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Source: Autism Pinoy List of Developmental Pediatricians in Metro Manila

DR. MIMI AVENDANO Philippine Children's Medical Center Neurodevelopmental Section, Child Neuroscience Division 924 6601


Medipoint Clinic LBH Building, 1431 Mabini Street, Manila 523 5476 to 78 Makati Medical Center -Room 331 892 1738 Medical Plaza Makati - LP Room 4 Dela Rosa corner Amorsolo St. Makati City 892 1738 Asian Hospital, Filinvest-Alabang 752 3167


Medical Towers Makati - Suite 407 103 Herrera St., Legaspi Village, Makati City 818 8582 CHRISTINE CONDUCTO Philippine Children's Medical Center

924 6601 Lloc. 307/325 DR. RIA DE GUZMAN UP-PGH, Department of Pediatrics 521 8450 loc. 2120 / 2101


St. Luke's Medical Center 723 1088 DR. JOSELYN EUSEBIO Eusebio Clinic 126 15th Ave., Cubao, Q.C. 911 8257 Quezon City General Hospital 455 2162 St. Luke's Medical Center - Rm 203 723 0101 local 6203 UERM Pediatric Clinic Aurora Blvd., Sta Mesa, Manila 716 1783 National Children's Hospital E. Rodriguez Ave., Q.C.724 0656 Mobile 0917 - 7938594 DR. AGNES G. FALCOTELO Capitol Medical Center - Rm 208 Sct. Magbanua St., Quezon City 3723825 -44 local 3235 Mobile: 0918-9109004 Fatima Medical Center - Rm 202 New Medicine Building 293 0227 / 293 1636 Quezon City General Hospital Child Development Unit, Seminary Road, Q.C. 455 2162 MBS Specialty Clinic

#7 Asuncion Street, Morning Breeze Caloocan City (beside MCU) 366 1188 / 362 4418 Fax No. 455 7791 c/o sister DR. MA. THERESA ARRANZ-LIM Unit 1414 MATI Bldg Medical City Origas Avenue, Pasig City Tel. No. 635-6789 loc 5187 Rm 273 Cardinal Santos Medical Center Wilson Street, Greenhills west San Juan, Metro Manila Tel. No. 7270001 loc 2273 Cell No: 09178994693 DR. STELLA GUERRERO-MANALO Rm 217 Medico Bldg. Lourdes St., Ortigas Center, Mandaluyong 633 6686 beeper: 1441 - 668832 DR. CARMENCITA PADILLA St. Luke's Medical Center - Rm 507 Don Santiago Bldg., Taft Ave. 723 0101 local 523 1426 DR. RHANDY PE BENITO Children's Medical Center (Fe del Mundo Medical Center) Banawe, Quezon City 712 0845 DR. MARNIE PRUDENCIO Phil. Children's Medical Center 924 6601 - 25 local 307 / 325


Makati Medical Center- Rm. 217 815 9911 local 7217 Cathy Phil. Children's Medical Center Quezon Ave., Q.C.

924 6601 - 25 local 273 Fax 819 5423 PGH MCAU Taft Ave., Manila 521 8450 local 402 DR. ANTONIO REMOLLINO Perpetual Help, Las Pias 874 8515 St. Lukes Medical Center, Quezon City 723 0101 Medical Plaza, Ortigas 636 7576 DR. VILMA BAGAY-SALCEDO St. Luke's Medical Center-Rm 524 E. Rodriguez Ave., Q.C. 723 0101 local 6524 7231083 Don Santiago Bldg. - Rm. 315 Taft Ave., Manila 523 1426 Mobile 0919-2451570 Residence 435 4315 / 922 3027 DR. NOEMI SALAZAR UST Hospital - Room 5006, MAB 749 9791 FEU Hospital - Room 513 Marian Arts Building, Fairviwe, Quezon City 935 4336 DR. CORNELIO BANAAG Psychiatrist Room 516 Medico Bldg. Medical City, San Miguel Ave. Pasig City 631 6961 loc. 516 Dr. PORTIA V. LUSPO Child & Adult Psychiatrist Phil. Children's Medical Center-Rm 16

