MUSIC has for long added a therapeutic value to our lives by providing an excellent avenue for communication and a convenient outlet for expressing one’s feelings. In recent times, music therapy has gone a step further to address physical, emotional, cognitive and social needs through songwriting, singing, moving to, or just listening to music. Mamoun Aburas, a speech-language pathologist, and audiologist describes his work with autistic children and those with attention deficit hyperactivity disorder (ADHD) through a programme called auditory integration training (AIT).

The procedure was pioneered by French Doctor Guy Bérard in the 1950s to address sensitive and asymmetrical hearing. Although the procedure lacks definite empirical evidence, after 35 years of clinical practice and study, Dr Bérard believed it made positive contribution in the aiding of behavioral or learning disorders. AIT has not met scientific standards for treatment for any condition but has come to be regarded as an experimental procedure by a few professional organisations.

Question: How did you become interested in this field? Can you tell us about your background?
Answer: I am a Speech-Language pathologist and I have worked with special needs children in Dasman Model School and Khalifa School here in Kuwait. I heard about auditory integrated training from one of my former colleagues. It piqued my interest so I studied Auditory Integration Training in 2004.
The training requires a bachelors or masters degree in special needs with experience of 3 to 5 years. I met the criteria. After the training, we are required to work with an instructor for the first fifteen cases.
I have treated about 35 kids so far, more than half of them in the last year. I am now based in Jordan but I came to Kuwait when I had gathered six children. Right now, I work with a few parents who organize themselves and call me. I’ve visited Kuwait a total of three times in the past year.

Q: What is auditory integration training?
A: Auditory integration training (AIT) is an intervention programme designed to correct or improve auditory hypersensitivity, distortions and delays in the signals that interfere with an individual’s ability to process auditory information normally. Inconsistencies and distortions in the way sounds are perceived can make it difficult to interpret auditory stimuli.

Q: How are these inconsistencies and distortions caused? How does it affect perception?
A: The ears must work together in a coordinated fashion; if the hearing in one ear is different from the other, the person may have auditory processing problems. This lack of coordination between the ears contributes to difficulties in following directions, comprehending what is said or read, and putting thoughts into words.
Some people hear certain frequencies much better than other frequencies. When this occurs, the person perceives sounds in a distorted manner, may be easily distracted, and may have difficulty understanding auditory information. These auditory problems are factors that contribute to disorders like learning disabilities, attention deficit, dyslexia, hyperactivity, central auditory processing disorder, sensory processing disorder, autism and pervasive developmental disorder.

Q: What is the main idea behind AIT?
A: The main idea is ‘What we hear is how we will behave’. So the main principle operating here is that hearing determines behaviour.

Q: What is the criteria for participation? Who does it most benefit?
A: AIT has primarily been used for children from 3 years of age. But a minimum of 3 years of age is mandatory because the hearing sense has to be mature that time. Some children who do not have any kind of disability have also been known to use it to improve their academic achievements. But mainly we use it for children who are autistic and have ADHD.

Q: What about adults? Can they also participate in this?
A: Actually, until now I haven’t worked with adults. I think this is because people are not aware of this audio integration training programme. But this helps with concentration, so it would be beneficial to adults looking to improve their concentration.

Q: Can people do this at home?
A: There is home programme available. Some people do it at home but the problem is that we cannot observe the children. In many cases, they cannot do the intervention the right way. So it is advisable to do the procedure with a trained practitioner.

Q: How is the training conducted?
A: Participants listen to specially modulated music through an instrument called an Earducator during our training sessions. The process is very non-intrusive and we rarely have instances where children get uncomfortable. We create a very relaxed and safe environment.
The training is made up of 20 sessions within ten days. So we have two sessions everyday with a gap of three hours in between. Each session lasts half an hour. These devices modulate the music and filter out specific frequencies. We conduct audio tests prior to training and after the first 5 hours of training indicate whether any specific filters may be used.

