Summaries and Critiques of 28 Reports
(January, 1993 - May,
Stephen M. Edelson, Ph.D. and Bernard Rimland, Ph.D.
Auditory integration training (AIT), as developed by French
otolaryngologist Guy Berard and based on the work of his
predecessor, Alfred Tomatis, typically consists of 20 half-hour
sessions of listening to specially modulated music over a 10- to
20-day period.AIT has been reported to be beneficial in several
conditions, including AD/HD, autism, dyslexia, and hypersensitive
hearing at certain frequencies.
The present review covers 28 reports on AIT. Twenty-three
reports concluded that AIT benefits various population subgroups,
three studies claim to show no benefit (or no benefit over that seen
in a control group), and two studies reported rather ambiguous or
contradictory results.Considering the great difficulties in both
providing a credible placebo treatment and assessing improvement in
the subject populations, these results are quite encouraging. The
balance of the evidence clearly favors AIT as a useful intervention,
especially in autism.
Following are summaries of all research studies known to us that
have investigated the efficacy of AIT.These studies were published
between January, 1993 and May, 2001 and have appeared in
peer-reviewed journals, professional newsletters, and/or were
presented at professional conferences.Twenty-six of the studies
utilized subjects with autism, attention deficit/hyper-activity
disorder, central auditory processing disorder, and/or mental
retardation. Two of the studies evaluated the physiological effects
of AIT on animals.
Section A of the paper summarizes those studies supporting the
efficacy of AIT; Section B summaries those studies that claim to
have found no support for its efficacy; and Section C summarizes the
results of two studies which we have classified ‘ambiguous,
contradictory, or controversial.’ Following these three
sections, Section D, we discuss two additional reports in a
Discussion section, followed by our Conclusions.
The summaries are listed chronologically within each disorder.
All used Berard-type equipment and procedures.(We are not aware of
any relevant research using the Tomatis approach during the time
The following abbreviations are used for the tests/checklists
utilized most often in the studies:Aberrant Behavior Checklist
(ABC-1), Autism Behavior Checklist (ABC-2), Behavior Summarized
Evaluation (BSE), Childhood Autism Rating Scale (CARS), Clinical
Evaluation of Language Fundamentals--Revised (CELF-R), Conner’s
Parent Rating Scales (CPRS), Fisher’s Auditory Problems Checklist
(FAPC), Screening Test for Auditory Processing Disorders (SCAN),
Self-Injurious Behavior Questionnaire (SIBQ), Staggered Spondaic
Word (SSW), and the Test of Nonverbal Intelligence (TONI).
Section A -- Studies Reporting Positive Effects of AIT
(1) Ocular Movements Among Individuals with Autism Pre- and
Post-Auditory Integration Training
Margaret P. Creedon in collaboration with Stephen M. Edelson and
Janice E. Scharre
Easter Seals Therapeutic Day School, Autism Research Institute,
and Illinois College of Optometry
Paper presented at the Annual Conference of the Association for
the Advancement of Behavioral Therapy, New York, 1993.
In an open-clinical study, visual tracking movements and
optokinetic nystagmus (a visual reflex) were assessed in 22 autistic
individuals, ages 6 to 13 years, prior to, immediately following,
and three months after AIT.Significant improvements were seen in
horizontal tracking immediately following AIT and in both horizontal
and vertical tracking three months post AIT.No changes were seen in
Parents completed the FAPC and the ABC-1. The FAPC indicated
significant improvement at 3 months post-AIT, and the ABC-1
indicated significant improvement both immediately following and 3
Comment. This was an open-clinical study with no
control group for comparison.
(2)Study of the Effects of AIT in Autism
Dawn Cortez-McKee and Jaak Panksepp
Bowling Green State University, Ohio
Paper presented at the Annual NW Ohio Autism Society Conference,
This open-trial clinical study utilized 33 autistic
individuals.Participants were assessed using multiple measures prior
to (two baseline measures), and at 1-week, 1-month, and 3 months
following AIT. The measures included: ABC-1, BSE, CARS, CPRS, FAPC,
and SIBQ. Significant improvement was seen on all of the measures,
except the FAPC, at the one- and three-month follow-up assessment
Comment. This study
was also an open-clinical trial with no control group for
(3 & 4) Two Studies of the Effects of Auditory Integration
Training in Autism
Tina K. Veale
Comprehensive Concepts in Speech and Hearing, Cincinnati,
Paper Presented at the International ASA Conference on Autism,
Toronto, Canada, 1993.
Study I. In a double-blind placebo pilot study,
five autistic subjects participated in the experimental group and
five in the control group. Parents completed three different
evaluation forms--the ABC-1, the CPRC, and the FAPC. These
instruments were completed prior to, one month following, and three
months following AIT.There were no initial differences between the
experimental and control groups, but positive trends indicating
improvement in the experimental group were seen at three months
following AIT for all three evaluation forms.
Study II. This was an open clinical study
involving 46 autistic participants. Parents completed the ABC-1,
CPRS, FAPC as well as the Autistic Behavior Composite Checklist and
Profile. Significant improvements were observed at one month and six
months following AIT. Some of the behavioral changes included:
reductions in hyperactivity, social withdrawal, auditory problems,
restlessness, and anxiety.
