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Effects of different types of auditory temporal training on language skills: a systematic review

Abstract

Previous studies have investigated the effects of auditory temporal training on language disorders. Recently, the effects of new approaches, such as musical training and the use of software, have also been considered. To investigate the effects of different auditory temporal training approaches on language skills, we reviewed the available literature on musical training, the use of software and formal auditory training by searching the SciELO, MEDLINE, LILACS-BIREME and EMBASE databases. Study Design: Systematic review. Results: Using evidence levels I and II as the criteria, 29 of the 523 papers found were deemed relevant to one of the topics (use of software - 13 papers; formal auditory training - six papers; and musical training - 10 papers). Of the three approaches, studies that investigated the use of software and musical training had the highest levels of evidence; however, these studies also raised concerns about the hypothesized relationship between auditory temporal processing and language. Future studies are necessary to investigate the actual contribution of these three types of auditory temporal training to language skills.

Training; Hearing; Language, Music; Software


INTRODUCTION

Since the 1990s, research has supported the hypothesis, initially proposed by Tallal & Piercy (11. Tallal P, Piercy M. Developmental aphasia: impaired rate of non-verbal processing as a function of sensory modality. Neuropsychol. 1973;11(4):389-98.), that language disorders are related to a deficit in auditory temporal processing (22. Tallal P. Auditory temporal perception, phonics and reading disabilities in children. Brain Lang. 1980;9(2):182-98.

3. Fitch RH, Miller S, Tallal P. Neurobiology of speech perception. Annu Rev Neurosci. 1997;20:331-53.
-44. Habib M. The neurological basis of developmental dyslexia. An overview and working hypothesis. Brain. 2000;123 Pt 12:2373-99.). According to Habib (44. Habib M. The neurological basis of developmental dyslexia. An overview and working hypothesis. Brain. 2000;123 Pt 12:2373-99.), difficulties are observed in the processing of the temporal characteristics of different types of sensory stimuli, including auditory, visual and sensory-motor stimuli, when the stimuli are presented in rapid succession. More specifically, difficulty involving auditory temporal processing is expressed as a limited capacity to process “short acoustical elements”, such as consonants, that comprise the rapid transition of formants. Limitations in this capacity can lead to difficulties, such as associating letters with their specific sounds, which can potentially result in dyslexia.

Based on this hypothesis, a large number of studies have investigated the effects of auditory temporal training on language skills (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.

6. Cohen W, Hodson A, O'Hare A, Boyle J, Durrani T, McCartney E, et al. Effects of computer-based intervention through acoustically modified speech (Fast ForWord) in severe mixed receptive-expres-sive language impairment: outcomes from a randomized controlled trial. J Speech Lang Hear Res. 2005;48(3):715-29.

7. Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, et al. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. J Speech Lang Hear Res. 2008;51(1):97-119.

8. Given BK, Wasserman JD, Chari SA, Beattie K, Eden GF. A randomized, controlled study of computer-based intervention in middle school struggling readers. Brain Lang. 2008;106(2):83-97.

9. Pinheiro FH, Capellini SA. Auditory training in students with learning disabilities. Pro Fono. 2010;22(1):49-54.

10. Murphy CFB, Schochat E. Effect of non-linguistic auditory training on phonological and reading skills. Folia Phoniatr Logop. 2011;63(3):147-53.

11. Halliday LF, Taylor JL, Millward KE, Moore DR Lack of generalization of auditory learning in typically developing children. J Speech Lang Hear Res. 2012;55(1):168-81.

12. Heim S, Keil A, Choudhury N, Thomas Friedman J, Benasich AA. Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: Changes in neural mass activity after training. Neuropsychol. 2013;24;51(5):990-1001.

13. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166(7):805-11.

14. Gaab N, Gabrieli JD, Deutsch GK, Tallal P, Temple E. Neural correlates of rapid auditory processing are disrupted in children with developmental dyslexia and ameliorated with training: an fMRI study. Restor Neurol Neurosci. 2007;25(3-4):295-310.

15. Russo NM, Nicol TG, Zecker SG, Hayes EA, Kraus N. Auditory training improves neural timing in the human brainstem. Behav Brain Res. 2005; 156(1):95-103.

16. Strehlow U, Haffner J, Bischof J, Gratzka V, Parzer P, Resch F. Does successful training of temporal processing of sound and phoneme stimuli improve reading and spelling? Eur Child Adolesc Psychiatry. 2006;15(1):19-29.

17. Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Neural plasticity following auditory training in children with learning problems. Clin Neurophysiol. 2003;114(4):673-84.

18. Megale RL, Iorio MC, Schochat E. Auditory training: assessment of the benefit of hearing aid in elderly individuals. Pro Fono. 2010;22(2):101-6.

19. Gil D, Iorio MC. Formal auditory training in adult hearing aid users. Clinics. 2010;65(2):165-74.

20. Filippini R, Beffi-Lopes DM, Schochat E Efficacy of auditory training using the ABR to complex sounds: Auditory Processing Disorder and Specific Language Impairment. Folia Phoniatr Logop. 2012;64(5):217-26.

21. Vilela N, Wertzner HF, Sanches SGG, Neves-Lobo IF, Carvallo RMM. Processamento temporal de crianças com transtorno fonológico submetidas ao treino auditivo: estudo piloto. J. Soc. Bras. Fonoaudiol. 2012;24(1):42-8.

22. Miranda EC, Gil D, Iório MC. Formal auditory training in elderly hearing aid users. Braz J Otorhinolaryngol. 2008;74(6):919-25.
-2323. Schochat E, Musiek FE, Alonso R, Ogata J. Effect of auditory training on the middle latency response in children with (central) auditory processing disorder. Braz J Med Biol Res. 2010;43(8):777-85.). One topic that is still being actively debated concerns the effectiveness of new approaches to auditory training, such as the use of software (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.

6. Cohen W, Hodson A, O'Hare A, Boyle J, Durrani T, McCartney E, et al. Effects of computer-based intervention through acoustically modified speech (Fast ForWord) in severe mixed receptive-expres-sive language impairment: outcomes from a randomized controlled trial. J Speech Lang Hear Res. 2005;48(3):715-29.

7. Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, et al. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. J Speech Lang Hear Res. 2008;51(1):97-119.

8. Given BK, Wasserman JD, Chari SA, Beattie K, Eden GF. A randomized, controlled study of computer-based intervention in middle school struggling readers. Brain Lang. 2008;106(2):83-97.

9. Pinheiro FH, Capellini SA. Auditory training in students with learning disabilities. Pro Fono. 2010;22(1):49-54.

10. Murphy CFB, Schochat E. Effect of non-linguistic auditory training on phonological and reading skills. Folia Phoniatr Logop. 2011;63(3):147-53.

