An Evidence-Based Review by Marie Foster
What is Therapeutic Listening? How Does It Help?
Therapeutic Listening Program (TLP) is a neuroscience-based program that produces highly beneficial outcomes for people with autism. People who use TLP find improvements in language development, sensory processing skills, find & gross motor coordination, memory, thinking skills, and emotional wellness (Advanced Brain, 2021)
Music modulation “exercises” the auditory processing system and central nervous system by altering the tone, pitch, frequency, and strength of the various sounds & music, as well as designating which ear hears sounds through headphones (Advanced Brain, 2021).
The ear integrates the neural organization of the nervous system, so when exercised, the eartaps into the power of the central nervous system to listen to and process information within the auditory environment (Pawell, 2006, 6).
Additionally, the modified sounds slightly alter the frequency coming through each headphone, which causes the brain to create and register a balanced new frequency, known as the binaural beat. The Quickshifts technique uses binaural beat technology to increase alpha brainwave activity in order to quickly shift alertness and set up the nervous system for optimal success (Hair et al., 2018, 4).
Therapeutic Listening Program improves communication between both hemispheres of the brain to promote inter-hemispheric collaboration and produce a calm, alert state (Hair et al., 2018, 4).
Sound-based therapies have been supported by a multitude of outcomes including enhanced awareness, improvement in interpersonal skills and social behavior, enhanced body awareness, improvement in activities of daily living, self-care, sleeping patterns, academic performance, and reduced anxiety (Hair et al., 2018, 3).
Therapeutic Listening Benefits and Autism
For people with autism spectrum disorder (ASD), one of the biggest challenges reported is hypersensitivity to sound, triggering a flight or flight response from the body. Therapeutic Listening Programs address this fear response by slowly desensitizing the listener to the sounds during treatment, and reprogramming the emotional memory system to recognize the sound as calming. When a listener is completing the training, they are in a calm and relaxed state, doing normal things, and by integrating the triggering sounds on a less intense level, the sounds are normalized and paired with everyday tasks (Advanced Brain, 2021).
This systematic review of literature is focused on the outcomes of the therapeutic use of music with children living with autism and was written to enhance the practice of using music as a therapeutic intervention by studying program needs and design. Outcomes from the use of music as a therapeutic intervention with children with autism spectrum disorder included improvement in interpersonal skills, social skills, and cognitive skills. Reported benefits included, but were not limited to increased appropriate social behavior; increased attention to task; increased vocalization, verbalization, gesture, and vocabulary comprehension; increased communication and social skills; enhanced body awareness and coordination; improved self-care skills; and reduced anxiety (De Vries et al., 2015, 229). They found that benefits of therapeutic listening include:
- Increased socially acceptable behaviors
- Increased social response behaviors
- Increased verbal communication
- Increased understanding and recognition of emotions
- Decreased anxiety
Three (50%) boys showed positive changes in behavior after the treatment. From a developmental point of view, the changes occurred in pre-linguistic areas for 5 out of 6 boys that are considered prerequisites for verbal communication. One boy was no longer considered autistic, two boys showed mild symptoms of ASD and three boys remained within the severely autistic range. (Brbić & Tomić, 2020, 53).
This study intended to investigate 12 areas of consideration after a therapeutic listening program. The parents rated each area before and after treatment from their point of view. The researchers found the following percentages of growth for each category (Brbić & Tomić, 2020, 52):
- Interpersonal Growth: 87%
- Listening and Speech: 85%
- Academic Achievement, Thinking, and Learning: 81%
- Attention: 80%
- Behavior: 79%
- Intrapersonal Growth to Know and Express Self: 69%
- Movement, Sports, and Rhythm: 66%
- Well-Being: 20%
The study started with 4 weeks of a sensory diet (chewing gum, heavy work, activities that provide sensory input), then 8 weeks of therapeutic listening programs. The children were assessed using the Sensory Profile and the Evaluation Tool of Children’s Handwriting (ETCH) assessment. Overall, the children showed improvements in auditory, multi-sensory, and tactile processing, as well as improvements in emotional regulation and behavioral outcomes. For their handwriting, the researchers found improvements in overall legibility of handwriting and improvements in lowercase letters and numbers (Hall & Case-Smith, 2007).