Comment. Study I included a control-placebo group, but
there were only five subjects in each group. Given this small
number, it is not surprising that, despite the benefits seen, there
were no significant differences between the two groups.Study II
which did find significant pre- and post-treatment differences was
an open-clinical trial and did not include a placebo-group.
(5)The Effects of Auditory Integration Training in
Bernard Rimland and Stephen M. Edelson
Autism Research Institute, San Diego, California
American Journal of Speech-Language Pathology , 1994, 5, 16-24.
This study involved an open-clinical research design which
included several experimental control measures.There were 445
autistic subjects in the study, with ages ranging from 4 to 41
years. A significant reduction in sound sensitivity was found, based
on the presentation of pure tones prior to and immediately following
the AIT sessions. Analyses of the hearing tests conducted prior to,
after 5 hours of listening, and after 10 hours of listening, showed
hearing acuity to have improved slightly while the amount of
variability within the audiogram decreased. Subjects were also
assigned at random to one of several filtering conditions (e.g.,
filter auditory peaks, no filters, filter painful frequencies). No
differences in the efficacy of the AIT were found among the
Parents completed several different questionnaires on a monthly
basis for 9 months.These included the ABC-1, CPRS, and the FAPC.The
responses to these behavioral measures indicated a sharp reduction
in problem behaviors, starting one month following the AIT listening
sessions. These changes remained stable throughout the entire 9
months of post-AIT evaluations.
Participants were assigned at random to one of three different
AIT devices. No differences were found in the efficacy of the
Correlational analyses were employed to attempt to develop a
profile of those individuals who may benefit from AIT. Lower
functioning individuals displayed significantly greater improvement,
as indicated by the ABC-1 and the CPRS.
No significant relationships were found between behavioral
improvement and age, degree of sound sensitivity, and the amount of
variability in the pre-AIT audiogram.
Comment. Although a placebo group was not employed in this
research project, the study did include several experimental
controls, such as videotape raters who were ‘blind’ to before/after
conditions, and random assignment to filter conditions and to AIT
(6) Positron Emission Tomography Measure of Modified Auditory
A Case Study
Jacqueline M. Cimorelli and Melanie K. Highfill
University of North Carolina at Greensboro & Center for the
Dev. of Comm. and Learning, Winston-Salem, NC
Presented at the ASA National Conference, Las Vegas, 1994.
Reported in ADVANCE for Speech-Language Pathologists and
Audiologists, June 26, 1995.
A single-subject research design investigated changes in brain
functioning following AIT using Positron Emissions Test (PET) Scan
technology. The research subject was an 8-year old male with mental
retardation and autism.PET scans were conducted prior to a second
set of AIT listening sessions (baseline), one day after the
listening sessions, and six months later. The results at both the
one-day and six-month follow-up evaluations indicated a
normalization of brain wave activity, including a decrease in
hyper-metabolism in the frontal lobe and an increase in activity in
the occipital lobe.
Comment. Although these results are encouraging, this
study involved only one subject; and there was no control subject
for comparison. Additionally, a PET scan had not been given prior to
the first set of AIT sessions; thus, the baseline information used
in the research study may not be an appropriate measure for
(7)Changes in Unilateral and Bilateral Sound Sensitivity as a
Result of AIT
Woodward Audiology, McLeansville, NC
The Sound Connection , 1994, 2, p.4.
Loudness tolerance was investigated in 60 children with autism
and related disorders.Uncomfortable loudness level (UCL)
measurements were performed prior to and immediately following AIT.
Prior to AIT, the results from the left and right monaural
presentations (to each ear independently) as well as the binaural
presentation (to both ears simultaneously) were much lower than 90
dBHTL, where 90 dBHTL is considered a normal lower limit of UCL.
Furthermore, the binaural tolerance to the speech noise was 9 to 11
dBHTL less than the monaural tolerance level, where 3 to 6 dBHTL is
considered normal. Following AIT, the monaural tolerance level
to each ear increased 13 to 15 dBHTL, but overall, the monaural and
binaural tolerance levels were lower than normal.This increased
tolerance to speech noise was statistically significant. In
addition, the binaural tolerance level was only 5 dBHTL lower than
the monaural sound presentations, indicating a more normal
Comment. This study involved a relatively large number of
subjects; however, the study did not employ a control group.
(8) Parental Perceptions of Change Following AIT for
Dana Monville and Nickola Nelson
Western Michigan University
Paper presented at the American Speech-Language-Hearing
Conference, New Orleans, 1994.
A survey was mailed to 150 parents of children diagnosed with
either autism or pervasive developmental disorder whose children had
received AIT between 1991 and 1993.Forty parents (27%) responded to
the survey.Of those who responded, 25 (63%) reported an increase in
attention span; 25 (63%) reported a decrease in sound sensitivity;
and 12 (30%) reported an increase in language. Four parents (10%)
reported an increase in tantrums and aggression.
Comment. Although the survey was sent to 150 families,
only 27% responded to the survey. It is possible that those who
observed positive changes in their children were more likely to
complete the survey than those who did not observe any changes.