9246601-25 local 305/325/307 UERM - Rm. 119 Medicine Bldg. 7716 1848/7150861-69loc. 280 Polymedic Hospital - Rm. 215 EDSA, Mandaluyong City 531 7959 / 5314911/21 loc. 23 DR. MARILYN ORTIZ Neurologist Phil. Children's Medical Center - Rm 15 Quezon Avenue, Quezon City Child Neuroscience Office PCMC 924 6601 local 304 / 271 Josie 924 6601 loc. 325/307 Espie/ Olive or Jasmin e-mail:


Neuropsychologist Suite 805 Kalaw-Ledesma Condo. 117 Gamboa St., Legaspi Village Makati City 816 4798 892 7205 DR. LOURDES A. CARANDANG Clinical Psychologist Cardinal Santos Memorial Hospital Room 231 Wilson St., Greenhills 727 0001 local 831 Neriss DR. EMMA LIWAG Clinical Psychologist Ateneo Wellness Center Ateneo de Manila University Katipunan Ave., Loyola Hts., Q.C. 426 5659


SpEd Diagnostician/Assessment St. Luke's Medical Center E. Rodriguez Sr., Quezon City 723 loca 0101 l 5707 725 8195

U.P. College of Education 10 Milan St., Greenpark Village Manggahan, Pasig City 920 5301 local 6955 646 3567 cell: 0919-3193362 PHIL. MENTAL HEALTH ASSOCIATION East Avenue, Quezon City 921 4958 / 924 9297

Developmental Pediatricians
Most therapy centers require a formal diagnosis from a developmental pediatrician before they can provide the proper intervention/s for your child.

A list of the developmental pediatricians, their clinic addresses and contact numbers are provided.

Please note that most developmental pediatricians are booked solid months in advance so we suggest that you call to set an appointment as soon as possible.

Traditional Interventions
Selecting the appropriate intervention/s for your child is a highly individualized and personal decision. There are several therapies available to help our children in the spectrum. For a program to be effective, it should build on the child's interests, teach tasks as a series of simple steps, actively engage the child's attention in highly structured activities, and provide regular reinforcement of behavior. Parental involvement has emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught. Parents should make sure that the intervention/s they choose will target specific deficits common with children with autism such as difficulty in

learning, communication/ language, imitation, attention, eye contact, motivation, compliance, and social interaction.

Applied Behavior Analysis (ABA)

Applied Behavior Analysis examines the possible cause(s) of behavior, using accepted principles of behavior management and then systematically determines how to replace the behavior with a more appropriate response. It looks for the behavior to change to a meaningful degree and that a direct correlation can be seen between the process and the end result. The goal of this method is to phase the child into regular education by reducing negative behaviors and teaching skills to enable learning in the regular classroom, such as sitting quietly, making eye contact, attending to a task, imitating others, and communicating. In ABA the child identifies an object such as "ball" and is given a small treat or other reward as a reinforcer for saying the correct word. (If implementing the GFCF diet and this therapy is used, make sure to provide the therapist with GFCF food for reinforcers.) Applied Behavior Analysis (ABA) is also called "Lovaas" or Discrete Trial Teaching (DTT). Dr. Ivar Lovaas founded this therapy back in the early 80s. It involves a therapist working in a structured environment to develop skills. The child and therapist work alone in a quiet room for 2-3 hour session. The recommended time depends on the child's needs and usually ranges from 30-35 hours per week for the first year. It is recommended to begin ABA somewhere between the ages 2-5.

Verbal Behavior (VB)

Mark L. Sundberg and James W. Partington base Verbal Behavior on the works of B.F. Skinner and the book "Teaching Language to Children with Autism or Other Developmental Disabilities." This therapy stresses the effectiveness of teaching language skills. Advocates of Verbal Behavior believe that it has improved ABA programs by emphasizing the important elements in language acquisition previously ignored by traditional Lovaas-based programs. (That is, capturing a child's motivation to develop a connection between the value of a word and the word itself). One of the primary ideas behind Verbal Behavior approach is that the meaning of a word is found in its function and not in the word itself. If

the function of language is not taken into account you often end up with a child who may be able to label or identify hundreds of objects but never uses them in functional ways or spontaneously requests them in the natural environment. Traditional Lovaas programming and Verbal Behavior are two distinct approaches to using the principles of ABA to better the lives of the children with autism. Although Lovaas style in programming has been in the spotlight longer, more and more people are going to an ABA program with an emphasis on Verbal Behavior as it is showing the ability to bridge the gaps left in traditional ABA programs.

