Auditory integration training

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, although there has been very little empirical evidence regarding this notion.^[1][2] It typically involves 20 half-hour sessions over 10 days listening to specially filtered and modulated music. It was used in the early 1990s as a treatment for autism; it has been promoted as a treatment for ADHD, depression, and a wide variety of other disorders.^[1] AIT has not met scientific standards for efficacy that would justify its use as a treatment for any condition.^[3][4][5][6]

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]

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 and occupational therapist; 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.^[7]

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^[8]) 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.^[9] 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]

AIT gained popularity in the early 1990s, supported by anecdotal evidence and promising but small trials. Preliminary research included such methodological flaws as lack of statistical power, lack of blinding, or lack of a control group. Later larger and better controlled studies failed to bear out the promise of AIT. The use of AIT is not supported outside of research protocols.^[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 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. doi:10.1542/peds.102.2.431. 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. PMC 2082994. PMID 16887860. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2082994. 
6. ^ Thomas Zane (2011). "Now hear this: How science and evidence won out against Auditory Integration therapies". The Current Repertoire (Cambridge Center for Behavioral Studies) 27: 2. http://www.behavior.org/resource.php?id=494. Retrieved 2 Feb 2011. 
7. ^ "ASHA Adopts AIT Policy". www.asha.org. http://www.asha.org/about/publications/leader-online/archives/2003/q3/030805c.htm. Retrieved 2009-02-21. 
8. ^ Bérard G (1993). Hearing Equals Behavior. Keats. ISBN 0-87983-600-8. 
9. ^ Stehli A (1991). The Sound of a Miracle. Doubleday. ISBN 0385411405. 
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.