New with a Question About Listening Therapy

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TandKIE
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New with a Question About Listening Therapy

Postby TandKIE » Mon Apr 06, 2015 7:22 pm

We would like to bring listening therapy/therapeutic listening into our 2 sons therapy plan. For those who have used one that you really like and saw very good results with, what did you use? What did you like about it? What did you not like about it?

To introduce myself, since this is my first post:

We have two sons, both of which have various special needs, medical issues, and learning disorders. One son is DX'd with Autism, one is informally DX'd with it. All doctors say yes, I disagree. But that's neither here nor there as he's getting the support and therapy he needs for his issues, so we don't squabble over labeling right now. :)

Our sons are 7 and 9. My husband and I have been married for nearly 14 years. We have used biomedical support for our kids but, beyond MB12 injections (which took our oldest son from 100% non-verbal to verbal in 10 days), it wasn't a great help to them. We are still working with a biomed doctor, but I think (and I am pretty sure he's somewhat in agreement) our time with him might be ending soon.

We also have some medical issues such as EoE, a g-tube, allergies, and more. We have a son who has dyslexia as well. We joke that before the year is out we will have completed the entire library of letters after their names.

rebeccaschool
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Joined: Thu Feb 26, 2015 3:36 am

Re: New with a Question About Listening Therapy

Postby rebeccaschool » Fri May 01, 2015 7:02 am

Listening therapy like so many other therapies isn't a scientifically proven methodology. Its effectiveness seems to be debatable. In my experience, listening therapy is highly subject dependent (in this case, the subjects being your sons). There have been cases where it has been highly successful. But there have also been cases where listening therapy didn't lead to any positive results.

So, you should keep this in mind before taking any decision.

kulkulkan
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Re: New with a Question About Listening Therapy

Postby kulkulkan » Fri May 01, 2015 11:27 am

There are plenty of studies published on various listening therapy (e.g. Tomatis, AIT) including controlled studies and a lot of anecdotal evidence to suggest that it works for some. However, even if there are randomized double blind studies proving efficacy for some treatment, it STILL doesn't mean it is going to work for your child. So, ultimately, you need try it to find out. Given limited to no downside from a side effect perspective, it makes sense to try if you can afford it. I had forgotten about this (was waiting for our son to turn 4 years old - he is five now!) and will revisit this.

Winnie
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Re: New with a Question About Listening Therapy

Postby Winnie » Sat May 02, 2015 10:19 am

Actually there aren't many studies regarding the efficacy of listening therapies (despite the many decades it has been around), and of those, most are of poor quality (most recent Cochrane review):

Cochrane Database Syst Rev. 2011 Dec 7;(12):CD003681. doi: 10.1002/14651858.CD003681.pub3.

Auditory integration training and other sound therapies for autism spectrum disorders (ASD).

Sinha Y1, Silove N, Hayen A, Williams K.

Abstract

BACKGROUND:
Auditory integration therapy was developed as a technique for improving abnormal sound sensitivity in individuals with behavioural disorders including autism spectrum disorders. Other sound therapies bearing similarities to auditory integration therapy include the Tomatis Method and Samonas Sound Therapy.

OBJECTIVES:
To determine the effectiveness of auditory integration therapy or other methods of sound therapy in individuals with autism spectrum disorders.

SEARCH METHODS:
For this update, we searched the following databases in September 2010: CENTRAL (2010, Issue 2), MEDLINE (1950 to September week 2, 2010), EMBASE (1980 to Week 38, 2010), CINAHL (1937 to current), PsycINFO (1887 to current), ERIC (1966 to current), LILACS (September 2010) and the reference lists of published papers. One new study was found for inclusion.

SELECTION CRITERIA:
Randomised controlled trials involving adults or children with autism spectrum disorders. Treatment was auditory integration therapy or other sound therapies involving listening to music modified by filtering and modulation. Control groups could involve no treatment, a waiting list, usual therapy or a placebo equivalent. The outcomes were changes in core and associated features of autism spectrum disorders, auditory processing, quality of life and adverse events.

DATA COLLECTION AND ANALYSIS:
Two independent review authors performed data extraction. All outcome data in the included papers were continuous. We calculated point estimates and standard errors from t-test scores and post-intervention means. Meta-analysis was inappropriate for the available data.