Occupational Therapy
The treatment of physical and developmental disorders through purposeful activities that improve & develop skills, needed for everyday independence. Both children with or without disability may receive therapy. Occupational therapy is beneficial when there are concerns regarding fine motor, sensory, visual motor, and/or motor planning. These children have a limited sensory experience and lack normal motor control.

Areas of Occupational Therapy Fine motor skills generally refers to actions of the hands, wrists, and arms, including dexterity, coordination, and strength. Handwriting is a complex process of managing written language by coordinating the eyes, arms, hands, pencil grip, letter formation, and body posture. The development of a childs handwriting can provide clues to developmental problems that may hinder the childs learning. Sensory integration (SI) is the process of receiving, organizing, and interpreting input, becoming the basis for motor planning, learning and behavior. When this process is disorganized, it is called Sensory Integration Dysfunction.

Speech Therapy
The purpose of speech-language therapy is to enhance intentional communication via expression of ideas, obtaining desires, sharing

information and interpersonal interaction. Language is the means by which communication is achieved.

Components of language include but are not limited to: understanding/verbal expression facial/manual gestures tone of voice body orientation

In order to use our language, knowledge of content (vocabulary, concepts), form (how words are linked into phrases/sentences) and use (what the child wants to get from using his/her language) is necessary. Therefore, speech therapy focuses around teaching the child what he or she needs rather than the use of language for communication.

For the child who is not currently using words, language is still possible through other means. A child may be taught to use various ways of utilizing their language skills to convey meaning. These may consist of gestures/signaling, eye contact, facial expression, vocalizations or manual tools such as communication pictures/boards/books.

Oral-motor skills are also addressed within speech-language services. Since proper structure and function of the oral areas is necessary for speech and sound production, intervention to improve coordination, strength, movement and placement of the lips, tongue, jaw and cheeks (both internally and externally) is required.

Picture Exchange Communication System (PECS)

The Picture Exchange Communication System (PECS) is a communication training system developed within the Delaware Autistic Program. PECS is used at the Delaware Autistic Program with students from the ages 2 through 21 years. Prior to using a picture exchange system, intensive verbal imitation training, sign language training and

picture pointing programs were used with non-vocal students with limited success. According to proponents of this program possible reasons for the limited success of these previously used training programs include: the use of arbitrary reinforcers, transient or temporally bound stimuli, oral-motor difficulties, speaker/listener role confusion, etc.

Students using PECS are required to give a picture of a preferred item to a communicative partner in exchange for the item. The initial communicative behavior targeted is requesting. In the request, preferred items are presented as reinforcement of the response. Further, request training takes place in a social context. Teaching students to request is a useful skill, and may facilitate the teaching of other communicative intents. The only prerequisite to beginning request training is the identification of those items or activities that are preferred by the student. Two therapists are initially required so that one sits behind the child and physically prompts him/her to give a picture in exchange for the reinforcer. Physical prompts are quickly faded in order to ensure independent communication. Once the requesting with pictures is firmly established the child is then encouraged to verbalize the request.

Floortime/ Play Therapy

Play therapy, or Floortime, as some refer to it, is the type of therapy coined by Dr. Stanley Greenspan. The theory behind the concept is to enter the child's world, play with the child on his or her terms, and slowly expand the base of play to include new ideas. Although there have been few studies on the efficacy of play therapy/ floortime, many parents have seen excellent results. For example, if a child is perseverating or obsessing with cars and perhaps watching the wheels spin, the play therapy approach would be to get down on the floor with the child and begin by watching the wheels spin with him or her, then eventually do other things with the car, such as drive it on the floor as a typical child would do. Slowly, over time, the child will learn to expand his or her repetoire of play, and will learn to interact with others. This therapeutic approach seeks to improve developmental skills through analysis and intervention in six areas of functioning. The first area has to do with a childs ability to regulate his or her attention and behavior, while being presented with a full range of sensations. The

second area has to do with the childs ability to maintain quality and stability of engagement in relationships. The third area has to do with a childs ability to enter into two-way, purposeful communication. At its most basic level, this program involves helping the child open and close circles of communication. A circle of communication is opened and closed when a child evidences some interest or behavior and the parent responds to that interest in a way that is acknowledge by the child.

