Auditory Integration Training
Auditory integration training (AIT), is one specific type of music/auditory therapy based upon the work of French otolaryngologists Dr. Alfred Tomatis and Dr. Guy Berard.
The premise upon which most auditory integration programs are based is that distortion in how things are heard contributes to commonly seen behavioral or learning disorders in children. Some of these disorders include attention deficit/hyperactive disorder (ADHD), autism, dyslexia, and central auditory processing disorders (CAPD). Training the patient to listen can stimulate central and cortical organization.
Auditory integration is one facet of what audiologists call central auditory processing. The simplest definition of central auditory processing, or CAP, is University of Buffalo Professor of Audiology Jack Katz's, which is: "What we do with what we hear." Central auditory integration is actually the perception of sound, including the ability to attend to sound, to remember it, retaining it in both the long- and short-term memory, to be able to listen to sound selectively, and to localize it.
Guy Berard developed one of the programs commonly used. Berard's auditory integration training consists of twenty half-hour sessions spent listening to musical sounds via a stereophonic system. The music is random, with filtered frequencies, and the person listens through earphones. These sound waves vibrate and exercise structures in the middle ear. This is normally done in sessions twice a day for 10 days.
Alfred Tomatis is also the inventor of the Electronic Ear. This device operates through a series of filters, and reestablishes the dominance of the right ear in hearing. The basis of Tomatis' work is a series of principles that follow:
- The most important purpose of the ear is to adapt sound waves into signals that charge the brain.
- Sound is conducted via both air and bone. It can be considered something that nourishes the nervous system, either stimulating or destimulating it.
- Just as seeing is not the same as looking, hearing is not the same as listening. Hearing is passive. Listening is active.
- A person's ability to listen affects all language development for that person. This process influences every aspect of self-image and social development.
- The capacity to listen can be changed or improved through auditory stimulation using musical and vocal sounds at high frequencies.
- Communication begins in the womb. As early as the beginning of the second trimester, fetuses can hear sounds. These sounds literally cause the brain and nervous system of the baby to develop.
A quartet of CAP defects have been identified that can unfavorably alter how each person processes sound. Among these are:
- Phonetic decoding, a problem that occurs when the brain incorrectly decodes what is being heard. Sounds are unrecognizable, often because the person speaking talks too fast.
- Tolerance-fading memory, a condition with little or poor tolerance for background sounds.
- Auditory integration involves a person's ability to put together things heard with things seen. Characteristically there are long response delays and trouble with phonics, or recognizing the symbols for sounds.
- The fourth problem area, often called auditory organization, overlaps the previous three. It is characterized by disorganization in handling auditory and other information.
Certain audiological tests are carried out to see if the person has a CAP problem, and if so, how severe it is. Other tests give more specific information regarding the nature of the CAP problem. They include:
- Puretone air-conduction threshold testing, which measures peripheral hearing loss. If loss is found, then bone-conduction testing, or evaluation of the vibration of small bones in the inner ear, is also carried out.
- Word discrimination scores (WDS) determines a person's clarity in hearing ideal speech. This is done by presenting 25–50 words at 40 decibels above the person's average sound threshold in each ear. Test scores equal the percentage of words heard correctly.
- Immittance testing is made up of two parts, assessing the status of, and the protective mechanisms of the middle ear.
- Staggered sporadic word (SSW) testing delivers 40 compound words in an overlapping way at 50 decibels above threshold to each ear of the person being tested. This test provides expanded information that makes it possible to break down CAP problems into the four basic types.
- Speech in noise discrimination (SN) testing is similar to Staggered Sporadic Word testing except that other noise is also added and the percentage correct in quiet is compared with that correct when there is added noise.
- Phonemic synthesis (PS) determines serious learning problems. The types of errors made in sounding out written words or associating written letters with the sounds they represent help in determining the type and severity of CAP problems.
Upon completion of an auditory integration training program, the person's hearing should be capable of perceiving all frequencies at, or near, the same level. Total improvement from this therapy, in both hearing and behavior, can take up to one year.
Research & general acceptance
Auditory integration training is based upon newly learned information about the brain. Though brain structures and connections are predetermined, probably by heredity, another factor called plasticity also comes into play. Learning, we now know, continues from birth to death. Plasticity is the ability of the brain to actually change its structuring and connections through the process of learning.
ALFRED TOMATIS 1920–2001
Internationally renowned French otolaryngologist, psychologist, educator and inventor Alfred Tomatis early-on perceived the importance of sound and hearing. He took his degree as a Doctor of Medicine from the University of Paris and specialized in ear, nose and throat medicine. The son of two opera singers, Tomatis early in his career treated some of his parents' fellow opera singers. From these experiences with the sound of music, he developed the principle that has come to be known as the Tomatis Effect, i.e. that the human voice can only sing what it hears.
Tomatis has been called the Einstein of the ear. It was his research that made the world aware that the ears of an infant in utero are already functioning at four and half months of age. Just as the umbilical cord provides nourishment to the unborn infant's body, Tomatis postulated that the sound of the mother's voice is also a nutrient heard by the fetus. This sound literally charges and stimulates the growth of the brain.
Dr. Tomatis took this further, into the realm of language. Tomatis concluded that the need to communicate and to be understood are among our most basic needs. He was a pioneer in perceiving that language problems convert into social problems for people. "Language is what characterizes man and makes him different from other creatures," Tomatis is quoted as saying. The techniques he developed to teach people how to listen effectively are internationally respected tools used in the treatment of autism, attention-deficit disorder, and other learning disabilities.
His listening program, the invention of the Electronic Ear, and his work with the therapeutic use of sound and music for the past fifty years have made Tomatis arguably the best known and most successful ear specialist in the world. There are more than two hundred Tomatis Centers worldwide, treating a vast variety of problems related to the ability to hear.
Problems with auditory processing are now viewed as having a wide-reaching ripple effect on our society. It is estimated that 30–40% of children starting school have language-learning skills that can be described as poor. CAP difficulties are a factor in several different learning disabilities. They affect not only academic success, but also nearly every aspect of societal difficulties. One example to illustrate this is a 1989 University of
Training & certification
Both Tomatis and Berard have certification programs in their therapies.
Katz, Jack, Ph.D., Wilma Laufer Gabbay, M.S., Deborah S. Ungerleider, M.A., and Lorin Wilde, M.S. Handbook of Clinical Audiology. Waverly Press, Inc., 1985.
Katz, Jack, Ph.D. "Central Auditory Processing Evaluation." (1996).
Masters, M. Gay. "Speech and Language Management of CAPD." (1996).
Musiek, Frank, Ph.D. "Auditory Training: An Eclectic Approach." American Journal of Audiology (1995).
"Auditory Integration and Alfred Tomatis." The Spectrum Center. <http://listeningtraining.com/ (December 2000).>
Cooper, Rachel. "What is Auditory Integration Training?" http://www.vision3d.com/adhd/ (December 2000).
Dejean, Valerie. About the Tomatis Method, 1997. Tomatis Auditory Training Spectrum Center, Bethseda, MD.
Masters, M. Gay and Jack Stecker Katz, N.A. Central Auditory Processing Disorders: Characteristic Difficulties. Miniseminar, 1994.