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Brief Report: The Effects of Tomatis Sound Therapy on Language in Children

with Autism

Article  in  Journal of Autism and Developmental Disorders · April 2008

DOI: 10.1007/s10803-007-0413-1 · Source: PubMed

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J Autism Dev Disord (2008) 38:562–566
DOI 10.1007/s10803-007-0413-1

BRIEF REPORT

Brief Report: The Effects of Tomatis Sound Therapy on Language

in Children with Autism
Blythe A. Corbett Æ Kathryn Shickman Æ
Emilio Ferrer

Published online: 3 July 2007

! Springer Science+Business Media, LLC 2007

Abstract Due to the myriad of problems associated with cation, reciprocal social interaction, and a restricted
autism, parents often consider alternative treatments. The repertoire of activities and interests (American Psychiatric
investigation was undertaken to determine the effects of the Association 1994). Individuals with autism frequently have
Tomatis Method on language skills in children with autism concomitant auditory processing problems especially as
utilizing a randomized, double-blind, placebo-controlled, related to the processing of speech (Gervais et al. 2004;
crossover design. The results indicated that although the Lepisto et al. 2005; Samson et al. 2005; Tecchio et al.
majority of the children demonstrated general improve- 2003). It has been suggested that impaired auditory per-
ment in language over the course of the study, it did not ception skills may be associated with deficits in commu-
appear to be related to the treatment condition. The percent nication and reciprocal social skills (Kellerman and
change for Group 1 (Placebo/Treatment) for treatment was Gorman 2005).
17.41%, and placebo was 24.84%. Group 2 (Treatment/ Considerable empirical evidence has shown that early
Placebo) showed –3.98% change for treatment and 14.15% intervention based on applied behavior analysis (ABA) can
change for placebo. The results reflect a lack of improve- result in significant, comprehensive and lasting improve-
ment in language using the Tomatis Method for children ments in children with autism (e.g. Birnbrauer and Leach
with autism. 1993; Eikeseth et al. 2002; Eldevik et al. 2006; Lovaas
1987; McEachin et al. 1993; Smith et al. 2000). Addi-
Keywords Autism ! Tomatis ! Alternative treatment tionally, traditional interventions such as speech and lan-
guage therapy have been used to improve the language and
communication skills of children with autism. However,
Introduction parents looking for solutions may consider alternative
treatments most of which have not been subjected to
Autism is a severe neurodevelopmental disorder charac- clinical research (American Academy of Pediatrics 2001).
terized by impairment in verbal and nonverbal communi- This paper describes a study designed to determine the
effectiveness of one such alternative treatment, the Tomatis
Method of sound based therapy (Tomatis).
B. A. Corbett (&)
Department of Psychiatry and Behavioral Sciences, University There has been growing interest in the United States in
of California, Davis, 2230 Stockton Boulevard, Sacramento, CA Tomatis and other alternative treatments, which incorporate
95817, USA forms of music therapy. However, there is a lack of research
e-mail: blythe.corbett@ucdmc.ucdavis.edu
to support or refute such interventions (Thompson and An-
B. A. Corbett ! K. Shickman drews 2000). To date, there have been no well-controlled,
The M.I.N.D. Institute, University of California, Davis, experimentally designed studies from peer-reviewed jour-
Sacramento, CA, USA nals examining the efficacy of Tomatis in autism. This is
concerning due to the time and financial resources that could
E. Ferrer
Department of Psychology, University of California, Davis, be directed to more proven interventions. Baranek warned
Davis, CA, USA that ‘‘relying on non-harmful but potentially ineffective

