Berard Auditory Intergration Training

AIT refers to the use of sound as a therapy to normalize hearing and listening. In sound therapy the ear is stimulated by sound: this includes the ear drum, the muscles, bones and ligaments of the middle ear, the cochlea and vestibular system and the auditory nerve pathways. Decades of clinical work have shown that sound can be used to improve auditory processing and overall neurological organization. Commonly observed outcomes of sound therapy include improved listening and learning ability, mental health and emotional well being.

Development of Sound Therapy

Several forms of sound therapy have been researched and developed over the past sixty years. Primary inputs have come from Volf, Tomatis, Berard and Steinbach. In the 1940's Christiaan Volf, a Danish physicist, developed sound therapy with which he treated hearing difficulties, speech and language problems. He found that impaired hearing at certain frequencies could be improved by listening to those lost frequencies. In the 1950's Alfred Tomatis, a French ENT spccialist, developed the use of filtered sounds in the treatment of voice, hearing and listening. Like Volf, he found that exposure to a full range of frequencies could restore the ability to hear in some cases. In working with opera singers like Maria Callas, he proved the following:

1. The voice can produce only the sounds that the ear can hear.
2. The right ear dominance is vital for language learning, language comprehension, expression, tone, and rhythm.
3. The specialization of the right and left brain hemisphere is essential for any formal learning.
4. Our emotional life is linked to our senses and suppression of listening is often also an emotional defence - as such it contributes to attentional deficits and learning problems. Resolving this emotional defence and creating again a desire to listen and communicate is an essential part of a successful sound therapy programme.

Tomatis has written numerous books, including 'The Ear and Language' published first in 1963 by Editions de Seuil, Paris. Currently there are 250 Tomatis sound therapy centers internationally.

In the 1960's Guy Berard, a French ENT physician, developed a sound filtering device based on Tomatis' work, but designed for effective short term therapy. He has successfully treated individuals with depression, attention deficit and hyperactive disorder (ADHD), attention deficit disorder (ADD ), learning disabilities, pervasive developmental disorders, central auditory processing disorder, autism and addictions (substance dependence). Berard found that AIT can significantly reduce some of the handicaps associated with these disorders. In his book 'Hearing equals Behavior' (Keats Publishing, Inc. 1982) clinical case histories illustrate the principles and outcomes of AIT. AIT is currently used in a number of French schools.

In the 1970's Steinbach, a German sound engineer and educator, developed a sound therapy based on high frequencies and purity of sound. Like Tomatis, he believes that high frequencies feed the brain and energize the nervous system and are best suited to retraining the ear for listening.

Research

Research spanning decades has examined various features of Sensory Processing Disorders and the efficacy of sensory stimulation therapies. Sound therapy was found to have a range of benefits for SPD for the following reasons:

1. Sensory stimulation organizes the brain - the nervous system is energized and organized by stimulation and functions more efficiently with stimulation. Sound therapy provides the type of stimulation that improves brain function. (Ayers 1972, Tomatis 1963)
2. Modulation of sensory input is a vital function of the nervous system. Good modulation means having control over one's level of alertness, ability to focus, switching attention on/off, diverting attention, ignoring certain stimuli and regulating the intensity of one's perceptions. Many of these functions are influenced by the brain stem and the vestibular system in the inner ear, both of which are regulators and organizers of sensory input. Sensory stimulation, particularly vestibular, improves modulation.(Ayers, 1972) AIT improves the modulation function of the brain stem and therefore effectively increases alertness, focus and attention span.( Kirby, W.J. 2000)
3. Modulation difficulties can be linked to hypersensitivity to any sensory input, whether visual, tactile or auditory. Painful or hypersensitive hearing is successfully treated with AIT. ( Berard, 1993 )
4. The Cerebellar & Vestibular System is responsible for the integration and processing of all sensory information ( including hearing, vision, taste and smell ), coordinating voluntary and involuntary motor movements ( including eye movements) and controlling the sense of balance, direction, time and rhythm. It also regulates anxiety. (Levinson,1984 & 1986, Goddard,1990 ) AIT is one method of providing stimulation to the CVS to help reorganize a dysfunctional system. Evidence lies in the results. After AIT there are commonly improvements in the following areas: better ability to taste and smell, reduced tactile defensiveness, better balance, motor coordination, handwriting, improved eye contact, eye-hand coordination, eye alignment, ability to tell time and understand left/right directionality. According to Frick and Shirley-Lawton (1994) those with known vestibular processing dysfunctions appear to make the greatest gains from AIT. These improvements typically occur in movement perception and security, overall arousal, organization and social/ emotional response.
5. Although hearing may test as normal, this does not mean that listening ability is intact. The sound message may get lost or distorted as it travels from the inner ear to the auditory centers of the brain. As a result the listener cannot interpret and comprehend what has been heard. This condition is known as Auditory Processing Disorder. One possible contributing factor is ear infections in the first 18 months of life and frequent ear infections there after. Interruption of clarity of hearing interferes with language development at its most crucial phase and can result in Auditory Processing Disorder. Katz, 1978, in summarizing the literature examining the effects of conductive hearing loss, goes so far as to suggest that "even slight or mild fluctuating hearing problems can have deleterious effects" on processing and indirectly on language development.
6. Auditory Processing Disorder may be present with or without a hearing loss. APD has been associated with learning disabilities since 1932, when researched by Monroe. Researchers Orton, Sawyer, Bannantyne, Tomatis and Tallal are among the many who have investigated this link. Typically persons with APD may demonstrate other characteristics sensory processing problems, including visual motor and balance deficits. Problems with listening, attending, following directions, processing speed, localizing sound source and listening against a noisy background are common. Improvements in all of these areas can be measured after AIT.
7. Right ear dominance and well developed laterality (left/right brain hemisphere specialization) is essential for language development, including speech, language comprehension and written language. This aspect has been well researched by many, including Tomatis (1991), who introduced the practice of training the right ear to be the dominant ear. AIT caters for this training, with the increase of stimulation to the right ear during treatment.
8. A slower than average processing speed of incoming auditory stimuli and therefore a slower response time, as well as a problem with sound discrimination hampers the person with an APD to use and understand language. As a result there are difficulties with matching sounds and letters, poor rote memory (for tables, rhymes, alphabet), reading and spelling problems and poor social skills. AIT is effective in treatment of these dysfunctions. (Tallal, Miller, Fitch 1993)

Bibliography

• Sensory Integration and learning disorders
  Ayers, A.J.
  Los Angeles: Western Psychological Services, 1978
• Hearing equals Behavior.
  Berard,G.
  Keats Publishing Company, New Western Psychological Services, 1972
• Auditory Integrative Training from a Sensory Integrative Perspective
  Frick, S.M. and Lawton-Shirley, N. (1994, December).
  Sensory Integration: Special interests newsletter, pp.1-3.
• A developmental basis for learning difficulties and language disorders.
  Goddard, S.
  Institute for Neuro-Physiological Psychology Monograph Series, No 1, and 1990
• The effects of conductive hearing loss on auditory function.
  Katz, J.
  Asha, 879-886, October 1978
• The effects of AIT on children diagnosed with on ADD and ADHD.
  Kirby, W.J.
  The Sound Connection, Vol 7, nr 3, 2000
• Smart, but feeling dumb.
  Levinson, H.
  New York: Warner Books, 1984
• Phobia Free.
  Levinson, H.
  New York, M. Evans and Co., Inc, 1986
• Neurobiological basis of speech: a case for the pre-eminence of temporal lobe processing.
  Tallal,P., Miller, S. and Fitch.
  Annals of the New York Academy of Sciences June 14 682: 27-47, 1993
• The Ear and Language
  Tomatis, A. A.
  Paris Editions du Seuil, 1963
• The Conscious Ear.
  Tomatis, A.A.
  Station Hill Press, 1991
• Changes in unilateral and bilateral sound sensitivity following AIT.
  Woodward, D.
  The Sound Connection, 1994

PRACTICAL APPLICATION

Assesments

The following information may be needed for assessment:

• Family interview
• Developmental and medical history
• Psychological assessment of client
• Educational progress reports, including remedial report (maths & language) or
• Language assessment by speech therapist (reading accuracy, comprehension, speed)
• Psychometric Assessment, e.g. IQ test
• Neurological assessment
• Audiometric assessment
• Recent medical examination, e.g. of ears
• Completion of APD questionnaires
• Psychotherapy records
• Referrals may be made to other specialists if required

Auditory Training

METHOD: During AIT selected music is played through an electronic device, The Earducator. This device randomly filters out sound frequencies. The client listens with headphones. If there are sound sensitivities these are filtered out. The therapist is present during the session.

DURATION: AIT requires 20 sessions Each session is thirty minutes of listening time. Ideally the trainee does two thirty-minute sessions daily for ten consecutive days. A weekend break is allowable.

RULES: No headphones are allowed after treatment. Loud music should be avoided.

