CONCERNING THE PRACTICE OF AUDITORY INTEGRATION TRAINING - THE BERARD METHOD AND RELATED SYSTEMS

It has come to the attention of the AIT International Practitioners that there are some misconceptions about the nature, scope and proper place of this method of auditory training, known as AIT. This letter is my attempt to inform, in the interest of scientific inquiry, and also to ensure the best welfare of those who could benefit from this method.

Since its arrival in South Africa, first in Cape Town, and subsequently countrywide, this new form of listening skills training enjoyed much interest, and has been discussed formally and informally by members of the profession, by speech therapists and audiologists alike. Frequently for many professionals the first inkling of its existence came in the form of patients making enquiry about AIT, or reports of  outcomes of AIT on children already in speech therapy.

There has, however, been a trend within the profession, as reported by members of the public, and as observed through the actions of the professional Associations for speech and hearing, to be misinformed about AIT and indeed even to resist becoming properly informed. Unfortunately there have been therapists who have blatantly misinformed their patients and other members of the public about AIT.

It is of course natural (if not laudable) behaviour to resist new developments. The “scientific” approach is all too often interpreted as being equal to the “conservative” approach, and it can easily happen that “scientists” will resist change, even to the point of persecuting the agent of change.

Ours is one of the caring professions that strive to maintain the highest standards in service provision to our clients. This high standard must not only encompass the use of treatments that are proven to be effective and do no harm, but we must also maintain a high standard of professionalism and ethical behaviour towards clients and colleagues alike.

Tensions will be inevitable in the pursuit of this ideal. For example, a therapist may be dedicated to “the Scientific Approach”, but in practise may have to consider using an “unscientific” intervention for the greatest benefit of a particular client. In such a case the therapist is compelled to weigh in the balance whether to remain the scientist ensuring that there is at least 40 years of sound research backing an intervention, or whether the intervention meets the criterion of ‘doing no harm’ but showing some promise of benefit.

In such an event, where should the ethically superior, professional choice lie? Should one remain with the less promising but so-called “scientific” intervention, or does one do that which holds more promise of benefit to the client?

Fortunately, the majority of the members of this profession would answer that the best interest of the client is paramount. The thorough professional understands that self-service , even service of the “club” or “Association”, must never be placed before service to the individual client:- to do this would be the sure road to malpractice.

In any case, David Eddy, Professor of Health Policy and Management at Duke University, USA, as reported in the British Medical Journal of October 1991, pointed out that ” only about 15% of medical interventions are supported by solid scientific evidence”. While he encourages research to improve this situation, he does not advocate that doctors stop providing those other “unscientific” interventions.

We, as members of the profession of Speech and Language Therapy, and Audiology, are no better off than the medical profession in the percentage portion of “scientific” against “experientially useful” activities. In our practice we do not advocate that these other interventions “should not be done” simply because they are non-“scientific”!

But having said this, there are leaders and policy-makers in our profession who have chosen to adopt this very attitude, that AIT ‘should not be done’ on the basis that it is purportedly ‘unscientific’ !  In South Africa the then chairperson of the professional board was of this very opinion, which led to the Association taking various actions that resulted in the humiliating scenario when their case was dismissed from court with a stiff reprimand.

Their attitude leaves the question to be answered – why would AIT be singled out for this imbalanced treatment? (refer to the statements in “Shout”  and the Health Professions Bulletin of South Africa, stating that only health professionals should do AIT, and that in the providing of this service they should not charge a fee, since it is still “entirely investigational”) .  Why the bias?  As Dr Jane Maddell, Audiologist and professor of clinical otolaryngology in the USA, and contributing author in “Clinical Audiology” asks ; “ Why should it (AIT) be held up to different standards than other clinical treatments?”  Dr. Maddell advocates continuing offering AIT as a clinical option, while continuing to collect data - just as we do with all other current interventions. (ASHA, winter 1997).

However, we find our Association (SASLHA), and Professional Board attempting to have us believe AIT merits some “special attention”. Perhaps there is a genuine concern that it might cause harm?  There is a persistent rumour spread by many long-standing members of the profession that AIT can “damage” ones hearing, and they have stated to members of the public that “published research has proven” this allegation!

Another rumour is that there is no research to support the claims of benefit made by practitioners of AIT. It is even rumoured that the research proves that AIT “does harm”, can cause epilepsy, paranoia, and is extremely painful !