Social Stories
Many persons with autism have deficits in social cognition, the ability to think in ways necessary for appropriate social interaction. This deficit can be addressed by a technique, which is used to help individuals with autism read and understand social situations. This technique, called Social Stories, presents appropriate social behaviors in the form of a story. There are a number of ways a social story can be implemented. For a person who can read, the author introduces the story by reading it twice with the person. The person then reads it once a day independently. For a person who cannot read, the author reads the story on an audiotape with cues for the person to turn the page as he/she reads along. These cues could be a bell or verbal statement when it is time to turn the page. Once the individual successfully enacts the skills or appropriately responds in the social situation depicted, use of the story can be faded. This can be done by reducing the number of times the story is read each week and only reviewing the story once a month or as necessary. Fading can also be accomplished by rewriting the story or gradually removing directive sentences from the story. Social stories are useful for helping individuals with autism learn appropriate ways to interact in social situations. They can be individualized to incorporate the specific needs of the person for whom the story is written. Activities are taught using flexible directive statements such as I will try to stay in my bed until morning, to encourage the individual to try to reach the final goal. They can teach routines, how to do an activity, how to ask for help and how to respond appropriately to feelings like anger and frustration.

Pivotal Response Training (PRT)

This intervention technique is based on the principles of applied

behavior analysis. The intervention identifies certain behaviors for treatment that will produce simultaneous changes in many other behaviors Pivotal behaviors are thought to be central to wide areas of functioning and positive changes in pivotal behaviors should be widespread effects on many other behaviors. Two important pivotal behaviors addressed using this technique are motivation and responsivity to multiple cues. The program works to increase motivation while increasing important skills, typically language acquisition, social interaction, and play skills, in hard to teach children in the spectrum.

Pivotal Response Training provides parents, teachers and caregivers with a method of responding to their child with autism/PDD, which provides teaching opportunities throughout the day. It can be used in structured one-on-one teaching or in the natural setting. Important aspects of training include turn taking, reinforcing attempts at correct responding, frequent task variation, allowing the child a choice of activities, interspersing maintenance tasks, and using natural consequences. This type of training is flexible and allows the teacher, parent or other caregiver to require more difficult responses as the child progresses. It was specifically designed for use by parents and can easily be integrated into everyday life in order to facilitate generalization and maintenance of behavior change.


Being able to predict or anticipate the activities of the day gives the child a sense of control, security and independence. Schedules can be used in the home or classroom. They help to clarify communication between parent/child and teacher/student.

Presenting information in a visual form Helps establish and maintain attention Gives information in a form that the child can quickly and easily interpret Clarifies verbal information Provides a concrete way to teach concepts such as time, sequence,

cause/effect Gives the structure to understand and accept change Supports transitions between activities or locations

Schedules are very helpful to children with autism who also have problems processing verbal commands. Children with autism as a whole are visual learners, so schedules are a natural and easy way to learn and understand. Schedules are made up of cards with pictures of activities or items with the name of the activity or item on it.

The schedule gives the child information such as: What is happening today (regular activities) What is happening today (something new, different, unusual) What is not happening today What is the sequence of events What is changing that I normally expect When it is time to stop one activity and move on to another one

Relationship Development Intervention (RDI)

Relationship Development Intervention (RDI) Based on the work of psychologist Steven Gutstein , Relationship Development Intervention (RDI) focuses on improving the long term quality of life for all individuals on the spectrum. The RDI program is a parent- based treatment that focuses on the core problems of gaining friendships , feeling empathy , expressing love and being able to share experiences with others. Dr. Gutstein's program is said to be based on extensive research in typical development and translates research findings into a systematic clinical approach. His research found that individuals on the autism spectrum seemed to lack certain abilities necessary for success in managing the real life environments that are dynamic and changing.


TEACCH (Training and Education of Autistic and Related Communication Handicapped Children) is a special education program that is tailored to the child's individual needs based on general guidelines. It dates back to the 1960's when doctors Eric Schopler, R.J. Reichler and Ms Margaret Lansing were working with children with autism and constructed a means to gain control of the teaching setup so that independence could be fostered in the children. What makes the TEACCH approach unique is that the focus is on the design of the physical, social and communicating environment. The environment is structured to accommodate the difficulties a child with autism has while training them to perform in acceptable and appropriate ways.