11. Halliday LF, Taylor JL, Millward KE, Moore DR Lack of generalization of auditory learning in typically developing children. J Speech Lang Hear Res. 2012;55(1):168-81.

12. Heim S, Keil A, Choudhury N, Thomas Friedman J, Benasich AA. Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: Changes in neural mass activity after training. Neuropsychol. 2013;24;51(5):990-1001.

13. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166(7):805-11.

14. Gaab N, Gabrieli JD, Deutsch GK, Tallal P, Temple E. Neural correlates of rapid auditory processing are disrupted in children with developmental dyslexia and ameliorated with training: an fMRI study. Restor Neurol Neurosci. 2007;25(3-4):295-310.

15. Russo NM, Nicol TG, Zecker SG, Hayes EA, Kraus N. Auditory training improves neural timing in the human brainstem. Behav Brain Res. 2005; 156(1):95-103.

16. Strehlow U, Haffner J, Bischof J, Gratzka V, Parzer P, Resch F. Does successful training of temporal processing of sound and phoneme stimuli improve reading and spelling? Eur Child Adolesc Psychiatry. 2006;15(1):19-29.
-1717. Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Neural plasticity following auditory training in children with learning problems. Clin Neurophysiol. 2003;114(4):673-84.) and musical training (2424. Overy K. Dyslexia and music. From timing deficits to musical intervention. Ann NY Acad Sci. 2003;999:497-505.

25. Dege F, Schwarzer G. The effect of a music program on phonological awareness in preschoolers. Front Psychol. 2011;2:124.

26. Gerry D, Unrau A, Trainor LJ. Active music in infancy enhance musical, communicative and social development. Dev Sci. 2012;15(3):398-407.

27. Moreno S, Besson M. Musical training and language-related brain electrical activity in children. Psychophysiol. 2006;43:287-291.

28. Yucel E, Sennaroglu G, Belgin E. The family oriented musical training for children with cochlear implants: speech and musical perception results of two year follow-up. Int J Pediatr Otorhinolaryngol. 2009;73(7):1043-52.

29. Moreno S, Marques C, Santos A, Santos M, Castro SL, Besson M. Musical training influences linguistic abilities in 8-year-old children: more evidence for brain plasticity. Cereb Cortex. 2009;19(3):712-23.

30. Chobert J, François C, Velay JL, Besson M. Twelve Months of Active Musical Training in 8- to 10-Year-Old Children Enhances the Preattentive Processing of Syllabic Duration and Voice Onset Time. Cereb Cortex. 2012 Dec 12. [Epub ahead of print].

31. Bolduc J. Effect of a music programme on kindergartners's phonological awareness skills 1. International Journal of Music Education. 2009;27(1):37-47.

32. Fujioka T, Ross B, Kakigi R, Pantev C, Trainor LJ. One year of musical training affects development of auditory cortical-evoked fields in young children. Brain. 2006;129(Pt 10):2593-608.
-3333. Gromko J. The effect of music instruction on phonemic awareness in beginning readers. Journal of Research in Music Education. 2005; 53(3):199.), compared with more traditional types of auditory training (1818. Megale RL, Iorio MC, Schochat E. Auditory training: assessment of the benefit of hearing aid in elderly individuals. Pro Fono. 2010;22(2):101-6.

19. Gil D, Iorio MC. Formal auditory training in adult hearing aid users. Clinics. 2010;65(2):165-74.

20. Filippini R, Beffi-Lopes DM, Schochat E Efficacy of auditory training using the ABR to complex sounds: Auditory Processing Disorder and Specific Language Impairment. Folia Phoniatr Logop. 2012;64(5):217-26.

21. Vilela N, Wertzner HF, Sanches SGG, Neves-Lobo IF, Carvallo RMM. Processamento temporal de crianças com transtorno fonológico submetidas ao treino auditivo: estudo piloto. J. Soc. Bras. Fonoaudiol. 2012;24(1):42-8.

22. Miranda EC, Gil D, Iório MC. Formal auditory training in elderly hearing aid users. Braz J Otorhinolaryngol. 2008;74(6):919-25.
-2323. Schochat E, Musiek FE, Alonso R, Ogata J. Effect of auditory training on the middle latency response in children with (central) auditory processing disorder. Braz J Med Biol Res. 2010;43(8):777-85.) that take place in acoustic cabins (“formal auditory training”). Currently, no consensus has been reached regarding the most effective approach to improving language skills such as phonological awareness, reading and speech discrimination.

The purpose of this paper is to perform a systematic review of the effects of different types of auditory temporal training on language skills; we focus on three main approaches: the use of software, formal auditory training and musical training.

METHOD

For this systematic review, a search was performed between March and April 2013 for papers published in Portuguese, English and Spanish. The following databases were searched: MEDLINE, SciELO, EMBASE and LILACS-BIREME. The keywords used in the search included “dyslexia”, “language skills”, “poor readers”, “literacy”, “learning”, “learning impairment”, language impairment”, “music education”, “computer-based auditory training”, “auditory intervention”, “auditory temporal processing”, “musical training”, “language” and the corresponding words in Portuguese and Spanish. In addition to the keywords listed above, “auditory perceptual disorders” and “language development disorders” were also included in a search of MeSH (Medical Subject Headings). There were no date restrictions, and the keywords were always combined. For selection from the search results, papers had to: include a main goal of investigating the effects of training on auditory and/or language skills, contain a description of the type of intervention and the post-training implications and be classifiable as level I or II in the evidence hierarchy proposed by American Speech-Language-Hearing Association (3434. American Speech-Language Hearing Association. Evidence-based practice in communication disorders: an introduction (technical report). 2004, http://www.asha.org/docs/html/TR2004-00001.html.
http://www.asha.org/docs/html/TR2004-000...
), which is presented in Table 1.

Table 1
Levels of evidence of the treatment efficacy studies (ASHA, 2004).

RESULTS

From a sample of 523 papers, 29 original papers classified as evidence levels I and II were included. The results will be discussed within the context of the type of training employed. We found papers related to the use of software (13 papers), formal auditory training (six papers) and musical training (10 papers).

Use of software

Table 2 shows the 13 papers that investigated auditory temporal training using different types of software (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.

6. Cohen W, Hodson A, O'Hare A, Boyle J, Durrani T, McCartney E, et al. Effects of computer-based intervention through acoustically modified speech (Fast ForWord) in severe mixed receptive-expres-sive language impairment: outcomes from a randomized controlled trial. J Speech Lang Hear Res. 2005;48(3):715-29.

7. Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, et al. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. J Speech Lang Hear Res. 2008;51(1):97-119.

8. Given BK, Wasserman JD, Chari SA, Beattie K, Eden GF. A randomized, controlled study of computer-based intervention in middle school struggling readers. Brain Lang. 2008;106(2):83-97.

