Auditory Integration Training
By: Anthony Kane, MD
What is Auditory Integration Training?
Auditory integration training (AIT) was developed by French otolaryngologist Guy Berard, in order to treat auditory processing problems. Berard claims that abnormal auditory processing results when there is discrepancies in how well someone hears different sound frequencies. For example, a person may be hypersensitive to the frequencies 2,000 and 8,000 Hertz, but hear all the other frequencies normally. Berard developed Auditory Integration Training as a way to reduce sensitivity to specific sound frequencies.
What Does Auditory Integration Training Treat?
Some researchers feel that many children who are diagnosed with ADHD actually have a central auditory processing disorder. This condition is particularly common if the child has other sensory integration disorders, such as touch sensitivity. AIT seems to help improve attention span deficits, to correct poor auditory discrimination skills, and to improve the ability to follow directions, all of which are common problems in ADHD children.
AIT was created to reduce sound sensitivity and improve language discrimination.
Dyslexia is usually thought of as a visual disorder. However, recent physiological findings indicate that the auditory processing system may be a major contributor to dyslexia. Brain studies of dyslexic people show a decrease in neurons on the left side of the medial geniculate nucleus, one of the central components of the auditory system. Interestingly, it is this part of the brain that processes fast-changing sounds. As we shall discuss, AIT focuses on training the child to improve his discrimination of this type of sound.
Vestibular Processing Dysfunction
The vestibular processing system is integrally related to the auditory processing system. AIT seems to improve vestibular dysfunction. In fact, some researchers feel that the presence of vestibular dysfunction is a good predictor that AIT will be successful.
In order to read, children must know that letter combinations represent spoken sounds. A child must be able to grasp the sounds that a combination of letters represents in order to read an unfamiliar word. For example, he must understand the `at' sound in order to read `cat' or `bat' correctly. A child who has an auditory perceptual problem may not be able to read because he is not able to hear the `at' sound properly.
AIT often enhances listening skills and the ability to perceive sounds more accurately. This may enable the child to hear the spoken sounds more clearly. Thus, the basic auditory perceptual skills involved in reading may be improved through AIT.
One often-overlooked reason for learning difficulties is that the child cannot understand the teacher's words. Many children have problems with hearing a message and then actively, correctly, and quickly, interpreting the meaning. The first step of speech comprehension depends upon the ability to receive the sounds. Children with auditory integration deficits have difficulty with this task. AIT may be a way of correcting this problem.
We think verbally. We organize and process our thoughts through the use of an inner dialogue. Some children with a verbal deficit also have problems with their own inner dialogue. It is thought that AIT can enhance the child's ability to organize and sequence his thoughts by improving his own inner dialogue.
Behavioral problems are often a result of a misunderstanding. Frequently children misbehave because they didn't understand what it was they were told to do. I address this problem in How to Improve Your Child's Behavior.
If the child has an auditory processing deficit he may not understand instructions. Adults will view this child as a behavior problem. The child thinks he was doing what he was asked, but finds this does not make his parents happy. He may eventually give up on ever pleasing his parents. This makes sense. From his point of view there is no relationship between listening to his parents and satisfying them. Why should be bother to try?
Since AIT helps the child to understand the spoken word, he will now have a better chance of understanding what it is that he is being asked to do. The child will appear to be more cooperative and obedient simply because he will now understand what he has been asked to do. This improvement will be reflected in school as well as at home.
Improved School Performance
When a child understands the words that the teacher is saying he will do better in school. This is not hard to understand.
However, there is more than that. Children with auditory processing problems have great inconsistencies in their work. This variance in performance is due to the child's level of fatigue. A child who has auditory dysfunction has to work harder to comprehend the spoken word. His experience is similar to one who is learning in a foreign language where he has to translate what he hears into words that he understands. This is tiring and as a result these children tune out frequently in order to rest.
Improved Social Skills
Children with normal auditory integration have a social advantage. Because they have difficulty focusing on tuning out background noises, children with speech comprehension problems tend to withdraw socially. AIT can help a child with his listening skills so that he will not be overwhelmed by the sounds of his environment. This helps the child do better with social relationships.
One of the most frequently reported changes as a result of AIT is an overall calmness in the listener. Some changes described include better sleep, an increase in attention span, a decrease in anxiety, and a decrease in hyperactivity.
How Auditory Integration Training Works
Auditory processing deficits seem to result from a defect in the brain stem's reticular activating system. This is the area of the brain that regulates information from the auditory and vestibular systems, selectively focusing on certain types of sensory inputs while inhibiting others.
The unpredictable, modulated music used in AIT stimulates the reticular activating system. Because the vestibular system is also integrated in this part of the brain, the unique sounds used in AIT also may be capable of producing improvements in posture, balance, and spatial orientation.
AIT works by allowing a sound sensitive child to adapt to the sounds. Adaptation is a built-in mechanism, which after continued exposure to a stimulus reduces the perception of that stimulus. AIT trains the child to filter out unimportant sounds so that he can focus on what is important. This results in better sound discrimination.
