4.2.0
Auditory Training
Photo by Alireza Attari, Unsplash, symbolic photo.
Auditory training — especially for the treatment of autism — is not new. Because many autistic individuals have acoustic hypersensitivity (hyperacusis), various researchers have developed adapted programs using filtered music.
In this chapter, I briefly review three different approaches and show that, despite Porges' arguments that his method and algorithms are unique, they all share similar mechanisms and mitigated results.
Tomatis method
Berard’s Auditory Integration Training
Porges’ Listening Protocol Project or Sound and Safe Project
Finally, I draw the reader to other techniques using electronically filtered or natural sounds, such as ASMR (Autonomous Sensory Meridian Response).
4.2.1
Tomatis Method
Alfred Tomatis (1920-2001) was a pioneer in this field. A French doctor specializing in otolaryngology, he began treating singers, including the famous Caruso. He then developed a program called "electronic ear" to treat psychological problems such as autism. His book L'oreille et la vie (1977), an international bestseller, was later translated into The Ear and the Voice (2005).
His most controversial method attempts to lead autistic children to recognize and respond to their mother's voice. The electronic ear, he maintained, could simulate the sound of the mother's voice as heard in the uterus and to lead the child gradually to accept and respond to her real unfiltered voice. He reported that this method often brought startling results, with children crying with joy as they recognized their mother's voice for the first time. Source: Wikipedia.
A report by Novella (2013) is critical. Most of the critics came from France (e.g. Brissonnet, 2003, p. 153-4), where at the same time Tomatis was treated with the highest honors.
4.2.2
Berard Auditory Integration Training (AIT)
A few years later, Guy Bérard, another French doctor, introduced his program of auditory integration training (AIT). His book Audition Egale Comportement (1982), in English Hearing equals behavior (Berard, 1993), presents his program. The standard protocol for Berard AIT consists of two 30-minute daily listening sessions for ten consecutive days. The listening sessions are separated by at least three hours to allow for a break from stimulation—more under https://berardaitwebsite.com/ and Wikipedia.
Annabel Stehli’s The sound of a miracle : a child's triumph over autism (1991) told the story of the author's daughter, an autistic girl who received AIT treatment from Bérard. According to Auditory integration training: a critical review (in Jacobson, 2005, p. 351–62), the book brought AIT to the attention of the English-speaking world. By 1994, more than 10,000 U.S. children and adults had received training at about $1,000 to $1,300 each, and AIT had become a multimillion-dollar industry.
Berard Auditory Integration Training by Sally Brockett (Sokhadzeh, 2019, chapter 13) also provides much information. Ask sally@ideatrainingcenter.com for a free download.
Here is also a dedicated YouTube channel.
The effects of auditory integration training on autism (Rimland, Edelson,1994) describes positive results.
Auditory Integration Training: A Double-Blind Study of Behavioral and Electrophysiological Effects in People with Autism (Edelson, Rimland, et al., 1999) also describes improvements.
The long-term effects of auditory training on children with autism (Bettison, 1996). Some positive effects.
However, in a meta-review Auditory integration training and other sound therapies for autism spectrum disorders (ASD) Sinha et al. (2011) concluded that «There is no evidence that auditory integration therapy or other sound therapies are effective as treatments for autism spectrum disorders.» This last study didn’t integrate the Porges program.
4.2.3
Other Electronic Programs
Music and Sound-Based Intervention in Autism Spectrum Disorder: A Scoping Review (Shahrudin, 2022) reviews 39 peer-reviewed original research articles (including the Listening Project). Conclusion: “Although evidence and reviews for effective therapy and study have been ongoing for a long period, there is data paucity to draw conclusions about the effectiveness of the intervention. Moreover, the evidence presented by most studies is weak due to the limited sample size, unverified methodology, absence or lack of a control/placebo group, and insufficient follow-up investigations. Thus, more research addressing these issues is required to further clarify the effectiveness of this intervention.”
Improving Emotion Perception in Children with Autism Spectrum Disorder with Computer-Based Training and Hearing Amplification (Leung, 2021) proposes a (non-polyvagal) hearing program.
4.2.4
ASMR (Autonomous Sensory Meridian Response)
If you try an auditory program of filtered music (Tomatis, Bérard, or Porges), you will experience the same result as viewing a desaturated color picture or tasting food without salt. It is dull–even boring. Some autistic and ADHD people may find it a relief, others are irritated (see Traumageek in medium.com about her experience with the Safe and Sound Protocol). But is it possible that the neutral character of the sounds is the magic key to all these methods? So why not use gentle, neutral sounds instead of electronically filtered sounds?
ASMR involves soft sounds, whispering, tapping, and other subtle noises to induce a calming sensation and relaxation in individuals. Many people find ASMR videos or audio recordings soothing and helpful for reducing stress or promoting sleep.
Autists like neutral tones - sounds (Barratt, 2015) Autonomous Sensory Meridian Response(ASMR): a flow-like mental state.
