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Title: Auditory Integration Training for ADHD and Dyslexia
Author: Anthony Kane, MD
Website: http://addadhdadvances.com
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Auditory Integration Training
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
ADHD
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.
Sound Sensitivity
AIT was created to reduce sound sensitivity and improve
language discrimination.
Dyslexia
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.
Reading Problems
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.
Speech Comprehension
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.
Thought Organization
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.
Behavior Improvement
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.
Calming Effect
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.
Study Results
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.
Complications
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.)
Conclusion
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
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Anthony Kane, MD
ADD ADHD Advances
http://addadhdadvances.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 (http://addadhdadvances.com/childyoulove.html),
child behavior and discipline
(http://addadhdadvances.com/child-behavior.html), 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: subscribe@addadhdadvances.com?subject=subsart
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