By Rosalie E. Seymour B.A. (Log) Pret.; AIT Practitioner; Speech and Language Therapist, Filtered Sound Training Director, Consulting in Autism
We learn so much about normal development by studying developmental differences, and difficulties. It is when we watch a child struggling to speak that we realise what a complex behaviour the act of speech is, and how marvelously we are made to have acquired such a skill so easily when we were young, and what a precious gift from God it is! When we see a child of 17 years still unable to read despite years of remediation, we may marvel at the intricacies of the brain’s development that allows some pre-schoolers to read with ease!
When development slows up, or goes wrong somewhere, a group of concerned adults (this may include doctors, paediatricians, neurologists, psychologists, educators, remediators and therapists) may gather to understand the factors involved, and to try and “solve” the problem, to get properly back on track.
Parents, especially, have been the ones who have sought for understanding of these factors.
Parents are usually the only members of the “team” of concerned adults who see the child’s behaviour all the way through night and day; - who notice a collection of puzzling differences in these children that extend far beyond public behaviour and scholastic success ( or the lack of it!).
SOCIAL / PRAGMATIC SKILLS and ATTENTION
One such common factor is that of poor pragmatic skills: the social skills aspect of communication. These children almost without fail seem to have difficulty with social tasks that come so easily to others:- turn-taking, give-and-take, topic control or keeping to the topic, how to repair a misunderstanding or miscommunication ….. As children develop, these skills are employed with increasing ease, but these are tasks that never reach a competence level in the child with SLD, autism, or a language deficit.
This lack is what causes these children to be labeled “immature” in reports. Usually, a child will make rapid progress in this area. They learn socially acceptable ways. The SLD or language – delayed child commonly does not acquire those skills as expected. He seems to lag behind socially – hence the label “immature” that is frequently given to his behaviour, or to him .
This is not the only area of immaturity seen. These children often are reported to be vague, unfocused, “dreamy”, and find it hard to concentrate for long enough on one task as do other children at their age level. They are seen to be impulsive, hasty, too quick off the mark, - sometimes to the point of rudeness. These are aspects of neurological maturity that develop with age. These children lag behind. They act immature.
As for the child with autism, one of the distinguishing marks of this disorder is a severe lack of social skills. This lack of even the most basic social skills has led experts and parents to conclude that these children lack any interest in social interaction. This is frequently a false assumption . Many people with autism, who later were able to tell their own story, have told how they longed to part of society just like anyone else, but they were unable to “crack the secret code” of how to do it. (Temple Grandin, Donna Williams, Jim Sinclair).
Another common factor, is that of hearing problems. An informal survey reveals that around 90% of children with Specific Learning Disability (SLD) have a history of repeated ear infection, upper respiratory infections, and allergies, that affected the ears. It has also been seen that about 90% of children with autism have had the same kind of medical history as the SLD children.
Medical opinion is divided as to the significance of repeated ear infections in the histories of these children. This is largely due to the way the terms are defined when doing research on this topic. We need to understand the basic terms, especially “hearing within normal limits”.
When an Audiologist tests hearing, she/he is looking for deafness, a hearing loss. The degree of hearing loss is given in percentages, or in decibels (dB). Normal hearing is between 0 to 25 dB, by usual standards. A child or adult can have lost up to 25 dB of sound and still be classed as “hearing within normal limits”.
It must be understood that “hearing within normal limits” does not necessarily mean good hearing at all. When you block out sound by putting your fingers in your ears, you may be losing as little as 10 dB only. You know how this sounds, though – one can have blocked out quite a lot of sound, i.e. lost quite a bit of auditory information. You probably can’t think of one teacher or parent who will accept talking to a child who has their fingers in their ears. Apart from the poor attitude this shows, we know they can’t be listening well with blocked ears! Should we accept this state of hearing loss as ‘normal hearing’?
When an adult loses this much sound, it doesn’t matter too much, because they have a store of knowledge and can “fill in the blanks”. This is not the same for a child, especially a young child. They are still learning about words, sounds, what things mean, etc.