Q: Can you elaborate on how exactly this works to bring improvement?
A: What this does is reduce the hyperactivity. Generally when we hear from the right ear, the signal goes to the left hemisphere. The left hemisphere is the area responsible for speech and language.
When you hear from the left side, the sound signal will go directly to the left hemisphere. You will not find a problem here. From the right ear, it will take more time; we are talking about just milliseconds. But if you are not hearing equally, you will not listen to the message very well and you react a different way. Remember, listening is very different from just hearing. Listening is what you understand.
The machine creates a balance between the two ears. In the first five sessions, we apply the music to both ears on the same level. After five days, we reduce the left side and enhance the right side.
Balanced hearing is very vital, it is important for us to hear equally from both ears. When we have some delay in the message from the left or right ear, the message will not be clear for children. Hence they may act in a different way than we expect them to. So in order for them to grasp the message with clarity, they must hear equally.

Q: How does the music bring balance in hearing?
A: They listen to music that has been specially designed. A lot of study has looked into tempos and frequencies to ascertain the right ones. I think almost $18,000 was spent while looking into the right choice of music.
When we hear through this machine, we listen to modular music. The first and very vital step in the process is the hearing test. We do an audio test for children prior to their training. Some people are sensitive to hearing so they hear more than they need. We need to know if they hear above the normal threshold so that we can make the necessary adjustments.
Some children may not get positive results, if this is not done. When we do the hearing test, you have to communicate with them and ask them if they hear a particular sound and they need to respond to it. Most of the children don’t do that. So if we do a hearing test and have a good result and we find any peaks of the audiogram sensitive sound frequencies, we do the filtering for them. This means that within 10 days of the session they will be able to hear normally.

Q: What type of music do you use in treatment? Is there a particular genre that works really well?
A: The music used for AIT should cover a wide range of frequencies, but most contemporary music covers only a narrow range of frequencies often between 750 Hz and 3,000 Hz. It is also important for the music to have a good tempo and beat. Periods of low volume do not provide sufficient signal to the device and will require constant adjustments with the input control. Songs that have a slow start or gradual fade out at the end are also not appropriate since we want as much active training time as possible during the duration of each song. Much of our contemporary music does not meet this criterion.
So frequencies are more in play here than any particular genre of music. In general, music considered appropriate for AIT includes pop, rock and roll, new age, reggae and jazz; while most classical music is not appropriate for AIT. The need for varied frequencies and a fast tempo come from the work done by Dr Guy Bérard and his clinical experience.
To give you an example of the range of music, we use CDs of Bob Marley, Hall & Oates, Bryan Adams and Chris De Burgh. The selection is made without any regard to personal preference or tastes in music. That does not factor in here.

Q: You mentioned that the music is filtered, what does it sound like?
A: Certain frequencies are enhanced, so it doesn’t sound like something you would hear ordinarily on your music player or radio. It sounds more like a damaged tape.

Q: Are there any side effects involved?
A: There are side effects. They are an increase in hyperactivity and sleep disorders with involuntary movements in autistic children. But this is very rare. Even when we have negative results, it proves that the machine is working because it is triggering a response.

Q: What about the volume levels? Are there any safety concerns with regard to that?
A: The volume of the music is strictly monitored. The machine has a safety margin. It does not reach above the levels to adversely affect hearing.

Q: What changes are observed after Auditory Integration Training?
A: Reports from parents vary on how soon changes are noticed. In my experience, above 70% of the parents observed positive changes during the actual 10-day training program. Some parents do not notice changes until a week, month or several months later. In some cases, progress may be subtle in the beginning but may then become increasingly apparent as time goes by.
But parents often report a reduction in tantrums, sound sensitivity, echolalia, hyperactivity and impulsivity. An increased ability in following directions, attention, auditory short-term memory, speech/language skills has also been observed. Increased socialization, cooperation, self-confidence and independence are also some of the benefits. Improvements in sensory processing, with a decrease in episodes of sensory overload are most typically reported by parents.

