Auditory integration training and other sound therapies for autism spectrum disorders (ASD): Cochrane systematic review
Assessed as up to date: 2011/03/19
Auditory integration therapy was developed as a technique for improving abnormal sound sensitivity in individuals with behavioural disorders including autism spectrum disorders. Other sound therapies bearing similarities to auditory integration therapy include the Tomatis Method and Samonas Sound Therapy.Objectives
To determine the effectiveness of auditory integration therapy or other methods of sound therapy in individuals with autism spectrum disorders.Search methods
For this update, we searched the following databases in September 2010: CENTRAL (2010, Issue 2), MEDLINE (1950 to September week 2, 2010), EMBASE (1980 to Week 38, 2010), CINAHL (1937 to current), PsycINFO (1887 to current), ERIC (1966 to current), LILACS (September 2010) and the reference lists of published papers. One new study was found for inclusion.Selection criteria
Randomised controlled trials involving adults or children with autism spectrum disorders. Treatment was auditory integration therapy or other sound therapies involving listening to music modified by filtering and modulation. Control groups could involve no treatment, a waiting list, usual therapy or a placebo equivalent. The outcomes were changes in core and associated features of autism spectrum disorders, auditory processing, quality of life and adverse events.Data collection and analysis
Two independent review authors performed data extraction. All outcome data in the included papers were continuous. We calculated point estimates and standard errors from t-test scores and post-intervention means. Meta-analysis was inappropriate for the available data.Main results
We identified six randomised comtrolled trials of auditory integration therapy and one of Tomatis therapy, involving a total of 182 individuals aged three to 39 years. Two were cross-over trials. Five trials had fewer than 20 participants. Allocation concealment was inadequate for all studies. Twenty different outcome measures were used and only two outcomes were used by three or more studies. Meta-analysis was not possible due to very high heterogeneity or the presentation of data in unusable forms. Three studies (Bettison 1996; Zollweg 1997; Mudford 2000) did not demonstrate any benefit of auditory integration therapy over control conditions. Three studies (Veale 1993; Rimland 1995; Edelson 1999) reported improvements at three months for the auditory integration therapy group based on the Aberrant Behaviour Checklist, but they used a total score rather than subgroup scores, which is of questionable validity, and Veale's results did not reach statistical significance. Rimland 1995 also reported improvements at three months in the auditory integration therapy group for the Aberrant Behaviour Checklist subgroup scores. The study addressing Tomatis therapy (Corbett 2008) described an improvement in language with no difference between treatment and control conditions and did not report on the behavioural outcomes that were used in the auditory integration therapy trials.Authors' conclusions
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 intergration 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.
Sinha Yashwant, Silove Natalie, Hayen Andrew, Williams Katrina
Auditory integration therapy for autism spectrum disorders
People with autism spectrum disorders have difficulties with communication, behaviour and social interaction, and many also experience abnormal responses to sounds. The purpose of this review was to assess the evidence for the effectiveness of auditory integration therapy and therapies like it that have been developed to improve abnormal sound sensitivity and autistic behaviours in such individuals. Seven relatively small studies met the inclusion criteria for the review. These often measured different outcomes and reported mixed results. Benefits for participants receiving auditory integration therapy were only reported in two studies, involving 35 participants, for two outcomes. A study of Tomatis therapy did not measure behavioural outcomes and did not find any difference in language development between intervention and control groups. As such, there is no evidence to support the use of auditory integration therapy or other sound therapies at this time.
Implications for practice
In the absence of evidence, the treatment must be considered experimental and care must be taken not to risk hearing loss. Parents need to be aware of the cost involved in pursuing these treatments.
Implications for research
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.
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