An audio treatment system offers hope to children with learning disabilities. It’s music to the ears of some parents
In her sparsely furnished office at the back of Brain Solutions, owner Kirsten Lopez flips open a laptop on her desk and turns the monitor to face me. A static image appears on a black background. It looks like some kind of puzzle, six blocks split into various colors and geometric shapes. The accompanying audio starts:
Teacher: On your desks, you should have shapes and grids. We’re going to play a game now with shapes and colors. When we’re done, we will have formed a secret picture. Make sure you listen to my instructions.
Student A: Are we doing art?
Teacher: No, Freddie. Art class was yesterday. Here we go. I’m only going to say the directions once, so don’t ask me to repeat them. Listen carefully. Everyone take the yellow triangle and put it on the yellow circle in the grid.
Student B: I don’t have a yellow triangle!
Teacher: Is that yours on the floor? Now, find the green square. It belongs on the red square.
Student B (whispering): Which square?
Student (C): I don’t know.
(In the background, a heater hums loudly. More students express their confusion, as the teacher keeps firing off instructions. I lose the thread of her voice as all the sounds swirl into an inaudible mess.)
Lopez stops the recording. This, she tells me, is what it’s like for the children she works with – children with anxiety, attention deficit disorder and other issues that interfere with their ability to learn. There are some 1 million of them in special ed classes in the U.S., and they find it very difficult to filter out background noise and focus on one thing, like a teacher’s voice. Everything blends into an unbearable din. Sensory overload may ensue. Some melt down, develop nervous tics, become sullen, can’t sleep. Parents can be held captive at home with children so irritated by stimuli they’re afraid to go out in public.
To help, Brain Solutions deploys a specific tool called the Tomatis (“toe-MAH-tis”) Method, which is part of a larger group of treatments the audiology community calls auditory integration therapy. The method was developed from the mid- to late-twentieth century by French otolaryngologist Alfred Tomatis, who devoted his life’s work – including 14 books and myriad inventions – to alternative approaches to hearing and listening problems. His and other auditory integration therapies are widely accepted in Europe; less so in the U.S., where there are approximately five dozen Tomatis practitioners and consultants, according to the organization’s website.
There’s no shortage of testimonials swearing to the Tomatis Method’s efficacy, and it seems to be gaining traction in Las Vegas, with Lopez’s now-bustling facility opening in 2010 and a few practitioner trainings offered here in 2011. But the mainstream health-care community advises parents considering auditory integration therapy for their children to seek more traditional, proven options first. Tomatis, they say, is still in its experimental phase.
Take a deep breath
Ironically, as I listen to Lopez tell me about the Tomatis method, I’m distracted by the rising voices of four boys being treated in the front office.
“The inability to modulate one’s voice is a sign there’s something going wrong in the brain,” she tells me.
The boys are talking and playing games under the watchful eye of Lopez’s assistant, Justin, in a room obviously furnished to make children feel at home. While being treated, subjects can do anything except eat, drink or read. That’s because treatments consists only of wearing a pair of special headphones hooked up to an iPod-like device (together called the Electronic Ear), listening to classical music and receiving subtle vibrations through the headphones.
According to the Tomatis company, the vibrations and music, which is altered to emphasize varying frequencies, exercise the tiny muscles of the inner ear and stimulate neuro-pathways in the brain. A basic treatment is 60 hours at certain intervals spread out over three months or so. At Brain Solutions, it costs $2,400.
“I didn’t do anything!” one boy shouts, from down the hall. “I. Am not. Talking. To you people!” another volleys, louder.
“OK… take a deep breath. Breathe,” Lopez says, as though psychically sending a message to Justin.
Behavioral issues don’t faze Lopez, whose day job is special education coordinator at Faith Lutheran Junior-Senior High School. Before becoming a teacher, she worked at an in-patient neuropsychiatric ward for children.
She says she was inspired to go through the six days of training and subsequent online continuing education required to earn her level 2 Tomatis practitioner license because of an experience with a former student. About five years ago, she says, this girl’s parents came to her and said they wanted their daughter to go to Faith Lutheran, but her neuro-processing was too poor.
“She’d been seen by an audiologist before, and her auditory processing was in the second percentile,” Lopez recalls. “She did the Tomatis method, and, afterward, she was in the fiftieth percentile, which is average. She successfully completed four years of high school and graduated.”
During our time together, Lopez works in at least half a dozen similar success stories, involving people (mainly children) with anxiety, autism spectrum disorder, expressive aphasia and other problems. The Web abounds with thrown-off-crutches type testimonials from parents. Nailing down exactly how and why the Tomatis method works, however, doesn’t come so easy.
Lopez says that, in many cases, it has to do with the different ways our brains perceive sound. About 90 percent of healthy listening, she tells me, comes from sound waves in the air; the other 10 percent is conducted through the bones in our skull. When that ratio gets out of whack, it causes problems. Auditory equipment allows Lopez to test the ratio. Often, she says, kids having issues related to sensory overload are picking up too much sound through bone conduction.
So, how, exactly, does the Electronic Ear cure that – or do the other things the Tomatis literature purports, such as stimulate reticular formation and improve motor responses?
“It is science that – I’m not even – it’s complicated,” Lopez says. “It’s the practicing of the timing and really that intensity. … It helps generate that 90-10 balance back.”