Building on the fact that children with autism are often visual learners, TEACCH brings visual clarity to the learning process in order to build receptiveness, understanding, organization and independence. The children work in a highly structured environment which may include physical organization of furniture, clearly delineated activity areas, picture-based schedules and work systems, and instructional clarity. The child is guided through a clear sequence of activities and thus aided to become more organized

It is believed that structure for autistic children provides a strong base and framework for learning. Though TEACCH does not specifically focus on social and communication skills as fully as other therapies it can be used along with such therapies to make them more effective.


Inclusion is a means of educating students in a general education classroom to the maximum extent appropriate based on individual needs. Inclusion is generally accepted to mean that primary instruction and provision of services for a child with a disability is provided in an age-appropriate general education class in the school the child would have attended if not disabled with appropriate additional supports for the student and the teacher. There may also be partial inclusion, in which a child may also remain in the segregated setting for some parts

of the day and enter into general education settings for other specific time periods.

Scerts (Prizant, Wetherby, Rubin, Rydell & Laurent, 2006)

The SCERTS Model is a comprehensive, team-based, multidisciplinary model for enhancing abilities in Social Communication and Emotional Regulation, and implementing Transactional Supports for children and older individuals with autism spectrum disorders (ASD) and their families. SCERTS is not an exclusive approach, in that it provides a framework in which practices and strategies from other approaches may be integrated, such as Positive Behavioral Supports (ABA), visual supports, sensory supports, augmentative and alternative communication (AAC), and Social Stories. The SCERTS model can be used with individuals across a wide range of ages and developmental abilities. It was developed by Barry Prizant, Amy Wetherby, Emily Rubin, Amy Laurent and Patrick Rydell, a multidisciplinary team of clinicians, researchers, and educators who have more than 100 years experience, and have published extensively in the field of autism.

The focus on Social Communication involves developing spontaneous, functional communication and secure, trusting relationships with children and adults. Emotional Regulation involves enhancing the ability to maintain a well-regulated emotional state to be most available for learning and interacting. Transactional Support includes supporting children, their families, and professionals to maximize learning, positive relationships and successful social experiences across home, school and community settings. The SCERTS Model, emphasizes the importance of child initiated communication in natural as well as semistructured activities for a broad range of purposes such as requesting , greeting, expressing emotions and protesting/refusing. Objectives for the child are developmentally appropriate and may target both verbal and non-verbal forms of communication. SCERTS is a collaborative educational model in that families and educators work together to identify and develop strategies to successfully engage the child in meaningful daily activities.

SCERTS differs from the focus of "traditional" ABA that typically targets children's responses in adult directed discrete trials with the use of behavioral techniques to teach language. In contrast, the focus of the SCERTS model is on promoting child-initiated communication in everyday activities. In philosophy and practice, SCERTS is closer to "contemporary" ABA practices such as Pivotal Response Training and Incidental Teaching, which use natural activities in a variety of social situations, as well as semi-structured teaching in social routines. In contrast to most ABA practices, SCERTS relies extensively on visual supports (e.g., photos, picture symbols) for supporting Social Communication and Emotional Regulation. SCERTS is based on child development research and research on the core challenges in autism, in a manner similar to Floortime and RDI.

The SCERTS Model is most concerned with helping persons with autism to achieve Authentic Progress, which is defined as the ability to learn and apply functional skills in a variety of settings and with a variety of partners. All of a child's partners, including educators, therapists, parents, siblings and peers potentially play an important role in a SCERTS Model Program, because activities in which goals and objectives are addressed include daily routines at home and school, as well as special therapies and activities that have the potential to enhance abilities in independent and self-help skills, with a particular emphasis on social communication and emotional regulation. For example, mealtimes across home and school settings may have the same objectives that include using pictures, words and/or gestures to select food items, to observe and imitate partners in order to benefit from their social models, and to respond to a partners' attempts to support a good emotional state that results in sustained attention and active participation. Objectives in play and social skills may also be identified and targeted at school with classmates, as well as at home with siblings or cousins. A plan to support a child's emotional regulation across each day is also developed based on a child's needs. The plan may include regularly scheduled exercise and regulating breaks, opportunities for sensory and motor activities, and a plan used by all partners to modify learning environments. Partners also become expert at reading a child's signals of emotional dysregulation and responding with appropriate support as needed to maximize attention and learning and to prevent escalation into more problematic behavior (e.g., offering deep pressure, simplifying difficult tasks. clarifying tasks through the

use of visuals e.g., 2 more then we are all done).

