Last week we had a visit from Martha Mack, a Tomatis practitioner in Melbourne Australia. Martha and her husband George have been running the Listen and Learn Center where both auditory training and neurofeedback are being offered. (See www.ListenAndLearn.com.au) Martha emigrated from Argentina some years ago to take up her psychology practice in Australia. The birth of a daughter with auditory processing disorder redirected her focus from a practice oriented to PTSD and chronic pain to one dealing with auditory processing problems. A French psychologist had immigrated to Australia to spread the word about Tomatis, so she got involved in that approach early on. Some five years ago Martha did training with Ron Minson in Denver (who also did our training years ago and gave us our introduction to the Tomatis Method). And Martha adopted The Listening Program as a complement to her practice some three years ago. Movement therapies are part of their offering as well. We met George at the class in Cleveland, where he was brushing up his neurofeedback skills.

At this point, incidentally, the daughter is seventeen years old and the issues around auditory processing have been essentially resolved. There are still some memory and concentration issues outstanding. Recently Martha and George got some notice from the local TV program Second Opinion, so the business side is looking up as well.

I had been aware of Tomatis longer than I have known about neurofeedback, so somehow I had the idea of Tomatis as being well before our time. Actually, he died on Christmas Day 2001, so he has really been more our contemporary. He was of course ahead of his time. Born to an opera singer on January 1, 1920, and discarded at birth, he was pulled from oblivion in a trashcan by his grandmother, who yanked him out by his ear and decided to keep him alive. He became an ear-nose-and throat specialist. He pioneered prenatal psychology by proposing that listening and consequently dialogue with the mother begins in the womb. His early theories along these lines first received recognition in 1957. This did not keep him from being ousted from the French Academy of Sciences for his strange ideas about auditory processing disorders and their treatment using auditory challenges.

It turns out that audition is the first functional sensory system at 16 weeks in gestation.
Further, it appears that laterality differences are already present in cochlear processing of sound, and that cortical functional differentiation with respect to auditory processing actually occurs later, well after birth. The latter may follow from the cochlear differentiation that gives preference to temporal processing to the right ear (left hemisphere) and to frequency-space processing to the left ear in standard brains.

Tomatis proposed that the voice can be a clue to what the ear is capable of hearing, and that training the ear to hear better will then be reflected in the voice and can be tracked. There is both a passive listening phase and an active speaking and listening phase of the training, and the music used as the stimulus is adapted to the particular properties of the child’s auditory responding. There is both a high-frequency emphasis in the training, for which someone like Mozart is used, and a lower-frequency emphasis, for which something like Gregorian chant is used.

Interestingly, a variety of disorders that are correlated with Auditory Processing Disorder tend to also remediate with the auditory intervention. These include developmental delay, communication and language delay (expressive and receptive language), dyslexia and learning disabilities, and dyspraxia. But they also include problems with attention, concentration and focus, memory, coordination and balance, gross and fine motor control, general clumsiness, and even visual perceptual and spatial organization deficits. And finally, they include problem of social relating.

This all becomes concrete when one surveys the extensive manner in which the effects of The Tomatis Method are tracked through the process. The principal categories are:
1) Mood
2) Positive Behaviors (incl. compliance, expression of affection, curiosity)
3) Negative Behaviors (repetitious behavior, anxiety, aggressiveness, tantrums)
4) Tactile Sensitivity
5) Auditory Sensitivity
6) Motor Skills (incl. balance, coordination)
7) Spatial Awareness
8) Receptive Language
9) Expressive Language
10) Social Language (non-verbal/verbal communication, familiar/unfamiliar relationships)
11) Academic Skills (incl. reading, writing)
12) Energy Level and Attention
13) Memory
14) Concentration
15) Social Behavior (eye contact)
16) Tactile Communication
17) Social Interaction
18) Adaptability
19) Fears

I am now beginning to hear all of this very differently than when the lecture started out. These problems are not just those that could be considered secondary to a primary auditory processing disorder, although individually many of them could be. These are many of our favorite “Problems of Disregulation.” I asked Martha where neurofeedback fits into her work, and she said that she does the auditory training first, and then mops up the residual issues with neurofeedback. Quite clearly she is using auditory processing work for the general purpose of enhanced self-regulation as well as to resolve the specific auditory processing problem.

