Comparing the Berard AIT and the Tomatis Method
Report On A
Project Comparing The Berard Approach Of Auditory Integration Training With The
Tomatis Method Of Audio-Psycho-Phonology, Based On The Outcomes For A Group Of
Children With Autism
by
Rosalie
Seymour, SLP/A, Berard AIT Practitioner
The differences between the Tomatis and the Berard AIT approaches
to auditory training are detailed in the following article, which is available
on the website of the Autism Research Institute called "Improving
the Auditory Functioning of Autistic Persons: A Comparison of the Berard
Auditory Training Approach with the Tomatis Audio-Psycho-Phonology Approach"
by
Bernard Rimland, Ph.D. and Stephen M. Edelson, Ph.D.Autism Research Institute
This report adds some comments about the experience of five (5)
children with autism who underwent both treatments during the period of 1990 and
1996.
A group of children with the diagnosis of autism who all attended
the same school for children with autism were given the opportunity through a
sponsorship in 1991 and 1992 to attend three sessions of Tomatis
Audio-Psycho-Phonology with a certificated practitioner.
Each of the three sessions included 100 hours of treatment, given
as sessions of approximately three hours per day, daily, at the practitioners’
rooms. During these sessions the children were free to play, draw, or rest as
they wished, as prescribed in the treatment protocol. Parent consultations were
held by the practitioner in separate sessions.
Two of these children had readily-identifiable auditory
hyperacusis, since they spent much of their day with their hands covering their
ears, and showed many behaviors associated with distress caused by sounds.
Another of the children, the only girl of the group, had suspected although not
identified hyper-sensitivity.
In
evaluating the outcomes from the three 100-hour sessions of Tomatis therapy, it
was recorded that:
-
The parents reported benefit from the individual
consultations with the practitioner in terms of feeling supported.
-
The girl who had an artistic flair and spent her sessions
drawing copiously seemed to improve in her creative style.
The only negative outcome was a disturbing reaction from the
younger of the boys with auditory
hyperacusis. His mother reported that he had become completely passive,
almost ‘like plasticine’. While previously he had tended to be stereotyped,
following limited and set routines, after these sessions he became even more
limited to the extent that he stood where he was put, or sat where he was set
down. He ceased all exploration or participation. During the sessions he would
pull the blanket over his head and lie without moving for their duration. This
withdrawal gradually receded, and his mother reported that after 6 months he had
almost regained his pre-treatment levels of activity.
No lessening of auditory
hyperacusis.
was observed in any of the children, in fact the older boy’s discomfort
continued to worsen until it reached the point where he was unable to join the
family for meals or for walks in the forest.
After the three sessions of Tomatis APP therapy had concluded,
there was a period of one year during which these children proceeded with their
daily scholastic routines. This was the ‘psycho-educational’ approach to
teaching, which involved an adapted curriculum, with speech therapy and
occupational therapy supports.
In 1993 and 1994 these children were able to attend a
practitioner of the Berard
Method of Auditory Integration Training. The families sought the treatment
on an individual basis, without sponsorship.
These sessions totaled ten (1) hours of auditory integration
training, split into two 30 minute sessions per day, for ten consecutive days.
As with the Tomatis sessions, headphones were worn to listen to
the music. During the sessions, children were allowed to play with ‘fidgets’,
but not read, draw or write. Parent information and conversations were held
during the half-hour listening sessions.
The
outcomes for the children were noticeable as follows:
-
The three children with hyperacute and painful hearing had
immediate benefits after AIT, that enabled them to become more participant
in their families.
-
The boy who had regressed severely during the Tomatis
sessions, reacted in the opposite way to AIT – he began to explore his
environment, he ceased body-spinning, his high-pitched stereotyped squeals
lessened. These changes meant that his mother had to keep a watchful eye on
him as he began to climb the fence and wander away. This occasionally led to
difficulties as the family adjusted to his being more ‘present’ as this was
unexpected behavior for him, but it was seen as a positive change away from
his stereotypes.
-
The older boy with severe painful hearing was able to rejoin
his family for mealtimes and enjoyed the school holidays in a noisy house
without difficulty for the first time.
-
There were reports of improved social responsiveness in all
the children.
One of the children, the boy with the stereotyped behaviors, went
on to take three sessions of
Berard
AIT,
and began to develop speech after the third ten-hour training had completed.
Summary
-
It was apparent that the outcome for these five (5) children
with autism was more positive after one ten-day session of
Berard AIT than
after the three sessions of the Tomatis therapy.
-
It was also noted that there were no significant negative
outcomes for any of the children, other than some tiredness during the ten
days of the sessions.
-
It was noted that the
Berard AIT had a
positive impact on painful hearing (auditory
hyperacusis) for all three the children who were identified with this
problem.