How Auditory Integration Training is Done
Using a cassette or CD player, the child listens to music that has been specially processed. If the child has certain frequencies of auditory sensitivity, these frequencies are dampened or filtered out.
The training takes place twice a day, each time for 1/2 hour, over a ten-day period. During the first five hours of training, each ear receives the same sound level input. For children with a speech or hearing impairment, the sound level is reduced in the left ear during the second five hours of training. The left hemisphere is responsible for processing speech and language. Since the right ear is connected more directly to the left hemisphere, Dr. Berard believes that a higher sound level in the right ear will stimulate the left hemisphere.
An audiogram is conducted prior to the first listening session to determine whether the person has auditory sensitivity. After the first five hours, the child gets a second audiogram to determine if the sensitivities are still present and whether new sensitivities have developed. A final audiogram is given after the completion of the listening sessions. The goal of the training is that all frequencies should be perceived equally well and the sensitivities should be eliminated.
Music Used in AIT
To be effective the music used for AIT should cover a wide range of frequencies and have a good tempo or beat. Most music does not meet these criteria. AIT experts have reviewed over 1000 CD's and created a list of 70 CD's that can be used in AIT training. It is interesting to note that unlike other auditory training programs, in AIT classical music plays no part. The 70 CD on the approved list are mostly jazz, pop, reggae, and contemporary rock.
For many children with ADHD, dyslexia, and a number of other developmental problems, AIT sounds very promising. Does it work?
Over the past decade, there were numerous studies to test if AIT is effective. Almost without exceptions, these studies were poorly done and nothing conclusive comes out of them. However, the general direction of the results suggests that this technique seems to do something positive.
There were contradictions. In one study involving 10 ADHD children, five received AIT and 5 listened to the same music without the processing. The 5 who received treatment showed real improvement in attention. However, a different study showed that the music without the processing was just as effective.
So it is your choice. You can go through an AIT therapist and pay $2000 or more for two weeks of treatment, or you can go to eBay and spend a dollar to buy a used CD and treat your child yourself. It is not clear from the research if one approach is better than the other. However, it does seem that both do help.
AIT is not without side effects. This is actually a point in its favor. One of the reasons so many natural treatments have 'no side effects' is because they don't do anything. There may not be proof that AIT helps with ADHD, but the presence of side effects is an indication that at least it is doing something.
One of the commonly reported complaints is a change in behavior. During the 10-day treatment period, many children exhibit agitation, hyperactivity, and rapid mood swings. This type of reaction occurs with other forms of sensory integration training, also. The reason for this is unknown.
Many children become less compliant. This results from an improved attention span. A child with a short attention span is easy to redirect. As the child's attention span improves during treatment the result is often the child becomes more focused and it is more difficult to get him to change tasks. Now on the whole better attention is a good thing. But it may not make your life as a parent any easier.
The Gains are Very Fragile
This is a big problem. Though in general the benefits seem to last, the child can lose them rather easily. The common reasons for this loss are:
Illness that affects the ear, such as an ear infection Exposure to loud sounds Certain medications Some other undefined reason Wearing headphones while listening to music. (There are several clinical cases of this occurring.)
From the evidence at hand it is very hard to make a good recommendation regarding AIT. There are a number of positives. First of all it is completelynon-invasive and basically safe. That means the worst thing that will happen is that it won't work. However, based upon the current research that might be that the only thing that will happen. It is really hard to say.
The treatment is relatively short. Unlike most therapies you can do the whole thing in a two-week period. It may take up to six months until you see the full effect, but your time investment is rather short.
On the other hand, this can be a very expensive treatment, on the average about $2000. And it is not clear what are the chances that it will work. Even if it does work it is not clear how much it will change your child's life.
Based upon all this uncertainty, I will not recommend what you should do. However, I will say what I would do. If my child has some signs of auditory integration problems, I would definitely consider trying one the auditory integration techniques.
I would get audiograms first to find out if there is a specific frequency of sound sensitivity. If there is I would be much more apt to put out the money for AIT provider who uses frequency dampening. If there were no specific frequency sensitivity I would probably get a CD from the recommended CD list and try that first.
When choosing a provider, I would look for someone who has experience with a number of the other auditory integration techniques. Even if AIT does work I have seen no indication of whether it is better or worse than anything else out there. I would like to have a reliable and experienced clinician make the decision of which technique is right for my child.
It is not really clear whether or not AIT really helps. However, there does seem to be a lot of indications that auditory processing defects play a significant role in contributing to ADHD, ODD, and learning disorders.
I have a special request for you. If you have any experience with AIT or another auditory processing therapy would you please post your comments. About 10,000 parents will be reading this article and the information you have may help hundreds of children. You can post your comments at http://adhd-add.blogspot.com/.
Anthony Kane, MD is a physician, an international lecturer, and director of special education. He is the author of a book, numerous articles, and a number of online programs dealing with ADHD treatment, child behavior and discipline, ODD, and education. Visit his website at http://addadhdadvances.com/. To sign up for the free ADD ADHD Advances online journal send an email to: firstname.lastname@example.org