(9) Auditory Integration Training
Jane R. Madell and Darrell E. Rose
Long Island College Hospital, Brooklyn, NY; and Mayo Clinic,
American Journal of Audiology , March, 1994, 14-18.
This study involved an open clinical trial of AIT on four
children. Their diagnoses included: autism, PDD, and learning
disabilities. Audiograms of all four children showed improvement
following AIT (i.e., a decrease in variability). Behavioral
improvement was observed in three of the four children.The benefits
reported were: increased calmness, decreased sound sensitivity,
and improvements in speech/language and word recognition in
Comment. Although this report included a great deal of
clinical detail, only four subjects participated in the study; and
there was no control group.
(10)Auditory Integration Training: A Pilot Study
Bernard Rimland and Stephen M. Edelson
Autism Research Institute, San Diego, California
Journal of Autism and Developmental Disorders, 1995, 25, 61-70.
The study utilized a blind-placebo controlled experimental
design. Eight subjects were assigned at random to the experimental
(AIT) group, and 9 were assigned to the placebo group. The placebo
group listened to the same, but unprocessed, music. Three months
following AIT, significant improvements were observed on the ABC-1
and the FAPC. Although there were no changes in sound sensitivity
nor changes in the audiogram, the majority of subjects had not been
reported to be sound sensitive, nor were they able to be tested
Comment. Although the subjects were assigned at random to
the AIT and placebo groups, there were initial differences between
the two groups. Regression analysis suggested the effects
observed were not artifacts of the initial differences.
(11) Epileptic Activity in Autism and Acquired Aphasia: A
Study Using Magneto-Encephalography
Jeffrey D. Lewine, Sherri L. Provencal, John T. Davis, and
William W. Orrison, Jr.
Department of Radiology, School of Medicine, University of Utah
Paper presented at the Autism Society of America National
Conference, Orlando, Florida, 1997
Magnetoencephalography and EEG recordings were used to measure
electrical activity in the brain in one child with dyslexia and one
high-functioning autistic adult. Baseline recordings demonstrated
larger than normal responses in the areas associated with
hyperacusis. Following AIT, a more normalized balance or symmetry in
electrical activity was observed.
Comment. These findings document physiological
changes due to AIT; however, there were only two subjects in the
study and no control group.
(12) Auditory Integration Training: A Double-Blind Study
of Behavioral, Electro-physiological, and Audiometric Effects in
Stephen M. Edelson, Deborah Arin, Margaret Bauman, Scott E.
Lukas, Jane H. Rudy, Michelle Sholar, and Bernard Rimland
Autism Research Institute, San Diego, CA; Massachusetts
General Hospital, Boston, MA; McLean Hospital, Belmont, MA; and
Upper Valley Medical Centers, Troy, OH
Focus on Autism and Other Developmental Disabilities ,
1999, 14, 73-81.
Nineteen autistic subjects were assigned at random to either the
experimental group (n=9), which listened to AIT-processed music, or
a placebo group (n=10), which listened to the same, but unprocessed,
music. All evaluations were ‘blind’ to group assignment.
Behavioral, electro-physiological, and audiometric measures were
assessed prior to and following AIT. Behavioral: A significant
improvement was observed in behavioral problems (using the ABC-1) in
the experimental group at the 3-month follow-up assessment.
Electrophysiological: Of the 19 subjects, three experimental group
and two placebo group subjects were able to cooperate with the
auditory P300 Event Related Potential (ERP) task.All five subjects
showed abnormal P300 ERPs prior to the AIT listening sessions.Three
months following AIT, all three subjects showed a dramatic
improvement in their auditory P300 ERP.No improvement was seen in
the placebo group.Audiometric: The subjects' poor communication and
attention skills precluded formal statistical evaluation of the data
from a battery of audiometric tests; however, an audiologist was
able to assign correctly 10 of the 15 subjects for whom partial data
were available to the treated and non-treated groups, on a ‘blind’
Comment. AIT was reported to produce both behavioral
improvement and normalization of brain wave activity. The behavioral
changes on the ABC-1 are consistent with those obtained in a
previous study (Rimland & Edelson, 1995, Section A, #10).
Although the electrophysiological findings are encouraging, they are
based on a total of only five subjects.
(13) Auditory Integration Training and Autism: Two Case
Mark Morgan Brown
Private Practitioner, Republic of Ireland
British Journal of Occupational Therapy mso-bidi-font-size: 10.0pt'>, 1999, 62, 13-18.
This is a clinical study of two autistic siblings, a 5-year old
male and a 3 1/2-year old female. Observations were made at three
and six months following AIT. Improvements were reported in
attention, arousal and sensory modulation, balance and movement
perception, praxis and sequencing, speech and language, social and
emotional maturity, and eye control.
Comment. Although this study provided detailed
descriptions of subjects prior to and after AIT, it involved only
two subjects and no control group for comparison.
Attention Deficit/Hyperactivity Disorder Reports
(14) Non-Pharmacological Techniques in the Treatment of Brain
Jeffrey M. Gerth, Steve A. Barton, Harold F. Engler, Alyne C.
