X-Vmsmail-To: @AUTISM
Newsgroups: bit.listserv.autism
Date:         Tue, 12 Jan 1993 16:11:51 -0600
              <AUTISM@SJUVM.BITNET>
From:         "Lynda W. Huggins" <HUGGINS@MERLIN.NLU.EDU>
Subject:      AIT Issues

                Autism and Auditory Integration Training:

                        A Discussion of Some Issues

        Stephen Edelson, Ph.D.                  Bernard Rimland, Ph.D.
        Center for the Study                    Autism Research Institute
          of Autism                             4182 Adams Avenue
        2207 B Portland Road                    San Diego, CA 92116
        Newberg, OR 97132

Auditory Integration Training (AIT) has received much attention in the
autism field since the publication of the book, "The Sound of a
Miracle", by Annabel Stehli.  In her book, Annabel told how her
daughter, Georgiana, received AIT from Dr. Guy Gerard, a physician in
Annecy, France.  After receiving AIT, Georgie made dramatic gains
socially, emotionally, and academically.  While Dr. Berard has used
AIT for many different conditions at his clinic in France, the present
discussion is limited to its use with children and adults with autism.

The first evaluation of AIT in the United States was a small pilot
study we conducted at Portland State University in 1990.  Overall, our
results were promising, thus we decided to continue our research with
a much larger group of participants (over 300).  We are examining
three questions in our current study: 1) Who is a good candidate
for AIT?  2) Of those who improve, in what ways do they improve? and
3) Which AIT device is more effective?  (Currently there are two
devices available in the U.S., the Audiokinetron developed by Dr. Guy
Berard and the BGC device developed by Bill Clark, an engineer, in San
Diego.)

There are now over 100 practitioners who administer AIT.  A list of
those who use the Audiokinetron can be obtained from the Georgiana
Foundation, (P.O. Box 2607, Westport, CT 06880). A list of those who
use the Audiokinetron and/or the BGC device can be obtained from the
Autism Research Institute (4182 Adams Avenue, San Diego, CA 92116).

Since the process of receiving AIT may be difficult for some people
with autism, we felt it would be helpful to provide suggestions on how
best to work with autistic individuals as well as to provide basic
information about the procedure.  We will address four important areas
in this paper-- 1) age of participant, 2) how to obtain an audiogram,
3) how to conduct the listening sessions, and 4) what results might be
expected following the AIT sessions.  We will discuss each issue
separately, relying primarily, but not solely, on information obtained
from Dr. Berard.

AGE.  AIT should not be given to children less than 4 years of age.
Although early intervention is often recommended for young autistic
children, Dr. Berard feels that giving AIT to a young child may
possibly cause more harm than good.  (One of the muscles in the middle
ear, the stapedius muscle, does not mature until age 4; and the brain
is still making some basic connections until age 4 or 5.)

OBTAINING AN AUDIOGRAM.  Obtaining an accurate audiogram requires both
attention and communication from the testee.  Audiograms can be used
for AIT only if one is 100% confident that the audiogram accurately
reflects the person's hearing.  Based on our experience and discussing
with other AIT practitioners, an accurate audiogram can be obtained
from about 1/2 of the people with autism.  Although some people claim
they can obtain an accurate audiogram on everyone, this does not seem
probable to us.

Dr. Berard feels that testing for audiograms must be conducted in a
sound-quiet room rather than a sound-proof room.  According to Dr.
Berard, a test in a sound-proof room does not provide the type of
audiogram needed for AIT.  He believes that there is too much bodily-
noise interference in a sound-proof room; and individuals with
hypersensitive hearing may hear their heartbeat and/or their blood
flow, which may interfere with the audiotest.

If an accurate audiogram cannot be obtained, AIT is conducted without
filters.  It is better not to use filters than to use the wrong
filters.  In addition, if many peaks are present, it is better not to
filter any of them.  The music is still being electronically modified
even when filters are not used.  Based on clinical experience, it
appears that many individuals for whom no filters were used have shown
benefits from AIT.  Since a number of subjects in our current large
scale study received AIT with no filters, we will soon be able to make
an objective assessment of this procedure.

There are a variety of ways to obtain a reasonable accurate audiogram.
The most accurate way is when the individuals can state, out loud,
when they hear the tone (by saying 'yes') and when they do not hear
the tone (by saying 'no').  An alternate method is to have them raise
their hand when they hear the tone, and lower their hand when they do
not hear the tone.  Still, some people with autism cannot do these
tasks.  Another method, which is quite effective, is to instruct the
individuals to drop a coin or a plastic chip into a bucket or to place
a plastic ring on a dowel after they hear a tone.  A child may need to
be trained for days or weeks prior to the actual audiogram to do these
last two tasks.

In many cases, there is only a limited amount of time in which one can
obtain an audiogram because of the person's short attention span.
Given this, we find the most effective way to test the person is to
present each tone at a very low volume, (e.g., -10 dB), and then
gradually increase the volume until the person responds to the tone.
The testee responds when he/she first hears the tone.  The person may
have a delay in responding, which is common with some of these
individuals.  Thus, the audiologist should first present the tone, and
then wait up to 10 seconds for a response.  also, it is important to
test each tone several times to make sure the person is responding
consistently to the tones.  If time is limited, then the audiologist
should at least try to retest the most important peaks, such as 750
Hz, 1000 Hz, 1500 Hz, 2000 Hz, 3000 Hz, and 8000 Hz.

