Auditory integration training: "miracle" in the treatment for autism?

LETTERS TO THE EDITORS

Auditory integration training: "miracle" in the treatment for autism?

Lorena Kozlowski^I; Maya Kroupnik^II; Ana Paula Kochen^III; Bianca Simone Zeigelboim^IV

^ITuiuti University of Paraná – Brazil and Université de Montréal – Faculté de Médicine – École d'orthophonie et d'audiologie - Canada

^IIUniversité de Montréal – Faculté de Médicine – École d'orthophonie et d'audiologie - Canada

^IIITuiuti University of Paraná – Brazil

^IVMaster Program in Communication Disturbances at the Universidade Tuiuti do Paraná

Dear Editor,

Problems of auditory sensation have been associated with autism: auditory hyposensitivity (i.e., 'tuning out behavior'), hypersensitivity (e.g., covering ears), and over selectivity to sound have been observed. Autism is associated with an abnormal pattern of activation of the temporal cortex (auditory associative cortex and the superior temporal sulcus).¹

Auditory integration training (AIT) is an audiological approach for the treatment of 'auditory distortions' and hyperacusis, which its proponents believe are central to the dysfunction experienced by persons with autism.²

The goal of AIT is to reduce the symptoms that are interfering with auditory functioning.

The treatment requires that an accurate audiogram be obtained, which has to be evaluated to determine if the subject shows 'hypersensitive hearing' or has 'uneven hearing', The client is then considered as a candidate for treatment. Treatment consists on listening to music for half an hour twice a day for 10 days. The music is filtered to eliminate the frequencies to which the person is 'hypersensitive', or where the audiogram demonstrates peaks and is also modulated so that different parts of the frequency band are randomly modified in intensity. Audiograms are repeated midway and at the end of the training sessions, to document 'progress' and to determine whether additional sessions are needed.

AIT is based on the theory that listening to altered music can improve the listener's ability to process auditory stimuli. The effectiveness of the treatment is determined by changes in both hearing and behavior.²

Several research studies have been published on the efficacy of AIT in autism.^3-4 The most frequently reported improvements include improved attention, improved auditory processing, decreased irritability, reduced lethargy, improved expressive language and auditory comprehension and reduction in sound sensitivity. Unfortunately, little scientific documentation exists to support these assertions.

Although two investigations indicate that AIT may help some children with autism, there are no controlled studies to support its use yet.^4-5

It is the position of the American Academy of Pediatrics that AIT has not been scientifically proven and currently should be considered as an experimental approach.⁴

Several problems contribute to the lack of consensus:

the available literature provides little information on outcome variables and their means on experimental and control groups;

The statistically significant changes in the subjects' thresholds were less than 1-5 dB (normal clinical variation test-retest);

AIT use behavioral audiometric data to support their claims of benefit, although many children are difficult to test.

Long-term follow-up study of this method is necessary for fair and empirical evaluation.

It is recommended that consumers be informed that AIT is experimental in nature and a controversial treatment option for autism before they participate in the treatment.

There is still much to learn about AIT. It may be useful to ask under what conditions AIT does demonstrate effectiveness. Its effectiveness should be further investigated, as for instance in a randomized controlled trial with evaluators blind to treatment type.

References

1. Boddaert N, Zilbovicius M. Functional neuroimaging and childhood autism. Pediatr Radiol. 2002,32:1-7.

2. Miller M, Lucker J. Auditory integration training. Am J of Audiology. 1997;6(2):25-32.

3. Rimland B, Edelson S. The effect of auditory integration training on autism. Am J of Speech-Language Pathology. 1994;3:16-24.

4. American Academy of Pediatrics. Auditory Integration Training and Facilitated Communication for Autism. Pediatrics. 1998;102(2).

5. Rimland B, Edelson SM. Brief reports: A pilot study of auditory integration training in autism. Journal of Autism and Developmental Disorders. 1995;25(1):61-70.

Study performed at the Tuiuti University of Paraná and Université de Montréal

Publication Dates

• Publication in this collection
  23 Feb 2005
• Date of issue
  Sept 2004