When observing activities in the SCERTS Model, there is always a high priority placed on: 1) children initiating as well as responding to partner's verbal and nonverbal communication; 2) children actively participating in activities with adults and peers, with an emphasis on joyful, shared positive emotional experience, and the development of trusting relationships, 3) partners implementing a range of interpersonal and learning supports to help a child be most available for learning and engaging, 4) partners being highly responsive and supportive in a flexible manner that depends on the child's emotional state, distractions in the setting, the child's success in the activity and the need for appropriate levels of support to actively participate.

In SCERTS, there is a great emphasis on child initiation in natural as well as semi-structured activities for a very broad range of communicative functions (e.g., greeting, requesting comfort, protesting/refusing, calling). Objectives are developmentally sequenced, including nonverbal (e.g., gestures) as well as verbal communication and are selected based on a child's functional needs in daily activities as determined by the child's team. Thus, the focus of the SCERTS model on promoting child-initiated communication in everyday activities differs from the focus of "traditional" ABA, that typically targets children's responses in adult directed Discrete Trials with the use of behavioral techniques to teach language. In Philosophy and practice, SCERTS is closer to "contemporary" ABA practices such as Pivotal Response Training and Incidental Teaching, which use natural activities in a variety of social situations with a variety of partners (peers and different adults), as well as semi-structured teaching in social routines. SCERTS also relies on visual supports (e.g., photos, picture symbols) extensively for supporting Social Communication and Emotional Regulation to a greater extent than ABA, and is based on child development research and research on the core challenges in autism, in a manner similar to Floortime and RDI.

For further information, including a detailed list of FAQ's and research support for the SCERTS Model, go to .

Vision Therapy

Just as language and motor skills are achieved through a sequence of developmental stages, vision must also follow a progression of development. An infant is not born with the visual abilities that he will need in order to function successfully in his world. These abilities must develop through a variety of experiences across a period of time. At any point during this process, the visual development may be hindered, altered or completely stopped, sometimes by injury, illness, emotional trauma, lack of appropriate stimulation, or other unidentified causes. When language and/or motor skill development is interrupted, parents and teachers seek to identify the problem and intervene with therapy or training activities designed to assist the child in overcoming the delay. A similar approach is available to parents of children (or to adults) who have inadequately developed visual abilities.

Distorted Input. When we speak of vision, we are referring to the ability of the brain to organize and interpret the information seen so it becomes understandable or meaningful. Even individuals with good eyesight (20/20 acuity), can have undiagnosed vision problems that make it difficult to correctly comprehend the visual message. If sensory input, whether it is visual, tactile, auditory, etc., is received in a distorted or faulty manner, the behaviors that are based on that input are likely to be distorted. Many of the behaviors characteristic of autism, and many behavior problems associated with learning disabilities, may include attempts to manage in spite of a visual system, and other systems that fail to provide understandable, reliable information.

Auditory Interventions

The Tomatis Method

Alfred Tomatis, MID, a French Ear, Nose and Throat specialist, was the first practitioner to develop an approach for treating listening difficulties. Tomatis originally defined the role of the ear as the 'integrator' because the ear was significant in structuring organization at all levels of the nervous system. He recognized the close relationship between the auditory and vestbular systems and the importance of both as integrators of the nervous system. He connected listening to the development of receptive and expressive language, learning, motor control and motivation. Through his clinical work with opera singers and factory workers, Tomatis recognized that the voice can only produce what the ear can hear, a principle now known as the "Tomatis effect". His study of the ear led to the conviction that, beyond hearing, the auditory system and vestibular system work together to detect and analyze movement. He described the function of the vestibular portion as picking up and discriminating the larger movements of the body, which we can see and feel. Similarly, the auditory system registers and regulates the finer movements of sound waves, which pass through the air and are funneled into the ear.

