Learning to Listen
A child who has trouble with speech and language may actually be overwhelmed by sound. Auditory training, though controversial, may help. By Priscilla Scherer
Susanna is a bright, brown-eyed, six-year-old chatterbox. Full of ideas and stories, she talks nonstop on the way to school. To look at her now, you'd never know that when she was four, she couldn't put more than three words together. She communicated with gestures and short phrases, not sentences. "When she talked, she seemed to be measuring every word, as if she were a non-English speaker just learning English," remembers her mother, Eliza.
Susanna had always loved listening to music, nursery rhymes, and jingles, but she could not sing them. It was as if words, music, and rhythm were competing with each other. She was also easily distracted, antsy in group situations, and even worse when her environment was acoustically muddled, as a gym, an indoor pool, or the uncarpeted block corner of her classroom. Susanna was helped by a controversial program called Auditory Integration Training (AIT), one of several systems developed over the years to help children who experience problems with speech and language development. These programs vary widely in intensity, time commitment, expense, and scientific underpinnings. Some have been popular in Europe for years, but are not covered by school or insurance programs in the U.S.
Do You Hear What I Hear?
In the last decade, educators have noted an increasing number of young children with language disabilities. Whether these disabilities are on the rise or whether heightened awareness accounts for the increase is unclear. Adopted children are thought to be at higher risk than average for language disorders. Again, it is not known whether this is due to parental vigilance or whether genetics, poor prenatal care, or early institutionalization account for higher apparent incidences.
Problems with auditory processing run the gamut from hyper- and hypo-sensitivity to sound, to distractibility in the presence of certain frequencies, to poor comprehension of verbal communication. Children who have these impairments may be able to focus on a task in a noisy classroom but squirm and become inattentive when the only sound is a hum of noise coming from the cafeteria down the hall. They may "forget" what they are saying halfway through a sentence.
These problems spill over into most, if not all, aspects of life. If you aren't able to process the conversation around you, academic as well as social skills suffer. Many children simply wall themselves off from others rather than deal with the confusing signals they're getting. Even in an apparently quiet room, a child with certain sensitivities can be distracted by a cacophony of vibratory sounds-those that the child hears more acutely through bone conduction. Think of the beat of a drum or a thunderclap, both of which you feel as well as hear. Many children with auditory processing problems are so busy "hearing" the vibrations, they lose the music of the sound. In a sense, they are overwhelmed by low frequency sounds. Thus, for some, the experience of hearing is terribly distracting, if not downright painful.
These children "resent communicating, talking, socializing," says Billie Thompson, Ph.D., a leading proponent and teacher of sound training. "This may show up as a lack of interest, aggressiveness and anger, a lack of curiosity, or a reluctance to ask questions."
Because of the wide variety of language problems, not every child who has auditory processing difficulties is a good candidate for listening training. Still, success stories abound. Children with a variety of conditions, from dyslexia to autism, have benefited from sound training.
At least a dozen different sound training programs have been developed for children with speech and language problems. Most of these programs owe their origins to Alfred Tomatis, a French ear, nose and throat specialist who began to develop a listening training program more than 50 years ago.
The Tomatis Method
The Tomatis method grew out of his observations of professional singers who could not sing as they once had, and of munitions factory workers who had problems hearing. He found that, for vastly different reasons, each group had lost the ability to hear certain sound frequencies. Eventually Tomatis posited that the inability to listen optimally was responsible for many behaviors associated with processing, attention deficit, and learning disabilities. He further believed that traumatic experiences, including premature birth, being separated from a birthmother (and her voice) in infancy, institutional care, and recurrent ear infections, could affect a child's ability to listen optimally, leading him to tune out.
Tomatis developed methods to train the ear to hear sounds in a broader frequency range while filtering out or ignoring other sounds. He believed that the ear acts as the brain's charger and that stimulating activity in the brain's essential connections-the neurons-improves a child's processing skills.
The Tomatis method involves a regimen that begins with an intensive, two-week, 30-hour listening program, followed by a second 30-hour regimen. Follow-up sessions may occur over a number of months, as necessary. Between two initial sessions, participants are encouraged to listen to music in higher frequency ranges (no rock!) and to read (or repeat) aloud several times a day to attune to one's own voice.