MAIN RESULTS:
We identified six randomised comtrolled trials of auditory integration therapy and one of Tomatis therapy, involving a total of 182 individuals aged three to 39 years. Two were cross-over trials. Five trials had fewer than 20 participants. Allocation concealment was inadequate for all studies. Twenty different outcome measures were used and only two outcomes were used by three or more studies. Meta-analysis was not possible due to very high heterogeneity or the presentation of data in unusable forms. Three studies (Bettison 1996; Zollweg 1997; Mudford 2000) did not demonstrate any benefit of auditory integration therapy over control conditions. Three studies (Veale 1993; Rimland 1995; Edelson 1999) reported improvements at three months for the auditory integration therapy group based on the Aberrant Behaviour Checklist, but they used a total score rather than subgroup scores, which is of questionable validity, and Veale's results did not reach statistical significance. Rimland 1995 also reported improvements at three months in the auditory integration therapy group for the Aberrant Behaviour Checklist subgroup scores. The study addressing Tomatis therapy (Corbett 2008) described an improvement in language with no difference between treatment and control conditions and did not report on the behavioural outcomes that were used in the auditory integration therapy trials.

AUTHORS' CONCLUSIONS:
There is no evidence that auditory integration therapy or other sound therapies are effective as treatments for autism spectrum disorders. As synthesis of existing data has been limited by the disparate outcome measures used between studies, there is not sufficient evidence to prove that this treatment is not effective. However, of the seven studies including 182 participants that have been reported to date, only two (with an author in common), involving a total of 35 participants, report statistically significant improvements in the auditory intergration therapy group and for only two outcome measures (Aberrant Behaviour Checklist and Fisher's Auditory Problems Checklist). As such, there is no evidence to support the use of auditory integration therapy at this time.


The various versions (and redux) of these therapies often have flashy and science-y sounding promotional websites, but definitely fall into the "caveat emptor" zone before investing hugely based on the claims.

There may be some listening-type therapies you can try without a huge investment, including just listening to music -- one small study found no difference in outcome between listening to music (unmodulated) and listening therapy (modulated music).

Here is a past related forum thread on the topic (there are others -- you can use the forum search function):
http://www.autismweb.com/forum/viewtopic.php?f=1&t=31276

Still, having said all that, there are parents who feel listening therapy was beneficial to their child. There does not seem to be any significant risk involved with most of these therapies -- just be aware of many of the pseudo-scientific sales pitches and associated costs.

Interesting recent related study -- not pertaining to listening therapies but does pertain to use of music (song) and speech:
Fronto-Temporal Connectivity is Preserved During Sung but Not Spoken Word Listening, Across the Autism Spectrum
http://onlinelibrary.wiley.com/enhanced/doi/10.1002/aur.1437
Winnie
"Make it a powerful memory, the happiest you can remember."

kulkulkan
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Joined: Tue Mar 13, 2012 1:37 pm

Re: New with a Question About Listening Therapy

Postby kulkulkan » Thu May 07, 2015 12:56 pm

The Cochrane review is using a threshold of "randomized" controlled trials only - using that high threshold, ABA wouldn't do well either, but that doesn't mean ABA doesn't work either. Most studies published on ABA are poor quality as well and rely on empirical evidence.

For more comprehensive review of various studies using AIT (28 studies highlighted) and Tomatis (35 studies highlighted), see below - most showing efficacy, and others not.

Tomatis
http://www.sacarin.com/code/Review%20of ... search.pdf

AIT
http://www.autism.com/understanding_ait_summary

Given no downside (aside some lost $ and time), it doesn't hurt to try. We have spent a LOT more $$$$$ and time on Verbal Behaviour which has a lot less evidence and no randomised controlled trials. I believe that VB was helpful as well but I cannot say that it would have been more or less effective than other therapy approaches such as Floortime, or RDI, or some combination thereof (EDSM), etc. And yes, it is certainly possible that unmodulated music may be just as effective as modulated music.

Winnie
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Joined: Sat Mar 18, 2006 2:48 pm

Re: New with a Question About Listening Therapy

Postby Winnie » Fri May 08, 2015 9:58 am

kulkulkan wrote:For more comprehensive review of various studies using AIT (28 studies highlighted) and Tomatis (35 studies highlighted), see below - most showing efficacy, and others not.

