Auditory Integration Training

[Guest guest]

http://www.researchautism.net/interventionitem.ikml?print & ra=4 & infolevel=4

Auditory Integration Training

You are currently viewing this item in Advanced level. Alternative information may be available in Intermediate or Basic.

To store this preference permanently register here

Ranking :

Type : Sensory

Other Names :

AIT Berard's therapy

Introduction

A person with autism listens to a selection of music which has been modified. Some of the high and low frequencies in the music are removed and the volume is carefully controlled. By listening to this modified music, the person with autism gradually learns to be less sensitive to sounds which they previously found disturbing. As a result, their behaviour improves

Opinion

We do not believe that AIT is helpful in improving symptoms of autism, although it may be of limited use in helping with sensory problems, such as hypercusis.

Great care should be taken because of the potential hazards of using AIT.

Further information

Please see the Trials page for details of the research studies we used to rank this intervention and the Ranking page for details of how we ranked those studies.

Disclaimer

Please read our Disclaimer about this intervention.

Audience

The supporters of auditory integration training believe it is suitable for children and adults with autistic spectrum disorders – including autism or Asperger syndrome – who who have additional sensory problems, such as painful or hypersensitive hearing.

Applicable Age Ranges

5-1011-1516-2121-4950-6465+

Aims

To improve abnormal sound sensitivity in individuals with behavioural disorders including autism.

Claims

Various claims have been made up to and including recovery from autism.

More modestly, it is claimed that changes such as a better concentration, awareness and a decrease in sound sensitivity may result. For example the Sound Learning Centre claims that AIT leads to

` improvements in many different areas: physiological, emotional, social, educational. Sometimes results are immediate, often improvements continue to develop over a period of weeks or months'.

Detail

The individual has to attend a clinic or similar venue. Home-based AIT is not available, although similar sounding programmes may be available at home e.g. The Listening programme.

Where possible, a hearing assessment is required before and after the treatment.

The individual sits comfortably in a relaxed environment. S/he then listens (through headphones) to music filtered through an Audiokinetron, a device designed by Bérard.

This machine is designed to randomly modulate the amplitude of the high and low frequencies in order to re-train the ears and `balance' the hearing.

The music can be modified by the AIT device in two ways: modulation and filtering.

Modulation involves attenuation of high or low frequencies (><1KHz, respectively) at random for blocks of .25 – 2 seconds, again randomly selected.

Filtering involves attenuation of narrow frequency bands around frequencies on the audiogram to which the individual seems particularly sensitive.

Time

The treatment comprises 30-minute sessions twice a day for ten days.

There is a minimum 3-hour rest period between sessions.

Most people require 10 days of treatment.

Involvement

No parental time is required other than to accompany the child or adult being treated.

The trainer spends 2 hours per day for 10 days, plus any time necessary for rest periods, assessment and report writing.

Costs

Reported costs are £1000 and up, per person per course of treatment.

Credentials

There are no formal internationally validated registered qualifications for AIT personnel although some are approved `Berard practitioners'.

A speech and language pathologist may be involved in some centres offering AIT.

Examination by a qualified health care professional or audiometrist should be carried out at the start, mid point and end of treatment to eliminate other hearing issues, e.g. wax, fluid, other impairment or damage to the ear drum.

Availability

AIT is widely available in the USA and at several locations in UK.

Hazards

Some individuals may be distressed by the experience of having AIT and there are some reports of damage to hearing due to volume and sound pressure.

The equipment used, the Audiokinetron, was disallowed for import by the USA Food and Drug Administration because of concerns about safety.

The cost of the treatment may result in financial hardship for some.

Contraindications

According to Berard, children under 3 are not suitable for treatment.

Individuals with hearing loss, infections, ear wax or damage to the inner ears should not be treated with AIT.

History

AIT was first developed by French ENT specialist Dr Guy Berard in the 1960's for reducing effects of auditory trauma. It was then used in dyslexia, depression and suicidal tendencies, with Berard claiming good results. It was first used for people with autism in 1975.

Accounts

There are numerous anecdotal reports of improvement. Some written accounts (Stehli, 1991) helped to provide world wide publicity.

`Auditory Integration Therapy appeared to help with his chronic sleep problem. He remains sensitive to certain sounds, but appears less distressed these days.' (Source: Isabelle, posted on the Autism-UK discussion list, 2007.)

Research

We have identified eleven scientific trials of AIT published in peer-reviewed journals. These trials included more than 180 individuals aged 3 to 39 years.