Improving Auditory Functioning: Berard vs. Tomatis
reprinted from
https://www.autism.com/treating_auditory
Update: Although this paper was written in 1991, we are not aware of any
research studies, published in peer-reviewed journals, indicating that the
Tomatis method is effective in helping autistic individuals. Additionally, Dr.
Tomatis has not retracted his theory that autism is a psychological disorder,
caused by the mother. In contrast, there are many studies showing that the
Berard method is effective. BR and SME, 2000
Background
The publication of the book The Sound of a Miracle by Annabel Stehli has created
a high level of interest in auditory training among the families of autistic
children. Georgie, the autistic girl about whom The Miracle was written, had
been taken by her parents to Annecy, France, to be given 10 days of auditory
training by Dr. Guy Berard, a French physician specializing in treating
individuals with auditory problems, including a few who were autistic. Desiring
to improve the functioning of their autistic children--specially those children
who, like Georgie, are highly sound-sensitive--many parents have begun to seek
the services of the small, though increasing, number of professionals who offer
what appears to be similar or related treatment.
Dr. Berard had been introduced to the concept of improving human well-being
through auditory stimulation in the 1960's by another French physician, Dr.
Alfred Tomatis, but quickly grew disillusioned with what he felt was the
excessive cost, time, intrusiveness and emphasis upon hypothetical psychological
factors of the Tomatis approach. The persons being treated were not autistic,
but instead had a variety of other, less severe problems.
Berardparted company with Tomatis, designed his own electronic
audio-stimulating device, and developed his own approach, utilizing what he felt
were the only valid components of the Tomatis approach and adding certain
innovations of his own. While the Tomatis approach might require the patient to
visit for several hours each day for many months--years in some cases--Berard,
focusing on only auditory problems, not psychological problems, felt that the
best results could be accomplished in one 10-day period, by having the patient
visit his office for two 30-minute periods on each of the 10 days. Berard
trained a small number of professionals in his method. Tomatis went on to
establish a great number of "Listening Centres" throughout the world, with
perhaps a dozen in the U.S. and Canada.
Current Status
Both the Berard Auditory Training approach and the Tomatis "Audio-Psycho-
Phonology" approach provide auditory stimulation to the listener; however, the
Tomatis method is quite different from the Berard method. Following is a
comparison of the two methods.
Published Research
We have been able to find no published studies in scientific journals on the
efficacy of either the Berard or Tomatis methods as applied to autistic
individuals.
Although a number of studies have investigated the efficacy of the Tomatis
method, most of these studies have not been published in scientific, refereed
journals but rather were informal reports presented at conferences or described
in unpublished manuscripts. In addition, most of these studies have not used
sound experimental procedures (e.g., no control group, evaluations of
effectiveness done by Tomatis proponents, etc.).
We are aware of only two studies investigating the effectiveness of the
Tomatis method that have been published in scientific journals. Both studies
were conducted with the cooperation of Tomatis specialists. A study conducted in
Canada examined a population of learning disabled, not autistic, children (Kershner,
Cummings, Clarke, Hadfield, & Kershner, 1990). In this study, one group of
children received the Tomatis program for 100 hours as well as standard remedial
procedures (i.e., school program), whereas a control group received only
standard remedial procedures. The tester, who conducted the two-year follow-up
assessment, was unaware of to which group the participants had been assigned.
Post-treatment measures assessing verbal and arithmetic abilities did not reveal
any differences between the two groups. On the Seashore Rhythm test, which
measures auditory attention, auditory discrimination, and short-term auditory
sequential memory, the control group children did significantly better than
those trained via the Tomatis approach. The Seashore Rhythm Test had been, in
particular, expected to show the benefit of Tomatis training.
A study conducted in South Africa by du Plessis and van Jaarsveld (1988)
examined the effectiveness of the Tomatis method on anxious children attending
an elementary school program. Children were assigned to one of three groups: (a)
children and their mothers received auditory training for 51 1/2 hours; (b)
children and their mothers received conventional counseling; and (c) children
and their mothers did not receive any intervention. The researchers examined a
number of variables, such as anxiety, personality, cognitive ability, and
listening skills. Overall, the children who received the Tomatis training did
significantly better than the two other groups; and children who received
counseling did significantly better than those children who did not receive any
form of intervention. A critical flaw with the design of this experiment is that
it was not "blind" -- the people who did the assessments (the mothers and
therapists) were aware of which group the children were assigned to.
There are many issues to consider when comparing the Berard program and the
Tomatis program. We have listed each issue separately to assist in comparing
these two approaches.
Conceptualizing Auditory Processing Problems
The Berard approach.