Tomatis
http://www.sacarin.com/code/Review%20of ... search.pdf
That review appears to be a marketing piece written by an individual involved the therapy, which is probably why it is published on a Tomatis marketing site (Sacarin Center) and not in a journal. I guess one would need to decide what aspect of improvement one hopes to find -- and which -- or rather if -- there is a marketed version of listening therapy actually shown to be efficacious for this purpose (there are dozens of flashy marketing versions making unsupported claims). Tomatis programs often claim to improve just about anything -- including "facilitating childbirth" and improving "retardation" (mentioned in the article you linked).

The review by the org founded by folks who promoted their own study (Rimland and Edelson) is not really a good source of an objective review.

Here is a comprehensive review of the ^same studies by ASHA (the national credentialing agency/research org for Audiologists and Speech Pathologists). Click "Research Findings" under Table of Contents:

http://www.asha.org/policy/tr2004-00260.htm

An audiologist is the professional with the expertise, background, and equipment to test for auditory processing disorders. OTs (and sometimes SLPs) frequently market these listening therapies as practice enhancers, but OTs do not have a background or expertise in central auditory processing, hearing, or the ear. The equipment for some of these programs can be sold to anyone with just about any background and minimal training is provided by the business selling the equipment.

kulkulkan wrote:Given no downside (aside some lost $ and time), it doesn't hurt to try.
There is a potential downside related to the equipment used in some of these programs:
http://www.asha.org/policy/tr2004-00260.htm#sec1.2.2

kulkulkan wrote:We have spent a LOT more $$$$$ and time on Verbal Behaviour which has a lot less evidence and no randomised controlled trials.
I'm not sure how this relates to the topic at hand -- I don't know of dozens of flashy marketing sites promoting Verbal Behavior with pseudo-scientific and unsupported claims (if you know of some, perhaps we can discuss these on another thread). No question that there are people claiming to provide "Verbal Behavior" who have minimal training and insufficient backgrounds/expertise.

kulkulkan wrote:And yes, it is certainly possible that unmodulated music may be just as effective as modulated music.
^Which is why I think this seems like a good place to start, before potentially spending thousands based on unsupported treatment claims.
Winnie
"Make it a powerful memory, the happiest you can remember."

kulkulkan
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Re: New with a Question About Listening Therapy

Postby kulkulkan » Fri May 08, 2015 11:18 am

My point is simply that there are more than 6-7 studies. The quality of evidence is not as great, whichever way one wants to spin it (ASHA or Rimland), but it is a lot more than other approaches that are not even studied and certainly better than just anecdotal evidence.

We are going to try AIT over the summer. It is fairly reasonable in terms of cost and 10-days only. If I can get our son to actually sit down and listen to modulated music for 30 minutes, that in itself would be a feat!

Winnie
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Joined: Sat Mar 18, 2006 2:48 pm

Re: New with a Question About Listening Therapy

Postby Winnie » Fri May 08, 2015 12:49 pm

kulkulkan wrote:My point is simply that there are more than 6-7 studies. The quality of evidence is not as great, whichever way one wants to spin it (ASHA or Rimland),
ASHA members would only gain from positive "spin" for AIT/Tomatis and the countless versions thereof, since they are the professionals with actual expertise in this area and the equipment/assessments to legitimately evaluate/diagnose APD and CAPD. But they did not find the evidence of benefit to warrant it as a recommended treatment.

The info from the autism.com site (Rimland's study, for instance, on the site of the org he founded) is self-explanatory in regard to spin (autism.com spins a great many treatments that the site supporters sell).

kulkulkan wrote: but it is a lot more than other approaches that are not even studied and certainly better than just anecdotal evidence.
It is also far more often repackaged and remarketed with pseudo-scientific and unsupported claims (by providers who do not have expertise in this area), and with the usual reliance on "testimonials," than many other approaches too. Tomatis has been around for over 60 years, so if it was as miraculous as many of the claims, it would have generated quite a bit more data and research interest by now. Just a "buyer beware."

kulkulkan wrote:We are going to try AIT over the summer. It is fairly reasonable in terms of cost and 10-days only. If I can get our son to actually sit down and listen to modulated music for 30 minutes, that in itself would be a feat!
What specific program/type of AIT will you be using? Interested to hear what you think of it and how it goes.
Winnie
"Make it a powerful memory, the happiest you can remember."

kulkulkan
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Re: New with a Question About Listening Therapy

Postby kulkulkan » Fri May 08, 2015 2:41 pm

Any treatment (with minimal side effects) that actually has enough studies to warrant randomized controlled trials is worth trying in my opinion regardless of efficacy. Results are not guaranteed for any specific child in any event no matter how strong a trial might be, or whether you keep researching it for another 60 years. So, this is an easy one to try. We are going to go with Berard AIT trial. It may not work and that`s okay.