Six trials (; Edelson, 1999; Maddell, 1999; Maddell and Rose, 1994; -Brown, 1999; Rimland, 1994 and Rimland, 1995 ) ) reported improvements in the AIT group, with no significant adverse reported.

Five studies (Bettison 1996; Gilberg, 1999 ; Link, 1997; Mudford, 2000; and Zollweg, 1997) reported no significant improvements compared to control groups.

However there is huge controversy over differing interpretation of these results, with two way accusations of bias.

Status

There are issues with all of the research studies identified to date.

Romanczyk et al carried out a review of the existing research studies into AIT in 2004. They raised concerns regarding limitations of the research findings including flaws that they argued limit interpretation of the data, questions regarding clinical significance, lack of replicability, and small sample size.

Mudford and Cullen carried out a similar review in 2005. They noted the same problems in research design, concluding that the evidence was far too limited to recommend this as a form of intervention.

Sinha Y. et al. also carried out a review of the existing research studies for the Cochrane Library in 2004. They set out a range of flaws in the existing studies including the fact that they `…largely measured different outcomes and reported mixed results.` The full analysis can be found on the Cochrane Library website .

Trials

Bettison, S. (1996). The long-term effects of auditory training on children with autism. Journal of Autism and Developmental Disorders, 26(3), pp 361-474. Read Abstract

Edelson, S.M. et al. (1999). Auditory integration training: a double-blind study of behavioral and electrophysiological effects in people with autism. Focus on Autism and other Developmental Disabilities, 14(2), pp 73-81. Read Abstract

Gillberg, C. et al. (1999). Auditory integration training in children with autism: brief report of an open pilot study. Autism, 1999, 1, pp 97-100. Read Abstract

Link, H.M. (1997). Auditory integration training (AIT): sound therapy? case studies of three boys with autism who received AIT. British Journal of Learning Disabilities, 25, pp 106-110.

Maddell, J.R. (1999). Auditory integration training: one clinician's view. Language, Speech and Hearing Services in Schools, 30, pp 371-377. Read Abstract

Maddell, J.R. & Rose. (1994). Auditory integration training. American Journal of Audiology, March, pp 14-18.

-Brown, M. (1999). Auditory integration training and autism: two case studies. British Journal of Occupational Therapy, 62, pp 13-18.

Mudford, O.C. et al. (2000). Auditory integration training for children with autism: no behavioral benefits detected. American Journal of Mental Retardation, 105(2), pp 118-129. Read Abstract

Rimland, B. & Edelson, S.M. (1994). The effects of auditory integration training on autism. American Journal of Speech-Language Pathology, 3(2), pp 16-24. (Includes same data as Rimland, 1995.)

Rimland, B. & Edelson, S.M. (1995). Brief report: a pilot study of auditory integration training in autism. Journal of Autism and Developmental Disorders, 25(1), pp 61-70. Read Abstract

Zollweg, W, Palm, D. and Vance. V. (1997). The efficacy of auditory integration training: a double blind study. American Journal of Audiology, 6, pp 39-47. Read Abstract

Future

Despite the generally negative evaluations some anecdotal reports suggest that AIT may be helpful for some individuals with highly specific needs and characteristics.

There is little point in additional research replicating earlier studies but it may be helpful to conduct studies specifically of the effects of AIT on specific individuals with specific sets of symptoms and problems e.g. hypercusis.

Any new research will need more focus on fidelity and effects. It should also take account of levels of functioning and communication, co morbidities, and any other symptoms.

We have little information on the effects of AIT combined with other approaches and this could be an area worthy of attention.

Summary

Opinion on the usefulness of AIT is mixed but the research evidence is generally not supportive.

There is no evidence to support claims of cure or recovery.

There is very poor evidence that AIT has been helpful in improving symptoms of autism.

There is mixed evidence on whether AIT has been helpful in improving the behaviour and functioning of individuals with autism and other sensory problems, such as hypercusis.

There are numerous anecdotal reports in support of AIT.

It should also be noted that the relationship between hypercusis and autism is not clear.

Reading

American Academy of Pediatrics, Committee on Children With Disabilities. (1998). Auditory Integration Training and Facilitated Communication for Autism. Pediatrics, 102(2), pp. 431-433.Read Full item

Bérard, G. Hearing equals behavior. New Canaan, CT: Keats Publishing Inc., 1993.

Bérard, G. Auditory Integration Training (Bérard's Method). In: Approaches to autism. 3rd ed. London: National Autistic Society, 1997, p. 11.