The children followed a Therapeutic Listening Program and teachers and OTs tracked students’ progress. This study found significant improvements in social skills, fine, gross, and visual gross skills, and verbal and nonverbal communication following treatment. These improvements were demonstrated in each child except one, in at least two of the areas studied (fine-motor, language, social, sensory processing, and visual-motor) (Bazyk et al., 2010).
In this study, 13 children with a diagnosis of a learning or developmental disability and sensory integration concerns. Each participant was currently receiving OT services, and diagnoses ranged from autism, ADD/ADHD, sensory integration disorder, anxiety, and/or developmental coordination disorder (Hair et al., 2018, 16). Overall, significant improvement was demonstrated in individualized goals, as measured by the COPM, and in posture and balance as measured by Clinical Observations. Analysis of qualitative statements from parent observation logs found improvements in all areas (social, visual, hearing, touch, body awareness, balance, planning, and ideas), except for touch. (Hair et al., 2018, 29).
In spite of 10 years of speech therapy, the patient pronounced only a few syllables “Ba, Da, Ma.” After 150 hours of passive and active Therapeutic Listening, she significantly improved in communication, attention, understanding, socialization, and learning in general (Brbić & Tomić, 2020, 53).
“After the first intensive, the patient started to talk more spontaneously. During the second intensive, mother voice recording and active vocal work were introduced, echolalia appeared as well as her coordination and motor planning improved. After her third intensive, a girl started to talk, sing and express herself. After the fourth intensive she had more balance and coordination, spoke spontaneously, hugged, and showed her affection, only a year and a half beforehand she was still nonverbal. After her 5th intensive, the girl was retested and the results showed a normal child’s development. 6th intensive brought further improvement in her body – not only promoted her speech, it liberated her from typical repetitive mannerisms.” (Brbić & Tomić, 2020, 54).
Therapeutic music is more beneficial than listening to the normal music, as one study compared listening to therapeutic music vs normal music in children with ASD for 25 sessions over 8 months for students aged 4 to 7. The group listening to therapeutic music had better scores at the end of the study than regular music listeners (Raberyron et al., 2020, 1)
More Articles for Further Reading:
Advanced Brain. (2021, April 6). The Listening Program®: A Trusted Approach for Autism Treatment. Advanced Brain Technologies. Retrieved November 6, 2022, from https://advancedbrain.com/blog/the-listening-program-a-trusted-approach-for-autism-treatment/
Bazyk, S., Cimino, J., Hayes, K., Goodman, G., & Farrell, P. (2010). The use of therapeutic listening with preschoolers with developmental disabilities: a look at the outcomes. Journal Of Occupational Therapy, Schools & Early Intervention, 3(2), 124- 138. doi:10.1080/19411243.2010.491013 https://www.tandfonline.com/doi/abs/10.1080/19411243.2010.491013
Brbić, I., & Tomić, L. (2020, July 22). An Integrative Review of the Effectiveness of the Tomatis Method in Children with Autism Spectrum Disorder. RAD CASA – MEDICAL SCIENCES, 543(50-51), 49-56. http://rad-med.com/wp-content/uploads/2020/10/08.pdf
De Vries, D., Beck, T., Stacey, B., Winslow, K., & Meines, K. (2015). Music as a Therapeutic Intervention with Autism: A Systematic Review of the Literature. Therapeutic Recreation Journal, 49(3),220-237. https://bctra.org/wp-content/uploads/tr_journals/6085-21166-1-PB.pdf
Hair, D., Taasan, P., & Tashjian, H. (2018, May). Measuring the Outcomes of Therapeutic Listening® in Children with Learning and Developmental Disabilities. Graduate Master’s Theses, Capstones, and Culminating Projects, 292. https://scholar.dominican.edu/cgi/viewcontent.cgi?article=1303&context=masters-theses
Hall, L., & Case-Smith, J. (2007). The effect of sound-based intervention on children with sensory processing disorders and visual-motor delays. The American journal of occupational therapy: official publication of the American Occupational Therapy Association, 61(2), 209–215. https://doi.org/10.5014/ajot.61.2.209
Pawell, C. J. (2006). Efficacy of Therapeutic Listening Intervention on Auditory Processing/Attention in Children Ages 3-11. Master’s Theses, 1-46.
