Auditory integration training and other sound therapies for autism spectrum disorders

Sinha Y, Silove N, Wheeler D, Williams K

The Cochrane Library, Issue 2, 2004
Chichester, UK: John Wiley & Sons Ltd.

Bottom Line

Does auditory integration therapy reduce the symptoms of autism?

  • Many children and adults with autism spectrum disorders (ASDs) experience abnormal sound sensitivity.
  • The sensitivity can lead to screaming, attempts to cover the ears, or the appearance of deafness.
  • The sound sensitivity is not present in all individuals with ASDs, nor is it specific to the condition.
  • Different treatments based on the modification of musical sounds have been created. These treatments are intended to retrain the ear to respond appropriately to sounds to which they are under- or over-sensitive.
  • The research so far has not been able to show that AIT is an effective treatment.
  • AIT remains an experimental treatment and more research is necessary to demonstrate if it has a positive effect on behaviour, ability to pay attention, overall cognitive skills, or any other aspect of autistic behaviour.

Question: Does auditory integration training (AIT) or any other form of therapy that involves the use of modified music improve abnormal sound sensitivity in people with autism?

Background: Many children and adults with autism spectrum disorders (ASDs) experience abnormal sound sensitivity, sometimes leading to screaming, attempts to cover the ears, or the appearance of deafness. The sound sensitivity is not present in all individuals with ASDs, nor is it specific to the condition. It may be related to other sensory problems seen in people with ASDs, such as over- or under-reactivity to pain, or to sensitivity to temperature. There have been different researchers who have devised treatments based on the modification of musical sounds. These treatments are intended to retrain the ear to respond appropriately to sound wave frequencies to which they are under- or over-sensitive.

Data Sources: The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, ERIC, PsychINFO, and LILACS were searched.

Participants: Children or adults with ASDs

Study Selection: The authors looked for randomized controlled trials (RCTs) conducted with children or adults with ASDs that tested the effectiveness of AIT or other forms of sound therapy. The control groups could be wait list, no treatment, usual therapy, or sham treatment.

Outcome Measures: There were multiple measures used in the studies cited in this review: Cognitive ability, basic autistic symptoms (social communication and behavioural problems), sound sensitivity, the ability to concentrate, level of activity, school and home quality of life, and any adverse reactions to treatment. The length of follow-up was measured at 1 month, 3 months and 12 months of therapy. Some of the studies used standardized testing, some used questionnaires, and some used checklists.

Data Extraction: Two of the authors assessed the suitability and quality of the articles found. Originally 278 articles and abstracts were found and 272 were discarded because they did not deal specifically with a sound therapy in children or adults with autism spectrum disorders.

Main Results: There were only 6 RCTs found and they all used AIT. No other treatment methods had been subjected to an RCT. All of the trials had problems with the way in which they were conducted (methodology). There was little or no consistency between trials in the tests used to measure effectiveness of the treatment, making it impossible to merge the results.

The following outcome categories could be reported.

  1. Behavioural problems: No significant differences were found between the treatment groups and controls. Rimland (1995) reported improvement, but the follow-up period was only 3 months.
  2. Cognitive ability: Only Bettison reported improvements at 6 and 12 months.
  3. Sound sensitivity: Bettison reported improvement; however, a non-standardized test was used.
  4. Listening skills and comprehension: Rimland reported improvement, but had used a subgroup of questions from the Fisher’s Auditory Problems Checklist, a use of the test that has not been shown to be reliable.
  5. Adverse reactions: There were no reports of deterioration in behaviour or damage to hearing. Only parental report of adverse reactions, not objective tests, was used.

Conclusions: Two of the authors assessed the suitability and quality of the articles found. Originally 278 articles and abstracts were found and 272 were discarded because they did not deal specifically with a sound therapy in children or adults with autism spectrum disorders.

Studies cited in the review:

Bettison S. The long-term effects of auditory training on children with autism. Journal of Autism and Developmental Disorders 1996; 26(3):361-374.

Edelson S, Arin D, Bauman M, Lukas S, Rudy J, Sholar M, Rimland B. Auditory Integration Training: A double-blind study of behavioural and electrophysiological effects in people with autism. Focus on Autism and Other Developmental Disorders 1999; 14(2):73-81.

Mudford O, Cross B, Breen S, Cullen C. Auditory Integration Training for children with autism: No behavioural benefits detected. American Journal on Mental Retardation 2000; 105(2):118-129.

Rimland B, Edelson S. Brief Report: A pilot study of auditory integration training in autism. Journal of Autism and Developmental Disorders 1995; 25(1): 61-70.

Veale T. Effectiveness of AIT using the BCG device (Clark method): A controlled study. World of Options International Autism Conference, Toronto, Canada (July 1993).

Zollweg W, Palm D, Vance V. The efficacy of Auditory Integration Training: A double-blind study. American Journal of Audiology 1997; 6(3): 39-47.