Auditory integration training (also known as AIT) involves a person listening to a selection of music or other sounds which have been electronically modified.
There are several different kinds of auditory integration training including the Bérard Method, Samonas Sound Therapy, and the Tomatis Method.
AIT is based on the idea that some people, including some autistic people, are hypersensitive (over-sensitive) or hyposensitive (under-sensitive) to certain frequencies of sound.
This sensitivity to certain frequencies is believed to cause a variety of perceptual problems (such as an inability to concentrate or to understand other people). It may also cause other problems (such as irritability or lethargy).
AIT is designed to improve the person’s ability to process sounds by ’re-educating’ the brain. This is done by playing electronically modified music or other sounds in which the frequencies have been changed.
The National Institute for Health and Care Excellence (NICE) made the following recommendations:
'Do not use auditory integration training to manage speech and language problems in children and young people with autism.' (NICE, 2013)
There is a limited amount of high-quality research evidence (seven group studies) and a limited amount of low-quality research (six single-case design studies) into the use of the different forms of auditory integration training for autistic people.
We believe that the theory behind auditory integration training is weak and unproven, there are some potential hazards in using some AIT machines and most forms of AIT are expensive.
Because of this we cannot recommend the use of auditory integration training
Please read our Disclaimer on Autism Interventions
Most suppliers of auditory integration training claim that their particular form of AIT is appropriate for people with a range of disabilities or with a range of problems, of all ages. For example,
The Tomatis Method SA website, accessed on 2 December 2015, states that the Tomatis method has helped people with
The different suppliers of auditory integration training agree that the main aim of AIT is to enable the individual to train his or her auditory system to accurately process sound. This is achieved by listening to modified sounds which stimulate connections between the ear and the central nervous system.
This is designed to desensitise individuals to sounds which they previously found disturbing (such as traffic noise) and to help them distinguish useful sounds (such as human speech).
It is also designed to help them to improve in areas such as attention and concentration, speech and language.
There have been various claims made for the use of auditory integration training as an intervention for autistic people. In general, the suppliers of the training claim that it leads to a decrease in sound sensitivity, as well as improvements in areas such as concentration, awareness, and communication.
For example, The Bérard AIT website, accessed on 8 March 2019, states that “Parents often report a reduction in tantrums, sound sensitivity, echolalia, hyperactivity and impulsivity.
Parents also observe increased ability in following directions, attention, auditory short-term memory, and speech/language skills. Increased socialization, cooperation, self-confidence and independence are also frequently observed. Improvements in sensory processing, with a decrease in episodes of sensory overload are typically reported by parents.”
Auditory integration training is sometimes also known as AIT, the audio-psycho-phonology approach, auditory intervention, auditory stimulation therapy, auditory therapy, sonic therapy, sound stimulation therapy and therapeutic listening.
AIT is based on the idea that some people, including some people with autism, are hypersensitive (over-sensitive) or hyposensitive (under-sensitive) to certain frequencies of sound.
This sensitivity to certain frequencies is believed to cause a variety of perceptual problems (such as an inability to concentrate or to understand other people). It may also cause other problems (such as irritability or lethargy).
AIT is designed to improve the person’s ability to process sounds by ’re-educating’ the brain. This is done by playing electronically modified music or other sounds in which the frequencies have been changed.
The following section describes the key elements of some of the most well-known forms of auditory integration training. However, there are many different providers of each type of AIT which means that the same form of AIT may vary considerably from one provider to another.
The Tomatis Method was the first AIT to be developed and each of the other AITs shares some of its characteristics.
The individual attends a clinic or similar venue. He or she sits comfortably in a relaxed environment. S/he then listens to modulated sounds through a special piece of equipment called an ‘Electronic Ear’. The latter has an earphone and an attached oscillator, which allows the individual to hear and feel the sounds at the same time.
The ‘Electronic Ear’ reduces the signal strength of low frequency sounds and amplifies higher frequencies (800–300 Hz). The sounds include specially created compact discs of Mozart music and Gregorian chants.
During the passive phase of treatment, that is, when the individual is not actively listening to the modulated sounds, he or she may draw, paint, play games, do exercises that increase their sensory awareness or that improve their balance and coordination. Adults draw, work on a puzzle, meditate, rest, or sometimes fall asleep as they start to relax more deeply.
The Bérard method is very similar to the Tomatis method in that the individual has to attend a clinic and has to listen to modulated music using specialist equipment. It differs from the Tomatis method in that it uses a different machine, tends to be shorter in length and does not have a passive phase of treatment.
The individual has to attend a clinic or similar venue. He or she sits comfortably in a relaxed environment. He or she then listens (through headphones) to music filtered through a special machine called an Audiokinetron or an Earducator.
