Article Reprinted from the National Austistic Society, UK. Original source here.

This web page has been written to provide information on a particular intervention/approach and any research connected with it, not as a recommendation. The outcome of any approach will depend on the needs of the individual, which vary greatly, and the appropriate application of the intervention. An intervention that may help one individual may not be effective for another. It would therefore not be appropriate for the NAS to recommend any one particular practice or therapy.

This web page has been written to provide information on a particular intervention/approach and any research connected with it, not as a recommendation. The outcome of any approach will depend on the needs of the individual, which vary greatly, and the appropriate application of the intervention. An intervention that may help one individual may not be effective for another. It would therefore not be appropriate for the NAS to recommend any one particular practice or therapy.

What is Auditory Integration Training?

Dr Guy Bérard (now retired) was an ear, nose and throat specialist, in Annecy, France, who invented and developed an auditory training device. Dr Bérard began developing this in the early 1980s, when he learned that he himself was becoming deaf. He conceived of the idea of developing an electronic machine that would exercise the entire hearing apparatus – the ear drum, the small bones in the ear, the cochlear membrane, etc as a form of physical therapy, in a manner somewhat similar to that in which deteriorating joints and muscles can be rejuvenated by physical therapy and exercise. This technique was used with many of Dr Bérard’s patients, some of whom had autism, and many others with a variety of auditory difficulties. In relation to autism, Bérard thought that sound sensitivity and consequent behavioural disturbance could result from distortions in hearing. Dr Bérard states that “Auditory Integration Training cannot be called a cure for autism, but many (people) benefit greatly from the treatment.” (Bérard, 1997).

Bérard believed that AIT would bring about a re-education of the hearing process (Sinha et al, 2004). However Mudford and Cullen (2005) argue that Bérard’s justification for using AIT with autism was scientifically tenuous at best. They report that AIT sparked controversy within the communication sciences’ professional community. Critics argued that there was no scientific evidence for the type of hearing abnormalities in autism reported by Bérard. It is also considered that AIT is theoretically inconsistent with knowledge about structures and mechanisms of the ear (Mudford and Cullen, 2005).

The device consists of a machine containing a number of electronic elements, including a variety of auditory filters, which makes the sound emanating from the machine modifiable to be appropriate for the individual person, in accordance with their auditory sensitivities and deficiencies as determined by audiometric testing. The treatment comprises thirty-minute sessions twice a day for ten days. In use, the child/adult sits before the machine, wearing earphones, while specially selected music is played into the machine. The machine filters and amplifies the music as necessary and feeds the resulting modified music to each ear independently. The volume is set as loud as is possible without discomfort. However Audiokinetrons and other auditory integration devices are subject to U.S. import ban due to exceeding maximum allowable exposure to sound pressure levels specified by the US Occupational Safety and Health Administration. (Mudford and Cullen, 2005).

The late Dr Bernard Rimland (from the Autism Research Institute in America) was in touch with a number of parents of children with autism who had taken their children to be treated by Dr Bérard. The mother of one of these children has written a book about the experience. (Stehli, 1992).

Research into AIT

An initial pilot project conducted by Drs. Rimland and Edelson at Portland State University in 1990 offered some interesting results and so a second study was undertaken which examined several specific issues of the AIT procedure.

Another research project carried out at The Autism Research Institute in Sydney (Bettison 1996) indicated that although Auditory Training (AT) did lead to a significant improvement in sound sensitivity in general, a structured listening (SL) programme led to about the same amount of improvement. (The structured listening programme was a simplified version of the AT procedure, and omitted the input of the special equipment used in AT). Bettison stresses however, that her results do not prove that AT and SL were the actual cause of the childrens improvements, nor, if the interventions were beneficial, which aspects were having the beneficial effect. She concludes that both SL and AT appear to help in reducing sound sensitivity in many, but not all, children with autism who are sound sensitive.

Mudford and Cullen (2005), Romanczyk at al (2004), Sinha et al (2004), and Simpson et al (2005) provide overviews and critiques of research studies on AIT to date. Romanczyk et al (2004) report that studies have produced mixed results regarding the efficacy of AIT as an intervention for people with autism. In particular Simpson et al (2005) state “few studies have convincingly produced scientific evidence that AIT is indeed responsible for reported changes in behaviour and functioning.” (p. 186). Sinha et al (2004) conclude that there is no clear evidence yet for AITs effect.

Mudford and Cullen (2005), Romanczyk et al (2004), and Sinha et al (2004) raise concerns regarding limitations of research findings including flaws that they argue limit interpretation of the data, questions regarding clinical significance, lack of replicability, and small sample size. Romanczyk et al (2004) also cite reports of negative side effects which they argue raise ethical questions concerning the use of this procedure with people with autism. AIT is one of the more expensive treatment options for people with autism (Simpson et al, 2005). Furthermore as Simpson et al (2005) point out AIT uses equipment capable of producing sounds at decibels that may be harmful to a persons auditory system, and therefore it is important that the intervention only occur under the direction of a trained AIT specialist.

Romanczyk et al (2004) conclude that the nonstandardised and unregulated manner in which AIT is practised may place those seeking this treatment at risk. Romanczyk et al (2004) and Sinha et al (2004) call for methodological changes for future research to ensure validity and replicability. In particular it is argued that research concerning the efficacy of AIT should identify and evaluate target behaviours using direct observation and behaviour checklists (Simpson et al, 2005). Sinha et al (2004) conclude that more research is needed to inform decision making about this therapy for individuals with autism spectrum disorders. However Mudford and Cullen (2005) came to the conclusion that future research efforts might better be placed studying potential treatments other than AIT. They categorically state: “Finally, our unambiguous recommendation for families considering purchasing AIT: There is no good evidence that AIT will change behaviour beneficially. No independent studies have shown that AIT has positive effects on behaviour of children or adults with autism.” (Mudford and Cullen, 2005, p. 361). Romanczyk et al (2004) recommend that if efficacy is validated standardised delivery and practice for AIT should be executed.