The Berard method is based on a physiologic-
educational, not emotional, approach (Berard, 1982). Berard argues that
behavioral and cognitive problems may arise when people perceive sounds in a
"differential" manner. That is, when certain frequencies are perceived much
better than other frequencies, sounds are perceived in a distorted manner and
may lead to difficulties in comprehension and behavior. Through auditory
training, Berard claims that distorted hearing and hypersensitivity to specific
frequencies are reduced and that, ideally, all frequencies can be perceived
equally well. Thus, environmental sounds, including speech, are perceived
normally.
The Tomatis approach.
Tomatis takes a psychological-emotional approach in
explaining how people may benefit from his program (Tomatis, 1974, 1978). Unlike
Berard, the Tomatis method does not claim to reduce hypersensitivity, but
rather, it claims to improve a person's listening and communication skills.
Dr. Tomatis theorizes that listening problems often start in utero. That is,
the fetus hears the sounds of his/her mother including breathing, heartbeat, and
voice while in the womb. Tomatis argues that the mother's voice has a strong
influence on the development and later communication abilities of the fetus. He
asserts that the mother conveys acceptance to the fetus when her voice is warm
and melodious. In contrast, if the mother's voice is harsh and cold, then the
fetus will perceive the mother as rejecting. After birth, if the infant feels
unwanted due to his/her perception of sounds in the womb, the infant will not
want to listen nor communicate with his/her mother; and as a result, the
mother-child bond never develops. The Tomatis program presents different types
of sounds to the listener in an attempt to recreate critical periods of
listening development. By listening to sounds one would hear in the womb, soon
after birth, and during early childhood, the listener is said to learn to
communicate and listen more effectively.
As mentioned above, the aim of the Berard method is to reduce
hypersensitivity and to hear all frequencies equally well. In contrast, the aim
of the Tomatis method is to improve listening skills. Tomatis asserts that the
best hearing, which is said to be accomplished through his program, is for high
frequencies to be heard much better than moderate frequencies and for moderate
frequencies to be heard much better than low frequencies.
Clients Who Are Said to Benefit From These Two Approaches
Berard approach.
Berard claims that auditory processing problems may lead to
a number of different disorders including autism, depression, dyslexia, learning
disabilities, and in some cases, suicidal ideation; individuals with any of
these disorders may benefit from auditory training.
Tomatis approach.
Tomatis claims that listening problems may lead to anxiety,
autism, depression, dyslexia, epilepsy, learning disabilities, low self-esteem,
neurosis, and P.M.S. In addition, his method is said to help people who are
facing mid- life changes, people who want to eliminate a foreign accent, and
people who Want to learn a foreign language.
As mentioned above, there are no published studies in scientific journals
supporting any of these claims for either the Berard or Tomatis methods.
Description of the Sound Output
Berard approach.
The device used to provide auditory training is called the
Ears Education and Retraining System (EERS). This device takes music from a
sound source (e.g., audio tape or compact disc), filters out specific
frequencies to which the individual has been found by audiometry to be
hypersensitive, modulates the sounds electronically, and then sends them via
headphones to the ears. After ten hours of listening to this processed music,
the listener should have made significant progress toward hearing all
frequencies equally well.
Tomatis approach.
The device used to provide auditory stimulation is called
the Electronic Ear. Unlike the EERS device, audiotapes containing previously
filtered music are played into the Electronic Ear. The Electronic Ear filters
the music further in an attempt to recreate what Tomatis believes to be the
critical early developmental stages of listening. In the first phase, the
listener is presented sounds that simulates those that may be heard in the womb.
These sounds are similar to the sounds presented by the EERS; that is, high and
low frequencies sounds are extracted from the audio source and then presented to
the listener. In contrast to the Berard approach, a cascade filter is used to
gradually eliminate low frequencies from the sound; and eventually, the listener
is presented primarily high frequencies. According to Tomatis, high frequency
sounds energize or "charge" the brain. In addition, the mother's voice is
filtered and presented to the listener during the first phase.
The second phase of the Tomatis program attempts to recreate the sounds one
would hear after birth. These sounds include listening to songs, repetition of
words, and stories. As in the first phase, these sounds are filtered with an
emphasis on high frequencies. The third phase, in which the person reads out
loud, is intended to integrate written language.
The sounds heard throughout the Berard approach may appear similar to those
used during the initial phase of the Tomatis approach. However, Dr. Gerard Binet
(1991), the only person with extensive experience with both the Tomatis approach
and the Berard approach (other than Berard) who is aware of the electronic
configuration of both machines, has firmly stated to the present authors that
there is no similarity between the two machines with regard to their audio
output.
Decibel Level and Hours of Listening
Berard approach.