9. Pinheiro FH, Capellini SA. Auditory training in students with learning disabilities. Pro Fono. 2010;22(1):49-54.

10. Murphy CFB, Schochat E. Effect of non-linguistic auditory training on phonological and reading skills. Folia Phoniatr Logop. 2011;63(3):147-53.

11. Halliday LF, Taylor JL, Millward KE, Moore DR Lack of generalization of auditory learning in typically developing children. J Speech Lang Hear Res. 2012;55(1):168-81.

12. Heim S, Keil A, Choudhury N, Thomas Friedman J, Benasich AA. Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: Changes in neural mass activity after training. Neuropsychol. 2013;24;51(5):990-1001.

13. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166(7):805-11.

14. Gaab N, Gabrieli JD, Deutsch GK, Tallal P, Temple E. Neural correlates of rapid auditory processing are disrupted in children with developmental dyslexia and ameliorated with training: an fMRI study. Restor Neurol Neurosci. 2007;25(3-4):295-310.

15. Russo NM, Nicol TG, Zecker SG, Hayes EA, Kraus N. Auditory training improves neural timing in the human brainstem. Behav Brain Res. 2005; 156(1):95-103.

16. Strehlow U, Haffner J, Bischof J, Gratzka V, Parzer P, Resch F. Does successful training of temporal processing of sound and phoneme stimuli improve reading and spelling? Eur Child Adolesc Psychiatry. 2006;15(1):19-29.
-1717. Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Neural plasticity following auditory training in children with learning problems. Clin Neurophysiol. 2003;114(4):673-84.). All of the papers included were randomized and/or controlled trials; therefore, these papers belonged to evidence levels I and II. Differences in the study groups (typically developing children, children with dyslexia, children with language impairment and learning impairment and adults with schizophrenia), types of software used (Fast ForWord, Earobics, AudioTraining, Treinamento Temporal Auditivo com estímulos não-verbais e verbais com fala expandida, STAR and others based on the Fast ForWord) and study designs, such as the inclusion of a comparison training group and the types of pre- and post-assessments, are systematized in the table.

Table 2
Auditory temporal training using different types of software.

Of these 13 papers, 10 included auditory temporal processing and language assessment before and after training (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.,77. Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, et al. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. J Speech Lang Hear Res. 2008;51(1):97-119.,1010. Murphy CFB, Schochat E. Effect of non-linguistic auditory training on phonological and reading skills. Folia Phoniatr Logop. 2011;63(3):147-53.

11. Halliday LF, Taylor JL, Millward KE, Moore DR Lack of generalization of auditory learning in typically developing children. J Speech Lang Hear Res. 2012;55(1):168-81.

12. Heim S, Keil A, Choudhury N, Thomas Friedman J, Benasich AA. Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: Changes in neural mass activity after training. Neuropsychol. 2013;24;51(5):990-1001.

13. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166(7):805-11.

14. Gaab N, Gabrieli JD, Deutsch GK, Tallal P, Temple E. Neural correlates of rapid auditory processing are disrupted in children with developmental dyslexia and ameliorated with training: an fMRI study. Restor Neurol Neurosci. 2007;25(3-4):295-310.

15. Russo NM, Nicol TG, Zecker SG, Hayes EA, Kraus N. Auditory training improves neural timing in the human brainstem. Behav Brain Res. 2005; 156(1):95-103.

16. Strehlow U, Haffner J, Bischof J, Gratzka V, Parzer P, Resch F. Does successful training of temporal processing of sound and phoneme stimuli improve reading and spelling? Eur Child Adolesc Psychiatry. 2006;15(1):19-29.
-1717. Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Neural plasticity following auditory training in children with learning problems. Clin Neurophysiol. 2003;114(4):673-84.). Of these 10 papers, 7 indicated learning gains in auditory and language skills only in the study group after training based on behavioral (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.,1010. Murphy CFB, Schochat E. Effect of non-linguistic auditory training on phonological and reading skills. Folia Phoniatr Logop. 2011;63(3):147-53.,1313. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166(7):805-11.,1616. Strehlow U, Haffner J, Bischof J, Gratzka V, Parzer P, Resch F. Does successful training of temporal processing of sound and phoneme stimuli improve reading and spelling? Eur Child Adolesc Psychiatry. 2006;15(1):19-29.) and electrophysiological measures (1212. Heim S, Keil A, Choudhury N, Thomas Friedman J, Benasich AA. Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: Changes in neural mass activity after training. Neuropsychol. 2013;24;51(5):990-1001.,1515. Russo NM, Nicol TG, Zecker SG, Hayes EA, Kraus N. Auditory training improves neural timing in the human brainstem. Behav Brain Res. 2005; 156(1):95-103.,1717. Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Neural plasticity following auditory training in children with learning problems. Clin Neurophysiol. 2003;114(4):673-84.). Therefore, these findings support the hypothesized relationship between auditory temporal processing and language skills (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.,1010. Murphy CFB, Schochat E. Effect of non-linguistic auditory training on phonological and reading skills. Folia Phoniatr Logop. 2011;63(3):147-53.,1212. Heim S, Keil A, Choudhury N, Thomas Friedman J, Benasich AA. Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: Changes in neural mass activity after training. Neuropsychol. 2013;24;51(5):990-1001.,1313. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166(7):805-11.,1515. Russo NM, Nicol TG, Zecker SG, Hayes EA, Kraus N. Auditory training improves neural timing in the human brainstem. Behav Brain Res. 2005; 156(1):95-103.

