A Critical Appraisal of Therapeutic Listening

History:

According to Frick (2002, p. 358), auditory training has been used in Europe since the mid-1900s to address sensory processing disorders and these techniques have been recently popularized in the United States. Frick has based her Therapeutic Listening program on the work of Dr. Alfred Tomatis and Dr. Guy Berard, both of whom are French physicians. Both the Tomatis and Berard programs are delivered by specific machines using earphones but these devices do not have FDA approval and have been banned in the United States (Barrett, 2003). Frick (2001) states “With the advent of new technology, similar altered music has become available on compact disc. The discs do not replace either the Tomatis Method or the Berard Method. The compact discs do provide a less intense way to access both the auditory and vestibular systems to impact neural function and integration and are easily available to clinicians in a variety of practice arenas.” The CDs referenced on Frick’s webpages are associated with Ingo Steinbach, a German engineer who also studied Tomatis’ and Berard’s methods.

Description:

As defined by the principle founder of this intervention technique, Therapeutic Listening “is a highly individualized method of auditory intervention utilizing electronically altered compact discs in protocols specifically tailored by sensory integrative professionals to match client need” (Frick, 2003). Presumably, the intervention includes a combination of listening to specially enhanced CDs and participation in a sensory-based occupational therapy program. There are very few references to Frick’s program in the literature, so practitioners need to attend her workshops in order to receive specific information about this intervention.

Goals of Treatment:

The goals of Therapeutic Listening are to improve the following functions: sensory modulation, balance, movement perception, exploration, sense of physical competence, praxis, sequencing, social competence, and language (Frick, 2002, p. 360).

Theory-base:

Frick (2003) states that “listening is a function of the entire brain; when we listen, we listen with the whole body.” This statement is not specifically explained or qualified, however, reference is made on the Vital Links website to accompanying interventions including postural training, respiratory intervention, and sensory diet. Tomatis (1993) believed that spectral enhancement of high frequency sound ranges would help listeners improve attention and awareness to sound. Because of the intricate linkages between auditory and vestibular systems, he also hypothesized that posture, laterality, and language development would improve when children listened to filtered music.

Appropriate clients for this method:

According to Frick (2002, p.360), clients of all ages can benefit from this technique but younger children (less than two years old) need a modified program that can be monitored by an experienced clinician.


Efficacy research:

The American Academy of Pediatrics (1998) and the American Academy of Audiology (1993) stated that there are no well-designed scientific studies demonstrating the usefulness of AIT. AIT devices, typically associated with the Tomatis and Berard intervention programs, do not have FDA approval and in 1997 the FDA banned the importation of the Electric Ear or any other AIT device made by Tomatis International, of Paris, France (Barrett, 2003).

Gilmor (1999) completed a meta-analysis of Tomatis-styled interventions and found that there was “compelling” evidence of improvement in the children who received intervention. However, all studies included in the meta-analysis had very small sample sizes and design problems with randomization and lack of control groups.

Edelson and Rimland are strong proponents of auditory integration interventions who have published supportive articles on AIT in the literature (1994, 1995). They published a literature review (undated) of auditory integration intervention studies that was widely distributed on the Internet and is frequently cited by parents and professionals as proof that AIT is effective. Many of the supporting studies that they cited in their review were published in newsletters, newspapers, and other forums where there is no rigorous peer-review. Also, they summarily dismissed any study that did not support auditory intervention techniques.

According to the National Research Council (2001, p. 100) “auditory integration therapy has received more balanced investigation than has any other sensory approach to intervention, but in general studies have not supported either its theoretical basis or the specificity of its effectiveness.

Critical appraisal:

There have been many negative opinions of auditory interventions published by respected organizations such as the American Academy of Pediatrics, the American Academy of Audiology, and the National Research Council. It is concerning to me that these techniques continue to be so readily embraced by occupational therapy clinicians who are seeking therapeutic answers for the children on their caseloads. This is a very clear example of how our profession needs to consider evidence-based practice. The profession is collectively concerned about the acceptance of occupational therapy in general and sensory integration/processing interventions in particular. We all need to be as educated as possible on what constitutes appropriate levels of evidence that will be broadly accepted, and subsequently respected, valued, and reimbursed.

Based on the published literature, there is currently very little evidence that Therapeutic Listening or any auditory integration therapy has proven to be an effective intervention. However, that does not mean it is not potentially useful. Rather, we need to conduct appropriate, well-designed studies and publish them in peer-reviewed journals. In the meantime, we need to be very cautious at how we present these interventions to the public.

References:

American Academy of Pediatrics Committee on Children with Disabilities (1998). Auditory integration training and facilitated communication for autism. Pediatrics, 102, 431-433.

Barrett, S. (2003, July). Mental Help: Procedures to Avoid. Retrieved November 22, 2003, from http://www.quackwatch.org/01QuackeryRelatedTopics/mentserv.html

Committee on Educational Inverventions for Children with Autism, National Research Council (2001). Educating Children with Autism. Washington, D.C.: National Academies Press.

Edelson, S.M., & Rimland, B. (n.d.). The Efficacy of Auditory Integration Training: Summaries and Critiques of 28 Reports (January, 1993 - May, 2001). Retrieved November 22, 2003, from http://www.up-to-date.com/saitwebsite/aitsummary.html

Executive Committee, American Academy of Audiology. (1993). Position statement: Auditory integration training. Audiology Today, 5, 21.

Frick, Sheila (2001, March). An Overview of Auditory Interventions. Retrieved November 22, 2003, from http://www.vitallinks.net/auditory.shtml

Frick, Sheila (2002). Therapeutic Listening: An Overview. In Bundy, A.C., Lane, S.J., & Murray, E.A. (Eds.). Sensory Integration Theory and Practice, 2nd ed. Philadelphia: F.A. Davis.

Frick, Sheila (2003, Spring). What is Therapeutic Listening? Vital Links. Retrieved November 22, 2003, from http://www.vitallinks.net/PDF/spring2003.pdf

Gilmor, T.M. (1999). The Efficacy of the Tomatis method for Children with Learning and Communication Disorders, International Journal of Listening, 13, 12-23.

Rimland, B. & Edelson, S. (1994). The effects of auditory integration training on autism. American Journal of Speech and Language Pathology, 3, 16 - 24.

Rimland, B. & Edelson, S. (1995). Auditory integration training in autism: A pilot study. Journal of Autism and Developmental Disorders, 25, 61 - 70

Tomatis, A. (1993). The Ear and Language. Ontario: Moulin.