Heller, David Freides, and
Georgia Institute of Technology, Emory University, and the
Atlanta Speech School
Technical Report prepared for the GTRI Fellows Council, Georgie
Tech Research Institute, Georgia Institute of Technology, June,
This study evaluated the effectiveness of AIT on 10 children with
auditory-based learning deficits. Eight of the ten had also been
diagnosed as having Attention Deficit Disorder.Subjects were given a
series of diagnostic tests, and parents were requested to complete
several questionnaires. Two subscales from the Woodcock-Johnson
Psycho-Educational Battery test were used to evaluate changes in
auditory processing. These subscales, the Sound Blending scale and
the Incomplete Words scale, indicated an improvement of one standard
deviation or more in 4 of the 10 subjects, and moderate improvement
in two other subjects.Performance on other criteria (e.g., CPRS and
the FAPC) “could not be meaningfully evaluated, given the amount of
Comment. Although improvement was reported in 6 of the 10
subjects, there was no control group.
(15) Auditory Processing Skills and Auditory Integration
Training in Children with ADD
Donna Geffner, Jay R. Lucker, Ann Gordon and Dolores A.
St. John's University, Jamaica, NY and Ann Gordon Associates,
Stony Brook, NY
Paper Presented at the Annual Convention of the
American-Speech-Language Hearing Association, New Orleans, 1994
This study investigated changes in audition and language in 16
children with AD/HD.A large number of tests were employed to
evaluate possible changes as a result of AIT.The measures included:
standard audiometric threshold testing, tolerance for tones and
speech, speech recognition in quiet and noise conditions, and the
Goldman-Fristoe-Woodcock (GFW) Test of Auditory Selective
Attention.Post-assessments were conducted within 3 months following
AIT. Significant improvement was observed in the subjects'
tolerance to tones and speech, speech recognition in the noise
condition, and in listening skills as measured by the GFW Auditory
Selective Attention Test and several subscales from the Detroit Test
of Learning Aptitude (oral commissions, attention span for unrelated
words, and attention span for related words).
Comment. No control group was utilized in this study.
(16) Long-Term Effects of AIT Comparing Treated and
Donna Geffner, Jay R. Lucker, and Ann Gordon
St. John's University, Jamaica, NY; and Ann Gordon Associates,
Paper Presented at the Annual Convention of the American
Speech-Language-Hearing Association, Seattle, 1996.
The study involved a one-year follow-up evaluation of children
with Attention Deficit Disorder. Those receiving AIT (n=10)
were compared to a control group (n=10) which did not receive
AIT.Using a tolerance testing procedure for 'uncomfortable'
listening levels, improvement of 6 dB in the left ear was observed
for the AIT group, but no change was observed in those in the
control group. No differences were found between the two groups with
respect to listening to 'comfortable' speech. Additionally, tests
evaluating speech recognition in noise and auditory-language
processing showed improvement for those in the AIT group but not for
those in the control group.
Comment. Although a control group was used in
this study, those in the control group did not receive a placebo
treatment that would have controlled for the possibility of a
(17) The Effects of Auditory Integration Training on Children
Diagnosed with Attention Deficit/Hyperactivity Disorder: A Pilot
Wayne J. Kirby
University of North Carolina at Asheville
Paper presented at the First Annual Congress of International
Association of Berard Practitioners, Antwerp, Belgium, 2000.
The Sound Connection , 2000, Vol. 7, pp. 4 &
This study employed a placebo-control design in which five
children listened to AIT-processed music and five children listened
to the same, but unprocessed, music. Subjects were assessed
using the Auditory Continuous Performance Test (ACPT) prior to and
three months following the experimental/placebo listening sessions.
The ACPT provides measures for impulsivity and inattention and also
includes a 'total number of errors' score. Comparison of the
two groups at three months post-AIT indicated a statistically
significant reduction in the total number of errors for those in the
AIT group.Improvement was also observed on the impulsivity and
inattention scores for the AIT group, but these results were not
significantly different from the results obtained from the placebo
Comment. Although a placebo group was utilized
in this study, there were only five subjects in each group.
Central Auditory Processing Disorder (CAPD) Reports
(18) The Effects of Auditory Integration Therapy on Central
Brenda Huskey, Kathryn Barnett, and Jacqueline M. Cimorelli
University of North Carolina at Greensboro
Paper presented at the American Speech-Language-Hearing
Conference, New Orleans, 1994.
In an experimental study, two auditory processing tasks were
administered to six subjects in the AIT treatment group and six
subjects in a control group.These tasks included the SSW test and
the Phonemic Synthesis Test (PST). Pre- and post-tests were given
prior to, and at 4 to 6 weeks, and at 8 to 12 weeks following AIT.
For the SSW test, there were no improvements in the subjects 4 to 6
weeks following AIT, but there were improvements on the total score
and on the left competing condition at 8 to 12 weeks following AIT.
There were no changes in the results from the PST.
Comment. Although a control group was
employed, there were only six subjects in each group.
Additionally, the control group did not receive a placebo treatment
to permit evaluation of the possibility of a ‘placebo-effect.’