A child is still learning about his auditory environment. He must still make connections, learn to listen, and get knowledge that is best done via the ears, and for this he must have an intact auditory system. He needs a good mechanism that will deliver all the auditory information for processing; clearly, without distortions.
It is standard practice to test the hearing of the speech- or learning-handicapped child, to see if there is some hearing loss (i.e. greater than 25 dB). In most cases, the hearing is said to be “within normal limits”. This result is usually taken to mean hearing is good. Not so!
We must also take into consideration that the child may have a Central Auditory Processing Disorder, (CAPD).
CENTRAL AUDITORY PROCESSING DISORDER
Most audiologists test to find a quantitative result, i.e. how many decibels of sound acuity have been lost. They do not usually test for a qualitative analysis, e.g.;-
- distortions in the ear’s response to sound, causing the person to hear some sounds better than others. This implies that they will hear some speech sounds better than others, e.g. vowels vs consonants
- lack of selectivity;- difficulty discriminating the different frequencies.
- laterality problems;- when some sounds (corresponding to different speech sounds) are better processed by the right hemisphere, and others by the left, leading to confusion in the interpretation of the heard information. This may also lead to the slowness of processing for meaning.
A Qualitative assessment of hearing difficulties, also called listening problems, has to be made. It is not enough to test hearing acuity to understand the child’s developmental language difficulty.
The existence of a CAPD can be expected when there are a number of problem behaviours in the area of listening. Diagnosis is important, but because the process can take long, it is recommended that while one awaits diagnosis of CAPD, one proceed with intervention 'as if' there had been such a diagnosis, if the signs for CAPD exist (see the 'auditory problems checklist', Some of these are:-
• the child has a slow response to what he hears,
• gets instructions wrong,
• forgets what he’s been told,
• has trouble spelling (phonics),
• has trouble with speech
• has trouble with language
• or learns poorly through the auditory channel.
It is for these children as if the ear receives the auditory information, but some interference disturbs the proper, harmonious decoding process that should lead to understanding. As a result comprehension of the message may be poor. If the hearing system does not perform its task efficiently, if the message is received with distortions in it, the meaning will be lost in places, and the child will have to work very hard to “fill in the gaps”.
After a while, the child tires and loses concentration; he may give up and his attention wanders. Perhaps he is still trying to process the question that was asked, instead of being ready to come up with the answer ! In a classroom such a child will probably be accused of 'daydreaming'.
The child has no idea that things sound differently to him than to others – all he sees is that everyone else is coping better than he does, and geting into less trouble than he does. Discouragement begins to grow. Added together with frustration, this lead to bad behaviour, and he either becomes disruptive in class, or withdraws (disengages).
CAPD can also cause severe developmental problems.
A difficulty with auditory processing may occur anywhere along the auditory pathway to the brain, even in the way the ear prepares itself to receive the sound; i.e. attention to the signal, or in the way the nerve cells respond to a sound signal. The system may be so dysfunctional that even a soft sound may elicit a strong response – a sound that doesn’t bother anyone may cause this person acute discomfort. This is called hyperacusis.
Research has shown that about 40% of people with autism have hyperacusis. It is also found that about 40% of learning disabled people suffer from this condition. In fact many people suffer from hyper-hearing at some time, without it being properly diagnosed.
TREATMENT OF CAPD
Until lately, there hasn’t been much that could be done about this condition of CAPD directly. The treatments have been supportive, e.g. teach the child to use a diary, check that he’s heard you correctly.
Any textbook about learning problems will have many chapters on what to do for visual problems, but very little about how to help children with CAPD.
Lately, a new option has come to the fore. A French Ear-Nose- and- Throat specialist, Dr Guy Bérard, developed a method of using electronically modulated music to bring the hearing mechanism to more effective function. In this way one can remove the obstacle to the development of good auditory processing.