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J Autism Dev Disord (2008) 38:562–566 563

treatments can squander valuable time that could be used in if Tomatis contributed to the improvement of receptive and
more productive educational or therapeutic ways’’ (Baranek expressive vocabulary in children with autism.
2002) (p. 418). Herein lies the impetus for this carefully
controlled investigation of Tomatis.
The Tomatis Method has often been compared to Methods
Auditory Integration Therapy (AIT) (Berard 1993), another
controversial treatment showing limited if any benefit for Participants
children with autism (for a review see: Baranek 2002). The
Tomatis Method and AIT are similar in that they both are Eleven children with autism between 3 years, 6 months
considered sound therapy and use high and low frequency and 7 years, 2 months were enrolled in this study. Inclu-
filtered music. However, the techniques are distinguishable sion required a diagnosis of Autistic Disorder based on the
in the application and intensity of the intervention. DSM-IV criteria (American Psychiatric Association 1994)
Alfred Tomatis, MD proposed that listening to modified corroborated by the Autism Diagnostic Observation Sche-
music would stimulate connections between the ear and the dule-Generic (ADOS-G); (Lord et al. 1999), and clinical
central nervous system (Thompson and Andrews 2000). judgment (B.A.C.). Participants needed to speak at least 1–
Anecdotal reports claim that Tomatis has improved the 3 words, have a pointing gesture, and tolerate wearing
communication, social and behavioral functioning of some headphones. Participants who had previous exposure to
children with autism. Neysmith-Roy (Neysmith-Roy 2001) auditory stimulation treatments were excluded. Demo-
conducted a study of six children with severe autism ages graphic information presented in Table 1.
4–11 years who were administered several blocks of
Tomatis treatment. The authors report improvement in Design
behavior and prelinguistic behaviors in some of the six
participants with the youngest subjects showing the most The study utilized a double-blind, placebo-controlled,
improvement. crossover design. Assessments were conducted at baseline,
The Tomatis Method consists of the administration of midpoint, and conclusion of the study. The investigation
prepared auditory stimulation recordings through equip- was approved by the University of California Institutional
ment designed to modulate the acoustical signal. The Review Board (IRB) and written parental informed consent
stimuli include specially created compact discs of Mozart was obtained prior to participation.
music and Gregorian chants. The acoustical signal modu-
lation equipment attenuates low frequency sounds and Measures
amplifies higher frequencies (800–300 Hz). Proponents
hypothesize that this modulation allows the child to grad- The Autism Diagnostic Observation Schedule-Generic
ually focus listening on language frequencies. During the (ADOS-G); (Lord et al. 1999) provides observation of a
protocol the child listens through an ‘‘Electronic Ear’’ (EE) child’s communication, reciprocal social interaction, and
headphone with an attached oscillator permitting the sounds stereotyped behavior including an algorithm with cut-offs
to be perceived through bone conduction as well as air for autism and autism spectrum disorders (Lord et al.
conduction. The primary aim of this study was to determine 1999).

Table 1 Demographic information of study participants

Participant Treatment group Age Gender Ethnicity IQ Language

#10 Treatment/Placebo Group 1 3.50 Male Hispanic 83 Single words

#05 Treatment/Placebo Group 1 3.92 Male Caucasian/NatAm/Hispanic 63 Single words
#08 Placebo/Treatment Group 0 4.00 Male Caucasian/NativeAmerican 65 Single words
#04 Treatment/Placebo Group 1 4.67 Male Caucasian 52 Few words
#03 Treatment/Placebo Group 1 4.92 Female Caucasian/Hispanic 60 Single words
#01 Placebo/Treatment Group 0 5.33 Male Caucasian 63 Single words
#02 Placebo/Treatment Group 0 6.08 Male Hispanic 66 Phrase speech
#07 Treatment/Placebo Group 1 7.08 Male Pacific Islander 68 Phrase speech
#11 Placebo/Treatment Group 0 7.08 Female Caucasian 83 Some full sentences
#06 Placebo/Treatment Group 0 7.17 Male Caucasian 68 Phrase speech
#12 Treatment/Placebo Group 1 7.42 Male Caucasian/Hispanic 64 Some full sentences

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564 J Autism Dev Disord (2008) 38:562–566

