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By Maurice H.
Miller, Ph.D.
All new modalities of therapy and management (like
new medications) must be evaluated for effectiveness
and safety. Anecdotal
reports by parents or clinicians, however well meaning,
are not sufficient to meet these criteria. When Auditory
Integration Training (AIT) is subjected to controlled,
double-blinded studies, there is no existing evidence
that AIT results in improved performance and behavior
for children with autism or other disorders of communication.
Such studies are now available and have appeared in
a number of highly respected peer-reviewed journals
which are summarized elsewhere. A review and analysis
of these studies led a distinguished panel of authorities
appointed by the American Speech-Language-Hearing Association
(ASHA) to conclude that AIT has not met scientific standards
for efficacy that would justify its inclusion as a form
of treatment for autism or other communication disorders.1
The American Academy of Audiology (1993), the American
Academy of Pediatrics (1998) and the Educational Audiology
Association (1997) all concur that AIT should be considered
an experimental procedure. The New York Department of
Health (1999) developed clinical practice guidelines
for the assessment of and intervention for children
with autism and pervasive development disorders. The
NYDOH concluded that the efficacy of AIT had not been
demonstrated and recommended that AIT not be used as
an intervention for young children with autism.
The theory behind AIT, as originally espoused by Guy
Bernard, a French otolaryngologist, is that children
with autism have hypersensitive hearing at select frequencies
manifested by “peaks” and “valleys”
on the pure-tone audiogram, i.e., thresholds for adjacent
audiometric frequencies differ by 5 dB or more and result
in a typical perception of some sounds resulting in
such behavioral disturbances as autism spectrum disorders,
learning disabilities, depression and aggressiveness.
However, these “peaks” and “valleys”
occur in the audiograms of many persons with intact
auditory systems and are often not reproducible on repeat
tests. Furthermore, they are not occurring at “adjacent
frequencies” since the tests are performed at
discrete frequencies (octave or inter-octave points)
not at frequencies tested with continuous sweep instrumentation.
Moreover, pure-tones are primitive non-challenging stimuli
providing limited information on what is occurring at
higher levels in the auditory system, i.e., brainstem
and cortex where some of the abnormal auditory problems
in these children may originate. (ABR functional MRI,
PET Scans are more appropriate tools of investigations.)
Audiologists such as the undersigned have serious concerns
about AIT’s safety. The equipment is often poorly
calibrated and is used by many practitioners without
training in Audiology. The potential exists that clinicians
without audiological expertise and experience in calibration
of equipment will damage the normal auditory mechanism.
Indeed exposing children, many of whom have small external
auditory canals, to sounds of high intensity means that
greater sound pressure levels will be delivered by AIT
equipment and may cause a permanent noise-induced sensorineural
hearing loss.2 Practitioners who have limited or no
audiological training may not have access to audiometric
testing results to allow them to monitor hearing levels
before and after treatment.
In conclusion, and despite enthusiastic reports from
some understandably well-meaning parents and practitioners,
AIT has not met criteria for effectiveness and safety.
Its use may raise false, unsubstantiated hope and may
delay or prevent treatment by other modalities which
have a stronger therapeutic base. And not to be discounted
is concern that the inadequately calibrated equipment
and failure to monitor hearing before and after treatment
may cause damage to essentially normal but vulnerable
auditory systems. Those who continue to use this equipment
should remember the watchwords of all ethical health
practitioners, “Do no harm.”
References
1American Speech-Language-Hearing Association.
(2004). Auditory Integration Therapy. ASHA Supplement
24, in press.
2Feigin, J. A., et al. (1989). Probe-tube
microphone measures of ear canal sound pressure levels
in infants and children. Ear and Hearing, 10(4),
254-258.
Further Reading
Miller, M.H. (1996). Concerns about AIT include candidacy,
instrumentation. Advance for Speech-Language Pathologists
and Audiologists, 6(1), 11.
Miller, M. H. & Lucker, J. (1997). Auditory
integration training. American Journal of Audiology,
6(2), 25-31.
Maurice H. Miller, Ph.D., is professor
of audiology and vice chair of the Department Speech-Language
Pathology and A. Steinhardt School of Education at New
York University. In addition, Dr. Miller serves as chief
audiological consultant and chair of the Communicative
Disorders Committee of the NYC Department of Health.
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