Q: What improvements have you noticed in children that you’ve personally treated?
A: I have two children who are working with me for the second time. One of them is autistic and we have seen a significant improvement in his speech. These cases are very difficult and the change may be just 10 or 15 percent. But any improvement, however little, the parents are really happy with it. The parents have also reported back improvements in their communication and social life.
In the ADHD case, there has been a good improvement in the child’s attention span. Mostly, in working with special needs children, you work in conjunction with speech therapists also. When with a speech therapist for a 45-minute session, a child does not concentrate and does not respond, there is great loss of both time and benefit. But after the music therapy sessions, my colleagues at speech therapy said that the sessions would go more smoothly. The child was more calm, at ease and responsive.

Q: What are some of the difficulties you face?
A: During the sessions, we face problems when children, who are unaccustomed to wearing a headphone, continuously try to remove them. For this, we ask the parent to let the children get used to wearing headphones. You need to help parents understand the steps to take so the child will understand what to expect. Otherwise, we’ll face a lot of problems in getting the children to wear the headphones for twenty sessions. We have to be creative; many times we use a headband. You have to stay with the children all the way. We massage their hands with lotion to keep them relaxed. Only two kids have refused the headphones. Proper preparation for the AIT program makes an important difference in the how well the child will cooperate with the procedures.
I have also faced many challenges in making people aware of the idea. I first started with one or two cases in six months. People aren’t aware of this. Those who have heard of this do not want to try it out. Perhaps, they are wary of trying out new technology. Dr Bérard, who invented this, also faced a lot of problems.

Q: The AIT programme has not been officially prescribed for treatment. What are your thoughts on this?
A: Till now, the machine has not been approved by the FDA for therapy. So we don’t call it therapy. It is termed educational intervention.
I think that most doctors don’t like the idea. They find it quite illogical that listening to music can change and alter behaviour. New research continues to document the benefits derived from this method. But there is a study being conducted right now, the result of which will come out later this year with documented results that will lend more validity to it.
When I started to first work with this, I must confess that I was not entirely convinced. It seemed illogical to me. But then I tried and started working with the cases. But on hearing a lot of good feedback from the parents, I know it can make a difference for the better.

Q: What is your impression of the condition of children with special needs in Kuwaiti society?
A: Well, the numbers are the same. But the awareness has increased to a great extent. There are a lot of schools now that cater to children with special needs. Also, the stigma has blunted quite a bit. The people are not embarrassed by their children so they send them to school. In 2004 there were only 4 schools, now there are about 20.
There are many parents who have become very actively involved with their child’s condition and do a lot to help them. They are constantly researching new studies, new therapies to bring about even the slightest change in their child.
But there are still some parents who give their children everything money can buy – toys, prepare a room, hire two speech therapists, etc. But unfortunately, all of that is not enough. In the end, if they do not spend time with them, it will make little difference.

biography
Mamoun Aburas
Work experience
Dasman Model School September 2007 – June 2011
Approval of Ministry of Education
Speech Pathologist
Abbas Ahmed Al Shawaf & Bros Co W.L.L.
November 2004 – September 2010
Bernafon Hearing Aid Distributor
Head of Audiology Department
Hassan Hearing Aid Center
January 2004-September 2004
Phonak, Oticon and Starkey Hearing Aid Distributor
Audiologist
Dasman Model School
September 2003 – November 2005
Approval of Ministry of Education
Speech Pathologist
Ministry of Education
September 2005-June 2007
Audiologist
Screening Test for Hearing Impaired Student
Khalifa School for Handicapped Children
March 2002-August 2003
Approval of Ministry of Education
Speech Pathologist & Audiologist
Al Shamery Hearing Center
March 2002-August 2002
Widex Hearing Aid Distributor
Audiologist
Education
Bérard Method of Education (July 2004)
Auditory Integration Training
IDEA Training Center – New Haven, CT, USA
Advanced Training Course in Speech (September 2003)
Pathology & Association Disorders
Through Amman University – Jordan
B.S. Speech Pathology & Audiology (February 2002)
Applied Science University – Amman - Jordan
General Secondary Education Certificate (June 1997)
Al-Jamil Private School – Kuwait
Memberships
Learning Disability Professionals Association of Kuwait (April 2002)
Bérard International Auditory Integration Training Society (October 2011)