Santosg
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Re: New with a Question About Listening Therapy

Postby Santosg » Fri May 08, 2015 11:51 pm

I have done one cycle of Listening Therapy with my son. It did result in improvements. Specifically, it helped with his auditory processing. It did not resolve most or all of his issues, but it did help with auditory processing--and from that, no doubt, his ability to both understand and mimic speech. I find this particularly important in autism. I have encountered a number of autistic people who have highly monotone voices. This is a consequence of their inability to really 'hear' inflection in speech patterns. Since they cannot hear them they cannot reproduce them. I think this is also one of the reasons that sarcasm--beyond all the other more obvious reasons--is something autistic people don't really understand. Even if you were to only rely on tone, it is very easy to identity the difference in 'nice hat' and a mockingly toned 'nice hat,' etc. Listening therapies are one of the interventions that Temple Grandin most credits with her overcoming auditory defensiveness and helping her successfully socialize. The price for some of these interventions is outrageous. I think the best thing to do is see if you can get these services through your school. They should have an OT on staff or one that they can contract that had the sound system available. I was able to get it through his regular OT at no additional cost, but this is bound to very from person to person. That said, you'd be surprised how many of these resources can be economically accessed with enough searching.

Winnie
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Re: New with a Question About Listening Therapy

Postby Winnie » Sat May 09, 2015 10:27 am

Santosg wrote:I have done one cycle of Listening Therapy with my son. It did result in improvements. Specifically, it helped with his auditory processing. It did not resolve most or all of his issues, but it did help with auditory processing--and from that, no doubt, his ability to both understand and mimic speech.
Santosg -- it sounds like you are talking about speech sound discrimination -- were there any pre- and post-tests that assessed auditory processing areas? Just wondering since this is such a broad area -- if central auditory processing improved one might expect this to be reflected in receptive language improvement as well.

Santosg wrote:I find this particularly important in autism. I have encountered a number of autistic people who have highly monotone voices. This is a consequence of their inability to really 'hear' inflection in speech patterns. Since they cannot hear them they cannot reproduce them. I think this is also one of the reasons that sarcasm--beyond all the other more obvious reasons--is something autistic people don't really understand. Even if you were to only rely on tone, it is very easy to identity the difference in 'nice hat' and a mockingly toned 'nice hat,' etc.
Actually the research indicates that people with autism may have some enhanced auditory processing (perception) skills including pitch and sound discrimination. Absolute pitch (or perfect pitch, as it is commonly referred to) is more common in people with autism than in the general population. My son has absolute pitch -- when he was in middle school his music instructor discovered this -- he is able to name any note on an instrument he hears without seeing it played (and very specifically -- like middle C sharp).

So I don't agree that a monotone voice and the recognition of sarcasm, for instance, is as simple as (or the result of) not being able to "hear inflection." I think this is very complex, and that it has more to do with associating the prosodic feature with recognition of other cues (affective and situational) -- sort of form v function -- which is different (and involving different neural processes) from just identifying or imitating prosodic features. Recent study:

Autism Res. 2015 Apr;8(2):153-63. doi: 10.1002/aur.1432. Epub 2014 Nov 26.

Prosody recognition in adults with high-functioning autism spectrum disorders: from psychoacoustics to cognition
http://www.ncbi.nlm.nih.gov/pubmed/25428545


Res Dev Disabil. 2015 Feb;37:162-70. doi: 10.1016/j.ridd.2014.11.013. Epub 2014 Dec 1.

Emotional prosody perception and its association with pragmatic language in school-aged children with high-function autism.
http://www.ncbi.nlm.nih.gov/pubmed/25463248


Autism Res. 2014 Apr;7(2):181-96. doi: 10.1002/aur.1355. Epub 2014 Mar 14.

Prosodic development in middle childhood and adolescence in high-functioning autism
http://www.ncbi.nlm.nih.gov/pubmed/24634421



Some other interesting articles -- this one is interesting in that early enhanced auditory discrimination may seem a marker for autism:

Autism Res. 2013 Dec;6(6):605-13. doi: 10.1002/aur.1324. Epub 2013 Aug 8.

