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The Tomatis® Method and Autism Spectrum Disorder

The Beginning

I was introduced to the world of sound in 2001, soon after opening my private practice as an occupational therapist. At that time, most interventions were “hands-on,” and it was foreign to think that by putting headphones on a child, we could achieve our goals at a faster rate. My first encounter with sound intervention was through a program described as an “aid for potty-training.” I am an optimist at heart, but I was admittedly skeptical of an approach claiming that listening to a special CD would improve potty-training. I almost decided not to try the program at all. It just seemed too much of a stretch for my science-based frame of reference. But, hearing that the program was also “good for attention,” my curiosity got the best of me and I decided to ask two families to try the program at no charge. Both families agreed and committed to allowing their child wear headphones and listen to a special CD every day for 14 days. At the end of the two weeks, one child showed no change; the other child was becoming more attentive, especially when listening. And sure enough, that child was much more willing to go through potty-training and even sat up straighter on the toilet seat. After seeing this result, I tried the system with more clients and got varied responses, but enough to make me much more curious. I decided to investigate further.

I came upon the Tomatis® Method in 2003. Dr. Alfred Tomatis was a French Ear, Nose & Throat specialist who developed an especially important intervention in the 1960’s, one that is still taking the world by surprise. During my research, I discovered that training for the Tomatis® Method was being offered in our country, the first US-based training in a very long time. Based on the results I was already seeing in my clients, I knew I had to explore this program. The three-week training was clearly based on current brain science.  It was extensive and extremely overwhelming. Even today, years later, Dr, Tomatis’ work and thought process continues to be validated through independent research.

I brought the training back to my center and began offering Tomatis® Sound Training to my clients. I was absolutely amazed at the results I witnessed in the first year. I have worked in the field of pediatric occupational therapy (OT) since 1997 and had sufficient experience and data to make a solid comparison. Without a doubt, I saw faster and more comprehensive results with programs including OT combined with Tomatis® training vs. typical weekly OT services alone. I have also compared intensive OT programs with and without the addition of Tomatis® and the results with Tomatis® training were still more far reaching. Today we certainly have even more empirical research with controlled group studies in both schools and rehabilitation to support the clinical findings.

What is the Tomatis® Method and Tomatis® Sound Training?

To begin to understand the Tomatis® Method, one must start first understand that the ear is a very powerful sensory organ, integrating our vestibular (movement) and auditory systems with other cranial pathways in the brain. The inner ear acts as a portal of sorts to use sensory registration, influence the central nervous system and impact on interhemispheric integration.  The Tomatis® Method challenges the middle ear to function with greater efficiency through the activation of two tiny muscles that propel sound to the inner ear. Through using the principles of neuro-plasticity, music is altered in ways that create random change, requiring the brain to remain alert and firing. An integral tool of the Tomatis® Method is the Electronic Ear, a device developed by Dr. Tomatis in 1954. This device has gone through many evolutions over the years and has become quite efficient as technology advanced. The client wears specialized headphones and listens to music that is filtered (altered) by the Electronic Ear. The switch between lower and higher frequencies forms part of the intervention and the ability of bone and air conduction to be delayed separately is a complicated, yet instrumental feature for those struggling with developmental delay.

Tomatis® Sound training is a global program that affects the client in different ways. Children show varied responses in motor coordination, the ability to process sensory information, changes in language and attention, and an increased ability to cope with their strong emotions. The Tomatis® Method program consists of a basic protocol of listening for 1 to 2 hours daily for a period of 10-15 days depending on the needs of the client. During the program, clients listen to mostly Mozart, Gregorian Chants, Strauss Waltzes and Marches. The high frequency violin concertos of Mozart music stimulate the brain while Gregorian Chants have a calming influence on the body, bringing the effect of feeling more “grounded” with better awareness of the body as it moves through space. Strauss Waltzes and Marches are used for their unique properties related to timing and rhythm, an important tool for clients with sensory-motor difficulties.

Different parameters to support the complexity of the brain

Tomatis® Sound Training is not only about listening to different pieces of music. Dr. Tomatis investigated multiple parameters to be layered on top of the listening, each playing a different role in the effect the program has on the brain. His first concern evolved into the findings of neuroplasticity, the big buzzword in the nineties. He understood that in order to keep stimulation going you have to “surprise the brain.” Our brain has an amazing ability to adapt to new and novel stimuli and then habituate in such a way that it stops paying too much attention to the stimuli and pushes the information to the background. For example, you may be startled one morning at the sound of a hammer banging while in your office. As you wonder how you will ever get any work done that day, you also find in a relatively short amount of time, that your brain habituates to the sound, pushing it to the background, allowing you to be able to attend to your work more easily.