If that is the case, then perhaps the entire business of The Listening Program ® and of The Tomatis Method ® should be considered firstly from the vantage point of challenging and training the frequency basis of brain organization. Once such organization is in place, a number of things resolve, including auditory processing problems. The processing of auditory information imposes the tightest constraints on the temporal integrity of brain processes. After all, time differences of less than one millisecond must be resolved at the brainstem if we are to localize sound properly. If we cannot localize sound properly, then we are overwhelmed by more than one conversation going on in a room, and auditory figure/ground separation becomes problematic. Further, the distinctions in sounds that children have difficulty differentiating (e.g., ba versus da) may take up no more than 40 milliseconds at the beginning of words. Once hearing and listening becomes effortful to accomplish, one is reduced to low-level functioning of decoding rather than devoting resources to higher-level analysis of content.

Tomatis became aware early on of problems in processing the higher frequencies, to which most of the hair cells in cochlea are in fact devoted. But there has been a shift toward attending to the lower frequency processing, and that holds true for the latest generation of The Listening Program as well. It makes sense to me that the lower frequency issues need to be taken care of first, before the high frequency domain opens up for us. The lower frequencies are more directly encoded in terms of their actual waveforms, whereas the high frequencies are encoded more like an FFT, in terms of spectral amplitudes. The relative phases of the waveforms are therefore available only in the lower frequency domain. At high frequencies, we must depend for localization information on the envelope of the activity, on the ebb and flow of amplitude, and thus on arrival time differences.

We have long known in neurofeedback that we don’t necessarily do a good job with auditory processing problems. Complementary methods may well be needed, and for that specific objective, The Listening Program filled the bill at our own office. Sue has recently taken the re-qualification training and received the latest set of auditorily processed discs. It is satisfying to observe that the auditory materials seem to be much more refined than what was available earlier, and that the low frequency regime is now being covered as a first order of business, under the rubric of “Sensory Integration Training.”

The Listing Program (www.Advancedbrain.com) is produced by Alex Doman, of Doman family fame. It is recommended that if the training is found to be beneficial, then it should be maintained over time at some repetition rate in order to maintain the gains, although clearly people don’t backslide to anything like the original baseline. Benefits typically hold some 9-12 months. So it is appropriate to think of The Listening Program as part of a continuing home use program.

I am tempted to think of a continuum in the frequency domain here, where the EEG neurofeedback takes us comfortably up to the range of 40-60 Hz. The range out to several hundred Hz could be covered with the low frequency part of the Tomatis Method or the low and mid-frequency portion of The Listening Program. The high frequency regime would be covered by the more traditional high-frequency training in both. We should evaluate whether the auditory challenge should become a regular part of the neurofeedback regime. And we might even ask the question whether auditory training could be helpful during the earliest stages of working with the autistic spectrum.

It is already well known that many autistic children benefit significantly from auditory training. If calming can be achieved thereby, could it be that that might actually be an easier way to get started than neurofeedback? Are headphones less of a battle than electrodes on the scalp? The low frequency part of the training could even be started, if necessary, without headphones. And perhaps the world divides, with some children easier to get started on the auditory program than on neurofeedback, the reverse being true for others. When Martha combines auditory training with neurofeedback in a single session, she does the auditory work first in a two-hour session.

Many of the autistic children who come to us are already doing The Listening Program, and they clearly still need our help through neurofeedback. The Tomatis Program is a stronger offering, but at the cost of much greater complexity, larger instrumental cost, and much more extensive clinician training. Martha Mack uses The Tomatis Method about 60% of the time, the Listening Program some 40% (the latter on a home use basis). Among other reasons, Martha prefers the Tomatis because she is more actively involved in that process. An advantage of The Listening Program is that the parents get to do it along with the child.

Martha uses the auditory TOVA ® for evaluation, and finds that the results differ from the visual TOVA not only for reaction time and variability but also for omission and commission errors. Interestingly, clinicians in the network who focus on learning disabilities tend to rely more on the auditory TOVA. It is a tougher screen. Our response will be to hasten to prepare an auditory version of the QIKtest, albeit one that is not quite so long as the TOVA. We will also use higher frequency tones, which will put us in a frequency range that is more relevant to the observed language processing deficits.

Reference: Dorinne S. Davis, “Sound Bodies and Sound Therapy”

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