Wednesday, June 19, 2013
Tomatis Therapy is Not a Conventional Treatment
In the last several days, I have received several comments from an annoyed Anon at http://childmyths.blogspot.com/2013/04/got-rad-dsm-v-rethinks-diagnosis-maybe.html. Among many other things, Anon says her granddaughter is receiving conventional treatments for her behavioral problems, including Tomatis therapy to improve brain functioning compromised by Fetal Alcohol Syndrome. When I stated that Tomatis therapy was not conventional treatment, Anon insisted that it was.
In fact, though, Tomatis therapy is an “alternative” treatment that is implausible in the context of established information about human development, and is without acceptable research evidence. Here is a discussion of Tomatis therapy and other “auditory integration therapies” from my forthcoming book Faith run mad:
Auditory Integration Therapy (AIT)
AIT practitioners cause patients to be exposed to the sound of music, electronically filtered and altered. Disorders for which AIT may be used include attention-deficit/hyperactivity disorder (ADHD), autism, dyslexia, learning disorders, and depression (Jacobson, Mulick, & Foxx, 2005). Most patients are children or adolescents.
One method of AIT was developed in the 1970s by the French otolaryngologist Guy Berard (1993). Berard’s technique involves auditory testing that looks for areas of hyperacuity, or sound frequencies to which the patient is unusually sensitive. Berard and his followers then present the patient with music filtered in such a way that the frequencies to which the patient is especially sensitive are less intense than others. This acoustically-modified music is played to the person for a total of 10 hours, in two ½ -hour sessions per day for 10 days. The popular music is played through devices like the Audiokinetron, Audio Tone Enhancer/Trainer, or EARS Education and Retraining System. These devices modulate the sounds by randomly clipping frequencies above or below 1000 Hz for random durations from .25 second to 2 seconds (Mudford & Cullen, 2005). (However, the United States Food and Drug Agency disallowed importation of the Audiokinetron in 1993, on the grounds that the greater than 130 dB sound it produces is greater than the intensity permitted by OSHA for exposure for an hour a day [Mudford & Cullen, 2005]).
A second French otolaryngologist, Alfred Tomatis (1977/1991), created a similar method of exposing children to music with the intention of treating autism and other disorders. Tomatis used music played through a device called the Electronic Ear. This progressively filtered out low frequencies. As a next step, the intensity of the sound to the left ear was reduced in order to “promote dominance of the right ear”. Children in treatment also spoke and sang into a microphone to hear their own altered voices. They simultaneously played with toys that promoted tactile and vestibular stimulation (much as is done in SIT).
AIT: Plausibility and Evidence
Neither Berard nor Tomatis attempted to develop a research-based theory for their treatments (Creaghead, 1999). One supporter of the Tomatis method has claimed that “auditory stimulation results in myelination of the auditory pathways… which improves the speed of processing” (Gerritsen, 2010, p. 50), an idea which he cites to a personal communication. In fact, hearing is already functional in utero, and myelination occurs as a result of maturational factors rather than being driven by stimulation. The system does show some plasticity (guidance of development by experience), but this is largely associated with functions like sound localization, which need to adjust as the baby’s head grows.
Berard considered areas of hyperacute hearing to be “traumatizing frequencies”, an idea without congruence with conventional understanding of hearing. His metaphor for AIT was a comparison to physical therapy, in which a stiff joint might be gradually moved into a wider range of motion; Berard thought of reduction of intensity in the same way, but with little explanation of how or why improvement might occur. More recently, practitioners of AIT under the name Digital Auditory Aerobics (DAA) have suggested that the treatment exercises the muscles that control the ossicles in the middle ear (http://www.georgianainstitute.org/quest.htm), muscles that serve to damp movement in response to excessively intense sounds.
Neither the Berard nor the Tomatis method has been supported by research evidence. The positive popular attitude toward AIT has been based primarily on a book written by the mother of a child Berard considered completely cured of autism (Mudford et al, 2000; Stehli, 1999). The enthusiasm of the autism researcher Bernard Rimland also played a role in bringing AIT to public attention. Rimland and Edelson (1994, 1995) reported “sufficiently promising” results from 445 autistic children whose parents paid $1000 each to bring the children to Oregon for treatment; no placebo-treated comparison group was included in the design. Mudford et al (2000) later failed to replicate Rimland and Edelson’s results, and three other failures to replicate were listed by Mudford & Cullen (2005).
A meta-analysis of work on the Tomatis treatment (Gilmor, 1999) concluded that there might be cautious support, but the study designs were generally weak. In a more recent series of case studies, 5 of 11 autistic children were said not to benefit significantly (Gerritsen, 2010).