AUDITORY INTEGRATION TRAINING

Auditory integration training (sometimes referred to as auditory training) as it is generally discussed in this country today was developed by Guy Berard, a French physician.  Berard used it to treat sound sensitivity which may be present in a number of disorders, including autism.  As of this writing the authors have located no research studies published in referenced scientific journals. It must be made clear, then, that the existent evidence as to the efficacy of auditory integration training is generally anecdotal rather than empirical in nature.

In an article for The Advocate, Stephen Edelson described auditory integration training as follows: "auditory training is accomplished by a device which randomly selects low and high frequencies from a music source (a cassette or CD player), and then sends these sounds via headphones to the trainee.  In addition, if the trainee has auditory peaks in his/her hearing (as evident from an audiogram), those frequencies are filtered from the music.  The trainee receives auditory training twice a day, each time for one half hour, for ten days.  For the first five hours of training, the sound level for both ears is equal.  For individuals with speech and language impairments, the sound level is reduced in the left ear after five hours of training.  Since the right ear is connected more directly to the left hemisphere than the right hemisphere, and since the left hemisphere is responsible for interpreting and producing speech and language, Dr. Berard believes that a higher sound level in the right ear will stimulate the left hemisphere." (Sposato, 1991-92)

By auditory peaks Edelson refers to those frequencies at which the listener hears better than at others (Sposato, 1991-92). A difference as small as five decibels (dB) between frequencies is considered a peak.  It should be noted that most normal hearing persons will have differences of five dB between frequencies.  Further, it is clear that it is difficult, if not impossible, to obtain a reliable audiogram for many persons with autism.  Berard and Edelson suggest that if an audiogram cannot be obtained, tones (frequencies) should be played in a free field to see if the person indicates discomfort at any particular frequencies.  Then "we filter out those frequencies that bother the person" (Sposato, 1991-92, Berard, 1992). At the training for potential auditory training practitioners in Connecticut in 1992, Berard suggested if an audiogram cannot be obtained that the music be presented with the randomly selected low and high frequencies and no frequencies filtered out.

Reports on the results of the training vary.  Some parents, including Annabel Stehli (1991), report that their children had been hypersensitive to sounds prior to the auditory integration training and afterwards this sensitivity was eliminated or markedly decreased.  Edelson's (1991) pilot study does not support this notion.  He does note statistically significant differences between those individuals who received auditory training (filtered music, N:8) and those who received normal music (N:9) in several areas.  These included a reduction in self-stimulatory behaviors, impulsivity, distractibility, and echolalia and increases in attention, auditory memory articulation and comprehension.This pilot study did not find a change in the subjects' ability to hear sounds as has been claimed by Berard (1992).

Theories as to why auditory training might work vary widely.  Berard believes that auditory training works to normalize a person's hearing by eliminating the "peaks and valleys."  In essence, he asserts that the person's hearing acuity is actually improved and the audiogram "flattened" (1992).  Edelson theorizes that auditory integration training trains the individual to shift attention rapidly.  He alternately suggests that "since low and high frequencies sounds are sent at random, the trainee cannot anticipate them.  As a result, the trainee cannot "tune-out" the sounds; thus, the person is being taught to "tune-in" his or her environment (Sposato, 1991-92).

While there is considerable anecdotal evidence that auditory integration training is undobtedly effective for some persons with autism, much debate continues as to which persons with autism are likely to benefit from this training regimen.  Temple Grandin is quoted (Sposato, 1991-92) as stating that persons with autism who were normal until some point in early childhood are the most likely to benefit from this treatment.  Stehli is quoted (Sposato, 1991-92) as believing that the treatment is most effective for high-functioning autistic persons with sensory input disorders.  Results of Edelson's pilot study do not support either claim (1991).  Berard makes remarkable claims for the effectiveness of this treatment (1992).  Some clinics in Missouri and other states advertise that auditory integration training is effective in treating depression, dyslexia, developmental disorders, attention deficit disorders, learning disabilities, painful hearing, auditory processing difficulties, and tinnitus (ringing in the ears or other sounds).  Existing scientific evidence gives parents and professionals little direction in decisions regarding which indviduals with autism are likely to benefit and which ones are not.  The authors have received personal reports of limited or no change in behavior of persons with autism following auditory integration treatment as well as other reports of dramatic improvements.  All of the latter reports, incidentally, are secondhand with none of the information being obtained directly from parents or from the authors' own direct observation of these persons.

The question remains as to whether or not auditory integration training may be considered a related service if schools may be required to pay for said training.  Further, debate rages amond professionals as to just which professional may ethically provide auditory integration training.

By Edna A. Smith, PhD. and Kris Garbec, M.A.

References

1.  Berard, Guy (1992). Presentation at the training for Auditory Integration Training practioners. Connecticut.

2. Edelson, Stephen (1991). Auditory training and the auditory training research project.  Unpublished manuscript.  Newberg, Oregon:
    Center for the Study of Autism.

3. Sposato, Beth, Ed. (1991). Auditory training - The Advocate interviews Dr. Stephen Edelson.  The Advocate. 23 (4), 6-8.