Various other methods such as Auditory Integration Training (AIT), Music Therapy and dietary changes do seem to improve the lives of certain individuals.
At the risk of excluding others, this section will concentrate on two methods that have a considerable history and some successes.
7.1 Auditory integrated training (AIT)
Dr Guy Berard, a French ear, nose and throat specialist, first put forward the theory that behavioural disturbance in autism could be caused by sensitivity to sound in the early 1980's. He showed that certain distortions in hearing could be picked up by peaks in a person's audiogram.
Having used a 'TOMATIS' device to treat his own deafness, Dr Berard built his first Auditory Integration Training (AIT) device and carried out a series of experiments to discover the most appropriate treatment duration and intensity.
After 5 years of testing, Berard ascertained that the best results were achieved with two sessions a day, with each session being a half-hour in length, separated by a minimum of 3 hours, and for 10 consecutive working days; the maximum interruption being the 2-day weekend.
Although AIT had been used as a treatment since the 1960's it was the book published in 1991 by Annabel Stehl called 'The Sound of a Miracle', which created a great wave of interest. She describes her autistic daughter Georgie's response to AIT and the major improvements that were seen.
7.1.2 What is AIT?
The device that Berard built consists of a machine containing a number of electronic components, including a variety of auditory filters, which makes the sound emanating from the machine modifiable to be appropriate for the individual person, in accordance with their auditory sensitivities and deficiencies as determined by audiometric testing.
In use the individual sits in front of a device, wearing earphones, while specially selected music is played into the machine. The machine filters and amplifies the music as necessary and feeds the resulting modified music to each ear independently. The volume is set as loud as is possible without discomfort.
In order to conduct AIT, the following procedures must be carried out:
- A health care professional should examine the individual's ears prior to AIT to ensure there is no excessive wax and/or fluid. Excessive wax or fluid may reduce the volume of the AIT input. It is the responsibility of practitioner to ensure that this has been done prior to AIT.
- It is not clear what the minimum age should be to receive AIT. For many years, Dr Guy Berard stated that 4 years was the minimum age, but he recently revised the minimum age to 3 years.
- The listener receives 18 to 20 listening sessions lasting for 30 minutes, over a 10-20 day period. In most cases, the listener has two sessions a day for 10 days. At some AIT clinics, the listener sessions are given 10 consecutive days; however, it is also acceptable to have a 1 or 2-day break after 5 days of listening. The number of sessions and length of them are not subject to change until formal research procedures determine that such changes are beneficial. In addition, there is no empirical research supporting the efficacy of booster sessions.
- During the listening sessions, the person listens to processed music. That is, the AIT sound amplifier attenuates low and high frequencies at random from the compact discs, and then sends this modified music through headphones to the listener. This random selection of frequencies is termed 'modulation'.
- The intensity level (volume) during the AIT listening sessions should not exceed 85 dBA (slow scale) and may be set at much lower intensities depending on the individual's comfort level. Basically, the music is played at a moderately loud, but not uncomfortable, level. For reference, 85 dBA is approximately as loud as standing 5 feet from a vacuum cleaner, with 92-94 dBA as loud as wind noise in a car with the window down. It is also important to note that the perception of intensity varies considerably depending on the pitch of the sound.
- Audiograms are typically obtained prior to, at the mid-point, and at the completion of the AIT listening session. The first and the mid-point audiograms are used to set filters on the AIT machines. These filters are used to dampen (40 dBA or more) those frequencies, which the person hears to acutely (peaks).
- Dr Guy Berard and Bill Clark, developer of the BGC method of AIT, state that filtering peaks is optional for those who are developmentally disabled. In addition, Drs Bernard Rimland and Stephen Edelson of the Autism Research Institute in San Diego have conducted three empirical studies and have found that filtering peaks in one's hearing is not related to one's level of improvement using various post-assessment measures. The music, in all cases, modulated throughout the 10 hours of listening, whether or not peaks are filtered.
- AIT involves several components including some audiological work, behaviour analysis and management, educational issues, and after-care counselling for the client and the family. The most satisfactory results can be obtained when a multi-disciplinary team approach is used for the administration of the AIT programme.