During the intensives, participants use specially designed headphones (the Electronic Ear) to listen to filtered classical music, mostly Mozart (which abounds with in higher frequencies) and Gregorian chants. While listening, the child can read, do puzzles, play games, or even sleep. As the process gradually filters out interfering lower frequencies, sounds become recognizable as music and speech. During the sessions, the child also speaks into a microphone as her speech is played back to her, to encourage listening to her own voice. This is also said to condition the ear to retain the effects of training.
In the U.S., educational applications of the Tomatis program are being introduced through Sound Listening Corporation in Phoenix, Arizona. "The Tomatis-based program, Solisten, is an educational, personal developmental and adaptive skills training program," notes Billie Thompson, the trainer for Solisten providers in the U.S.
Auditory Integration Training (AIT)
Guy Beard, an otolaryngologist and student of Tomatis until 1955, developed his own method, Auditory Integration Training, designed to normalize distorted or painful sound. AIT involves two half-hour sessions a day (with at least three hours between sessions) for 10 days, which may or may not be repeated, depending on the trainee's response. Like Tomatis, AIT also makes use of specially designed headphones (the Audiokinetron) and filtered music. The regimen is individualized, depending on the participant's particular weaknesses, but the filtered music sounds like someone is changing the radio dial while turning the volume up and down. Sounds include classical, folk, and rock music, along with some static.
Some argue that the benefits of AIT don't always last. "I think of AIT as the Atkins diet to Tomatis' Weight Watchers," says a parent whose child has gone through both programs. "With AIT, you see dramatic, sometimes immediate, results, which may or may not be sustained. With Tomatis, the progress is slower, but it builds over time and is generally longer lasting." The two programs target different areas of the ear, which may explain the differing results.
In 1997, the Scientific Learning Corporation introduced the Fast ForWord program. The Fast ForWord program is designed to facilitate the development of a child's language skills by increasing the rate at which children process information.
Compared to other language training programs, Fast ForWord has amassed a fairly large amount of research to back claims of benefit. This computer-based therapy, which can be done at home, is designed to help children distinguish sounds that occur rapidly and may thus be confused ("b" and "d" for example). The length of the program depends on the rate at which a child progresses. On average, children will complete it in six to eight weeks, made up of five 20-minute sessions a day. Research indicates increases in reading scores of up to two grade levels, with long lasting improvements in language use and comprehension. Results seem to be limited to language processing and hearing correctly.
Michael is a seven-year-old dreamer, distracted by his own thoughts as much as by the ambient noise in his surroundings. Like Susanna, Michael experienced multiple developmental delays and was eventually diagnosed with persistent developmental disorder, although he did not fit neatly into this category. Michael was quick to learn appropriate responses to given situations but less good at initiating responses independently. He was also acutely sensitive to sound.
Michael began to experience changes during his first week of AIT. "I noticed it right away," says his mother, Betty. "We were waiting for the subway, and a musician was playing a fiddle. Michael had always held his hands over his ears when he heard music, especially if it was amplified, but that day he looked up at me and smiled and said, 'Ma, do you hear that music?' Needless to say, I was thrilled."
He became much less sensitive to sound in general and, thus, less guarded. When he returned to school after the two-week training, his teachers and therapists found him less anxious, more able to participate in class, more open to learning. Betty was ecstatic.
Within a few weeks, however, the progress he'd made began to reverse, and Michael went back to his baseline. Betty took him for an evaluation by a pediatric neurologist. As he went over Michael's records, he commented, "You are obviously a smart woman, and you've gotten the best help for your son. But I don't understand how you could have been taken in by AIT. There is no scientific evidence to support it." I told him, "If you had a son with a vague diagnosis like Michael's, you wouldn't be asking a question like that."
Does Listening Training Work?