Perhaps a quote from David Eddy will suffice in answer : “ Agreement of the experienced without evidence is a poor basis for producing advice”. (Brit. Journal of Medicine, Oct 1991).

It would seem that there is a crushing lack of information about the origin, claims of, and practice of Bérard AIT, and that the very people who could be expected to know their facts are content to merely “form their own opinion “ with a blithe disregard to the existence of these facts.

Dr William Hay, quoted in  A New Health Era, 1934, told medical practitioners :
“Facts have always discounted theory, and always will; so get the facts for yourself and let others be satisfied with unproven theory”

These are the days of the information superhighway- information is so easily accessible. Why the ignorance amongst professionals, even those in institutes for higher learning?

There are facts about AIT, and there are rumours.

There are research results and case studies. (See www.aitinstitute.org/ait_clinical_studies.htm )

Which should feed the opinion of the professional? Is it really adequate that the position statement concerning AIT in South Africa was drawn up without consultation and discussion with the (then only) AIT expert in the country? Is it adequately professional to make “rulings” concerning AIT and its practice with no reference nor consultation with adequately informed and trained parties? Surely the “scientifically-minded” professional would answer “No!”

Let’s recall what “scientific” means:
The “scientific method” requires the observation of phenomena, collection of data, and the “publicly observable events”. Should it not be asked why those very people who want AIT crushed because it is “unscientific”, never once visited the therapist who brought AIT into the country, to observe, investigate, question, and otherwise inform themselves?  What unusual “scientific” behaviour indeed!

It has by now become apparent to practitioners of Bérard AIT and also to its detractors, that the attacks on this intervention have no factual basis. As every objection is answered with fact, a new red herring is thrown up. The letter printed in the Living and Loving of January 2000 was typical, in which a speech therapist accused AIT practitioners of presenting AIT as “…a panacea for all ills…”

Let me here present a fact: - no South African AIT practitioner has made such a claim. How odd of the professional therapist to have done so in a public forum!

It is essential to know that AIT - the Bérard Method - is a non-medical intervention. The American FDA has ruled that it has no jurisdiction over it, as an educational / training system. AIT is probably best understood in the context of aerobics, passive exercise, massage, and such. Obviously just as there are medical implications in physical exercise, in gym, even in education, nobody would suggest that gym or education are medical interventions!! Passive exercise can benefit the paralysed as well as the un-fit and flabby. So too, AIT can benefit a wide range of people, the functional as well as the dysfunctional.  

There are people with medical conditions (autism, language disorder, Downs syndrome, etc ) who also have poor listening skills, and who could benefit from AIT. There are people in responsible jobs whose listening skills could benefit from enhancement, and who seem to benefit from AIT too. There are scholastic benefits possible, and well-ness issues involved. But for all that, it is a common-domain intervention. As with any such issue, the application needs special training to properly perform it, but still it remains non-therapeutic in the medical sense. AIT is an International entity, and in this arena is held to be non-medical, and Dr Bérard himself confirms its common-domain stature, as does the International Practitioners Forum.

However, the non-medical nature of AIT does not mean that a therapist should be barred from practising it, after suitable training. After all in voice therapy, techniques are used that are shared with other disciplines, medical and also public speaking and singing:- who would suggest that a therapist using these techniques should not charge a fee for her service? Should a therapist also not charge for using the Auditory Discrimination in Depth programme, just because teachers also use it? or PECS, etc etc etc.

In stuttering therapy any number of techniques may be selected by the speech therapist, some of which  (relaxation techniques, self-knowlege, re-scripting) are used by many others. Just because these techniques are used by the therapist does not mean they are the sole domain of the profession of Speech and Language Therapy! And who would suggest that a therapist should not charge a fee for that portion of time used a “common domain” intervention? This has not been our practice to-date - why are we being led to believe that we should  single out AIT for such special consideration?

Did those who devised this position statement in South Africa really suppose that they weren’t clearly seen to be trying to “bury” AIT? To what end? What could possibly be the motivation in so strongly opposing this one out of any number of new auditory training methods?

It is plain that certain actions by the Associations and Professional Boards need examination, since they defy logic and explanation. Perhaps it is time to call for accountability and transparency, in the spirit of the climate in health care today.  Above all we should call for a re-evaluation of the actions of certain colleagues to determine IN TRUTH whose interest was being served by these actions :- the patient we have in our care, or the agenda of vested self-interest that has no place in the health professions, and certainly ought not to be elevated in our midst.

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