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Yes, there is such a 90-10 ratio, says Anne Oyler, associate director of audiology for the American Speech-Language Hearing Association. But an imbalance in that ratio shouldn’t cause problems.
“Sound all ends up in the same place, at the cochlea, although how it gets there may be different,” says Oyler. “It shouldn’t matter.”
She’s skeptical of the Tomatis Method, reflecting the association’s official stance. She notes that there are members of the association who practice it and other auditory integration therapies, but says there is very little solid data to support them.
“At this point, our position is that it should be a research subject, and people should know that they’re in a research study when they undergo the treatment,” Oyler says. “We’d love to see someone do a randomized, controlled trial, and that rigorous standards have been used to see whether it works or not.”
Tomatis’ website touts research and results, but the page devoted to learning disabilities and behavior problems shows only a 1999 study done by Tim Gilmore, which did not include a control group. (The page on psychological disorders contains more recent, randomized clinical trials, done overseas.)
Over the years, practitioners and proponents of the Tomatis Method have published numerous reports of success with clients. A recent example is the 2007 International Journal of Listening article by Deborah Ross-Swain of The Swain Center in Santa Rosa, Calif. Ross-Swain, a former chief of speech pathology at the University of California, Davis, Medical Center, concluded, “The Tomatis Method of auditory stimulation can be effective as an intervening strategy for auditory processing disorders.”
In 2003, an American Speech-Language Hearing Association working group put out an overview of the available research on auditory integration therapies in the U.S. Members found their task challenging because, according to their summary, there were few unbiased, data-based studies that weren’t somehow limited scientifically, and whose results were published in peer-reviewed scientific journals.
They concluded, “There is limited evidence in the scientific literature to support the notion that auditory integration therapy improves the behavior of individuals who undergo this procedure.”
The working group said people are better off seeking treatment tailored to their specific disorders than trying a one-size-fits-all method, such as Tomatis. Oyler agrees. When clients come to her, she says, she assesses them and plans specific treatments based on their individual diagnoses.
When people go to Brain Solutions, Lopez gives them several tests and has them fill out questionnaires and go through interviews. The main goal, though, is to determine whether they can benefit from the program, which follows the same pattern and progression for every client.
Lopez likens skeptics from the traditional medicine community to those who don’t believe in the power of acupuncture, despite its being practiced for centuries and embraced by millions. She believes the greater medical community doesn’t value Alfred Tomatis’ science, which the company literature summarizes this way: “Ninety percent of the sensory messages that stimulate our brain, including movement and touch, involve the inner ear! The ear thus acts as a sensory integration system. The corrective action of the Tomatis Method acts simultaneously on the three core functions of the ear: balance, energy and hearing.”
Lopez also notes that Alfred Tomatis and others have long espoused the concept of neuro-plasticity, or the ability to re-route pathways in the brain, while mainstream medicine is just now catching onto that.
“We do know more about the plasticity of the brain,” Oyler says. “Kids who have hearing loss – you can put something in their ear, and it can change that.”
Still, she says, experimental methods like Tomatis don’t reflect the way the medical community approaches learning, the brain and how the process changes over the years.
‘Like a new boy’
Tell that to Christopher Choi, a Las Vegas physician who took his son, Austin Choi, for the 60-hour program at Brain Solutions.
For several years, Austin Choi had suffered from Tourette’s syndrome, anxiety and mild ADD. He has a high IQ and a very well-developed left-brain, Christopher Choi says, but his right brain lagged. He had trouble focusing, sitting still, looking you in the eye, and he eventually developed a tic that was so severe his parents would have to pull him out of school for as much as two weeks at a time.
“There’s nothing bad about tics. They don’t cause physical problems or other issues for the child except the social stigma,” Christopher Choi says. “What happens with these kids is, they develop depression, because socially they’re outcasts. … They can become antisocial, even suicidal.”
Austin Choi is an eighth grader at Faith Lutheran, where counselors recommended Brain Solutions. By the time the Chois got there, they’d tried several different solutions, including a trip to a neurologist at Loma Linda Medical School in California and a smorgasbord of medications.
Until this point in our conversation, Christopher Choi reminds me of my own doctor stoically explaining the various problems I’ve seen him for over the years. But that changes when I ask Choi what happened to Austin at Brain Solutions. He pauses, then, in a more animated tone with a hint of disbelief, he says, “It was amazing. I have not seen anything like it.”
Austin Choi’s tics have vanished. He holds his father’s gaze while they talk. He can descend a staircase on his own. He can sit for an hour and focus on his homework. At first, his father says, he thought it was temporary, but it’s been four months and the improvement continues.
“He’s like a different child, a different boy,” Christopher Choi says. “He’s always done well in school, but this semester his scores were close to 100 percent.”
Christopher Choi concedes that it could be hormones. Around Austin’s age, children frequently grow out of developmental problems. Still, he unabashedly recommends the Tomatis Method: “The kid loved going there,” he says. “They were very attentive to each patient. … It was money well-spent.”
Lopez says she’s had some level of success with everyone she’s worked with in the last two years except one boy, but she also adds that the Tomatis Method is one tool among many.
“There’s no magic bullet,” she says. “Anybody who comes to a place like this is really working to put as many pieces of the puzzle in place as they can to make sure their child is as resilient as he can be. Diet’s not the answer, meds aren’t the answer, but all these things together might work.”