Dr. Tomatis found ways of technically supporting the music so the brain remains “surprised” by the stimuli and maintains the level of stimulation during the entire listening time. This energizes the brain and increases the potential for the central nervous system to make connections, thereby increasing the potential for new learning. Dr. Tomatis well understood the balance needed between high and lower frequency music and trained Tomatis® consultants are able to determine the appropriate music to use depending on the needs of the individual client. The consultant designs the program to achieve and sustain the experience of feeling “centered” (grounded), while gradually including high frequency music as clients become increasingly ready to accept higher intensities of stimulation. It is this balancing process that attracts me as an occupational therapist. My golden reason for bringing the Tomatis® method into my intervention program was to address the needs of clients who struggle with sensory modulation (balance between calming and seeking sensory information) and/or emotional regulation / inhibition (inability to control emotional responses effectively). Once the body is calm and more available, then the actual skill building can begin. This balance between calming and stimulating is often the taproot of the “behaviors” families find so difficult to deal with.

In addition to the “surprise” effect to the brain, Dr. Tomatis also included the use of air and bone conduction in his work. Air conduction is used for regular listening as the air moving between two people transmits the sound to our ears. Bone conduction allows sound to travel via vibration through our bones. The baby listens to mommy’s voice by about 5 months in utero through vibrations from mommy’s spinal column. This is essentially our first listening experience and has a strong impact on our vestibular system (movement ability) and contributes greatly to the effect of feeling “grounded” in our bodies. The Tomatis® program uses headphones equipped with a bone conductor in the center of the head strap. The bone conductor is positioned on the top of the head in the vicinity of the Corpus Collossum, an area where nervous system fibers connect information between right and left-brain hemispheres. The bone conductor must stay in close contact with the skull to get the most from this aspect of the program.

Flexibility of program delivery

 When clients live far and cannot travel to our center, we frequently send a device to the families for use in their home. We see great physical changes in sensory motor abilities simply through listening. To this day, it never ceases to amaze me that these changes are possible only through listening. Do not understand me wrong; Tomatis® training is not a cure. It is a support for learning processes in the brain, including motor, communication, emotional regulation, and academic learning, especially reading. Tomatis® is not a miracle solution for any one area. Rather, it sets the stage and creates the momentum for the body to feel more capable to indulge in skilled learning. When I train others, I always talk about the Tomatis® Method as a powerful influence that turns the key towards development and the motivation to learn.

Many clients of all ages have difficulty processing information at the speed demanded by today’s learning environments. Dr. Tomatis also found a technical way to slow down the music information in milliseconds to create a delay in both air and bone conduction, giving the central nervous system more time to be ready to process information. This is especially helpful for clients who experience a delay in listening skills and cannot absorb information for meaning at the rate and speed we typically need to do. Our brain works in microsecond timing, so milliseconds for the brain is quite long. The Tomatis® program adds filters to raise the potential for increased stimulation through higher frequencies, especially to focus on communication and attention. Again, the Tomatis® Method is not a cure, but a powerful tool to maximize the effectiveness of intervention currently taking place.

Laterality, the balance between left and right ear, in the Tomatis® Method

Another key aspect of the program is working on the balance between the left and right ear. Many autistics show a higher preference to use the left ear as the leading ear, as opposed to the right ear. Most of them also show auditory sensitivity to information, tending to hold their hands over their ears or shutting down their auditory system in order to focus. Science has yet to figure out exactly why this is so common, but I postulate that it has to do with their high need to remain vigilant in different environmental conditions. Our left ear is naturally attuned to background information while our right ear is naturally attuned to foreground information, albeit the subject or speaker. While we listen to each other with our right ear, our left ear is in continuous surveillance of the background to detect possible important information. When our auditory systems are intact, the brain disregards unimportant background information from conscious thought, enabling us to keep listening to the speaker without being distracted by the background information. This is a very difficult adaptation for many autistics.