(19) Clinical Outcome Evaluation: Auditory Integration
Training mso-bidi-font-size: 10.0pt'>
Jane H. Rudy, Sharon S. Morgan, and Marianne Shepard
Upper Valley Medical Centers, Troy, Ohio
Paper presented at the Ohio Speech-Language-Hearing Conference,
In an open-clinical study, 13 subjects diagnosed with attention
deficit/hyperactivity disorder (ADHD) and/or central auditory
processing dysfunction (CAPD) were given a variety of assessments
prior to, immediately following, and three months post-AIT. These
tests examined hearing acuity, central auditory processing (SSW,
SCAN), auditory evoked potentials (i.e., brain waveforms--P200 and
P300), language function (CELF-R), and intelligence (TONI).
Immediately following AIT, there were significant improvements in
the SSW, SCAN, and CELF-R, and no change in the TONI. Three-months
post-AIT, there was additional improvements in the SSW and CELF-R,
but no further change in the SCAN. There was also a significant
improvement in the TONI. An analysis of the P200 waveform indicated
a significant change in amplitude but no change in the P300 waveform
latency. No significant changes in hearing acuity were detected
during any of the assessments.
Comment. This was an open-clinical
study, and there was no control group.
Studies Investigating Mixed Populations
(20) Auditory Integration Training: One Clinician's
Jane R. Madell
Long Island College Hospital and State University of New York,
Language, Speech, and Hearing Services in Schools , 1999, 30, 371-377.
Changes in speech perception were evaluated in several disorders
prior to and following AIT.The populations included: autism,
pervasive developmental disorder (PDD), multisystem developmental
disorder (n=46), attention deficit disorder or attention
deficit/hyperactivity disorder (n=26), and central auditory
processing disorder with leaning disabilities (CAPD/LD,
n=46).Subjects' speech perception was assessed by asking them
to recognize words in both quiet and competing noise
environments. Improvement in speech perception was documented in
both the quiet and noise conditions following AIT.In a second part
of this study, uncomfortable loudness thresholds (UCLS) were
evaluatedin individuals diagnosed with autism (n=24), PDD (n=26),
and CAPD (n=10). UCLs also improved in these children
Comment. This is an excellent clinical study with
many subjects and multiple measures of change.However, a control
group was not used for comparison.
(21) A Comparative Study of the Earducator and the
IDEA Training Center, North Haven, Connecticut
The Sound Connection , 2001, 8, 1 & 6.
This study compared the effects of two Berard AIT devices--the
Earducator and the AudioKinetron. A total of 19 children
diagnosed with autism, learning disabilities and attention
deficit disorder participated in this study. The children were
assigned at random to either the Earducator or the AudioKinetron;
and the evaluators, the parents, were ‘blind’ to group assignment.
The ABC-1 and the Attention Deficit Disorders Evaluation Scale were
used to assess changes.The results showed improvement in both groups
of children and no differences between the two AIT devices.
Comment . Although the aim of this study was to compare
two Berard AIT devices, a placebo group would have also provided
additional information regarding the effectiveness of the two AIT
Reports of Animal Studies
(22) An Animal Model of Auditory Integration Training
M. Waldhoer, J. Panksepp, D. Pruitt, M. Vaningan, D. McKee, J.
Rossi III, and J. Lindsey
Bowling Green State University & Toxicology, Wright-Patterson
Air Force Base
Paper presented at the Annual Society for Neuroscience
Convention, San Diego, 1995.
This study was undertaken to follow up the positive findings seen
in an earlier study on autistic children conducted by these authors
(see Section A, #2).AIT was administered to newborn domestic chicks,
selected as the species of choice because of their responsivity to
sounds. Starting at two days of age, subjects were included in
one of three groups--AIT (experimental), music (control 1, same
music as the AIT group but not processed), and silence (control
2). Following AIT, those in the experimental group exhibited
an increase in growth and a reduced inhibition to separation-induced
vocalizations in response to music.Post-mortem analysis of the brain
tissue indicated a reduction in serotonin and 5-HIAA levels in the
two music groups (experimental and control 1). In addition, an
analysis ofthe behavioral effect of cyproheptadine, a general
serotonin antagonist, yielded comparable behavioral effects.The data
suggest that AIT may modify serotonergic tone in the brain.
Comment. Although behavior changes were
observed in chicks who received AIT, neurochemical changes were
found both in the AIT and placebo-music groups (control 1).
(23) Biochemical Changes As a Result of AIT-type Modulated and
Jaak Panksepp, John Ross III, and T.K. Narayanan
Bowling Green State University, Ohio
Lost & Found: Perspectives on Brain, Emotion, and
Culture , 1996/7, Vol. 2, p. 1 & 4.
This experiment involved four conditions in which groups of
chicks were exposed to either AIT-type modulated music (using the
EASe Disc 1, produced by Vision Audio, Inc., Joppa, MD); unmodulated
music (the same music source but not processed); human voices (male
and female); or no sound.For both the modulated and unmodulated
conditions, neurochemical assays indicated a dramatic increase in
norepinephrine and its principle metabolite, MHPG. The researchers
also found increases in brain dopamine and its metabolite (HVA), but
these changes were not as large. No clear changes were observed in
brain serotonin and epinephrine.Very little change was observed for
those included in the 'human voice' and 'no sound' conditions.
