integration training program, the person's hearing should be capable of perceiving all frequencies at, or near, the same level. Total improvement from this therapy, in both hearing and behavior, can take up to one year.

Research & General Acceptance

Auditory integration training is based upon newly learned information about the brain. Though brain structures and connections are predetermined, probably by heredity, another factor called plasticity also comes into play. Learning, we now know, continues from birth to death. Plasticity is the ability of the brain to actually change its structuring and connections through the process of learning.

Problems with auditory processing are now viewed as having a wide-reaching ripple effect on our society. It is estimated that 30–40% of children starting school have language-learning skills that can be described as poor. CAP difficulties are a factor in several different learning disabilities. They affect not only academic success, but also nearly every aspect of societal difficulties. One example to illustrate this is a 1989 University of Buffalo study where CAP problems were found to be present in a surprising 97% of youth inmates in an upstate New York corrections facility.

Training & Certification

Both Tomatis and Berard have certification programs in their therapies.

Resources

Books

Katz, Jack, Ph.D., Wilma Laufer Gabbay, M.S., Deborah S. Ungerleider, M.A., and Lorin Wilde, M.S. Handbook of Clinical Audiology. Waverly Press, Inc., 1985.

Periodicals

Katz, Jack, Ph.D. "Central Auditory Processing Evaluation." (1996).

Masters, M. Gay. "Speech and Language Management of CAPD." (1996).

Musiek, Frank, Ph.D. "Auditory Training: An Eclectic Approach." American Journal of Audiology (1995).

Other

"Auditory Integration and Alfred Tomatis." The Spectrum Center. (December 2000).>

Cooper, Rachel. "What is Auditory Integration Training?" http://www.vision3d.com/adhd/ (December 2000).

Dejean, Valerie. About the Tomatis Method, 1997. Tomatis Auditory Training Spectrum Center, Bethseda, MD.

Masters, M. Gay and Jack Stecker Katz, N.A. Central Auditory Processing Disorders: Characteristic Difficulties. Miniseminar, 1994.

[Article by: Joan Schonbeck]

Wikipedia: Auditory integration training
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Auditory integration training (AIT) is a procedure pioneered in France by Guy Bérard, who promoted it as a cure for clinical depression and suicidal tendencies, along with what he said were very positive results for dyslexia and autism.[1][2] It typically involves 20 half-hour sessions over 10 days listening to specially filtered and modulated music. AIT has not met scientific standards for efficacy that would justify its inclusion as a mainstream treatment.[3][4] It was used in the early 1990s as a treatment for autism.[1] A 2006 systematic review found insufficient evidence to support its use for autism, and reported no significant adverse effects.[5]

The American Academy of Pediatrics and three other professional organizations consider it an experimental procedure. The New York State Department of Health recommends that it not be used to treat young children with autism.[3] The U.S. Food and Drug Administration (FDA) has banned the Audiokinetron, the original device used to perform AIT, from importation into the U.S. due to lack of evidence of medical benefit.[1] The American Speech-Language-Hearing Association has concluded that AIT has not met scientific standards for safety.[3]

Contents

Training regimen

Auditory integration training (AIT) aims to address the sensory problems such as hearing distortions and hyperacusis (oversensitive hearing), which are said to cause discomfort and confusion in persons suffering from learning disabilities, including autism spectrum disorders. These hypersensitivities are believed to interfere with a child’s attention, comprehension, and ability to learn.

The training typically involves the child attending two 30-minute sessions per day, separated by a minimum of three hours, for ten consecutive working days. The child listens via headphones to a program of specially filtered and modulated music with wide frequency range. The program is modified for each child with certain frequencies of sound filtered using an electronic device, which randomly switches between low- and high-pass filtering for random durations between 1/4 and 2 seconds. The filtering device also varies the sound's intensity, creating a modulated effect.[3] The volume is set as loud as possible without causing discomfort.[2] If the listener has shown unusual sensitivities to certain frequencies, these may be filtered out additionally.[1]

The original device for delivering this training, the Audiokinetron or Ears Education and Retraining System (EERS), was banned by the U.S. Food and Drug Administration from importation into the U.S. due to lack of evidence of medical benefit.[1][3] Although no AIT device has been approved for marketing as a medical device by the FDA, devices used only to aid education are not subject to FDA regulation. Several other unapproved devices are now used to deliver AIT; one example is the Digital Auditory Aerobics (DAA) system, which replaced the Audiokinetron in the U.S., and which contains 20 half-hour CDs containing the output of the banned Audiokinetron,[3] thus getting around the banned use of the original device.[1]

