Delacato suggests the use of earplugs a means of diminishing the discomfort of autistic children who cannot tolerate loud sounds or certain frequencies. Earplugs, cotton, rubber, or plastic, have been helpful in some cases, as have been the kinds of heavy-duty industrial protective ear covers worn by workers who must work around jet engines or in other noisy environments. However, many autistic children refuse to wear these devices, and of course muffling die sounds diminishes the child's ability to hear speech and receive other important auditory information. One mother of an autistic child with hyperacute hearing, an engineer, designed a small soundproof (anechoic) chamber, which was reportedly extremely effective in excluding environmental noise, so her son could sleep. She constructed the soundproof mini-chamber from a card table, some velcro-fastening tape, and the foam mattress pads that are corrugated in several directions, like an egg crate. The foam was secured to the bottom surface of the card table, and to the legs of the table, so the table could be placed, cave-like, on the child's bed while he slept.

One cause of sound sensitivity is a deficiency of the mineral magnesium. We all need several hundred milligrams of magnesium each day. Unfortunately our food supply can no longer be expected to provide that much. One symptom of magnesium deficiency is hypersensitive hearing, and hyperirritability in general. Magnesium supplements are readily available, and an appropriate amount would be about 20 milligrams for each 10 pounds of body weight, per day. (Thus, 100 mg of magnesium for a 50 pound child.)

If magnesium deficiency is the cause of the sound sensitivity, improvement will be seen in a very few days.¹⁸

Auditory Training
Can autistic individuals with hyperacute hearing be trained to overcome the hypersensitivity? Possibly so. Two French physicians, Alfred Tomatis and Guy Berard, have independently pioneered approaches, which involve the use of electronic devices to modulate sounds in such a way that hypersensitive hearing, and certain other hearing problems, can be remedied.

Tomatis Listening Centers, which administer sound treatment in accordance with Tomatis' teachings, are found in many cities in Europe and North America.

Unlike Tomatis, Berard has conducted his work only from his clinic in Annecy, although the electronic sound modulating device he has developed is being used by a few practitioners elsewhere.

Although both Tomatis and Bernd treat a variety of problems, dyslexia in particular, which they attribute, at least in many cases, to faulty auditory processing, autistic patients represent only a small part of the practices of the Tomatis Centers, and of Berard. Nevertheless, a member of families with autistic children have had their children treated by Tomatis or Berard with what are surprisingly often positive evaluations.

The Berard treatment consists of 10 hours of listening to music, which has been played through Berard's electronic modulating device. The patient is first given a careful audiogram by Berard to the peaks on the audiogram. Berard points out that audiograms am typically concerned with the valley&-the areas of impaired auditory acuity-with very little attention paid to the peaks which represent the frequencies at which the hearing is hyperacute, and therefore quite possibly a source of pain or discomfort. Based on the results of the audiometric testing, Berard sets the frequency filters on his device so that the patient is protected from hearing the sounds to which he or she is hypersensitive. Specially-selected music is played through earphones into both ears. The electronic circuitry has been designed so that the music entering each ear is briefly interrupted and restarted in an unpredictable pattern. One might say that the entire hearing apparatus is thus exercised by the electronically modified music, which is played rather loudly, but not loudly enough to be painful or uncomfortable.

The 10 hours of Berard's treatment are usually divided into 20 half hour sessions, given over 10-day period. A second audiometric test is generally conducted at the end of a fifth day, so that the filters may be reset, depending on the effects of the first five days (10 sessions) of auditory training. The Tomatis approach, which is based on

psychophilosophical concepts quite different from Berard's, may involve 100-150 hours listening to electronically modulated music, over a period of several months. Frankly, I am rather uncomfortable with the Tomatis approach. Not only is it far longer more expensive than Berard's, but it invokes a number of assumptions, I found hard to accept such as the significance he places on the sound of the mother's voice on the auditory and emotional development of the fetus.

To my knowledge there have been no scientifically controlled evaluations of either the Berard or Tomatis auditory training procedures, as they are applied to autism, or for it matter, any other of the various disabilities for which the Berard and Tomatis methods are recommended, although a number of small clinical trials are reported in the literature supplied by Berard and Tomatis. The Institute for Child Behavior Research has been in contact with a number of parents in the U.S. and elsewhere whose autistic children have been treated by the Berard and Tomatis methods, and, as noted above, the parent evaluations are surprisingly favorable. At the time of this writing, a double-blind, placebo controlled evaluation of Berard training on a sample of autistic children is being conducted by my colleague Dr. Stephen Edelson and myself. The results of this first experimental evaluation of Auditory training are expected to be available by raid-1991.

During my three decades of work in the field of autism, I have met quite a number of high functioning autistic adults, including some who have earned college degrees and even postgraduate degrees in various fields. In all cases but one there were residual behavioral eccentricities and oddities. The only exception was a young woman who had graduated from college with honors and was working toward her Ph.D. when I met her. After spending several hours with her I could find no sign of autism, yet this young woman as a child had been hospitalized on the autism ward in Bellevue, and her records indicated clearly that she had been diagnosed autistic-appropriately so-as a child. This woman's family attributed her recovery entirely to her having been treated for 10 hours by Dr. Berard. Her story is told in the book The Sound of a Miracle by her mother, Annabel Stehli, which is in press at the time of this writing, and which is condensed in the December 1990 Readers Digest.

If the reader is skeptical that something so simple as 10 hours of auditory training might be sufficient to bring even a small minority of autistic individuals to full recovery, over a period of time, I can assure you that I am no less skeptical. On the other hand, to permit such skepticism (prejudice) to remove a treatment modality from consideration without thorough investigation would be inexcusable, in my view.

Dr. Berard retired in April 1990. At present, his method of auditory treatment is not available. However, we at ICBR are working on several options which we hope will be helpful, but which it would be premature to discuss at this time. Parents of autistic children and adults with hypersensitive hearing will find information about treatment options in the ARRL as such information becomes available. If the problem is acute, write to ICBR, and we will send the information more quickly and in greater detail. In the meantime, any readers with additional suggestions on methods for dealing with hyperacute hearing are invited to share them with ARRI readers.¹⁸