by Pierre Sollier, M.F.C.C.
Director, The Mozart Center in Lafayette, CA
"Look!" Laura said, pointing a finger towards her son Patrick who was running happily around the office. "Now he is hyperactive!" "No," I answered quietly. "He is just starting to be the little boy you always wanted to have!" When Patrick had come to me a few months earlier, he sat in a corner of the playroom, silently and with an empty stare. On other days, he rocked on his belly, muttering incomprehensible words or repeating the same set of sentences over and again. He covered his ears with his hands when hearing faint sounds but didn't budge when a door banged behind him. He loved lining up little cars meticulously on the carpet of the office, forgetting the world around himself. Patrick had been diagnosed recently with autism and his parents were in despair.
Over the last few months, Patrick's behavior has changed dramatically. Now he rarely puts his hands over his ears to protect himself. He has started to make more eye contact and is more and more in touch with his environment. His speech has become clearer and he has started to relate to his teacher and to the kids in his Special-Ed class. On that particular day, he was having fun at the expense of three other boys who were not autistic. They had set up a target to shoot at in a corner of the playroom, and Patrick was rushing to steal it, before they could aim at it. He was smiling mischievously: it was great fun! Laura had a hard time adjusting to the image of her son: her little boy who had spent most of his time lost in a world of his own, was now playing with other kids.
This change had been brought about by the Tomatis Method-a program of auditory stimulation-developed by Dr. A. Tomatis, a French Ear, Nose and Throat specialist. While not originally developed to treat autism, the Tomatis Method has shown encouraging results in the treatment of autism. About 60 % of autistic children seem to respond positively to it. It is certainly not a cure, and none of the professionals using it claim to perform miracles. However, in conjunction with other therapies, it can greatly improve the life of autistic children. Parents report that it speeds up other therapies and that their children overall become more present, more aware of their surroundings and that it improves their relationship with others. In many cases, language improves and behavior changes, making the life of both the parents and the children easier.
The Tomatis Method
The aim of the Tomatis Method is to develop or reestablish communication when it has been lost or impaired. The ear and its various functions, Tomatis points out, plays a key role in this respect.
First, the vestibule, which is part of the inner ear, controls balance, coordination, and muscle tone. There is not one single muscle of the body, including the muscles of the eyes, that is not under the control of the vestibular system. The vestibule also plays a key role in processing sensory input. When it runs smoothly, sensory-integration is optimal and no problems arise. If this is not the case, the child feels bombarded by thousands of pieces of information all at once and tries to protect himself by cutting off his environment. This can only reinforce the child's sense of isolation. One of the goals of the Tomatis Method is to regulate the vestibular function and to make sensory integration easier. This is the first step in reestablishing communication. Even more importantly, the vestibule also impacts speech: this is demonstrated by the fact that children, who do not talk, often start to make sounds when their vestibule is stimulated. A proper functioning of the vestibule is therefore of prime importance.
As we know all too well, ears are also made for hearing and listening. Tomatis points out that those are two different processes. Hearing is a passive one; listening is an active one, involving the desire to put the ear to good use. For instance, when we tune out, absorbed totally in the world of our thoughts, we do not hear the music on the radio. This small "autistic" experience is generalized in autistic children. It is not the "tuning out" that is exceptional but the "tuning in". Restoring the desire to "tune in", to listen, is therefore the key to restoring communication with the external world and with oneself.
The desire to speak goes hand in hand with desire to listen and communicate. The desire to use the voice is not different from the desire to use the ear: both are connected at the physiological level. Tomatis demonstrated that, to produce a sound, we have to hear that sound first. That means that the ear controls the voice. The ear-brain-larynx link is essential in producing language. But it can only be put at work if the desire to communicate exists. So, by creating the desire to listen, we also lay the groundwork for using expressive language.
Finding how to awaken this desire was Tomatis' first priority. In his search for a solution, he came upon the very simple idea of using the mother's voice. He realized that the fetus perceives the mother's voice, and reacts to it. He hypothesized that this might be the first attempt to dialogue, the first step in the listening process. So, he started to conduct experiments in which he had children listen to their mother's voice. He electronically filtered her voice, to match it to the sounds heard in the womb. Amazingly, those children started to bond better, first with their mother, then with the people around them. It was the proof that listening starts early on and that it was possible to use the voice of the mother therapeutically. Feeding back the filtered mother's voice gives the child a chance to be "reprogrammed." It is a symbolic way to relive the developmental phases, leading to language, hoping to make up for any step that might have been missed. This description of the process may lead to a misunderstanding. To be clear, in no way does this mean that Tomatis blames the mother for the child's difficulties. Lack of sensory maturation, difficulties at birth, diseases, or other events in life may have interrupted or impaired those first attempts to communicate. Tomatis emphasizes that we do not know the origin of autism. But we know for sure that many autistic children live in fear and that the mother's voice can do wonders to soothe those fears and help them to finally awaken to the world of communication.