Brain function effects of autonomous sensory meridian response (ASMR) video viewing (Sakurai, 2023)
https://ourworldandautism.com/guides/do-autistic-people-like-asmr/ Do Autistic People Like ASMR? A Closer Look at ASMR and Autism
https://neurolaunch.com/asmr-autism/ ASMR and Autism: Exploring the Soothing Connection
4.2.5
Porges’ Safe Sound Protocol
In 2005, Porges and Bazhenova published Evolution and the autonomic nervous system: A neurobiological model of socio-emotional and communication disorders on the Institute for Child Study, University of Maryland server. It was accessible under http://icdl.com/porges.html, but the link is no longer active. The protocol described is very similar to that of the following study (2014). The post-intervention control was three months later. Although Porges used some of these cases in his follow-up presentations or workshops, he didn't say how long the positive effect lasted or whether the children needed follow-up sessions. A long follow-up (catamnesis) is missing.
In Reducing auditory hypersensitivities in autistic spectrum disorder: preliminary findings evaluating the listening project protocol, Porges, Bazhenova, et al. (2014) present a new study. In this experiment, children with autism receive a 45-minute session of filtered music on five consecutive days.
Because we encourage readers to go to the publication for details of the study, we will quote extensively from two parts of the article, which we have reorganized for clarity:
1. Contrast with traditional auditory intervention therapies
Since LPP delivers computer altered acoustic stimuli through headphones, it shares some of the features of auditory intervention therapies (i.e., AIT). However, although LPP is a “sound therapy,” it is not a traditional clinically available AIT and differs from these procedures in method and theory.
LPP is based on the polyvagal theory.
LPP focuses on auditory hypersensitivities that individuals with and without clinical diagnoses may express.
The effectiveness of LPP can be measured through well-defined behavioral and physiological features of the social engagement system.
LPP was designed to engage and exercise the neural regulation of the middle ear muscles
The duration of LPP is shorter (i.e., less than 5 h) than most forms of AIT.
Our comment: The main arguments Porges presents are all related to Polyvagal Theory (1.), the Social Engagement System (3.), and the relationship of the Middle Ear Muscles (MEM) to hypersensitivity — the latter argument being an essential part of the PVT. The only acceptable argument concerns the shorter duration of LPP compared to other forms of auditory training (e.g. Berard or Tomatis). However, the other “auditory intervention therapies” based on the work of Berard or Tomatis — a non-polyvagal theoretical framework — make the same claims of success.
2. Limitations
At the end of the article, the authors list eleven limitations of the current study. Here are four of them (original text, reorganized):
The participants were receiving other treatments during the intervention and assessment period. Several participants were receiving daily interventions using behavioral approaches and other therapies, which may have enhanced or dampened the effects of the LPP.
Improvements were observed in the groups not receiving the filtered music. Approximately 40% of the parents of children not receiving the filtered music reported improvements on at least one behavioral feature.
The methods employed could not confirm whether auditory hypersensitivity was due to a compromise in functional neural regulation of the middle ear muscles (as proposed by the polyvagal theory) and remediated through an exercise model.
The hypothesized link between the middle ear transfer function and auditory hypersensitivities could be limited. Hyper- sensitivities, especially to high frequency sounds, might be due, not to the neural regulation of the middle ear muscles, but to the olivary cochlear reflexes. Tests of inner ear function and the degree of auditory hypersensitivity to high frequency sounds need to be evaluated to rule out this possibility.
In summary:
The experience is not conclusive, as participants received other treatments in parallel.
40% of the parents of children who did not receive the filtered music reported improvements in at least one behavioral characteristic.
Comparing this protocol to “traditional auditory intervention therapies,” Porges insists on the unique polyvagal theory that supports his intervention. However, he says his method hasn't confirmed the link between the middle ear muscles and hypersensitivity. He admits that the olivary cochlear reflexes (related to cranial nerve VIII, not V or VII) could be the regulating neural factor. CN VIII doesn't belong to the social engagement neural group (V, VII, IX, X, and XI).
Finally, Porges mentions hypersensitivity to higher frequencies, although the “reptilian” link to autism is based on low frequencies.
Different centers in the USA offer this training, for example:
External evaluation of the Listening Project or Safe Sound Protocol
Since 2014, we found only one study. In 2023, a Japanese team published Initial Outcomes of the Safe and Sound Protocol on Patients with Adult Autism Spectrum Disorder: Exploratory Pilot Study (Kawai, 2023). Their conclusions of the study, including six adults, were mitigated: “In conclusion, the SSP has a partial effect on social impairments in adults with ASD (…) it is a non-invasive and impressive short-term treatment program, and the fact that all participants were able to complete the entire program suggests that the SSP may become a viable approach to core symptoms of ASD. On the other hand, the SSP did not elicit active prosocial behavior as previously reported in children.”
Porges and Onderko will publish Safe and Sound: A Polyvagal Approach for Connection, Change, and Healing in April 2025. According to the presentation on Amazon.com, “the Safe and Sound Protocol (SSP) is a groundbreaking listening therapy based in Polyvagal Theory (PVT), which looks at the role the autonomic nervous system and vagus nerve play in regulating health and behavior. Resetting the nervous system to its homeostatic state with SSP is the lock, waiting to be opened.”
Conclusion:
I don't want to judge the results. Many participants in auditory Tomatis, Berard, or Porges training may have excellent results, and others may not. There are so many factors involved. Supporting the presentation of the technique with a well-developed theory such as the PVT undoubtedly adds a solid placebo effect. However, similar methods work — or not — with or without the Polyvagal Theory. Therefore, the role of the middle ear muscles remains elusive.
>> to the next chapter Vagal Stimulation