Auditory training methods in children with psychiatric diagnosis: an integrative literature review

Simões, Humberto de Oliveira; Zanchetta, Sthella; Furtado, Erikson Felipe

doi:10.1590/1982-0216/202022218318

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REVIEW ARTICLES • Rev. CEFAC 22 (2) • 2020 • https://doi.org/10.1590/1982-0216/202022218318 copy

Auditory training methods in children with psychiatric diagnosis: an integrative literature review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose:

to identify auditory training approaches used in the pediatric population with psychiatric diagnoses and to characterize the contexts in which the intervention took place, as well as protocols and discernment of the results.

Methods:

a search was carried out in four databases, using the fixed terms "auditory training" OR "auditory rehabilitation". Regarding the sampling, there was a considerable range of diagnoses, signs and symptoms, including the most common ones. Articles published until August 2018 whose population did not present hearing loss were selected; articles whose subjects had made use of any personal sound amplification products, presented otitis or had any isolated diagnosis of auditory processing disorder, were excluded.

Results:

16 articles out of the 103 references found, met the inclusion criteria. The samplings studied were children and adolescents with learning, language or reading disorders, dyslexia, attention deficit hyperactivity disorder, autism spectrum disorder and schizophrenia. The bottom-up intervention and the combined approach (bottom-up and top-down), in the formal context, were the most frequent approaches, whose results led to the improvement in linguistic, metalinguistic and auditory skills. The amount and frequency of sessions, as well as their duration varied.

Conclusion:

the heterogeneity of auditory training techniques diversified the results. However, it seems there is a potential for recommending auditory training in the reviewed population.

Keywords:
Child Psychiatry; Psychiatric Diagnoses; Signs and Symptoms; Auditory Training; Auditory Processing