More is less: pitch discrimination and language delays in children with optimal outcomes from autism.
Full text: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3869875/


More -- this one seems to indicate that children with autism lose the discrim edge in connected speech (longer phonemic sequences):
J Autism Dev Disord. 2008 Aug;38(7):1328-40. doi: 10.1007/s10803-007-0520-z. Epub 2008 Jan 3.

The relationship between form and function level receptive prosodic abilities in autism
http://www.ncbi.nlm.nih.gov/pubmed/18172749


J Autism Dev Disord. 2014 Aug 9. [Epub ahead of print]

Mapping the Developmental Trajectory and Correlates of Enhanced Pitch Perception on Speech Processing in Adults with ASD
http://www.ncbi.nlm.nih.gov/pubmed/25106823


Biol Psychol. 2008 Jan;77(1):25-31. Epub 2007 Aug 31.

The perception of invariant speech features in children with autism.
http://www.ncbi.nlm.nih.gov/pubmed/17919805


Many (many!) more studies can be found on PubMed regarding this general topic by searching 'autism' with terms such as auditory discrimination, prosodic or prosody, auditory processing, etc.
Winnie
"Make it a powerful memory, the happiest you can remember."

Santosg
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Re: New with a Question About Listening Therapy

Postby Santosg » Sat May 09, 2015 6:26 pm

Hi Winnie,

I did not have any formal testing done. He did improve in his receptive language, but this all took place with a number of other interventions. As in most issues with autism, beyond the general trifecta of deficiencies that make up the diagnosis, there are such wide differences it is difficult to make conclusive statements. Some autistic children are auditorially defensive. My son was the opposite. Loud sounds that might make another child cry with fear would not even be noticed by him.

Thanks for the links to the studies. The studies are useful, of course, but also limited by the fact that they focus on HFA and children that have optimal outcomes. I would say, though, that distinctions between auditory processing and prosody don't have clear boundaries. I don't think that the distinctions are that valid. I'm sure that there is broad overlap in the neural pathways that are used. The ability to recognize pitch is music and pitch is human speech should be closely related. I agree that children with autism do have a better sense of perfect pitch. I do music with my son and he's able to identify 'do' when I play it on the piano with a lot more ease than I can. The ability to identify patterns is better in autistic children because they are more focused on identifying explicit patterns. But they have an inability to recognize the underlying functions behind the patterns--, so we get things like echolalia. In my mind, its a bit like hyperlexia. You find autistic children that can read very advanced books at a young age, but without being able to explain basic stories. Why? Because they are looking for patterns and not meaning. So, the way that autistic people hear is different not only because of neuroanatomical issues, but also as a result of what they are 'paying' attention to. I think in the latter autistic differences in hearing are the result of what criteria is being filtered for, what is being treated as important and relevant. Now, I can call my son's name and he'll not respond. I can play a song he likes and he'll come running. Is this the result of one neural network being impaired and another that is functional? I doubt it. I think it is that he responds to each stimulus according to his interest. Obviously, the inability to respond to your know does imply a broader set of cognitive and social deficits, but you get my point.

Having said all that, I did notice an improvement in his ability to hear a song playing in another room. I might play it before and it would take him a full minute to actually come into the room. After the sound therapy, he would be in the room far sooner. I could see that he just processed it faster.

Winnie
Posts: 4213
Joined: Sat Mar 18, 2006 2:48 pm

Re: New with a Question About Listening Therapy

Postby Winnie » Sun May 17, 2015 10:34 am

Santosg wrote:Thanks for the links to the studies. The studies are useful, of course, but also limited by the fact that they focus on HFA and children that have optimal outcomes. I would say, though, that distinctions between auditory processing and prosody don't have clear boundaries.
I don't think that the distinctions are that valid.
I must not have communicated that well – I didn’t mean that prosodic features (like pitch) were distinct/separate from auditory processing –

Santosg wrote:I'm sure that there is broad overlap in the neural pathways that are used. The ability to recognize pitch is music and pitch is human speech should be closely related.
This reminded me of a recent neuroimaging study (related) that might have some therapeutic implications:

Autism Res. 2015 Apr;8(2):174-86. doi: 10.1002/aur.1437. Epub 2014 Nov 5.

Fronto-Temporal Connectivity is Preserved During Sung but Not Spoken Word Listening, Across the Autism Spectrum.
Sharda M1, Midha R, Malik S, Mukerji S, Singh NC.

http://www.ncbi.nlm.nih.gov/pubmed/?term=song+spoken+word+autism
Winnie
"Make it a powerful memory, the happiest you can remember."


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