These machines are designed to randomly modulate the amplitude of the high and low frequencies in order to re-train the ears and ‘balance’ the hearing. The music can be modified by the AIT device in two ways: modulation and filtering.
Modulation involves reducing the signal strength of high or low frequencies (1 KHz, respectively) at random for blocks of .25 – 2 seconds, again randomly selected.
Filtering involves reducing the signal strength of narrow frequency bands around frequencies on the audiogram to which the individual seems particularly sensitive.
The costs of auditory integration training will depend to a large extent on the form of auditory integration being used, the specific supplier you are using, whether you are paying for a therapist or for a set of CDs, and if any travel and accommodation is required.
We have been unable to identify the costs of using the Tomatis Methods from any of the suppliers of the method. However, according to an article on the Parent Map website, written in 2014 and accessed on 8 March 2019, “The current cost of treatment ranges $50–$55 an hour, depending on the phase.” Given that the Tomatis Method is an intensive intervention which can take 70 plus hours to complete, it is likely that some suppliers may charge in the region of $3,500 or more.
According to the Henry Spink Foundation website, accessed on 8 March 2019, “[The Bérard method] costs on average £400”. However according to the Advanced Sensory Educational Services (ASES) website, accessed on 8 March 2019, it costs $1,200, although this fee does include a range of services. “The $1200.00 Berard AIT cost at the ASES Center includes initial evaluation, information for aftercare, handouts, periodic monitoring for six months, and no more and no less than 20 one-half hour listening sessions in a ten day period. Cost for audiologist's exams are not included.”
The amount of time it takes to use AIT will depend on a number of factors including the overall length of treatment, the frequency of treatments and the time taken to administer a single dose, as well as the needs of the person undertaking it.
According to the Learning Center net website, accessed on 8 March 2019, “Each client’s Tomatis Method program is tailored to meet his or her specific needs. The length depends on two factors:
Some clients respond more quickly than others. As much as possible, we try to give an accurate estimate for the duration of the program before starting. Keeping this in mind, an average program consists of three blocks and approximately 70 hours in total. However, some clients may need additional blocks.”
According to the Bérard AIT website, accessed on 8 March 2019, “The practitioner follows the Berard AIT protocol. Key points include: 10 days of listening sessions provided 2 times a day for 30 minutes each session. It is acceptable to have a 1 or 2 day break but only after the first 5 days of listening.” “’Booster’ sessions are not permitted. If it appears that the individual may benefit from more AIT, the entire 10 days should be done.”
There are some reports of damage to hearing due to volume and sound pressure when using the Audiokinetron during AIT. This machine was disallowed for import by the USA Food and Drug Administration because of concerns about safety.
The proponents of sound therapies have stated that these concerns are groundless. For example, Lucker (1998) stated that “... when typical use settings were employed for each machine, maximum output levels were reduced significantly. These lower output peaks are felt to be within acceptable risk levels.”
There are some contraindications (something which makes a particular treatment or procedure potentially inadvisable) for AIT but different suppliers provide different information about those contraindications. For example, according to the Bérard AIT website, accessed on 8 March 2019, children under 3 are not suitable for treatment.
According to the Listen Well website, accessed on 8 March 2019, “For some people (like people with epilepsy or tinnitus), auditory stimulation is not advisable, and should only be done under strict supervision of an expert”.
We therefore suggest that no-one should undertake any form of AIT without first consulting an appropriately qualified medical practitioner. We also suggest that individuals with contraindications, such as hearing loss, infections, ear wax or damage to the inner ears, should not be treated with AIT.
Some forms of AIT, such as the Tomatis method, are widely available in the USA and at several locations in the UK but can only be delivered in a clinical setting.
Other forms of AIT are widely available in the UK and the USA and can be carried out at home, school or in the clinic.
Some forms of auditory integration training may require ongoing support from a therapist who is trained in their use, others can be bought off the shelf.
There are no formal, internationally validated registered qualifications for sound therapists, although some providers state that they have been approved by a relevant body such as the Bérard Institute or the Tomatis Institute.
Dr. Alfred Tomatis (a French ear, nose and throat specialist) developed the first auditory training or listening training device in the 1950s. He used progressively filtered sound, specifically those sounds rich in high frequencies (e.g. classical music, the mother's voice, Gregorian chants) to effect change.
Dr Guy Bérard (another French ENT specialist) developed Bérard’s therapy in the 1960’s. Bérard, who originally worked with Tomatis, felt that the original protocol was too lengthy and developed a different method of filtering sound. It was then used in dyslexia, depression and suicidal tendencies, with Bérard claiming good results. It was first used for autistic people in 1975.
Staff at Advanced Brain Technologies (ABT) developed The Listening Program in 1998. ABT felt that the existing AIT programmes were too expensive and difficult to use, so developed a programme using CDs that could be listened to at home under the under the guidance of an “Authorized Provider”.