The sound level during auditory training is intended to be "loud but not
painful." Berard states that in the great majority of cases, the
person should receive one 10-hour series of auditory training, over a 10- to
20-day period. It is undesirable to receive more than 10 hours of auditory
training in a three-month period. Occasionally, a second 10-hour series is given
6 or more months later.
Tomatis approach.
The recommended level used in the Tomatis program ranges
from 60 to 80 db (80 db would be considered loud). In general, listening hours
range from 45 to 100 hours over a four-month period. However, if the person has
autism, it is recommended that the person receive 150 to 200 hours of listening
over a 6 to 12 month period (Gilmor & Madaule, 1989).
Some Tomatis Listening Centres have begun to give an abbreviated version of
the Tomatis method to autistic individuals. This involves listening to the
Electronic Ear for 2 1/2 to 3 hours a day for 10 to 12 days, for about 30 hours.
This shortened program is possibly a response to the relatively short 10-hour
training period used in the Berard program. This abbreviated version is so much
shorter than the 150- to 200-hour program for autism described by Gilmor and
Madaule (1989) that it is difficult to believe it can be considered comparable.
Adverse Reactions
Neither the Berard nor Tomatis approach is harmful. Both consist of music and
voices played through earphones at levels much quieter than many environmental
sounds commonly heard. Yet some individuals report rather mild--not severe--side
effects during and after the training sessions, including irritability, mood
swings, hyperactivity and fatigue. No hard empirical data are available, but our
impression thus far, from talking with many parents, is that the Berard approach
is less troublesome in this regard.
Discussion and Comment
We have some concerns about the Tomatis approach which we would like to
share. These concerns are heightened by the rather aggressive efforts by a
number of Tomatis practitioners to recruit autistic children as clients.
Irrelevance of Tomatis Training. The recovery of Georgie and the improvement
of a number of other autistic persons appears to be a consequence of Berard's
intentional reduction of the auditory sensitivity of these individuals. So far
as we have been able to determine, nowhere in the writing of Tomatis does he
address the central problem of reducing hypersensitive hearing. It thus seems as
though proprietors of Tomatis Listening Centres are opportunistically marketing
services that are irrelevant to the issue. The claim made by some Tomatis
practitioners of an 80% to 85% improvement in autistic patients has no empirical
foundation.
Psychological emphasis of the Tomatis training. We are disturbed by the fact
that Tomatis Centres are billed as "Listening Centres'.' and place heavy stress
on psychological-emotional factors. Autism is a brain disorder which has no
demonstrated relationship to the mother's voice as heard by the fetus before
birth. That is pure, unfounded, unlikely speculation. This aspect of the Tomatis
approach is repugnant. Blaming the mothers for causing harm to the child, albeit
unintentional harm, is a concept which is dead and should be buried. We believe
that Tomatis should state his current position on this point precisely, if he no
longer blames the mother.
In any case, it is a poor premise on which to base
therapy.
Duration and cost of Tomatis training. As noted above, Tomatis experts have long
claimed that autism requires 150-200 hours of auditory training over a 6- to 12-
month period. This is obviously very expensive, intrusive and time-consuming.
Now that the Berard approach is known to accomplish auditory training in 10
hours, over a 10- day period, a number of Tomatis practitioners claim to be able
to do the Tomatis method for autistic children in 10 to 12 days, at 2 1/2 to 3
hours per day. One must be suspicious of this sudden discovery.
The present writers feel that the Tomatis organization is obliged to sponsor
quality research, by independent research specialists, to evaluate the
effectiveness of the "Audio- Psycho-Phonological" approach. Families are
entitled to empirical data, not more theories and statements based on faith.
References cited
Berard, G. (I 982). Audition dgale comportment. Sainte-Ruffine: Maisonneuve.
Binet, G. (1991). Personal communication.
du Plessis, W.F., & van Jaarsveld, P.E. (1988). Audio-psychophonology: A
comparative outcome study on anxious primary school pupils. Suid-Afrikaanse
Sielkundige, 18, 144-151.
Gilmor, T.M., & Madaule, P. (1989). Opening communication: A perspective
on autism, (pp. 95-104). In T.M. Gilmor, P. Madaule, & B. Thompson (Eds.), About
the Tomatis method. Ontario, Canada: The Listening Centre Press.
Kershner, J.R., Cummings, R.L., Clarke, K.A., Hadfield, A.J., & Kershner,
B.A. (1990). Two-year evaluation of the Tomatis listening training program with
learning disabled children. Learning Disability Quarterly, 3, 43-53.
Stehli, A. (1991). The sound of a miracle. New York: Doubleday.
Tomatis, A.A. (1972). La liberation d'Oedipe. Paris: Les Editions ESF.
Tomatis, A.A. (1978). Education and dyslexia. Fribourg: Association
Internationale d'Audio-Psycho-Phonologie.
ARI Publ. 111, 10/91
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