The Stanford-Binet Intelligence Scale-Fourth Edition voices. Sound frequency filtering was up to 9,000 Hz.
(SB4); (Thorndike et al. 1986) is a standardized measure of Block 4 exposed participants to 10 days of mixed active
cognitive functioning administered to all participants to and passive listening for 2 h each day with filtering ranging
provide a measure of overall intellectual ability (IQ). from 2,000 Hz up to 9,000 Hz.
The Peabody Picture Vocabulary Test-Third Edition After completion of this first round (treatment or pla-
(PPVT-III); (Dunn and Dunn 1997) is a measure of single- cebo), participants completed the mid-point assessment.
word receptive vocabulary used as the primary dependent The second round of the study followed using the same
measure schedule of blocks for an additional 18 weeks. Once the
The Expressive One Word Vocabulary Test (EOWVT) second round was completed, participants returned for their
(Brownell 2000) is a measure of single word expressive final assessments.
vocabulary also used as a dependent measure.
Statistical Analysis
Treatment Procedures
Data analysis was designed to evaluate the effects of
The Tomatis Method was administered by two trained Tomatis treatment on the functioning of children with
assistants at The Listening Clinic in Sacramento, CA. Each autism compared to placebo condition. It was hypothesized
subject was randomly assigned to either treatment first, that a positive response to treatment would result in a
Group 1, (Treatment/Placebo) or placebo first, Group 0 significant improvement in receptive and expressive lan-
(Placebo/Treatment). The M.I.N.D. Institute researchers guage. A repeated measures Analysis of Variance (ANO-
and parents remained blind to the experimental conditions VA) was used to analyze the profile of scores across the
until the conclusion of the study. levels of treatment (experimental versus placebo condition)
The experimental condition involved receiving the and across the three time periods. In this way we asked, if
Tomatis Method. Each subject listened to three different the groups differ in the dependent measure, do the lan-
pieces of professionally produced Mozart music and one of guage measures show changes across the different time
Gregorian chant daily for a total of 2 h, passed through the periods, and are such changes different across both groups?
EE for attenuation and modulation. Audio-vocal feedback
was included consisting of verbal activities, such as
repeating phrases into a microphone allowing feedback of Results
their own voices. According to proponents of Tomatis, the
combination of filtered music, the EE and auditory feed- The means and standard deviations for the primary
back results in enhanced auditory perception by stimulating dependent language measures, PPVT and EOWVT, are
middle ear hair cells leading to alterations in the central presented in Table 2. Repeated measures ANOVA was
nervous system. Therefore, these three key components applied to compare the time period values and there were
were not included in the placebo condition. Specifically, no differences between the groups in the PPVT F
the placebo condition involved listening to commercially (1,9) = 1.34, p = 0.28. There was a time effect in the PPVT
produced Mozart and Gregorian chant CDs and not using F(2,8) 5.82 p = 0.03 that appears to be linear; there was a
an active microphone or the EE. constant increase in the PPVT scores over time. The
Consistent with a cross-over design, the experimental overall time by group interaction was not significant F
phase of the study was divided into two equal rounds and (2,8) = 3.5, p = 0.08 although the linear contrast of this
three assessment time periods. The Tomatis protocol was interaction was significant F (1,9) = 7.30, p = 0.02, but not
divided into four blocks lasting 3 weeks each, followed by the quadratic F (1,9) = 0.84, p = 0.38. Although small, the
a break for a total duration of 18 weeks. time by group interaction suggests that individuals in
Block 1 included 15 days of passive listening to music Group 0 (placebo/treatment) show a steeper increase in
for 2 h each day. Participants listened to non-filtered PPVT scores over time than in Group 1 (treatment/pla-
sounds of Mozart music and Gregorian Chants with gating cebo).
(randomly alternating between high and low frequency The results for the EOWVT are similar in showing no
sounds). Block 2 consisted of 10 days of active listening differences between groups F (1,9) = 0.72, p = 0.42. The
for 2 h each day alternating between filtered and non-fil- time effect was also significant F (2,8) = 4.83 p = 0.04
tered music. The compact discs introduced sound fre- indicating a linear increase in EOWVT over time with no
quency at 1,000 Hz filtering up to 9,000 Hz. In Block 3, quadratic component. Further, there was no time by group
participants experienced 10 days of mixed active and interaction F (2,8) = 0.50, p = 0.63. The means and stan-
passive listening for 2 h each day. Microphone work was dard deviations for the ADOS and IQ are presented in
introduced and participants listened to their modulated Table 3.