Next, Tomatis developed an electronic device that both filters sounds and switches them on and off. He also developed special headphones that have, in addition to the normal earpieces, a vibrator to be placed on the top of the skull, and that transmits the sounds directly to the bone. The filtered music or the voice is gently fed to the clients through these special headphones.
Hypersensitivity, Sensory Integration And Autism
Many autistic people are hypersensitive to sounds. The intensity of their pain can be excruciating. That is why they try to cover up their ears with their hands, burst into huge temper tantrums or go into self-stimulating activities. It is wrong to believe that this sensitivity is limited to the auditory system. Both the skin and the bones of the body are equally conductive of sounds. It is the whole organism that responds to sounds. Unlike most people, they do not have the screening mechanism to protect them from the sonic assaults of their environment.
Other senses are also responding to this onslaught of stimulations. Tactile defensiveness is, in some cases, another way to attempt to protect oneself. Lack of eye contact might be another strategy to avoid to "taking in" what is perceived as overwhelming. To make things worse, sensory channels are often not isolated from each other: autistic children can experience light as sound or vice-versa. This can only lead to feeling that the world is a terrifying and chaotic place. It is thus clear that reducing hypersensitivity, regulating sensory-integration are key steps in reconnecting the autistic person to the environment. As long as problems of this kind persist, the autistic child will not be willing to come out of his autistic shell.
The Tomatis Method desensitizes children who are hypersensitive to sounds. This process takes place gradually. Parents report that little by little their children respond less to the sounds that used to upset them. "He can now hear the vacuum cleaner or the mixer without losing it." says the mother of a five-year old. Another family, who attended a wedding, reported that their son stood near the band for an hour and a half without covering his ears with his hands, a constant feature before the treatment. On parallel tracks, tactile defensiveness decreases and eye contact increases. Fine motor functions are also often observed to increase. Parents may notice a change in sleep patterns and appetite. Some children fall asleep more easily, sleep soundly and longer. Others, who had little appetite, might eat more, are less picky and willing to eat something new. As sensory regulation takes place, the autistic child starts to notice the world around him.
Parents report that their children develop a stronger presence.
"He is more together."
"She is more tuned in. She pays more attention."
"He makes more eye contacts. When I drive to the Center, he looks out of the window.
He never did that before."
"She looks people in the face now."
Those are some of the comments made by parents. Those steps are small at first. It also never is a straight line: there are still good and bad days. But the trend often is upward, especially when parents look back over a period of a month or two. It takes time for the nervous system to integrate, reorganize and digest the treatment, and to implement cognitive and behavior changes.
During this period, the child becomes more emotionally expressive. He may be more demanding for a while. It is his way of expressing feelings as he comes out of his autistic shell and should be accepted as such: a little step in the right direction. He may also spontaneously show more affection, sitting on his own will on his mother's lap, accepting to be held and cuddled. At this stage, it is important not to try to elicit such expressions of affection, because the child is only able to express those sporadically at first. He has his own time table. Affectionate behavior will increase as the child becomes more tuned in to the people around him.
Autistic children are also known to be afraid of transitions and to stick to a very rigid set of rules and behaviors. Parents' observations indicate that they start to show progressively more flexibility and that new behaviors appear. Hand flapping, repetitive body movements and self destructive behaviors decrease too.
Language may develop in different ways. For autistic children without language, vocalization increases and may develop in a sort of babble. For children who have language skills, parents notice that they speak more clearly, use longer sentences and more appropriate words. They may also become more personal, using correctly personal pronouns ("I", "You"). Receptive language improves too: "She looks me in the eyes when I talk to her. Her comprehension is much better." The teachers of the children that are involved in behavioral-based therapies often report that the kids focus better and for longer periods of time. Their rate of success in doing drills or exercises is also increasing. As their desire to communicate and their ability to do so expands, they handle social situations, including the classroom, much better. Instead of isolating themselves, they will seek the attention of others and try to reach out. The periods of isolation diminish and the autistic shell slowly melts away.
COMMENT: This seems like another useful option for patients with autism.