IS AUDITORY INTEGRATION THERAPY EFFICACIOUS?
Viewpoints AUTISM: IS AUDITORY INTEGRATION THERAPY EFFICACIOUS? CHILD AND ADOLESCENT PSYCHIATRY VIEWPOINT
Randall F. White, MD, FRCPC; Andro Giorgadze, MD Medscape Psychiatry & Mental Health. 2007; ©2007 Medscape Posted 03/01/2007 AUDITORY INTEGRATION TRAINING AND OTHER SOUND THERAPIES FOR AUTISM SPECTRUM DISORDERS: A SYSTEMATIC REVIEW Sinha Y, Silove N, Wheler D, Williams K Arch Dis Child. 2006;91:1018-1022. Epub 2006 Aug 3.
Summary According to proponents, sound therapies such as auditory integration training (AIT) can ameliorate behavioral and cognitive dysfunction of various developmental disorders, especially autism-spectrum disorders. While several AIT techniques exist, French otolaryngologist Guy Berard developed the most widely used method, in which the patient hears electronically modified music for 30 minutes through headphones during 20 sessions.[1] The current trial searched for randomized controlled trials of sound therapies for adults or children with pervasive developmental disorders using standardized instruments as outcome measures. Six such studies were identified involving a total of 171 subjects. Five of the trials used the Aberrant Behavior Checklist as the main outcome measure; its application was not uniform across studies, however, rendering a meta-analysis impossible. There were additional problems with the trials: (1) Concealment of treatment allocation was inadequate in all 6 trials. Outcome assessors were blinded in all trials, but in 4, the principal investigators were not blinded. (2) Duration of follow-up varied from 3 to 14 months. Three studies found significant improvement in the mean outcome score at 3 months. The largest trial, with 80 subjects, found no significant difference in mean outcome scores between treatment and control groups at 12 months. Two of the trials provided a small amount of data on adverse effects, reporting no significant concerns. The reviewers concluded that sound therapy for autism-spectrum disorders is "an experimental treatment at best."
Viewpoint Sound therapies, especially Berard's AIT, are in clinical use throughout North America and other regions for a variety of disorders. This review, which examined studies only on people with autistic disorders, lays bare the inadequate evidence base for this treatment. Most of the trials were small, all were methodologically flawed, and they had inadequate outcome measures and follow-up durations. Despite the paucity of experimental support, compelling anecdotal evidence for these therapies is widely available in books and on the Internet. The treatments seem benign, although concern exists about hearing damage if stimuli are loud; their popularity is therefore understandable, given that parents of autistic children are often desperate. Informed clinicians will have to convey this information to patients and their families and offer an alternative, if possible, and perhaps help them through the disappointment of a false hope. Abstract
References 1.Edelson SM. Auditory integration training. Available at: http://www.autism.org/ait2.html Accessed February 20, 2007. Randall F. White, MD, FRCPC, Psychiatrist, St. Paul's Hospital, Vancouver, Canada, British Columbia Andro Giorgadze, MD, Staff Physician, Sumter Regional Hospital, Americus, Georgia
Disclosure: Randall F. White, MD, FRCPC, has disclosed that he owns stock, stock options, or bonds in Roche Holdings AG, GlaxoSmithKline PLC, Novartis AG, Merck KGAA, Sanofi-Aventis, and Novo Nordisk.
Disclosure: Andro Giorgadze, MD, has disclosed no relevant financial relationships.