16. Strehlow U, Haffner J, Bischof J, Gratzka V, Parzer P, Resch F. Does successful training of temporal processing of sound and phoneme stimuli improve reading and spelling? Eur Child Adolesc Psychiatry. 2006;15(1):19-29.
-1717. Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Neural plasticity following auditory training in children with learning problems. Clin Neurophysiol. 2003;114(4):673-84.). However, relevant methodological concerns are present in some of these studies. Tallal et al. (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.), Fisher et al. (1313. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166(7):805-11.) and Strehlow et al. (1616. Strehlow U, Haffner J, Bischof J, Gratzka V, Parzer P, Resch F. Does successful training of temporal processing of sound and phoneme stimuli improve reading and spelling? Eur Child Adolesc Psychiatry. 2006;15(1):19-29.) did not investigate the presence of a test-retest effect by including a non-trained group (control group). Additionally, Heim et al. (1212. Heim S, Keil A, Choudhury N, Thomas Friedman J, Benasich AA. Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: Changes in neural mass activity after training. Neuropsychol. 2013;24;51(5):990-1001.), Russo et al. (1515. Russo NM, Nicol TG, Zecker SG, Hayes EA, Kraus N. Auditory training improves neural timing in the human brainstem. Behav Brain Res. 2005; 156(1):95-103.) and Hayes et al. (1717. Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Neural plasticity following auditory training in children with learning problems. Clin Neurophysiol. 2003;114(4):673-84.) did not include an alternative training group to investigate whether the improvement after training was specifically related to the type of training, for example, auditory temporal training. Murphy and Schochat (1010. Murphy CFB, Schochat E. Effect of non-linguistic auditory training on phonological and reading skills. Folia Phoniatr Logop. 2011;63(3):147-53.) investigated the influence of non-verbal auditory training on language skills in two experiments. In the first experiment, only the group of children with dyslexia that underwent auditory temporal training exhibited improvement in language skills compared to an untrained control group; in the second experiment, a group of children with dyslexia exhibited improvement in language skills following auditory training, but not after a period with an alternative intervention (language training). The other three studies reached varying conclusions: in the Gillan et al. study (77. Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, et al. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. J Speech Lang Hear Res. 2008;51(1):97-119.), auditory and language skill improvement occurred for all of the trained groups of children with language disorders (i.e., the study group and the alternative groups) demonstrating that the auditory temporal training was as effective as language training; in the Halliday et al. study (1111. Halliday LF, Taylor JL, Millward KE, Moore DR Lack of generalization of auditory learning in typically developing children. J Speech Lang Hear Res. 2012;55(1):168-81.), although the trained group (children with typical development) exhibited improvements in auditory temporal processing after training, this learning did not generalize to the language skills, which casts doubt on the use of auditory training to improve language; in the Gaab et al. study (1414. Gaab N, Gabrieli JD, Deutsch GK, Tallal P, Temple E. Neural correlates of rapid auditory processing are disrupted in children with developmental dyslexia and ameliorated with training: an fMRI study. Restor Neurol Neurosci. 2007;25(3-4):295-310.), although there was no gain in auditory skills after training, the language skills of the children with dyslexia improved. Therefore, the authors discussed whether the improvement in language after training might have been related to the improvement of indirectly trained skills, such as cognitive skills, rather than sensory capacity, such as auditory temporal processing.

The other three studies only investigated language skills after auditory temporal training (66. Cohen W, Hodson A, O'Hare A, Boyle J, Durrani T, McCartney E, et al. Effects of computer-based intervention through acoustically modified speech (Fast ForWord) in severe mixed receptive-expres-sive language impairment: outcomes from a randomized controlled trial. J Speech Lang Hear Res. 2005;48(3):715-29.,88. Given BK, Wasserman JD, Chari SA, Beattie K, Eden GF. A randomized, controlled study of computer-based intervention in middle school struggling readers. Brain Lang. 2008;106(2):83-97.,99. Pinheiro FH, Capellini SA. Auditory training in students with learning disabilities. Pro Fono. 2010;22(1):49-54.). Cohen et al. (66. Cohen W, Hodson A, O'Hare A, Boyle J, Durrani T, McCartney E, et al. Effects of computer-based intervention through acoustically modified speech (Fast ForWord) in severe mixed receptive-expres-sive language impairment: outcomes from a randomized controlled trial. J Speech Lang Hear Res. 2005;48(3):715-29.) reported improvements in language skills for all groups (including a non-trained group), which may indicate the presence of a test-retest effect; Given et al. (88. Given BK, Wasserman JD, Chari SA, Beattie K, Eden GF. A randomized, controlled study of computer-based intervention in middle school struggling readers. Brain Lang. 2008;106(2):83-97.) corroborated the results of Gillan et al. (77. Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, et al. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. J Speech Lang Hear Res. 2008;51(1):97-119.) by reporting improvements following all types of training, which indicates that the success of training in terms of improving language skills is not necessarily related to a specific focus on temporal aspects; Pinheiro & Capellini (99. Pinheiro FH, Capellini SA. Auditory training in students with learning disabilities. Pro Fono. 2010;22(1):49-54.) reported an improvement in the trained group only, although there was no alternatively trained group for comparison in this study.

Formal auditory temporal training

Table 3 shows the six papers that investigated the effectiveness of formal auditory temporal training (using an acoustic cabin) (1818. Megale RL, Iorio MC, Schochat E. Auditory training: assessment of the benefit of hearing aid in elderly individuals. Pro Fono. 2010;22(2):101-6.

19. Gil D, Iorio MC. Formal auditory training in adult hearing aid users. Clinics. 2010;65(2):165-74.

20. Filippini R, Beffi-Lopes DM, Schochat E Efficacy of auditory training using the ABR to complex sounds: Auditory Processing Disorder and Specific Language Impairment. Folia Phoniatr Logop. 2012;64(5):217-26.

21. Vilela N, Wertzner HF, Sanches SGG, Neves-Lobo IF, Carvallo RMM. Processamento temporal de crianças com transtorno fonológico submetidas ao treino auditivo: estudo piloto. J. Soc. Bras. Fonoaudiol. 2012;24(1):42-8.

22. Miranda EC, Gil D, Iório MC. Formal auditory training in elderly hearing aid users. Braz J Otorhinolaryngol. 2008;74(6):919-25.
-2323. Schochat E, Musiek FE, Alonso R, Ogata J. Effect of auditory training on the middle latency response in children with (central) auditory processing disorder. Braz J Med Biol Res. 2010;43(8):777-85.). The samples were diverse and included children with language disorders, children with auditory processing disorders and adult and elderly hearing aid users. All papers were controlled, with high levels of evidence (I or II) according to the ASHA criteria (3434. American Speech-Language Hearing Association. Evidence-based practice in communication disorders: an introduction (technical report). 2004, http://www.asha.org/docs/html/TR2004-00001.html.
http://www.asha.org/docs/html/TR2004-000...
).

Table 3
Formal auditory temporal training.

Of the six papers, only one analyzed auditory temporal processing and language following auditory temporal training (1919. Gil D, Iorio MC. Formal auditory training in adult hearing aid users. Clinics. 2010;65(2):165-74.). The researchers applied the auditory training to a group of adult hearing aid users. Compared to the untrained group, the results showed that the trained group exhibited improvements in temporal processing after training that were verified by electrophysiological measures of auditory function (reduced of P3 latencies). The trained group also exhibited improvements in language that were verified by the application of a self-assessment questionnaire that quantified auditory difficulties experienced in daily situations involving communication in quiet, noisy and reverberant environments.

Of the other five papers, one investigated the effects of formal auditory training on language skills (1818. Megale RL, Iorio MC, Schochat E. Auditory training: assessment of the benefit of hearing aid in elderly individuals. Pro Fono. 2010;22(2):101-6.), and the other four investigated the effects on auditory skills (2020. Filippini R, Beffi-Lopes DM, Schochat E Efficacy of auditory training using the ABR to complex sounds: Auditory Processing Disorder and Specific Language Impairment. Folia Phoniatr Logop. 2012;64(5):217-26.