Most AIT practitioners are speech-language pathologists or audiologists; other practitioners include psychologists, physicians, social workers, and teachers. No operator training is required for the DAA.[3] However, the lack of proven benefit to clients has led the American Speech-Language-Hearing Association to warn its members that they may be found in violation of ASHA's Code of Ethics if they provide AIT services.[6]

Insufficient efficacy and evidence basis

A systematic review of randomized controlled trials of AIT found insufficient evidence to support its use; no significant adverse effects were reported.[5]

Several professional organizations state that AIT should be considered experimental: these include the American Academy of Audiology, the American Speech-Language-Hearing Association, the American Academy of Pediatrics,[4] and the Educational Audiology Association.[3] After reviewing the available research, the New York State Department of Health concluded that AIT's efficacy had not been shown, and recommended that it not be used to treat young children with autism.[3]

History

Guy Bérard's Audition Égale Comportement (English translation Hearing Equals Behavior[7]) was the first book about AIT. Annabel Stehli's The Sound of a Miracle told the story of the author's daughter, an autistic girl who received AIT treatment from Bérard. [8] The latter anecdotal book provided wide publicity to AIT in the English-speaking world. By 1994, over 10,000 U.S. children and adults had received training, at a cost of around US$1000 to US$1300 each, and AIT became a multimillion dollar industry.[1]

An early 1990s study of the efficacy of AIT in autism was promising, and two additional studies also showed positive effects.[9] More recent research has failed to find sufficient evidence to support the use of AIT.[1][5][10]

References

  1. ^ a b c d e f g h Mudford OC, Cullen C (2005). "Auditory integration training: a critical review". in Jacobson JW, Foxx RM, Mulick JA (eds.). Controversial Therapies for Developmental Disabilities: Fad, Fashion, and Science in Professional Practice. Routledge. pp. 351–62. ISBN 080584192X. 
  2. ^ a b "Auditory Integration Training". National Autistic Society. 2008. http://www.nas.org.uk/nas/jsp/polopoly.jsp?a=3233. Retrieved on 2009-02-03. 
  3. ^ a b c d e f g h i Working Group in AIT (2004). "Auditory integration training: technical report" (PDF). ASHA Suppl (American Speech-Language-Hearing Association) (24): 96–102. http://www.asha.org/NR/rdonlyres/EC6C8637-57F3-4AD2-AEBB-66F6BE3DEE72/0/v1TRAIT.pdf. 
  4. ^ a b Committee on Children With Disabilities, American Academy of Pediatrics (1998). "Auditory integration training and facilitated communication for autism". Pediatrics 102 (2): 431–3. PMID 9685446. http://aappolicy.aappublications.org/cgi/content/full/pediatrics;102/2/431.  Policy reaffirmed May 1, 2006.
  5. ^ a b c Sinha Y, Silove N, Wheeler D, Williams K (2006). "Auditory integration training and other sound therapies for autism spectrum disorders: a systematic review". Arch Dis Child 91 (12): 1018–22. doi:10.1136/adc.2006.094649. PMID 16887860. 
  6. ^ "ASHA Adopts AIT Policy". www.asha.org. http://www.asha.org/about/publications/leader-online/archives/2003/q3/030805c.htm. Retrieved on 2009-02-21. 
  7. ^ Bérard G (1993). Hearing Equals Behavior. Keats. ISBN 0-87983-600-8. 
  8. ^ Stehli A (1991). The Sound of a Miracle. Doubleday. ISBN 0385411405. 
  9. ^ Edelson SM, Rimland B (2001). "The efficacy of auditory integration training". Autism Research Institute. http://www.autism.com/families/therapy/aitsummary.htm. 
  10. ^ Weiss MJ, Fiske K, Ferraioli S (2009). "Treatment of autism spectrum disorders". in Matson JL, Andrasik F, Matson ML. Treating Childhood Psychopathology and Developmental Disabilities. Springer. pp. 287–322. doi:10.1007/978-0-387-09530-1_10. ISBN 978-0-387-09529-5. 

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