Raberyron, T., Robledo del Canto, J.-P., Carasco, E., Bisson, V., Bodeau, N., Vrait, F.-X., Berna, F., & Bonnet, O. (2020, August 12). A randomized controlled trial of 25 sessions comparing music therapy and music listening for children with autism spectrum disorder,. Psychiatry Research, 293(113377). https://www.sciencedirect.com/science/article/abs/pii/S0165178120320308
How We Use Therapeutic Listening Programs at Kid’s Work Therapy
Kid’s Work is a pediatric occupational therapy clinic specializing in the use of sensory integration techniques to treat children’s sensory motor development difficulties. Sensory integration (SI) is the way the brain organizes & processes information from the senses— simply put, “Information processing”. SI treatment has been used for over 30 years throughout the country and is growing in many other parts of the world. During the past 10-15 years this knowledge base has grown tremendously and SI treatment is accepted as part of the mainstream practice by pediatric OT practitioners. This approach utilizes tactile, proprioceptive, vestibular, oral motor, and visual senses.
Occupational therapists include the auditory channels via a Therapeutic Listening Program with specialized headphones & specially modulated music on MP3 chips. These therapists have been using this program for many years and show very promising and often remarkable results in a relatively short period of time. This is a new treatment approach and is cutting edge rather than mainstream. We feel that Therapeutic Listening has tremendous potential and therefore offer this treatment to our students.
Many researchers consider Therapeutic Listening Program (TLP) to be a form of sensory integration therapy that uses sound vibration to stimulate brain processing. There are many theories as to why TLP works, including the close connection between the ear & voice, language, emotional, and psychological development. It is felt the movement that occurs in the structures of the ear in response to the vibration of sound has a tremendous effect on total brain functioning. In addition, information about time & space is conveyed and internal rhythms are influenced
The TLP may be used separately from or as an adjunct to your current therapy program. This dynamic home program involves listening to specifically modulated music through headphones. The sounds are modulated and filtered by electronic means. A specifically tailored treatment plan is developed for each child and may incorporate 6-12 chips. The program involves listening two times per day for 30 minutes a session. The program lasts from a minimum of six weeks to several months, depending on the child’s response & carry-through. As a child progresses in response to the TLP, changes in music selection & protocol are recommended.
Changes that May Occur With TLP:
|Arousal, attentiveness, and focus||Pragmatic language|
|Speed of processing for motor and language||Affect, facial expression and responsiveness|
|Balance and coordination||Motivation|
|Praxis, which includes the following:Coming up with an ideaPlanning how to carry it ourSequencing & timing the tasksCompleting the task||Awareness of the environment and increased verbal interaction|
|Self initiation of play & work behaviors||Awareness and regulation of hunger/thirst pattern|
|Social & emotional development||Most regular eating and sleeping patterns|
|Improved eye contact & tracking||Gravitational security (decrease in fear of movement/feet leaving the ground)|
|Decrease in self-stimulating behaviors||Decreased sensory defensiveness|
|Receptive and expressive language||Increased organization|
Please call Kid’s Work at (805) 815-5634 if you would like to learn more about obtaining this specialized therapy for your child or someone you know. For additional information & research, please refer to the Vital Links website at www.vitallinks.net. This handout is adapted from materials developed by Frick/Oetter/Lawton-Shirley, 1997.
In conclusion, the therapeutic listening program has been extensively studied in the field of occupational therapy. We have highlighted the benefits of these programs in areas such as sensory processing, attention, social skills, and overall functional abilities. It has been found that TLP can help individuals with neurological conditions improve their ability to process auditory information, leading to improvements in attention, communication, and behavior. Additionally, these programs have been found to improve gross and fine motor skills as well as social skills. Overall, the use of therapeutic listening programs in occupational therapy can lead to meaningful improvements in the functional abilities of individuals with neurological conditions, making it a valuable addition to any occupational therapy treatment plan.