Research on the effectiveness of listening training is limited to small studies with conflicting results. In France the Tomatis method is well-respected, and in Germany and Switzerland, it is covered by national health insurance. But in the U.S., the scientific community does not yet recommend it. "We don't have enough information yet to tell us which children's language disorders respond best," says Louise Levy, audiologist and director of the Communications Center in New York City. Many children in Tomatis training are very young, nonverbal, and often unable to cooperate with the testing procedures. Furthermore, some benefits may be subjective. "But I would say that any person who goes through Tomatis will probably benefit in some way," she contends.
Success may depend on the pace and duration of the training, particularly with the Tomatis method, which is individualized, depending on the baseline skills and progress of the child. A few children respond well after the minimum 60 hours, but most take longer. Some have required as many as 200 hours of listening intensives to achieve and maintain desired skills. Many parents do not have the patience or financial resources to commit to that kind of plan.
"We're all hoping for a miracle," says Betty. These words were echoed by every parent I met who had a child undergoing Tomatis or AIT training.
I decided to enroll my own daughter, who has language-based learning disabilities, in a Tomatis-based program. We've completed the first 30 hours and are struggling to keep up with the homework. I can tell you that, for us right now, this is a creative, if rigorous, educational adjunct. During and since the training, my daughter has become less easily frustrated by challenging tasks. She is less on edge in general and has begun to modulate her own voice.
At eight years old, my daughter still struggles with reading. When she reads aloud, she uses a tight, monotonal voice. As part of our sound training homework, she is repeating after me as I read a phrase, and her voice and pronunciation are becoming more melodic as she listens to herself. She is even copying my tones of voice. And by repeating while looking at the words, she is learning to sight read. For us, this is not a miracle, it is hard work. But maybe it is the hard work that makes the miracle.
Priscilla Scherer is a registered nurse and medical writer who lives with her husband and daughter (adopted internationally) in New York City.
Spotting a Problem
Consult a speech and language pathologist (you can find a referral from the American Speech-Language-Hearing Association at www.asha.org) if your child:
*has chronic ear infections;
*is easily distracted by background noise;
*has a short attention span;
*requires repetition of directions and explanations more than half the time;
*responds slowly to questions;
*often misunderstands what you say;
*often forgets a sequence of steps (if you ask him to go to the kitchen and bring you a paper towel, he may get there but forget why he went);
*has difficulty with phonics, spelling, and reading.
How to Find an Auditory Training Program
The following centers can direct you to reputable providers across the country. Some school districts, agencies for child development, and health insurers have begun to provide reimbursement for this training, so be sure to inquire about coverage. Also, the Society for Auditory Intervention Techniques (www.sait.org) provides a list of member practitioners but "makes no warranty or representation as to the qualifications, character, training, or expertise of the listed individuals." The site also provides a list of questions to ask a practitioner before signing on.
*Sound Listening and Learning Center, 301 E. Bethany Home Rd., Suite A-107, Phoenix, AZ 85012. 602-381-0086. www.soundlistening.com.
*The Davis Center, 98 Rt. 46 West, Budd Lake, NJ 07828. 973-347-7662.www.thedaviscenter.com.
*The Spectrum Center, 4715 Cordell Ave., 3rd floor West, Bethesda, MD 20814. 301-657-0988. www.tomatis.net.
*The Scientific Learning Corporation, 300 Frank H. Ogawa Plaza, Suite 500, Oakland, CA 94612. www.scilearn.com. For information about the Fast ForWord Language Program.
Childhood Speech, Language & Listening Problems
by Patricia Hamaguchi, John Wiley, Second edition, 2001.
The best overview for parents wondering whether their child has a speech, language, or listening problem. Contains benchmarks by age for language and learning progress.
The New Language of Toys: Teaching Communication Skills
by Joan Heller and Sue Schwartz, Woodbine House, Second edition, 1996.
How-to guide for parents, teachers, and caregivers for using toys to develop communication skills.
When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder
by Teri James Bellis, Ph.D. Forthcoming, February 2002
Like Sound Through Water: A Mother's Journey Through Auditory Processing Disorder
by Karen J. Foli, Ph.D. February 2002
Copyright © 2002 Adoptive Families magazine. Reproduction in whole or in part without permission is prohibited.
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