21. Vilela N, Wertzner HF, Sanches SGG, Neves-Lobo IF, Carvallo RMM. Processamento temporal de crianças com transtorno fonológico submetidas ao treino auditivo: estudo piloto. J. Soc. Bras. Fonoaudiol. 2012;24(1):42-8.

22. Miranda EC, Gil D, Iório MC. Formal auditory training in elderly hearing aid users. Braz J Otorhinolaryngol. 2008;74(6):919-25.
-2323. Schochat E, Musiek FE, Alonso R, Ogata J. Effect of auditory training on the middle latency response in children with (central) auditory processing disorder. Braz J Med Biol Res. 2010;43(8):777-85.). Megale and Schochat (1818. Megale RL, Iorio MC, Schochat E. Auditory training: assessment of the benefit of hearing aid in elderly individuals. Pro Fono. 2010;22(2):101-6.) investigated the effectiveness of formal auditory training in elderly hearing aid users and reported effects similar to those of the Gil & Iorio study (1919. Gil D, Iorio MC. Formal auditory training in adult hearing aid users. Clinics. 2010;65(2):165-74.). Using the Abbreviated Profile of Hearing Aid Benefit (APHAB) self-report scale, these researchers also demonstrated qualitative improvements in language skills after training. Auditory temporal skills were not investigated, but auditory closure and auditory figure-ground skills improved after training.

Of the other four papers, three reported gains in auditory temporal processing after training using electrophysiological (2020. Filippini R, Beffi-Lopes DM, Schochat E Efficacy of auditory training using the ABR to complex sounds: Auditory Processing Disorder and Specific Language Impairment. Folia Phoniatr Logop. 2012;64(5):217-26.,2323. Schochat E, Musiek FE, Alonso R, Ogata J. Effect of auditory training on the middle latency response in children with (central) auditory processing disorder. Braz J Med Biol Res. 2010;43(8):777-85.) and behavioral measures (2020. Filippini R, Beffi-Lopes DM, Schochat E Efficacy of auditory training using the ABR to complex sounds: Auditory Processing Disorder and Specific Language Impairment. Folia Phoniatr Logop. 2012;64(5):217-26.,2222. Miranda EC, Gil D, Iório MC. Formal auditory training in elderly hearing aid users. Braz J Otorhinolaryngol. 2008;74(6):919-25.). Filippini et al. (2020. Filippini R, Beffi-Lopes DM, Schochat E Efficacy of auditory training using the ABR to complex sounds: Auditory Processing Disorder and Specific Language Impairment. Folia Phoniatr Logop. 2012;64(5):217-26.) applied formal auditory training to groups of children with both language and auditory processing disorders; in contrast to the untrained group, both of the trained groups showed improvements in auditory temporal skills after training, as demonstrated by improved performance in behavioral measures of auditory processing and a reduction of the latency of the auditory brainstem response to complex sounds in background noise (c-ABR). Like Gil & Iorio (1919. Gil D, Iorio MC. Formal auditory training in adult hearing aid users. Clinics. 2010;65(2):165-74.) and Megale et al. (1818. Megale RL, Iorio MC, Schochat E. Auditory training: assessment of the benefit of hearing aid in elderly individuals. Pro Fono. 2010;22(2):101-6.), Miranda et al. (2222. Miranda EC, Gil D, Iório MC. Formal auditory training in elderly hearing aid users. Braz J Otorhinolaryngol. 2008;74(6):919-25.) applied formal auditory training to a group of elderly hearing aid users and compared that group to a non-trained group (control group) of elderly hearing aid users. The results of this study also indicated greater gains in auditory skills in the trained group compared to the control group. In contrast, Villela et al. (2121. Vilela N, Wertzner HF, Sanches SGG, Neves-Lobo IF, Carvallo RMM. Processamento temporal de crianças com transtorno fonológico submetidas ao treino auditivo: estudo piloto. J. Soc. Bras. Fonoaudiol. 2012;24(1):42-8.) compared children with phonological disorders who received formal auditory training to children who received alternative training (informal training) and an untrained group. Neither of the trained groups exhibited any significant differences in auditory temporal skills before and after training, a result that was likely related to the small sample of participants in the study.

All studies applied formal auditory training using similar materials (compact discs with tasks involving auditory closure, temporal ordering, figure to ground for digits, sentences and non-verbal sounds) and the procedures employed by Musiek and Schochat (3535. Musiek FE, Schochat E. Auditory training and central auditory processing disorders. Semin Hear. 1998;19(4):357-66.).

Musical training

Table 4 lists 10 papers that investigated musical training and that were classified as evidence level I or II (2424. Overy K. Dyslexia and music. From timing deficits to musical intervention. Ann NY Acad Sci. 2003;999:497-505.

25. Dege F, Schwarzer G. The effect of a music program on phonological awareness in preschoolers. Front Psychol. 2011;2:124.

26. Gerry D, Unrau A, Trainor LJ. Active music in infancy enhance musical, communicative and social development. Dev Sci. 2012;15(3):398-407.

27. Moreno S, Besson M. Musical training and language-related brain electrical activity in children. Psychophysiol. 2006;43:287-291.

28. Yucel E, Sennaroglu G, Belgin E. The family oriented musical training for children with cochlear implants: speech and musical perception results of two year follow-up. Int J Pediatr Otorhinolaryngol. 2009;73(7):1043-52.

29. Moreno S, Marques C, Santos A, Santos M, Castro SL, Besson M. Musical training influences linguistic abilities in 8-year-old children: more evidence for brain plasticity. Cereb Cortex. 2009;19(3):712-23.

30. Chobert J, François C, Velay JL, Besson M. Twelve Months of Active Musical Training in 8- to 10-Year-Old Children Enhances the Preattentive Processing of Syllabic Duration and Voice Onset Time. Cereb Cortex. 2012 Dec 12. [Epub ahead of print].

31. Bolduc J. Effect of a music programme on kindergartners's phonological awareness skills 1. International Journal of Music Education. 2009;27(1):37-47.

32. Fujioka T, Ross B, Kakigi R, Pantev C, Trainor LJ. One year of musical training affects development of auditory cortical-evoked fields in young children. Brain. 2006;129(Pt 10):2593-608.
-3333. Gromko J. The effect of music instruction on phonemic awareness in beginning readers. Journal of Research in Music Education. 2005; 53(3):199.). Infants, typically developing children, children with dyslexia and children with cochlear implants were included.

Table 4
Musical training.