Follow Up

A repeat is rarely required but if needed can be done after one year. Counselling support for the parents and child is available throughout treatment and thereafter as needed. Psychotherapy can be required prior or post AIT, if emotional development was delayed or impaired by sensory processing problems. Several sessions of general sensory integration ( vision, balance, sound, muscle tone) and preparatory stress reduction is recommended prior to AIT. This curbs emotional regressions during AIT.

Who Uses It

AIT is suited both as a treatment for specific sensory disorders, as well as for enhancement of performance and learning ability in any field of human endeavor. As a performance enhancer it has been used by academic students, musicians, creative writers, sportspersons for creativity, endurance, motor coordination, emotional balance, on the job performance, better communication skills and language learning. AIT is suited as treatment for:

• Mental/emotional conditions Neurological based disorders
• Psychological trauma
• Attention Deficit Disorder
• Chronic stress
• Learning problems
• Depression
• Pervasive Developmental Disorders
• Anxiety
• Central Auditory Processing Disorder
• Underachievement in career
• Autism

Benefits

Therapists, teachers, parents and trainees have observed the following benefits:

• Improved academic performance due to improved motivation, task completion, memory, comprehension, expressive skills
• Improved language skills, eg. comprehension, spelling, sound discrimination
• Longer concentration span/ better attentiveness
• Improved listening/ social responsiveness
• Increased verbalisation and communication
• Easier, more frequent interaction with others, increased eye contact
• More appropriate social behavior
• Better self control
• Emotional maturation - age appropriate behavior
• More comfort with self/calmness
• Increased independence and self esteem
• Resilience to daily stress
• Higher energy levels
• More appropriate vocal intensity (volume)
• Reduction of hyper-acute and or painful hearing and therefore reduction in:
  - Complaints of sounds causing pain or discomfort
  - Noise or tinnitus in ears
  - Startle response to noise

Checklist for Central Auditory Processing Disorder

(From 'When Listening Comes Alive', by Paul Madaule, Moulin Publishing, 1994)

We cannot 'see' listening: the only way to 'get at it' is indirectly - through skills that are related to it in one way or another. This checklist offers a catalogue of listening skills. There is no score.

Developmental History

This knowledge is extremely important in early identification and prevention of listening problems. It also sheds light on possible causes. The following are common Indicators of possible auditory processing problems:

• stressful pregnancy
• difficult birth
• adoption
• early separation from mother
• delay in motor development
• delay in language development
• recurring ear infections

Receptive Listening

This is the listening that is directed outward. It keeps us attuned to the world around us, to what is going on at home, at work or in the classroom. Problems in receptive listening are indicated by:

• short attention span
• distractibility
• over-sensitivity to sounds
• misinterpretation of questions
• confusion of similar sounding words
• frequent need for repetition
• inability to follow sequential instruction

Expressive Listening

This is the listening that is directed within. We use it to control our voice when we speak and sing. Problems are indicated by:

• flat and monotonous voice
• hesitant speech
• weak vocabulary
• poor sentence structure
• overuse of stereotyped expressions
• inability to sing in tune
• confusion or reversal of letters
• poor reading comprehension
• poor reading aloud
• poor spelling

Motor Skills

The ear contains the vestibular system, which controls balance, coordination, body image and spatial perception. It's functioning is directly linked with the listening function of the ear. The following motor problems are commonly linked APD:

• poor posture
• fidgety behavior
• clumsy, uncoordinated movements
• poor sense of rhythm
• messy handwriting
• hard time organization, structure
• confusion left/right
• mixed dominance for eyes, ears, hands, feet
• poor sport skills

Energy Levels

Poor neurological organization leads to fatigue - instead of tasks becoming automatic, Constant effort is required. In addition the brain is getting insufficient sensory stimulation, leading to low energy. The following are common indicators:

• difficulty getting up
• tiredness at the end of the day
• habit of procrastinating
• hyperactivity
• tendency toward depression
• feeling overburdened with every day tasks

Behavioral and Social Adjustment

A listening difficulty can be linked to these behaviors:

• low tolerance for frustration
• poor self confidence
• shyness
• difficulty making friends
• tendency to withdraw, avoid others
• irritability
• immaturity
• low motivation, no interest in school work
• negative attitude to schoolwork

Are There Any Risks?

AIT is a gentle, non-invasive and supportive form of therapy. Any discomforts experienced are always addressed immediately by the therapist. Emotionally regressive behavior in children may be an immediate response to AIT - this dissipates quickly with the assistance of and correct handling by the therapist.

Call Anca now on +61 2 94183692 or on +61 414 414 286 for your personal appointment.