In general hearing tests are designed to determine when the testee
first hears the tone.  While most non-autistic individuals respond
when the tone is presented at a very low volume, the person with
autism may respond only after hearing the tone at a moderate volume.
Although the resulting audiogram does not reflect the person's true
threshold, one can still interpret the peaks in the person's hearing
because it is the relative position of the peaks to one another that
is important to determine for AIT, not the absolute threshold.

THE LISTENING SESSIONS.  AIT sessions last 30 minutes and are given
twice a day for 10 days.  Some people with autism may have difficulty
sitting quietly for 1/2 hour.  The younger the individuals, the more
difficult it may be for them.  Attentiveness can be taught to an
individual through shaping.

Since some people with autism are tactilely sensitive, the pressure of
headphones around the ears may bother them.  We recommend that a
person become accustomed to wearing soft headphones prior to receiving
AIT.  This should be gradually introduced over a period of time.  The
type of headphone should fit **around** the ears, (cup-like), rather than
fit in the ear (e.g., walkman-type).

During the training sessions, the listeners should not use their hands
on tasks that require thought and attention.  Thus, activities like
drawing pictures or working on puzzles should be avoided.  Basically,
a person only has a limited amount of attention; and motor activities
such as using one's hands may redirect too much attention away from
the listening sessions.  In addition, higher-order cognitive tasks
such as reading may also take too much attention away from the
sessions.  However, if the listeners cannot sit still for an extended
period of time, it is acceptable for them to eat bits of food or drink
liquids as well as to look at picture books.

Another issue in AIT is fluid in the middle ear.  A person may receive
AIT if some fluid is present in the middle ear.  Many people with
autism suffer from allergies, and this may be associated with some
fluid in the middle ear.  Some people always have fluid in their
middle ear.  However, AIT should not be given to a person who has a
middle ear infection.  If a person has an ear infection, AIT may be
painful and even ineffective.  An EENT may need to determine whether
an individual has an infection in the middle ear and/or just fluid.

Dr. Berard has stated that it is best not to have tubes in one's ears
during AIT.  AIT may still be effective; however, it may not be as
effective as without tubes because some of the AIT sounds may be
displaced by going through the tubes rather than directly striking the
eardrum.  It would be best to wait until the tubes are removed before
starting AIT.

AFTER THE LISTENING SESSIONS.  Some parents expect to see a
significant change in their child's behavior immediately after the
completion of the AIT sessions.  This is rarely the case.  Some
changes are subtle and may take several months to notice.  If the
person does change following AIT, it may be difficult to determine
whether the changes are due to AIT or due to maturation.  Since
maturation is usually gradual, we tell parents if their child
'surprises' them more than usual after AIT (i.e., does something
unexpected), it may be a result of AIT.  For example, children may
start talking on the telephone for the first time or play
appropriately on a playground slide when they never did this before.
They may surprise their parents once or twice a week without AIT; but
what if, after AIT, they surprise their parents 5 or 6 times a week?
In this case, the changes may be a result of AIT.  However, we can
never be certain that the AIT has caused the improvement.

Within a couple of months after receiving AIT, some individuals may
exhibit certain behavior problems that they had not exhibited in the past,
such as aggression, self-stimulatory behavior, or ritualistic
behaviors.  This pattern seems to be quite common for many
individuals.  Based on our experience, these behaviors are short-
lived, lasting anywhere form 2 days to 2 months.  At the same time
though, other more positive behaviors may start to appear, especially
in the areas of social, emotional, and academic development.

Some autistic children appear to become worse after receiving AIT.
Their behaviors are often described as "out-of-control" or the child
is described as "hard-to-handle".  Some children are more assertive
(aggressive), more stubborn, and/or less compliant after receiving
AIT.  After reviewing the family and school situations of these
children, our opinion is that most of these children were not
receiving proper behavioral management strategies to deal with their
behaviors, both in the home and school environments.  Behavioral
management strategies refer to establishing clear and strict
boundaries as well as being consistent in handling these behaviors.
These behavior problems typically do not last very long for those
parents and teachers who utilize strict behavioral strategies.  It is
our recommendation that parents learn and properly execute appropriate
behavior management skills prior to having their children receive AIT.
(Note:  The advice is appropriate for autistic children whether or not
they have been given AIT.)

It is believed that only in a small minority of cases will more than
one series of AIT be required.  In these cases, Dr. Berard suggests
that one should wait at least 9 months before receiving it again.  At
this time, we do not know how to tell if a person will benefit from
receiving AIT a second time, whether this may counteract previous
gains, or whether there will be no effect.  Georgie had AIT only once
and made dramatic improvement.  We are currently examining this issue,
and we hope in the near future to have a better understanding of the
effect of receiving AIT more than once.

CONCLUSION.  AIT is an adventure and an experience.  Not everyone will
benefit from AIT, but we have seen many cases in which we and the
families feel that AIT has produced a noticeable improvement.  We will
continue our research to obtain a further understanding of this
intervention, and we hope other researchers will engage in similar
investigations.

-------------------------

The Center for the Study of Autism distributes a 2-page instruction
sheet and an audiotape to help parents teach their son/daughter how to
practice for this audiotest.  The Center also distributes an
instruction sheet on how to practice sitting quietly and wearing
headphones.  If you are interested in obtaining this instruction
packet, please send $3 to:  Heather Waddell, Center for the Study of
Autism, 2207 B Portland Road, Newberg, Oregon 97132.
Comments: Gated by NETNEWS@AUVM.AMERICAN.EDU