Of the ten papers selected, five investigated auditory temporal skills and language skills before and after music training (2424. Overy K. Dyslexia and music. From timing deficits to musical intervention. Ann NY Acad Sci. 2003;999:497-505.,2626. Gerry D, Unrau A, Trainor LJ. Active music in infancy enhance musical, communicative and social development. Dev Sci. 2012;15(3):398-407.,2828. Yucel E, Sennaroglu G, Belgin E. The family oriented musical training for children with cochlear implants: speech and musical perception results of two year follow-up. Int J Pediatr Otorhinolaryngol. 2009;73(7):1043-52.,2929. Moreno S, Marques C, Santos A, Santos M, Castro SL, Besson M. Musical training influences linguistic abilities in 8-year-old children: more evidence for brain plasticity. Cereb Cortex. 2009;19(3):712-23.,3131. Bolduc J. Effect of a music programme on kindergartners's phonological awareness skills 1. International Journal of Music Education. 2009;27(1):37-47.), and all of these papers reported gains in both skills. Three of these studies investigated the effect of music training on infants and children with typical development (2626. Gerry D, Unrau A, Trainor LJ. Active music in infancy enhance musical, communicative and social development. Dev Sci. 2012;15(3):398-407.,2929. Moreno S, Marques C, Santos A, Santos M, Castro SL, Besson M. Musical training influences linguistic abilities in 8-year-old children: more evidence for brain plasticity. Cereb Cortex. 2009;19(3):712-23.,3131. Bolduc J. Effect of a music programme on kindergartners's phonological awareness skills 1. International Journal of Music Education. 2009;27(1):37-47.). For example, Gerry et al. (2626. Gerry D, Unrau A, Trainor LJ. Active music in infancy enhance musical, communicative and social development. Dev Sci. 2012;15(3):398-407.) compared the effects of passive musical experiences (just listening to music) and active musical experiences (singing lessons, practice with percussion instruments and rhythm classes) in six-month-old-infants. Both groups were compared to an untrained group. The results demonstrated that, compared to infants assigned to the passive musical experience, the active group showed superior development of prelinguistic communication gestures and social behavior after training. Additionally, the active training group exhibited accelerated acquisition of knowledge about Western musical tonality and exhibited improvements in pitch discrimination after active training. In the Moreno et al. (2929. Moreno S, Marques C, Santos A, Santos M, Castro SL, Besson M. Musical training influences linguistic abilities in 8-year-old children: more evidence for brain plasticity. Cereb Cortex. 2009;19(3):712-23.) and Bolduc (3131. Bolduc J. Effect of a music programme on kindergartners's phonological awareness skills 1. International Journal of Music Education. 2009;27(1):37-47.) studies, music training was applied to groups of children who were compared to alternative groups that received either painting training (2929. Moreno S, Marques C, Santos A, Santos M, Castro SL, Besson M. Musical training influences linguistic abilities in 8-year-old children: more evidence for brain plasticity. Cereb Cortex. 2009;19(3):712-23.) or alternative musical training (3131. Bolduc J. Effect of a music programme on kindergartners's phonological awareness skills 1. International Journal of Music Education. 2009;27(1):37-47.). Moreno's study reported that, after musical training, the study group showed enhanced reading and pitch discrimination skills in speech as indicated by the amplitudes of specific event-related potential components elicited in music and speech tasks. The authors concluded that the results indicated brain plasticity by showing that relatively short periods of training (24 weeks) had strong effects on the functional organization of the children's brains. In the Bolduc study (3131. Bolduc J. Effect of a music programme on kindergartners's phonological awareness skills 1. International Journal of Music Education. 2009;27(1):37-47.), after a specific music training program (Standley and Hughes music training), the study group exhibited gains in tonal and rhythmic perceptive skills and phonological awareness skills.

The positive effects of music training on language and auditory skills have also been demonstrated in infants and children with specific impairments, such as children with dyslexia (2424. Overy K. Dyslexia and music. From timing deficits to musical intervention. Ann NY Acad Sci. 2003;999:497-505.) and profoundly deaf infants with cochlear implants (2828. Yucel E, Sennaroglu G, Belgin E. The family oriented musical training for children with cochlear implants: speech and musical perception results of two year follow-up. Int J Pediatr Otorhinolaryngol. 2009;73(7):1043-52.). Overy et al. (2424. Overy K. Dyslexia and music. From timing deficits to musical intervention. Ann NY Acad Sci. 2003;999:497-505.) analyzed the effect of musical training on children with dyslexia and reported a significant improvement in auditory temporal skills after training that was verified with tasks involving rapid auditory processing and phonological skills. The authors suggested that timing skills might play a key role in the transfer of musical abilities to language abilities. Yucel et al. (2828. Yucel E, Sennaroglu G, Belgin E. The family oriented musical training for children with cochlear implants: speech and musical perception results of two year follow-up. Int J Pediatr Otorhinolaryngol. 2009;73(7):1043-52.) applied musical training to infants and children with cochlear implants. To investigate the effects of the training, language and auditory temporal processing assessments were performed before and after training and were compared between the trained group and an untrained control group. The researchers that the music group showed greater improvements in the discrimination of pairs of notes and greater improvements on tests that examined different levels of speech perception.