Comment. Changes were not observed in the human voice
condition(placebo group) and no sound conditions, but neurochemical
changes were found in the modulated condition (AIT group) and the
unmodulated condition (placebo group). These findings indicate that
listening to music produced neurochemical changes.
Section B -- Studies Purporting AIT to be Ineffective (N=3)
(1) Auditory Integration Training for Children with Autism: No
Behavioral Effects Detected
Oliver C. Mudford, Barbara A. Cross, S. Breen, Chris Cullen,
David Reeves, Judith Gould, and Jo Douglas
Keele University, University of Manchester, and UK National
American Journal of Mental Retardation, 2000, 105,
In a double-blind crossover design, 16 autistic children were
evaluated for a 4-month period.Several measures were used in this
study including: parent and teacher rating scales (ABC-1, Nisonger
Child Behavior Rating Form), direct observations (stereotypy, object
obsessive, disruptive behaviors, stigmatising behaviors, vocal
stereotypy), intelligence/cognitive testing (Leiter International
Performance Scale), speech-language evaluation (Reynell
Developmental Language Scales III), social/adaptive behavior
(Vineland Adaptive Behavior Composite), standard audiometric
testing, and parent reports. Improvements were observed in
both the AIT group and the placebo group on adaptive/social behavior
and expressive language. Statistically significant improvements in
hyperactivity and ear occlusion were observed in thesubjects who
participated in the placebo condition.
Comment. Although the significant improvements seen in
those in the placebo condition were dismissed by the authors, it is
quite possible that these improvements may have been due to the
subjects having received AIT eight months earlier (i.e., they may
have participated in the AIT group prior to the crossover). This is
a real possibility given: (a) the two areas of improvement in the
placebo group are consistent with findings associated with AIT; and
(b) Rimland and Edelson (1994, see Section A, #5) and Gillberg et
al. (1997, see Section C, #2) documented improvement up to 9 months
following AIT. The present authors called this possibility to
Mudford’s attention and suggested that the data be reanalyzed to
test it. Mudford refused, claiming that additional analyses of the
data would increase the likelihood of error. On the contrary,
reanalysis of the data would have decreased the likelihood of
error.Here we see an eagerness to declare AIT ineffective when the
data do not necessarily support such a conclusion.
Central Auditory Processing Problems (CAPD) Reports
(2) The Effects of Auditory Integration Training for Children
with Central Auditory Processing Disorder (CAPD)
Karen A. Yencer
State University of New York at Buffalo
Doctoral Dissertation, 1996; American Journal of
Audiology, 1998, 7, 32-44.
Thirty-six children diagnosed with central auditory processing
disorder participated in an experimental condition (i.e., listened
to AIT music), a placebo condition (i.e., listened to unmodulated
music), or a control condition (i.e., did not listen to music).
Children with autism, pervasive developmental disorder (PDD), and
multiple-handicaps were excluded from the study. A battery of tests
were administered to the subjects prior to and one month following
the listening sessions. These included: standard audiometric
testing, the SSW test, the Phonemic Synthesis test, the Standard
Progressive Matrices test, FAPC, auditory brainstem response (ABR),
event-related potential (P300), and a speech-in-noise test.The P300
analyses indicated some improvement in the AIT condition (mean
latency from 366.2 msec. to 348.5 msec.) versus a slight worsening
in the placebo condition (mean latency from 400.8 msec. to 402.2
msec.).Significant improvements were found for the three conditions
on all measures except the speech-in-noise test.
Comment. Yencer examined changes following AIT
after only four weeks following the AIT sessions. Stephen M.
Edelson, who consulted on this study, noting that Berard and others
had stated a need for at least 3 months of follow-up, insisted that
she examine changes for at least three months following the AIT
sessions. However, Yencer chose to conduct follow-up measures for
only one-month because of her dissertation schedule. Cutting corners
may be acceptable in meeting academic requirements, but not
acceptable where decisions affecting the welfare of handicapped
children are concerned. Note that Huskey, Barnett, and
Cimorelli (1994) investigated AIT on a similar population (i.e.,
CAPD) and found no improvement at 4 to 6 weeks following AIT, but did observe improvement at 6 to 8 weeks post-AIT (see Section
Studies Investigating Mixed Populations
(3) The Efficacy of Auditory Integration Training: A Double
William Zollweg, Vere Vance, and David Palm
University of Wisconsin at La Crosse; Research Associates, Inc.;
and Gundersen Lutheran Hospital
American Journal of Audiology , 1997, 6, 39-47
The study involved a double-blind research design involving 30
participants who were assigned at random to either an experimental
(AIT) group or a placebo-control group. The participants were 7 to
24 years old, and the majority carried diagnoses of mild to profound
mental retardation. Some of the participants were diagnosed as
having autism. Evaluations were conducted using audiometric tests, a
Loudness Discomfort Level test, and the ABC-1 at 3, 6, and 9 months
following AIT. Although no differences were found between the
AIT and control groups with respect to hearing and behavioral
changes, both groups showed improvements. The results from the
Loudness Discomfort Level test indicated that the control group had
a higher tolerance for the frequency 250 Hertz than the AIT group at
the 9-month post-assessment measure.