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J Autism Dev Disord (2008) 38:562–566 565

Table 2 Means, Standard Deviations, % change for the PPVT and EOWVT
Treatment Group Pre Mid Post % Change
PPVT EOWVT PPVT EOWVT PPVT EOWVT PPVT EOWVT

Placebo/Tomatis Group 0 32.20 25.20 40.20 29.40 47.20 34.40 P = 24.84 P = 16..67
(25.21) (19.82) (26.69) (22.65) (24.45) (25.00) T = 17.41 T = 17.00
Tomatis/Placebo Group 1 20.83 16.50 20.00 18.00 22.83 21.50 P = 14.15 P = 19.44
(28.52) (21.11) (25.76) (18.73) (29.36) (23.30) T = –3.98 T = 9.10
Total Sample 26.00 20.45 29.18 23.18 33.91 27.36
(26.38) (20.01) (26.98) (20.40) (28.85) (23.81)
Note: T = Treatment, P = Placebo

are heterogeneous. There is notable variability in terms of

Table 3 Diagnostic and psychological variables pre and post treat-
ment IQ and language skills at baseline. However, since we
employed a randomized design we were unable to control
Participant Treatment ADOS ADOS IQ IQ
Group Pre Post Pre Post
for these possible effects.
In summary, our results did not demonstrate treatment-
#01 Group 0 16 14 63 62 specific improvement in receptive and expressive language
#02 Group 0 9 8 66 69 in children with autism. Due to the fact that this is the only
#03 Group 1 18 23 60 71 known experimental study investigating the Tomatis
#04 Group 1 18 20 52 59 Method, we are unable to unequivocally state that Tomatis
#05 Group 1 16 16 63 53 does not show some benefit for children with autism.
#06 Group 0 13 16 68 49 However, our results do not provide evidence for the pre-
#07 Group 1 13 17 68 44 sumed benefit of the treatment compared with music alone,
#08 Group 0 15 17 65 61 a finding similar to studies of AIT indicating a lack of
#10 Group 1 10 12 83 70 empirical support or unconvincing findings for the use in
#11 Group 0 13 14 83 84 autism (Dawson and Watling 2000).
#12 Group 1 12 11 64 65 Despite our design and experimental control, there are
limitations to report. The study may be underpowered due
to the small sample size and the heterogeneous sample
Discussion makes it difficult to determine if certain factors such as age
or level of functioning make a child more responsive to
The primary purpose of this study was to determine if treatment. Future investigations will need to consider
Tomatis contributed to the improvement of the receptive contributing factors for general improvement including the
and expressive language in children with autism. The re- treatment intensity, and placebo effects. Other forms of
sults showed no significant differences on the language placebo such as ‘‘white noise’’ or comparing music treat-
measures across the groups attributed to the treatment ment to consistent interactive play with a therapist on a
condition. In regards to receptive language, there was an regular basis may be informative. Explorations into the
overall trend for the participants to progress or develop in a broader beneficial aspects of intervention and participation
linear way. All subjects showed improvement in their in research may be valuable and warrant our expanded
language skills over time; however, the change did not study.
appear related to the treatment condition. It is unclear if the
Acknowledgments We would like to acknowledge the families of
improvement is associated with general developmental
those children who participated in our research who committed to
progress or some other factor. nearly 1 year of assessments and treatments. Funding was provided
Although the participants were randomly assigned to the by the University of California, Davis M.I.N.D. Institute.
groups, the developmental level appeared to be different
for each in that the placebo/treatment group was higher
functioning than the treatment/placebo group. It has been References
suggested that variables such as age and level of func-
American Academy of Pediatrics. (2001). Counseling families who
tioning at the start of treatment need to be carefully con-
choose complementary and alternative medicine for their child
sidered when evaluating outcome (Rogers 1998). As is with chronic illness or disability. Committee on Children with
evident in Tables 1 and 2, the participants in this sample Disabilities. Pediatrics, 107(3), 598–601.