Of the other five studies, three only investigated auditory skills after training (2727. Moreno S, Besson M. Musical training and language-related brain electrical activity in children. Psychophysiol. 2006;43:287-291.,3030. Chobert J, François C, Velay JL, Besson M. Twelve Months of Active Musical Training in 8- to 10-Year-Old Children Enhances the Preattentive Processing of Syllabic Duration and Voice Onset Time. Cereb Cortex. 2012 Dec 12. [Epub ahead of print].,3232. Fujioka T, Ross B, Kakigi R, Pantev C, Trainor LJ. One year of musical training affects development of auditory cortical-evoked fields in young children. Brain. 2006;129(Pt 10):2593-608.), and the other two only investigated language skills (2525. Dege F, Schwarzer G. The effect of a music program on phonological awareness in preschoolers. Front Psychol. 2011;2:124.,3333. Gromko J. The effect of music instruction on phonemic awareness in beginning readers. Journal of Research in Music Education. 2005; 53(3):199.). All of the studies of auditory skills indicated gains in these skills after training. For example, in Moreno & Besson's study (2727. Moreno S, Besson M. Musical training and language-related brain electrical activity in children. Psychophysiol. 2006;43:287-291.), the effect of musical training on typically developing children was compared with the effects of an alternative type of training (training in painting) and no training (i.e., an untrained control group). Electrophysiological measures of auditory function were assessed before and after training in all groups, and the results indicated that the amplitude of a late positive component was largest in response to strong incongruities; however, this amplitude was reduced after training only in the music group. Chobert et al. (3030. Chobert J, François C, Velay JL, Besson M. Twelve Months of Active Musical Training in 8- to 10-Year-Old Children Enhances the Preattentive Processing of Syllabic Duration and Voice Onset Time. Cereb Cortex. 2012 Dec 12. [Epub ahead of print].) applied active musical training in to children with typical development, and the mismatch negativities (MMNs) assessed before and after training were compared to a control group. While no between-group differences were identified before training, enhanced pre-attentive processing of syllabic duration and voice onset time, as reflected by greater MMN amplitudes, was noted after 12 months of training only in the music group. Fujioka et al. (3232. Fujioka T, Ross B, Kakigi R, Pantev C, Trainor LJ. One year of musical training affects development of auditory cortical-evoked fields in young children. Brain. 2006;129(Pt 10):2593-608.) also investigated auditory cortical responses (auditory evoked potentials) before and after one year of musical lessons. According to these authors, a clear musical training effect was expressed as a larger and earlier N250m peak in the left hemisphere in response to the sound of a violin in the musically trained children compared to the untrained children. The other two studies on the effects of music training on language skills also indicated gains after training (2525. Dege F, Schwarzer G. The effect of a music program on phonological awareness in preschoolers. Front Psychol. 2011;2:124.,3333. Gromko J. The effect of music instruction on phonemic awareness in beginning readers. Journal of Research in Music Education. 2005; 53(3):199.). Dege and Schwarzer (2525. Dege F, Schwarzer G. The effect of a music program on phonological awareness in preschoolers. Front Psychol. 2011;2:124.) studied the effects of musical training and the effects of two alternative types of training (phonological awareness and sports) on language skills in typically developing children. The results indicated improvements in phonological awareness after training in both the study group and the phonological awareness group. In the Gromko study (3333. Gromko J. The effect of music instruction on phonemic awareness in beginning readers. Journal of Research in Music Education. 2005; 53(3):199.), kindergarten children who received four months of music instruction showed significantly greater gains in the development of their phoneme segmentation fluency compared to children who did not receive music instruction.

DISCUSSION

Most of the papers that investigated the use of software demonstrated that this approach can be an effective form of training for improving auditory temporal processing (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.,77. Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, et al. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. J Speech Lang Hear Res. 2008;51(1):97-119.,1010. Murphy CFB, Schochat E. Effect of non-linguistic auditory training on phonological and reading skills. Folia Phoniatr Logop. 2011;63(3):147-53.

11. Halliday LF, Taylor JL, Millward KE, Moore DR Lack of generalization of auditory learning in typically developing children. J Speech Lang Hear Res. 2012;55(1):168-81.

12. Heim S, Keil A, Choudhury N, Thomas Friedman J, Benasich AA. Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: Changes in neural mass activity after training. Neuropsychol. 2013;24;51(5):990-1001.
-1313. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166(7):805-11.,1515. Russo NM, Nicol TG, Zecker SG, Hayes EA, Kraus N. Auditory training improves neural timing in the human brainstem. Behav Brain Res. 2005; 156(1):95-103.

16. Strehlow U, Haffner J, Bischof J, Gratzka V, Parzer P, Resch F. Does successful training of temporal processing of sound and phoneme stimuli improve reading and spelling? Eur Child Adolesc Psychiatry. 2006;15(1):19-29.
-1717. Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Neural plasticity following auditory training in children with learning problems. Clin Neurophysiol. 2003;114(4):673-84.). However, whether this learning generalizes to language skills remains controversial (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.

6. Cohen W, Hodson A, O'Hare A, Boyle J, Durrani T, McCartney E, et al. Effects of computer-based intervention through acoustically modified speech (Fast ForWord) in severe mixed receptive-expres-sive language impairment: outcomes from a randomized controlled trial. J Speech Lang Hear Res. 2005;48(3):715-29.

7. Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, et al. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. J Speech Lang Hear Res. 2008;51(1):97-119.

8. Given BK, Wasserman JD, Chari SA, Beattie K, Eden GF. A randomized, controlled study of computer-based intervention in middle school struggling readers. Brain Lang. 2008;106(2):83-97.

9. Pinheiro FH, Capellini SA. Auditory training in students with learning disabilities. Pro Fono. 2010;22(1):49-54.
-1010. Murphy CFB, Schochat E. Effect of non-linguistic auditory training on phonological and reading skills. Folia Phoniatr Logop. 2011;63(3):147-53.,1212. Heim S, Keil A, Choudhury N, Thomas Friedman J, Benasich AA. Early gamma oscillations during rapid auditory processing in children with a language-learning impairment: Changes in neural mass activity after training. Neuropsychol. 2013;24;51(5):990-1001.

13. Fisher M, Holland C, Merzenich MM, Vinogradov S. Using neuroplasticity-based auditory training to improve verbal memory in schizophrenia. Am J Psychiatry. 2009;166(7):805-11.

14. Gaab N, Gabrieli JD, Deutsch GK, Tallal P, Temple E. Neural correlates of rapid auditory processing are disrupted in children with developmental dyslexia and ameliorated with training: an fMRI study. Restor Neurol Neurosci. 2007;25(3-4):295-310.

15. Russo NM, Nicol TG, Zecker SG, Hayes EA, Kraus N. Auditory training improves neural timing in the human brainstem. Behav Brain Res. 2005; 156(1):95-103.

16. Strehlow U, Haffner J, Bischof J, Gratzka V, Parzer P, Resch F. Does successful training of temporal processing of sound and phoneme stimuli improve reading and spelling? Eur Child Adolesc Psychiatry. 2006;15(1):19-29.
-1717. Hayes EA, Warrier CM, Nicol TG, Zecker SG, Kraus N. Neural plasticity following auditory training in children with learning problems. Clin Neurophysiol. 2003;114(4):673-84.). For example, in some studies, the language improvements observed after training related to test-retest effects (66. Cohen W, Hodson A, O'Hare A, Boyle J, Durrani T, McCartney E, et al. Effects of computer-based intervention through acoustically modified speech (Fast ForWord) in severe mixed receptive-expres-sive language impairment: outcomes from a randomized controlled trial. J Speech Lang Hear Res. 2005;48(3):715-29.), but in other studies, these improvements seemed to result from any type of training and were not specific to auditory temporal training (77. Gillam RB, Loeb DF, Hoffman LM, Bohman T, Champlin CA, Thibodeau L, et al. The efficacy of Fast ForWord Language intervention in school-age children with language impairment: a randomized controlled trial. J Speech Lang Hear Res. 2008;51(1):97-119.,88. Given BK, Wasserman JD, Chari SA, Beattie K, Eden GF. A randomized, controlled study of computer-based intervention in middle school struggling readers. Brain Lang. 2008;106(2):83-97.). Additionally, variables such as the duration of the training, the characteristics of the software, the type of the training and the assessment measures applied before and after training are likely important and intensify concerns regarding the genuine influence of auditory temporal training on language skills.