In the 1950's Tomatis developed a listening technique to 're-educate the ear' based upon the following four principles:

* Motivational and emotional needs begin with listening. * Listening plays a fundamental role in language. * Through it's close connection with the vestibular system, the auditory system relates self to self, to others, and to the universe * The brain needs sound energy to enable the thinking process and integration

Tomatis developed the first auditory training or listening training device,

the electronic ear. This device uses progressively filtered sound, specifically those sounds rich in high frequencies (i.e. classical music, the mother's voice, Gregorian chants) to effect change. Tomatis was the first to recognize the importance of high frequency audition. He spoke of high frequency sound as charging the brain. The Tomatis method of auditory training is a chnic-based program, requiring the use of specialized equipment and the expertise of a practitioner trained in the Tomatis approach.

Auditory Integration: Berard Method (AIT)

Most of the clinically based auditory training techniques are based on the early work of Tomatis, including that of Guy Berard, MID, a French medical doctor who studied and worked with Tomatis.

Berard felt that the original protocol of Tomatis was too lengthy and developed a different method of filtering sound. This technique, which uses filtered popular music in which sound frequencies are electronically modulated at random intervals for random periods of time, is called Auditory Integration Training (AIT). Berard believes that hypersensitive hearing causes auditory processing problems. Berard and his technique gained worldwide recognition in 1990 with the publication of Annabel Stehli's biographical account of her daughter Georgie. The Sound of a Miracle describes how Georgie, diagnosed with severe autism, greatly benefited from a course of 20 AIT treatments with Berard. AIT is a clinic based program; implementation relies upon the use of the Audiokinetron, a device developed by Berard for filtering music and upon a practitioner with specialized training.

Both the Tomatis and Berard programs are delivered by specific machines using earphones. With the advent of new technology, similar altered music has become available on compact disc. The discs do not replace either the Tomatis Method or the Berard Method. The compact discs do provide a less intense way to access both the auditory and vestibular systems to impact neural function and integration and are easily available to clinicians in a variety of practice arenas.

The Samonas Method

The SAMONAS method is another listening approach, which has combined some of the ideas of Tomatis with advances in both technology and physics. Ingo Steinbach, a German sound engineer with a broad background in music, physics, and electronics developed this method. All of the recordings used in Steinbach's work are based on the SONAS (System of Optimal Natural Structure) principle, which make it possible to maintain the valuable elements and Structure of natural sounds throughout the entire process of recording, processing and reproduction. The choice of music is based on the principles of music therapy. Most selections are classical music and some include nature sounds.

Steinbach wanted his recordings to be as realistic and as spatially expansive as the sounds one hears in the concert hall. He realized that sound reflects the space in which it is recorded, and that choosing the space for recording was a critical factor in the quality of the recording. He also paid particular attention to the music used and the instrumentation. He uses only natural instruments, which produce tones rich in harmonics. Additionally, Steinbach believes that sound carries intention and that the musician's state of mind is reflected in his/her work. For this reason, he only records when he feels that the musicians are playing with a sense of joy. Steinbach also developed a special device called the envelope shape modulator which enhances the upper frequency range of the music, thereby 'spectrally activating' the recordings, The higher frequencies provide information about directional distances of sounds as well as other detailed information about the sound source. In addition to the spectral activation, there are also brief passages on the CDs with intensive filtering so that almost nothing but the overtones are heard. Listening to these 'high extension' passages theoretically trains the ear to pay attention to the upper ranges in the sound spectrum. The higher tones are the parts of the sound spectrum that captivate attention and hold interest. These recordings are identified as SAMONAS, which stands for Spectrally Activated Music of Optimal Natural Structure.

Steinbach creates several different levels of compact disc with varying intensities of spectral activation and filtering. The less intense compact discs are available to therapists with an understanding of the implication of filtered sound. These lower level CDs can be incorporated into entrylevel practices in the use of modulated sound such as Therapeutic Listening (see below).

The more intense compact discs require a longer more intensive training period which provides the therapist with more advanced information regarding sound and training in more sophisticated pieces of equipment used in SAMONAS Sound Therapy. To use the title "trained in Samonas" a therapist must complete a five day training course; a year of practical experience and then present documented case studies for peer review.

Therapeutic Listening

Therapeutic Listening is a term used to describe combined use of a number of electronically altered compact discs in a prescribed manner, but with equipment that can be used in many environments. Sheila Frick, OTR designed this program. Therapeutic Listening TM implies that the listening programs are individualized to each client and are suited for application in home and school settings. Maximum effectiveness in treatment outcomes is promoted by daily use. The use Of Modulated and filtered music in conjunction with sensory integrative Occupational therapy techniques seems to increase the effectiveness of both treatment modalities. There is commonly a decrease in the time necessary to meet treatment goals in the areas of: modulation, balance and movement perception; an increase in exploration of the environment, sense of physical competence, and drive to challenge one's practice and sequencing abilities; and improved social competence and language abilities.