Berkell, D.E. et al. (1996). Auditory Integration Training for individuals with autism. Education and Training in Mental Retardation and Developmental Disabilities, 31(1). pp. 66-70. Read Abstract

Bettison, S. Auditory integration training – some observations of the effects on individuals. Autism News, 1999, December, pp. 4-5.

, M. Auditory integration therapy (AIT): research summaries. Listen to Learn Centre, 2000?

Dawson G. and Watling R. (2000). Interventions to Facilitate Auditory, Visual, and Motor Integration in Autism: A Review of the Evidence. Journal of Autism and Developmental Disorders, 30(5), pp. 415-421. Read Abstract

Edelson, S.M. & Rimland, B. (2001). The efficacy of auditory integration training: summaries and critiques of 28 reports (January 1993-May 2001). San Diego: Autism Research Institute. Read Full paper

Edelson S.M, Rimland B and Grandin T. (2003). Response to Goldstein's Commentary: Interventions to Facilitate Auditory, Visual, and Motor Integration: "Show Me the Data". Journal of Autism and Developmental Disorders, 33(5), pp. 551-552(2)

Friel-Patti, S. (1994). Commitment to theory. American Journal of Speech-Language Pathology, 3, pp. 30-34. Read Abstract

Goldstein (2000) Commentary: interventions to facilitate auditory, visual, and motor integration: "Show me the data". Journal of Autism and Developmental Disorders, 30(5), pp 423-425

Goldstein H. (2003). Response to Edelson, Rimland, and Grandin's Commentary. Journal of Autism and Developmental Disorders, 33(5), pp. 553-555.

Gravel JS. (1994). Auditory integrative training: placing the burden of proof. Am J Speech Lang Pathol, 3, pp. 25-29.

Howlin, P. (Date unknown). A visit to The Light and Sound Therapy Centre. London: National Autistic Society. Read Full item

, M.A. (2004). Comments on auditory integration therapy. Hearing Health. Read Full item

Mudford, O.C. & Cullen, C. (2005). Auditory integration training: a critical review. In son, J.W., Mulick, J.A. & Foxx, R.M. (Eds). Controversial therapies for developmental disabilities: fads, fashion and science in professional practice. Mahwah, New Jersey: Lawrence Erlbaum Associates.

National Autistic Society. (2006). Auditory integation training. London: NAS. Read Full item

Rimland, B. and Edelson, S.M. (1994). Is theory better than chicken soup? American Journal of Speech-Language Pathology, 3, pp.38-40.

Rimland, B. and Edelson, S.M. Auditory integration training in autism: a pilot study. San Diego, CA: Autism Research Institute, 1992. (ARI Publication No: 112)

Rimland, B. and Edelson, S.M. Letter about auditory integration training. Autism, 1998, 2(1), pp. 91-92.

Rimland, B. and Edelson, S.M. Response to Howlin on the value of auditory integration training. Journal of Autism and Developmental Disorders, 1998, 28(2), pp. 169-170.

Romanczyk R.G. et al. The myriad of controversial treatments for autism: a critical evaluation of efficacy. In: Lilienfeld S.O., Jay Lynn, S. and Lohr, J.M. (eds.), Science and pseudoscience in clinical psychology. New York: Guilford Press, 2004, pp. 363-395.

Simpson R.L. et al . Physiological / biological / neurological interventions and treatments. In: Simpson R.L. et al (2005). Autism spectrum disorders: interventions and treatments for children and youth. California, Corwin Press, pp. 169-205

Sinha Y. et al. (2004). Auditory integration training and other sound therapies for autism spectrum disorders. Cochrane Database of Systematic Reviews, Issue 1. Art. No.: CD003681. DOI: 10.1002/14651858.CD003681.pub2 Read Full item

Stehli, A. (1991). The sound of a miracle: a child's triumph over autism. New York: Doubleday. (Mother's anecdotal account of how AIT helped her child.) Read Abstract

Tharpe, A.M. (1999). Auditory integration training: the magical mystery cure. Language, Speech, and Hearing Services in Schools, 30, 378–382. Read Full item (PDF document.)

Veale, T.K. (1994). Auditory integration training: the use of a new listening treatment within our profession. American Journal of Speech and Language Pathology, 3, pp 12-15. Read Abstract

More Information

AIT should not be confused with

the Tomatis method, which shares some characteristics but is an auditory therapy.

AIT plus, which combines AIT with Light Therapy and Sound Modulation Therapy

Problems

Altered sensesHearing/Sound perception