Few studies were found that employed formal auditory training using an acoustic cabin (1818. Megale RL, Iorio MC, Schochat E. Auditory training: assessment of the benefit of hearing aid in elderly individuals. Pro Fono. 2010;22(2):101-6.

19. Gil D, Iorio MC. Formal auditory training in adult hearing aid users. Clinics. 2010;65(2):165-74.

20. Filippini R, Beffi-Lopes DM, Schochat E Efficacy of auditory training using the ABR to complex sounds: Auditory Processing Disorder and Specific Language Impairment. Folia Phoniatr Logop. 2012;64(5):217-26.

21. Vilela N, Wertzner HF, Sanches SGG, Neves-Lobo IF, Carvallo RMM. Processamento temporal de crianças com transtorno fonológico submetidas ao treino auditivo: estudo piloto. J. Soc. Bras. Fonoaudiol. 2012;24(1):42-8.

22. Miranda EC, Gil D, Iório MC. Formal auditory training in elderly hearing aid users. Braz J Otorhinolaryngol. 2008;74(6):919-25.
-2323. Schochat E, Musiek FE, Alonso R, Ogata J. Effect of auditory training on the middle latency response in children with (central) auditory processing disorder. Braz J Med Biol Res. 2010;43(8):777-85.). Of these few papers, only one investigated performance on both auditory and language tests after training, but only in a qualitative manner (1919. Gil D, Iorio MC. Formal auditory training in adult hearing aid users. Clinics. 2010;65(2):165-74.). A few other limitations were also noted. First, although the studies had non-trained control groups, most of the studies did not have alternative groups, which are essential for comparing the influence of the main training with the influences of other types of training. Second, the small numbers of participants call into question the statistical power of the results. Therefore, our review of the current literature indicates that few definitive conclusions can be drawn about the effects of this approach on language skills.

Regarding musical training, of the ten studies that investigated language performance after training, most described improvements in language skills in the individuals who underwent musical training (2424. Overy K. Dyslexia and music. From timing deficits to musical intervention. Ann NY Acad Sci. 2003;999:497-505.

25. Dege F, Schwarzer G. The effect of a music program on phonological awareness in preschoolers. Front Psychol. 2011;2:124.
-2626. Gerry D, Unrau A, Trainor LJ. Active music in infancy enhance musical, communicative and social development. Dev Sci. 2012;15(3):398-407.,2828. Yucel E, Sennaroglu G, Belgin E. The family oriented musical training for children with cochlear implants: speech and musical perception results of two year follow-up. Int J Pediatr Otorhinolaryngol. 2009;73(7):1043-52.,2929. Moreno S, Marques C, Santos A, Santos M, Castro SL, Besson M. Musical training influences linguistic abilities in 8-year-old children: more evidence for brain plasticity. Cereb Cortex. 2009;19(3):712-23.,3131. Bolduc J. Effect of a music programme on kindergartners's phonological awareness skills 1. International Journal of Music Education. 2009;27(1):37-47.,3333. Gromko J. The effect of music instruction on phonemic awareness in beginning readers. Journal of Research in Music Education. 2005; 53(3):199.). Nevertheless, of these seven studies, only five investigated whether the improvements also occurred after auditory temporal training (2424. Overy K. Dyslexia and music. From timing deficits to musical intervention. Ann NY Acad Sci. 2003;999:497-505.,2626. Gerry D, Unrau A, Trainor LJ. Active music in infancy enhance musical, communicative and social development. Dev Sci. 2012;15(3):398-407.,2828. Yucel E, Sennaroglu G, Belgin E. The family oriented musical training for children with cochlear implants: speech and musical perception results of two year follow-up. Int J Pediatr Otorhinolaryngol. 2009;73(7):1043-52.,2929. Moreno S, Marques C, Santos A, Santos M, Castro SL, Besson M. Musical training influences linguistic abilities in 8-year-old children: more evidence for brain plasticity. Cereb Cortex. 2009;19(3):712-23.,3131. Bolduc J. Effect of a music programme on kindergartners's phonological awareness skills 1. International Journal of Music Education. 2009;27(1):37-47.), and only one included an alternative type of training and a non-trained group (2626. Gerry D, Unrau A, Trainor LJ. Active music in infancy enhance musical, communicative and social development. Dev Sci. 2012;15(3):398-407.). Therefore, although all of the studies reported positive effects of training on language skills, additional studies are needed that include alternative training groups, large samples and standardized musical training to replicate the current findings.

Another topical issue regarding auditory training is the fact that, in general, perceptual training methods of this type include simultaneous training of several perceptual, cognitive and linguistic skills. For example, in interventions intended to improve spectro-temporal auditory processing deficits in individuals with dyslexia (55. Tallal P, Miller SL, Bedi G, Byma G, Wang X, Nagarajan SS, et al. Language comprehension in language-learning impaired children improved with acoustically modified speech. Science. 1996;271(5245):81-4.), the training exercises were designed to also include specific components of linguistic processing and attention and memory skills. Therefore, results based on these interventions reveal whether the combination of all of the training tasks contributed to the improvements observed after training or whether the same results would have been obtained after training only a single skill. Further studies should include broader top-down skill assessments that incorporate, for example, attention and working memory tasks, before and after training. Only then will it be possible to investigate the extent to which auditory training influences other skills that are also related to language development.

When comparing the three approaches, it should be noted that the studies involving software and musical training had higher levels of evidence (level I) because some of these studies included alternative trainings and larger samples. Nevertheless, the software approach remains the most controversial because since the majority of the studies of this approach called into question the hypothesized relationship between auditory temporal processing and language; for example, research has demonstrated that not only auditory temporal training but also alternative types of training that are not related to auditory temporal processing lead to improvements in language skills. These results also address the influences of other top-down skills, as discussed previously. Because all types of perceptual training are likely to lead to gains in memory and attention capacity, language skills seem to improve regardless the type of training applied. It is also notable that there were no blind studies in any of the approaches, which indicates the need for more studies with higher levels of evidence.

In conclusion, based on our review of the current literature, the studies that investigated the use of software and musical training had the highest levels of evidence and, consequently, the most reliable data regarding the auditory temporal processing hypothesis. Each of the approaches requires additional studies that employ alternative training groups and blind designs to investigate the actual contribution of auditory temporal training to language skills.

The authors would like to thank Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) for funding support.

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  • No potential conflict of interest was reported.

Publication Dates

  • Publication in this collection
    Oct 2013

History

  • Received
    16 Apr 2013
  • Reviewed
    9 May 2013
  • Accepted
    9 May 2013
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