Therapeutic Listening programs can be carried out at home, school or in the clinic with ongoing support from a therapist who is trained in their application. A typical program may be in place for two to six months for initial gains; however, many individuals continue past this time frame or find several of the compact discs useful as part of an ongoing sensory

diet. Currently, EASe, and 'entry level SAMONAS' CDs fall under this use. With the rapid growth of sound therapy, it is likely that other products will also be included in the future.

Listening Fitness

Another home listening program, the Listening Fitness program, is just being introduced in the United States and Canada. This program provides listening training using sound stimulation. It is designed by Paul Madaule who worked closely with Dr. Tomatis and has used the Tomatis method for over 30 years. While the Listening Fitness program shares some similarities with the Tomatis Method, it differs substantially in assessment procedures, audio equipment, and focus and is not regarded as being equivalent. It can be a useful part of a home treatment regimen where the goal is to help an individual to develop and improve both receptive and expressive listening. Like the other listening techniques, Listening Fitness includes a passive phase of intervention. Unlike the other auditory based home programs, Listening Fitness provides an active component or the 'expressive phase'. This is where one gains control over voice and body through voice exercises (humming, singing, reading in a microphone). The total program lasts about 10 weeks With usually 1 hour of listening a day and a short interruption between the 2 phases. Close monitoring and coaching are provided throughout the program.

Listening Fitness Instructors are carefully screened and trained, and are supervised for I year by a highly qualified training team of consultants from the Listening Centre in Toronto. Founded over 20 years ago by director Paul Madaule, the author Of When Listening Comes Alive, the Listening Centre is a leader in the field of listening. Currently the Listening Fitness program is being used with children with listening and learning difficulties. At this point in time it is not being used with individuals with a medical or neurological diagnosis Such as Autism ADD, or other neurological disorders.

Interactive Metronome

Recent clinical studies are indicating that another auditory based intervention which is quite different from all of the above listening techniques may also be effective with individuals who experience difficulties with motor planning and sequencing. Interactive Metronome is based on the premis that neural timing difficulties underlie difficulties with learning, cognitive and social skill and interfere with praxis. Occupational therapists have understood that motor planning and sequencing are key facets in the development Of functional skills. They have traditionally addressed these difficulties with sensory integrative techniques.

A new PC-based interactive version of the traditional music metronome is now being introduced as a viable tool for individuals with a broad variety of challenges. From existing studies and clinical reports, the most promising areas Of use include treatment for persons with difficulties in motor planning and sequencing, rhythmicity and timing, primary motor control, language and speech, learning and cognition and social development and communication. Stanley 1. Greenspan, MD, a psychiatrist and clinical professor of psychiatry at the George Washington University Medical School, is (lie Director of Research for the Scientific Advisory Board of the Interactive Metronome. He states that "the ability to plan and sequence action emerges early in the first year of life. It is essential for adaptive motor delopment and language development." He goes on to state that "it is essential for complex social behavior involving a number of sequential steps, such as sharing toys, complex greeting patterns, or simply playing with others." In a letter to parents of children with special needs. Greenspan states that "the soon to be published research using this tool strongly indicates new hope that the new method may enable children to improve underly processing abilities for motor planning and sequencing, strengthening their most fundamental learning capabilities."

A program utilizing the Interactive Metronome entails 15 hours of treatment. The typical training schedule is 3 times a week. In the Studies, treatment protocols of less than 3 times a week were not known to be as effective.

Traditional Interventions
Selecting the appropriate intervention/s for your child is a highly individualized and personal decision. There are several therapies available to help our children in the spectrum.

For a program to be effective, it should build on the child's interests, teach tasks as a series of simple steps, actively engage the child's attention in highly structured activities, and provide regular reinforcement of behavior. Parental involvement has emerged as a major factor in treatment success. Parents work with teachers and therapists to identify the behaviors to be changed and the skills to be taught.

Parents should make sure that the intervention/s they choose will target specific deficits common with children with autism such as difficulty in learning, communication/ language, imitation, attention, eye contact, motivation, compliance, and social interaction.
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