Please note: we have not included the Listening Program in this evaluation as the authors of the only published study, Porges et al (2014), wrote that “... although LPP is a “sound therapy,” it is not a traditional clinically available AIT and differs from these procedures in method and theory.”
A number of other providers have developed a range of other AIT programmes, such as SAMONAS therapy, at various times.
We have identified thirteen scientific studies of auditory integration training for autistic people which have been published in English-speaking, peer-reviewed journals. *
Seven of these studies used a group design, comparing a group of autistic children receiving AIT to a different group receiving something else or not receiving an intervention at all. Six of these studies used a single-case design (where there was no group receiving something else).
The majority of the studies followed the timing in the original protocol suggested by Berard, that is a total of 20 sessions, split over 10 days, with two sessions per day, each lasting 30 minutes or so. However, in one study Neysmith-Roy (2001), this protocol was repeated every three to eight weeks over the course of a whole year.
We have identified four studies of the Tomatis method, which included 62 individuals aged 4 to 11 years.
We have identified nine studies of the Bérard Method, which included more than 200 individuals aged 3 to 39 years.
The results indicated that although the majority of the children demonstrated general improvement in language over the course of the studies, these improvements did not necessarily appear to be related to the treatment.
We have been unable to identify any scientific studies of the other forms of AIT, such as SAMONAS therapy, used with autistic people published in peer reviewed journals.
*Please note: We have not included articles with fewer than three autistic participants, articles which did not examine the efficacy of auditory integration for autistic people or articles on the Listening Program. We have not included the latter as it differs considerably from the other forms of auditory integration training in terms of theory and delivery.
There are limitations to all the research studies identified to date, as detailed in the reviews below. For example, In the Al-Ayadhi et al (2013) study, 34 of 72 children were successfully treated for ear infections during the treatment period, confounding interpretation of findings.
Although a number of studies have been published since the last review by Sinha et al (2011), we believe that none of these studies are of sufficiently good quality to have amended their conclusions.
Sinha Y. et al. (2004) carried out a review of the existing research studies for the Cochrane Library in 2004. They set out a range of flaws in the existing studies including the fact that they “…largely measured different outcomes and reported mixed results.”
Sinha et al (2011) carried out an updated review for the Cochrane Library in 2011. They concluded
“There is no evidence that auditory integration therapy or other sound therapies are effective as treatments for autism spectrum disorders. As synthesis of existing data has been limited by the disparate outcome measures used between studies, there is not sufficient evidence to prove that this treatment is not effective. However, of the seven studies including 182 participants that have been reported to date, only two (with an author in common), involving a total of 35 participants, report statistically significant improvements in the auditory integration therapy group and for only two outcome measures (Aberrant Behaviour Checklist and Fisher’s Auditory Problems Checklist). As such, there is no evidence to support the use of auditory integration therapy at this time.”
For a comprehensive list of potential flaws in research studies, please see ‘Why some autism research studies are flawed’.
There is a limited amount of high-quality research evidence (seven group studies) and a limited amount of low-quality research (six single-case design studies with three or more participants) into the use of the different forms of auditory integration training for autistic people.
We agree with the recommendations from the last Cochrane review on this topic, Sinha et al (2011), which reported
“Given the lack of evidence that auditory integration training (AIT) or other sound therapies are effective as a treatment for autism, future research is discouraged. However, we suggest that any further trials of AIT should build on existing evidence and provide high level evidence about whether this treatment is effective for outcomes that are relevant to individuals with ASD.
To provide this level of evidence, future trials should:
1. use gold-standard criteria for diagnosing autism, so that groups can be compared;
2. use sample sizes capable of detecting differences, if these exist;
3. use outcome measures that are valid and clinically meaningful;
4. present information in a way that is accepted for randomised control trials;
5. consider the effect of intellectual ability, age of participant at treatment, severity of symptoms and other potential subgroup variations so that clinically meaningful information is provided;
6. collect information about potential confounders, such as other therapy, so between-group equivalence can be established.”
This section provides details of scientific studies into the effectiveness of auditory integration training for autistic people which have been published in English-language, peer-reviewed journals.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
This section provides details of other publications on this topic.
You can find more publications on this topic in our publications database.
If you know of any other publications we should list on this page please email info@informationautism.org
Please note that we are unable to supply publications unless we are listed as the publisher. However, if you are a UK resident you may be able to obtain them from your local public library, your college library or direct from the publisher.
It should be noted that the relationship between autism and hyperacusis (an extreme aversion and hypersensitivity to sounds) and autism is not clear.
AIT should not be confused with AIT plus, which combines AIT with Light Therapy and Sound Modulation Therapy.