Finding a simple fix for complex problems is highly appealing, which drives a persistent market in simple fixes, whether or not they are actually effective. The growing “brain training” industry is an example of this – the concept being that performing simple tasks, such as playing particular games, can have wide-ranging cognitive benefits. Unfortunately the evidence has not been kind to this notion.
Related to the brain training concept is auditory integration training. One permutation of this, the Tomatis Method, describes it this way:
The sound message is correctly heard but poorly analyzed in an emotional framework. The brain protects itself by constructing barriers that can result in the development of various disorders.
You can do the listening sessions repeatedly by using specially designed devices that stimulate the brain and progressively help it more effectively analyze the sensory message.
Your ear is not used only for hearing. It also stimulates your brain and establishes your balance. Well-tuned listening is therefore an essential component for promoting personal development.
This is a common approach to marketing such therapies – argue that one factor is a dominant cause of a host of problems, describe the method for addressing that one factor, which then leads to a happy, healthy, fulfilling life. This marketing formula appears well established.
Plausibility becomes progressively lower as the claims extend to disorders and symptoms that are further removed from the alleged cause. Auditory integration training is a plausible treatment for those with certain language disorders – those caused or contributed to by faulty integration of sensory information.
The Tomatis Method lists the following areas of application:
Affective and Emotional Disorders
Pervasive Developmental Disorder (PDD)
Personal Development and Well-Being
Improvement of the Voice and of Musicality
Preparation for Childbirth
Integration of Foreign Languages
Such lists always look as if they were compiled by marketers, not scientists or clinicians. In any case, what is the evidence they offer for the effectiveness of this method? They summarize the results of one study for auditory processing disorders, three for anxiety, and four for learning disabilities and behavioral problems (one was a meta-analysis of five studies with a total of 225 subjects). That’s it, and they did not provide references.
The studies are all small and uncontrolled or not blinded, many are just case series where Tomatis practitioners followed the progress of their clients. In other words – this is very low grade evidence, barely above testimonials, and completely unreliable, especially since many relied upon subjective outcomes.
In anxiety research, for example, there is a known confounding effect where the introduction of any novel method will cause a non-specific placebo effect. This factor needs to be controlled for in a blinded fashion, or else the results will be uninterpretable.
I could not find much in a PubMed search to support auditory integration training or the Tomatis Method specifically. I did find one review of auditory integration for autism spectrum disorder which concluded that:
There is no evidence that auditory integration therapy or other sound therapies are effective as treatments for autism spectrum disorders. As synthesis of existing data has been limited by the disparate outcome measures used between studies, there is not sufficient evidence to prove that this treatment is not effective.
At present there is insufficient evidence to justify using the therapy for ASD.
I did find preliminary evidence for altered auditory processing in those with panic disorder. It is not clear, however, if this contributes to the anxiety or is simply a result of the anxiety, or if both symptoms are a result of an underlying disorder. It is a huge leap to conclude that training auditory processing will affect the anxiety.
This precise kind of logical leap is common, however, with the marketing of dubious therapies. The fallacy is in assuming that addressing what might be a marker or a superficial manifestation of a deeper issue will somehow address or fix the deeper issue.
Auditory integration therapy may be a reasonable hypothesis for certain language disorders, but there is little plausibility for other symptoms, such as anxiety or developmental disorders. What evidence we do have is either too preliminary and flawed to be of use, or is negative.
The marketing of specific brands of auditory integration therapy goes far beyond the evidence and displays many of the features of a dubious therapy. Chief among these is indication creep – an ever-expanding list of conditions it is alleged to treat, to expand the market for a treatment that has yet to be established even for its more plausible indications.
This therapy is also part of a broader trend of “brain training” therapies, the core notion being that training the brain (i.e. learning and practice) in one area can have wide-ranging cognitive benefits. So far the literature seems to support the opposite conclusion, that the benefits from cognitive tasks do not generalize beyond the specific tasks themselves.