AUDITORY INTEGRATION TRAINING
This method is known as Auditory Integration Training. It was developed by him to treat his own progressive hearing loss. His search for a treatment for his condition led him to develop the AUDIOKINETRON. This electronic device distorts the music that is played through it, with rapid and random switching from low sounds to high sounds. These sounds are played to the listener over headphones for 20 sessions each lasting half an hour. At the end of this time, the hearing mechanism has adjusted itself, and has become an efficient transmitter of auditory information.
Dr Bérard likens the effect of this electronic modulation of the music to a type of physical therapy of the hearing mechanism, a sort of aerobic work-out. The alternation of the low and high sounds act on :
- the eardrum, because the low frequencies go through the lower part of this membrane to the round window, and then to the cochlea. The high frequencies are transmitted by the upper part of the drum to the ossicles, causing them to move.
- the cochlea, through many possible mechanisms, e.g. the movement of the fluid within the organ.
It starts out at a medium loudness level, like a moderately-paced exercise session, and then increases in intensity until one reaches the optimum level of intensity. This level is maintained then for the remainder of the sessions.
Signs of change : During AIT, there are sometimes changes in behaviour that can be attributed to fatigue and the person’s reaction to changes in their “perceptual field”. Fatigue is common, sometimes headaches occur, or a change in sleeping or eating patterns. Sometimes there is a spurt of challenging behaviours, and occasionally the child may revert to earlier behaviours. These changes are of a temporary nature, and disappear shortly after the end of the course of treatment.
The improvement in the auditory processing mechanism continues to impact on the child’s behaviour and learning over the next three months or so, and one commonly sees a slow, but sometimes dramatic, improvement that is sustained.
The checklists that have been used to chart the behavioural improvements are :- the Connors Scale, Fischer’s Auditory Problems Checklist, and the Aberrant Behaviour Checklist. Others are also used by practitioners.
Various neurological measures have also been used, e.g. EEG ‘s, brainstem measures, and PET scans, as well as urinary peptide analyses. Parent and professional reports are favourable, with no negative effects being reported from the treatment.
A listening test is often done at the beginning, middle, and end of training, The final audiogram usually shows some changes, towards a more even graph, with less extreme peaks and valleys evident. Occasionally there is a minor improvement in hearing threshold.
Auditory Integration Training as a treatment in autism was first described by Annabel Stehli in her excellent books. These achieved 'best seller' status and tell about what changes can be expected from this training.
AUDITORY TRAINING- A LOGICAL FIRST STEP
Practitioners find the training is of benefit to children and adults with learning disorders / dyslexia. Many people have been enabled to live less restricted lives, move out of special education, improve social responsiveness, and often become more confident people after AIT.
FST / AIT is a part of the tool kit to get the job done . What is so exciting about AIT, is that it is a valuable tool that reaches deeper than we’ve been able to go thus far in our services to these children and adults.
These changes in people with autism, dyslexia and learning disabilities after AIT have challenged previously-held beliefs about these conditions. It does seem that the ear is a significant part of these disorders, and that AIT may be a helpful part of the solution.
There is indeed something that can be done about auditory processing disorders, and it seems it can be done in ten hours of stimulation.
FST / AIT lays a good foundation for further therapies in problems like speech and language disorders, autism, dyslexia, and a variety of problems of neurological origin. Auditory training has always been the logical starting point in speech therapy, and remedial education, and FST / AIT seems to be a powerful new intervention to fit in this slot.
Practitioners might use a South-African device, The Earducator, that enjoys Dr Bérard’s endorsement and is supplying the international market. Another device, the Digital Auditory Aerobics (DAA) system is supported by the Georgiana Institute and is found to have comparable results. Some pc-based systems have been developed, e.g. the Filtered Sound Training (FST) system, that allows high - quality modified sound to be delivered conveniently at home via a laptop and headphones.
The effectiveness of FST, whichever device is used, is supported by more than 28 research studies (see AIT Clinical Studies) that endorse its effectiveness and safety. AIT is not a cure, but it is a useful part of the tool kit to assist people with listening skills difficulties in an intensive, ten-day programme that has been shown to produce benefits.
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