Comment. There are several severe
problems with this study.First, the title should have stated “… in a
Mixed Population” since fewer than a third of the subjects were
autistic; thus one cannot generalize these findings to the autism
population. Neither Berard, nor any other responsible investigator,
has proposed AIT as a treatment for mental retardation. Second, the
volume level was much higher than recommended.The recommended volume
level is 80 dB SPL or lower.The decibel level in the Zollweg et al.
study was measured as high as 122 dB SPL.Finally, an analysis of the
audiograms indicated that 27% were given the wrong narrow band
filters. Given the methodological flaws, these findings are not
applicable even to the mentally retarded population.
(1) The Long-Term Effects of Auditory Training on Children
Autism Research Institute, Sydney, Australia
Journal of Autism and Developmental Disorders , 1996, 26, 361-374.
“Eighty children, 3-17 years of age, with autism or Asperger
syndrome and mild to severe distress in the presence of some sounds,
were randomly allocated to two groups. The experimental group
received auditory training and the control group listened to the
same unmodified music under the same conditions. Significant
improvements in behavior and severity of autism were maintained for
12 months by both groups. Informal data suggested that a range of
abnormal responses to sound and other sensory abnormalities may also
have improved.Verbal and performance IQ increased significantly 3 to
12 months after interventions. Findings suggest that some aspect of
both auditory training and listening to selected unmodified music
may have a beneficial effect on children with autism and sound
sensitivity, …” [Author Abstract]
Comment: The results indicated significant improvement in
both the experimental (AIT) and placebo groups, but there were no
differences between the two groups. Bettison attributed
these improvements to listening to music in a structured
environment. However, critics have interpreted these findings
as evidence of ‘no benefits’ associated with AIT, which is a
While this is an exemplary study in many respects, the
instruments used to assess changes associated with AIT had severe
shortcomings. One of the primary measures used to investigate
changes in sound sensitivity was a modified version of the Hearing
Sensitivity Questionnaire (HSQ) designed by Rimland and Edelson
(1991). The HSQ was designed only as a survey of sound
sensitivity in the autism population and not an instrument to
evaluate treatment effectiveness. Rimland and Edelson did not use it
as an assessment measure in any of their three studies on AIT.
Additionally, Bettison employed a scoring method for the HSQ that
was said to provide a measure of the person’s degree of sound
sensitivity. This scoring method lacks even face validity (i.e., the
appearance that the checklist is valid).For example, if a parent
agreed with the item: ‘Have there been certain sounds which the
person does not seem to hear?,’ this response was considered an
indication of hypersensitivity to sounds rather than hyposensitivity to sounds.
Another measure used in the study, the Developmental Behavior
Checklist, had been used previously in clinical settings, but it was
also not designed to measure treatment effectiveness.When evaluating
the efficacy of an intervention, it is crucial that the appropriate
measurement tools be used.
(2) Auditory Integration Training in Children with Autism:
Brief Report of an
Open Pilot Study
Christopher Gillberg, Maria Johansson, Suzanne Steffenberg, and
Autism , 1997, 1, 97-100
Nine children with "an autistic disorder" were given AIT for 10
days, in accordance with the procedure recommended by Guy Berard.No
control group nor control procedure was used.At the end of the
9-month follow-up period, 8 of the 9 children showed improvement on
the Autism Behavior Checklist (ABC) total score, and 7 of 9 children
showed improvement on the ABC sensory subscale.Rimland and Edelson
calculated the significance level of the differences, using standard
matched paired t-tests and derived a p<.01 level for the
ABC total score and p<.02 for the sensory score (“
mso-bidi-font-size:8.0pt'>Auditory integration training in
children with autism [Letter to the Editor],” 1998, Autism, 2, 91-92).
Comment. This study has several serious problems.Gillberg
relied on two diagnostic checklists to measure changes as a
result of AIT, the CARS and the ABC-2. Neither checklist was
designed to evaluate treatment effectiveness.Additionally, despite
the small sample size (only 9 cases), Gillberg et al. required an
alpha level of .005 to test for statistical significance instead of
the usual .05 and .01 level.This extremely low, very conservative
alpha level is uncommon in research. Its use in a small sample study
virtually guarantees that no treatment will be found
effective.As a result, Gillberg et al. (1997) erroneously concluded
that no benefits were seen in their study on AIT.In response to
Rimland and Edelson’s (1998) ‘Letter to the Editor,’ protesting
Gillberg et al.’s statistical analyses, Gillberg et al. (1998)
stated “… a moderate reduction in sensory problems may have
occurred” (p. 94; “ mso-bidi-font-size:8.0pt'>Auditory
integration training in children with autism: reply to Rimland and
Edelson [Letter to the Editor],” Autism, 1998, 2,
93-94). Contrary to what Gillberg et al. concluded, the results were
definitely positive. The failure to include a control group is
unfortunate, but should not result in understating the value of AIT.
Section D: Tabulation of Studies, Discussion and Conclusion
Table 1: Tabulation of Studies
(Number of Studies)
Ambiguous, Controversial, &/or Contradictory
1 (Mudford et al.)