123
566 J Autism Dev Disord (2008) 38:562–566

American Psychiatric Association. (1994). Diagnostic and statistical Lord, C., Rutter, M., DiLavore, P., & Rissi, S. (1999). Autism
manual of mental disorders (4th ed.). Washington, DC, USA: diagnostic observation schedule-WPS. Los Angeles, CA:
American Psychiatric Publishing, Inc. Western Psychological Services.
Baranek, G. T. (2002). Efficacy of sensory and motor interventions Lovaas, O. I. (1987). Behavioral treatment and normal educational
for children with autism. Journal of Autism and Developmental and intellectual functioning in young autistic children. Journal of
Disorders, 32(5), 397–422. Consulting and Clinical Psychology, 55(1), 3–9.
Berard, G. (1993). Hearing equals behavior. New Canaan, CT: Keats. McEachin, J. J., Smith, T., & Lovaas, O. I. (1993). Long-term
Birnbrauer, J. S., & Leach, D. J. (1993). The murdoch early outcome for children with autism who received early intensive
intervention program after 2 years. Behaviour Change, 10(2), behavioral treatment. American Journal of Mental Retardation,
63–74. 97(4), 359–372, discussion 373–391.
Brownell, R. (2000). Expressive one-word picture vocabulary test Neysmith-Roy, J. M. (2001). The Tomatis Method with severely
(3rd ed.) Novato, CA: Academic Therapy Publications. autistic boys: Individual case studies of behavioural changes.
Dawson, G., & Watling, R. (2000). Interventions to facilitate South African Journal of Psychology, 31(1), 19–28.
auditory, visual, and motor integration in autism: a review of Rogers, S. J. (1998). Empirically supported comprehensive treatments
the evidence. Journal of Autism and Developmental Disorders, for young children with autism. Journal of Clinical Child
30(5), 415–421. Psychology, 27(2), 168–179.
Dunn, L. M., & Dunn, L. M. (1997). The peabody picture vocabulary Samson, F., Mottron, L., Jemel, B., Belin, P., & Ciocca, V. (2006).
test (3rd ed.) Circle Pines, MN: American Guidance Service Can spectro-temporal complexity explain the autistic pattern of
Publishing. performance on auditory tasks? Journal of Autism and Devel-
Eikeseth, S., Smith, T., Jahr, E., & Eldevik, S. (2002). Intensive opmental Disorders, 36(1), 65–76.
behavioral treatment at school for 4- to 7-year-old children with Smith, T., Groen, A. D., & Wynn, J. W. (2000). Randomized trial of
autism. A 1-year comparison controlled study. Behavior Mod- intensive early intervention for children with pervasive devel-
ification, 26(1), 49–68. opmental disorder. American Journal of Mental Retardation,
Eldevik, S., Eikeseth, S., Jahr, E., & Smith, T. (2006). Effects of low- 105(4), 269–285.
intensity behavioral treatment for children with autism and Tecchio, F., Benassi, F., Zappasodi, F., Gialloreti, L. E., Palermo, M.,
mental retardation. Journal of Autism and Developmental Seri, S., et al. (2003). Auditory sensory processing in autism: A
Disorders, 36(2), 211–224. magnetoencephalographic study. Biological Psychiatry, 54(6),
Gervais, H., Belin, P., Boddaert, N., Leboyer, M., Coez, A., & 647–654.
Sfaello, I., et al. (2004). Abnormal cortical voice processing in Thompson, B. M., & Andrews, S. R. (2000). An historical commen-
autism. Nature Neuroscience, 7(8), 801–802. tary on the physiological effects of music: Tomatis, Mozart and
Kellerman, G. R., & Gorman, J. M. (2005). Auditory abnormalities in neuropsychology. Integrative Physiological and Behavioral
autism: Toward functional distinctions among findings. CNS Science, 35(3), 174–188.
Spectrums, 10(9), 748–756. Thorndike, R., Hagen, E., & Sattler, J. (1986). The Stanford-Binet
Lepisto, T., Kujala, T., Vanhala, R., Alku, P., Huotilainen, M., & intelligence scale (4th ed., SB4). Itasca, IL: The Riverside
Naatanen, R. (2005). The discrimination of and orienting to Publishing Company.
speech and non-speech sounds in children with autism. Brain
Research, 1066(1–2), 147–157.

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