Autistics are keenly aware of their background all the time as they operate from a base of fear that something will occur, and they will not be able to cope with it. This stems from their sensory processing challenges in that they do not perceive information through their senses the same way a neurotypically developing person would do. Where neurotypicals experience the world in synchronous order and can see, hear, move, and talk at the same time with no cost to our system at large, autistics gain information from one system at a time, creating a cacophony of “noise” in the brain, which disenables them from making sense of the full scope of information. Therefore, the environment does not dissolve into the background. It remains a constant threat to their attentional system. They cannot habituate to these sensations and high vigilance to their environment becomes a protective mechanism to trigger the fight, flight or freeze response when needed. The problem with this defense mechanism is that it causes great difficulty in developing the right ear for the necessity of language, speaking, and communication in general. Again, we need natural balance to be restored, and this is very difficult indeed. We must first regulate the entire system so the need for fight or flight is alleviated, then the Tomatis® consultant would start adding different features to enhance information to the right ear. This is a complicated process, and the discerning consultant will know when to use the Tomatis® tools at his or her disposal to continue the trajectory of change according to their frame of reference and scope of practice.

There is one aspect I wish my colleagues in audiology would investigate in more depth. The acoustic reflex in the middle ear is responsible for dampening lower frequency sounds so as not to overwhelm the inner ear. The stapedius muscle in the middle ear is very involved in this reflex. The stapedius is an extensor type muscle, such as a taut back muscle enabling us to sit upright, and has the same striated fibers as the larger muscles in our bodies. Sound sensitivity is caused mainly by lower frequency sounds and I would be interested to know if constant high vigilance to the environment also results in a malfunction in the stapedius, causing too much extension and decreasing the flexibility of the muscle. There is also the possibility that, due to lower muscle tone in the rest of the body (which may contribute to lower registration of information), the stapedius muscle could also be too lax to operate this reflex effectively. There are still so many questions, but we absolutely see in our client population that Tomatis® work supports a decreasing need for environmental vigilance and activating the fight, flight or freeze response, while increasing the brain’s ability to be available for communication and learning.

Active work in the Tomatis® Method

Most of our discussion thus far has centered on the parameters of the Tomatis® Method with regard to passive listening.  Dr. Tomatis was also a great believer in completing active work with the voice over a microphone while listening. This stems from his work with many singers, whom his opera singer father, Humberto Tomatis, referred to him. It surprises many to know that your own voice has the capability to energize you. Think of how children talk to themselves from time to time as they focus on work. You may even find yourself talking aloud when trying to figure out something new. When studying in college, I liked to get up early in the morning when everything was quiet and read aloud in order to gain better access to my own learning, although at the time I did not know why this was so helpful to me.

Dr. Tomatis did not want anyone to need listening intervention forever. He believed that if you can train your voice to keep up the energy to your brain, you have the perfect built-in support system. For this reason, we must make sure that all frequencies listened to reach the cortex and that the voice can then emit the prosody and intonation of a full range of frequencies to maintain the quality of energy needed. Think of someone who is feeling depressed. He would tend to speak in a lower, softer, almost tired voice with little capability of energizing the brain. Think of your upbeat, high-energy friend. She would exhibit a tendency to talk faster, remain excited and maintain a high frequency quality in her voice in order to maintain and reflect her energy. Many autistics have great difficulty using their voices to impact their brain in a modulated way for the purposes of energy, impacting on the increase of blood flow (oxygen) to both hemispheres. The spectrum of voice abilities is varied, from high pierced screeching types of repeated sounds, to monotone voices and echolalia, to using speech to communicate. It is an important consideration to continue “passive into active” work in order to gain the fullest compliment we can to support function. The Tomatis® Method is also the only sound program globally available that also filters (alters) the voice for improved expressive function.

The mother’s voice

A final parameter that deserves a chapter of its own, but will only be discussed briefly here, is the use of the mother’s voice in the Tomatis® Method. The attachment and bonding of this first relationship sets the tone for future relationships in our lives. Autistics have great difficulty with relationships due to sensory and communicative profiles, making it very difficult for this bonding to come to a full realization. Adding the mother’s voice into the Tomatis® Method becomes an important piece for gaining the intrinsic motivation for relational bonding and promoting communicative intent and willingness to enact upon our world.

Finally…

The Tomatis® method is not a therapy intervention of its own and is not approved as such by the FDA. It is a listening education in which we use the ears to gain a portal to the brain and support the multiple layers of growth autistics need to develop. I have included this work in our practice since 2003 and have been training others in this method since 2009. Including this in my scope of practice has been an exciting road thus far. It makes developmental sense and can be used to augment the typical developmental trajectory for each client. My wish is for all children to become the best they can be, not to change who they are. It starts with accepting each person with his/her own individual differences, and giving them access to the necessary pieces of their own development to make their lives easier, more productive, and more fulfilling.

More information and testimonials available at www.atotalapproach.com and www.tomatis.com

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