1 (Zollweg et al.)
a Note that none of the studies failed to show
Of the 28 research studies that evaluated physiological,
behavioral, and cognitive changes in the subjects, the authors of 23
(82%) studies concluded that their data supported the efficacy of
AIT, three (11%) claimed to have found no evidence of efficacy, and
two (7%) report ambiguous, contradictory results.
We recognize at the outset that no research study is perfect--all
have flaws and shortcomings of various kinds. However, the 23
studies with positive outcomes, by and large, exhibited fewer and
less serious shortcomings than the subset of three supposedly
negative studies. All three of these studies demonstrated an
alarming bias favoring negative results [Mudford et al. (Section B,
#1), Yencer (Section B, #2); and Zollweg et al. (Section B,
Two additional published reports clearly show a
negative bias regarding AIT by some researchers. In a ‘Letter to the
Editor’ entitled “When is a significant change not
significant?,” Patricia Howlin criticized a controlled-placebo
AIT study (Rimland and Edelson, 1995, Section A, #10) by stating
that the statistically significant differences on two measures were
clinically not important (Journal of Autism and Developmental
Disorders , 1997, 27, 347-348). Howlin’s
criticisms were based on her misunderstandings. She stated “Thus,
the mean fall in the ABC score was less than 0.4 points; hardly a
dramatic change in a scale of 58 items” (page 348). Howlin assumed
that the maximum possible score on the ABC-1 was 58; however, the
maximum possible score was only 3. Thus, the difference of almost
0.4 points is a meaningful proportion of the 0 to 3 range and is clinically significant. Regarding another measure, Howlin
stated that a 12-point difference on the 93-item FAPC was also not
clinically important.Howlin was wrong again. The FAPC contains 25
items, not 93 items; thus, an average change on 12 of 25 items is
quite dramatic and clinically significant.Again, the results were
positive, not negative.
In another report, Rankovic, Rabinowitz, and Lof
(1996) measured the sound output levels of a single AudioKinetron,
as reportedly used by a local AIT practitioner (American Journal
of Speech-Language Pathology, 5, 68-72). The highest
output level used by the practitioner was measured at 110 dB SPL,
and the maximum output level of the AIT device was measured at 118
dB SPL. The authors concluded that these output levels can be
harmful to hearing, and warned that AIT is potentially dangerous. However, an AIT device, like any radio, compact disc or
audiocassette player, can be set to play too loudly.Should all be
banned as potentially dangerous? Every practitioner is aware
of his/her responsibility to make sure that the device is played at
an appropriate level. Basing conclusions on a single, very probably
atypical case, is a poor practice—the authors’ conclusions are not
A good deal of what has been written about AIT is excessively
skeptical, negative or derogatory, permeated with the assumption
that AIT is ineffective.Our review of all the research on the
efficacy of AIT that we have been able to find refutes this negative
Probably because AIT lacks a plausible rationale and is
counter-intuitive, it has become the target of skepticism and of
negatively biased research.One’s opinion about an intervention, like
one’s opinion about an individual, should be based on evidence
rather than prejudice.The present authors were themselves skeptical
when first learning about AIT. Their interest was stimulated,
despite their initial skepticism, by a number of
almost-too-good-to-be-true clinical reports from parents of autistic
children who had been treated at Dr. Guy Berard’s clinic in Annecy,
France.There is a place for skepticism, but there is also a place
for safe, non-intrusive, short-term and relatively inexpensive
therapies with reasonably good track records.
It is of interest that all seven studies that sought evidence of
physiological change (e.g., electrophysiological, biochemical) as a
result of AIT, including the two animal studies, reported positive
findings (Section A, #s 6, 11, 12, 19, 22, 23; Section B, #2). This
is an area where further research is indicated, in our opinion.
‘Placebo’ Music -- Less Inert Than We Think?
Five studies described in this paper utilized a placebo group and
found significant improvements in both the AIT group and the
placebo group (Bettison, 1996, Section C, #1; Panksepp et al.,
1996/7, Section A, #23; Waldhoer et al., 1995, Section A, #22;
Yencer, 1998, Section B, #2; Zollweg et al., 1997, Section B,
#3).While such findings are typically construed to indicate ‘no
benefits’ from AIT, we believe there may be more to the story than
Jaak Panksepp has raised the intriguing possibility (personal
communication) that the presumably inert ‘placebo’ music may have
had, contrary to expectation, a significant beneficial effect.Guy
Berard specified that the music used in his version of AIT must have
(1) a good tempo/beat, (2) a large variation in frequency within
short intervals, and (3) a strong unpredictability component.
Bill Clark, an audio engineer and developer of a popular AIT device,
after analyzing the output of over one thousand compact discs,
identified about 70 discs that best meet Berard’s specifications.
Most AIT practitioners use the music from Clark’s list As
Panksepp points out, this small subset of carefully selected,
attention-arousing music is not a random sample of available music
and may, in fact, confer benefits that disqualify it from placebo
status.Panksepp suggests such music arouses and activates
attentional circuits in the brain (Panksepp, 1996/7, See Section A,
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