STUDY	DEGREE OF RECOMMENDATION AND LEVEL OF EVIDENCE*	SAMPLING						AUDITORY TRAINING		EFFECTIVENESS OF INTERVENTION	MAIN RESULTS
STUDY	DEGREE OF RECOMMENDATION AND LEVEL OF EVIDENCE*	TGwI	CGwI	CGnoI	EGnoI	Diagnosis	Age (years)	Sessions	Approach and context	EFFECTIVENESS OF INTERVENTION	MAIN RESULTS
Feldman; Schmidt; Deutsch (1968)¹⁹	B/2C	48	---	---	16	Reading Dis.	Third-grade schoolers	50 sessions; 70min., 3 times a week; 17 weeks	Top-down and bottom-up; informal	Reading and auditory behavioral evaluation	1- The results have little evidence to back up the hypothesis that an auditory skills development program would favor socially disadvantaged children with reading disorder; 2- The chosen methodology was not effective in answering the hypothesis of the study, since the auditory training program did not have positive effects on the reading skills.
Wharry; Kirkpatric; Stokes (1987)³⁶	B/2C	27	---	---	---	Learning Dis.	7 - 13	20 sessions; 30min., 4 days/week; 5 weeks	Both not specific	Auditory Attention Span for Related Syllables (Baker; Leland, 1967)	1- Highest post-auditory training scores; 2- Teachers should focus on the listening methods of teaching, more than the visual or the integrative listening-visual ones.
Bettison et al. (1996)²⁰	B/2C	80 dividedin 40 each with different interventions	---	---	---	ASD	3 - 17	20 sessions; 2 sessions of 30 min.; 10 days	Bottom-up; formal	Questionnaires	1- Both groups significantly improved sensitivity to sounds after intervention; 2- Only the control group maintained improvement after 12 months.
Hayes et al. (2003)¹⁰	B/2C	27	---	15	7	Learning Dis.	8 - 12	35 to 40 sessions; 60 min/day; 8 weeks	Top-down; formal	Behavioral and electrophysiologic auditory assessment	1- There was no difference after training, between the groups, in academic and cognitive skills.; 2- Latency of BAEPs click and /da/ there was no difference between pre- and post-training; 3 - Reduction of the P1N1 amplitude and decrease of latency of N2 for /ga/ stimulus in the trained group, where there’s also been increase of P2N2 amplitude.
Schäffler et al. (2004) - study 1 ²⁹	B/2C	140	---	---	---	Dyslexia	7 - 21	10 to 15 min./dayineach; 10 days	Bottom-up; formal	Auditory behavioral assessment	1- 23% of subjects, after auditory training, managed to accomplish all tasks; 2 - Reduction of 20% of subjects with failures in three or more tasks; 3 - The order effect task was carried out with greater difficulty.
Warrier et al. (2004) - Experiment 2 ²⁶	B/2C	13	---	4	7	Learning Dis.	8 - 13	35 to 40 sessions; 60 min./day; 8 weeks	Top-down and bottom-up; formal	Behavioral and electrophysiologic auditory assessment	1- After auditory training, the trained group with correlation below interval (Training-Out) presented increase in latency of N2 (11-17 ms) and better performance of the speech test in the correlation form silence to sound.
Santos et al. (2007)¹¹	B/2C	10	---	---	10	Dyslexia	9 - 12	Daily phonological training; audiovisual training twice a week; 50min.; 6 weeks	Top-down; formal	Behavioral and electrophysiologic auditory assessment and language assessment	1- Faster and more precise to identify words with modified frequency, without difference to EGnoI after training; 2 - Improvement in the performance of the reading test; 3 - No effect between the groups for the electrophysiologic, but with increase of amplitude (latency bandwidth of 700-1200 ms) after training.
Joly-Pottuz et al. (2008)²¹	B/2C	19	---	---	---	Dyslexia	7 - 10	Daily phonological training; audiovisual training three times a week; 50 to 70 min.;3 weeks	Top-down and bottom-up; formal	Linguistic assessment	1- Variables evaluated after phonological auditory training with difference, except for reading of words; 2 - Significantly improved phonological awareness and decoding after training in both groups; 3 - Repetition of words and nonwords, without cumulative evolution.
Pinheiro; Capellini (2010)²⁷	B/2C	20	---	---	20	Learning Dis.	8 - 14	18 sessions; 50 min.; 9 weeks	Bottom-up; formal	Behavioral and electrophysiologic auditory assessment and linguistic assessment	1- Better performance after intervention in the auditory processing tests; 2 - Better timing of EGnoI for accomplishing behavioral and phonological awareness tests; 3 - Improvement in identifying syllables and phonemic transposing, and total score in the phonemic skills of trained groups.
Russo et al. (2010)¹²	C/4	5	---	---	---	TEA	Average 9.4	Sessions not defined, finished when reached 85%; 5 to 10 weeks	Top-down; formal	Electrophysiologic auditory assessment	1- Four out of five children improved latency figures in BAEPs with speech; 2 - All five children improved in at least one of the variables measured in the cortical speech processing.
Murphy; Schochat (2011)³⁰	B/2C	12	---	---	18	Dyslexia	7 - 14	Sessions not determined; 20 min., 5 times a week; for2 months	Top-down and bottom-up; formal	Behavioral auditory assessment and linguistic assessment	1- There was significant improvement in the reading of words and phonological awareness tests in both groups; and, in EGnoI alone, in the behavioral auditory assessment; 2 - Significant difference in the scores of behavioral auditory assessment and linguistic assessment after intervention.
Gray; Miller; Evans (2012)²²	B/2C	7	---	---	4	ADHD	12 - 40TGwI = 7EGnoI = 31	900 trails/day; 60 to 120 min./day; 4 consecutive days	Bottom-up; formal	Behavioral auditory assessment	1- Significant improvement in identifying auditory stimuli in face of contralateral masking; 2 - The number of false alarms and thresholds, between groups, was not significant; however, EGnoI decreased by half the number of false alarms after intervention.
Filippini; Befi-Lopes; Schochat (2012)¹³	B/2C	23	---	---	7	SLI (n= 14) CAPD (n=9)	7 - 13	8 sessions; 50 min.; 8 weeks	Bottom-up; formal	Behavioral and electrophysiologic auditory assessment	1- In reevaluation, groups that received intervention presented significant improvement in temporal order skills; 2 - BAEPs with speech, in silence, there was no significant difference in neither of the groups. BAEPs of speech with ipsilateral noise influenced amplitude and latency values negatively; however, the trained groups presented better responses in reevaluation.
Vatanabe et al. (2014)²⁸	B/2C	10	---	---	10	Reading Dis.	8	8 sessions; 40 min.; 8 weeks	Top-down and bottom-up; formal	Behavioral auditory assessment and linguistic assessment	1- Significant improvement of TGwI in reevaluation in all behavioral auditory assessments; 2 - In the CONFIAS (Portuguese abbreviation for phonological awareness sequential evaluation instrument) test, all tasks were significantly improved in their scores in reevaluation, in both groups.
Fisher et al. (2015)²³	B/2B	43	43	---	---	Schizophrenia	14 - 30	Sessions not determined; 40 h (1h/day, 5 days/week). 8 weeks	Top-down; formal	Comparison between initial starting point and after 20h of training using auditory processing speed - psychophysical threshold under a moderate perceptual challenge	1- Significant interaction of the time and treatment condition for global cognition, verbal memory and problem-solving and a difference in the level of tendency in visual learning; 2 - In TGwI, advancing the initial reward was significantly associated with the gains in global cognition and verbal memory, whereas these associations were not significant in CGwI; 3 - Individuals auditorily trained became more efficient in the fast processing of successive auditory stimuli; this improvement was significantly associated with the gains in global cognition.
Kozou et al. (2018)²⁴	B/2C	30	---	---	30	ASD	7 - 12	2 sessions a week, 30 min. each; 6 weeks	Bottom-up; formal	Behavioral auditory assessment and language assessment	1- Auditory skills of ASD children range from completely normal to substantially defective, especially in the dichotic test, and usually lower than those of children with typical development; 2 - ASD group with phonological awareness skills inferior to the group with typical development; 3 - Auditory training in children with ASD was beneficial to improve difficulty in dichotic hearing, as well as other not trained fields of language and auditory processing skills.

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[1] Corresponding address: Sthella Zanchetta, Dpto. Ciências da Saúde, divisão de Fonoaudiologia FMRP-USP, Rua Miguel Covian, 120, Monte Alegre, CEP: 14049-000 - Ribeirão Preto, São Paulo, Brasil, E-mail: zanchetta@fmrp.usp.br