7.1.3 Does it work?
As with many therapies in this field, anecdotal evidence shows that AIT can have dramatic results. Comparative studies have shown moderate improvements in behaviour and some evidence for a decrease in sound sensitivity has been shown.
Society for Auditory Integration Training
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7.2 Vitamin B6 (and Magnesium)
Research on the use of vitamin B6 with autistic children began in the 1960s. In 1966 two British neurologists reported that 11 of 19 autistic children excreted abnormal metabolites in their urine when given a tryptophan load test (tryptophan is an amino acid).
Giving these children a single 10mg tablet of vitamin B6 normalized their urine; however, no behavioural studies were done.
A German researcher reported in 1968 that 12 of 16 autistic children had shown considerable behavioural improvement when given high dosage levels (100mg to 600mg per day) of vitamin B6. Three patients spoke for the first time after the vitamin B6 was administered in this open clinical trial.
When Dr Bernard Rimland published his book, 'Infantile Autism,' in 1964, he received many enquiries from parents of autistic children throughout the US, including a number who had tried the then new idea of 'megavitamin therapy' on their autistic children.
Rimland sent out a questionnaire to a thousand parents, which showed that just under 60 had experimented with large doses of vitamins. Many of these had seen positive results in their children. As a result, he undertook a large-scale study, on over 200 autistic children, of megadose quantities of vitamin B6, niacinamide, pantothenic acid, and vitamin C, along with a multi-vitamin tablet especially designed for the study.
At the end of the four-month trial it was clear that vitamin B6 was the most important of the four vitamins investigated, and that in come cases it brought about remarkable improvement.
Later research included the addition of magnesium supplements. For most children dosage levels of B6 ranged between 300mg and 500mg per day. Several hundred mg/day of magnesium and a multiple - B tablet were also given, to guard against B6-induced deficiencies of these other nutrients.
Soon after these findings were published, French researchers undertook additional B6/magnesium research on autistic children. Although sceptical that anything as innocuous as a vitamin could influence a disorder as profound as autism, they became believers after their first, reluctantly undertaken, experiment on 44 hospitalised children. They have since published six studies evaluating the use of vitamin B6, with and without additional magnesium, on autistic children and adults. Their studies typically used as much as a gram a day of vitamin B6 and half a gram of magnesium.
7.2.2 Improvements seen
In many cases, behavioural improvements are seen in a few days and in a few cases improvements take a little longer. In half of cases, no improvement is seen and in some cases (less than 10%) behavioural problems are made worse.
Of those that showed improvements the following have been reported:
- Increased use of language;
- Improved sleeping habits;
- Decreased hyperactivity;
- Improved attention;
- Increased interest in learning; and
- Decreased aggressiveness
7.2.3 How does it work?
B6 is given to normalise body metabolism. Researchers have shown that the vitamin helps normalise brain wave activity, urine chemistry and immune system functioning. Magnesium is given to help the body make proper use of B6.
However, despite the remarkably consistent findings in the research on the use of vitamin B6 in the treatment of autism, and despite its being immeasurably safer than any of the drugs used for autistic children, there are at present very few practitioners who use it or advocate its use in the treatment of autism.
Dr Rimland, a firm supporter of B6/magnesium treatments has stated that:
'There is no biological treatment for autism, which is more strongly supported in the scientific literature than the use of high dosage vitamin B6 (preferably given along with normal supplements of magnesium). Eighteen studies have been published since 1965, showing conclusively that high dose vitamin B6 confers many benefits to about half of all the autistic children and adults on whom it has been tried. While B6/magnesium is not a cure, it has often made a big, worthwhile difference'.
None of the studies of B6 in autism have reported any significant adverse effects, nor would any significant adverse effects be expected.
However, some studies have shown a side effect known as peripheral neuropathy, where numbness and tingling in the hands and feet are seen (similar to the sensation one gets when one's hand or foot 'falls asleep'. The foot numbness in some cases interfered with walking).
However, these patients were not taking magnesium, the other B vitamins, nor any of the other nutrients that should be taken if one is taking large amounts of B6. It is at least possible that the adverse reactions were due not to B6 'toxicity' but to deficiencies of magnesium and the other B vitamins induced by taking large amounts of B6.
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