Information on Autism

Alfred A. Tomatis — Paris, 1986.

I willingly respond to the request made of me to give an overview of what I think about autism, but I wish to make clear from the outset that I simply wish to evoke the positive results we have been obtaining in this field for some decades now. There are, to be sure, failures as well, and we shall endeavour to analyse what occurs in their case.

The purpose of this essay is therefore neither to define what autism is nor to delineate what its aetiology might be.

As everyone knows, the pathogenesis of autism is obscure. With great dialectical reinforcement it feeds the discourses of specialists, all too often to the detriment of the child himself who is grappling with this syndrome; and to the detriment, too, of the family so sorely tried in the face of such a problem. For all the relational structures of the family find themselves disturbed, distorted, dramatically disorganised by such a context.

This syndrome exists. We are given to encounter it frequently in our Centres and to treat it according to a methodology that I shall describe.

I shall remain on a purely descriptive plane in order to present, with the greatest possible objectivity, the results we obtain. It is known that in such a field all the doors are open onto very thorough, specific research conducted according to the particular cases.

One has only to be confronted with autism to find oneself very quickly before a multiform “generic”. There is, to be sure, a common trunk, but also a thousand and one details that give rise to as many clinical pictures as there are autistic children, and that bring into relief as many relational disorganisations as there are families involved.

Thus nothing will be said here of the organic or non-organic nature of this syndrome. Nor shall we speak of any genetic factor. Our concern is to get to the essential by indicating what we do. As for the positive or negative results obtained, it is always easy afterwards to put forward hypotheses. They will have their interest if they lead to a genuine therapeutic attitude. But if it is a matter of revelling in words and giving rise to theses without issue, it is better to tell oneself that one knows nothing where autism is concerned, and that each person does what he can.

A pedagogy of listening

Our action, therefore, develops at the level of a pedagogy of listening. It matters little to us to know why the autistic child does not listen. We are assured only that he hears — at least he seems to demonstrate this to us — but that, deliberately, he refuses to listen.

The consequences do not wait to make themselves felt. Refusing to listen, that is to say to integrate language, the child will live in a sonorous universe from which speech is excluded. A particularly painful situation, just as trying for the one who is invested with it as for the family, which finds itself utterly helpless in the face of this refusal of all semantics.

Thus the autistic child lives intensely and paradoxically in an acoustic-sonorous world from which all semantic signification is eliminated, unknown. Although he can hear a fly buzzing, he is not capable of perceiving its name when it is pronounced beside him. Everything here happens as though a cleavage had occurred between sensing and perceiving. The passive action, the one that leaves him immersed in sounds, subsists at times even excessively, while the transcendence towards the vigilance from which consciousness will emerge does not come about.

There is therefore, as one can see, a mechanism that is absent; whether it has been lost, or has not matured, or is non-existent, the fact remains. It is not there.

In this way, autistic children are assailed by thousands upon thousands of stimulations, but none of them enters into a categorial structuring. They hear but do not listen. They have eyes and do not see. They have a mouth and do not speak.

It is true that, on this plane, autism is far more widespread than one might believe, and the cases we report here are in fact only extreme cases.

The surrounding universe of autistic children is paradoxical, without linkage, without synthesis as to the unfolding from one event to another. They reassure themselves in their own fashion by a few stereotypes that fix them upon themselves, while at the same time giving them a semblance of behavioural reality.

The world presents itself to them without unity, without development. Their vision is made up of a succession of spaced-out snapshots. Sounds manifest themselves as repetitive sequences, without any one of them being able to have a reference to speech. For indeed, if a single word were semantically perceived, felt, the syndrome would disappear.

It is not a matter, as one unfortunately sees so often, of “training” a child to pronounce words. That has no meaning. And all the educational approaches based on this system are necessarily doomed to failure. In the end they result only in the verbalisation of a few dozen words, and that after months or years of effort.

But then what is to be done?

The opportunity we have had to treat a great many autistic children has led us to think that, for a reason we do not necessarily seek to bring into relief, the desire to communicate has not been born in these children. And notably the desire to communicate with the mother.

What does this mean? It seems opportune here to recall that the ear is a particularly precocious organ, onto which is grafted the most ontological of desires, that of communicating.

The human being is indeed an eminently social creature, and the sense of his communion with the group is conceivable only if the faculty of listening is rapidly put to use.

This faculty develops all the more swiftly in that the human ear, as an anatomical organ, is completed within the very first months of intra-uterine life. The “embryo-foetus” is already a listener. And the whole neurological apparatus appended to this organ is operational from the fifth month of foetal life. Moreover, the temporal auditory brain is completed at birth.

This astonishing precession of the ear as the organ of listening allows us to understand why it is not excessive to claim that the desire to listen is the most ontological desire of being.

This desire to listen determines the human condition of the one who is to be born, since already his communication is being established, revealing to him his belonging to the surrounding world of sound. Let us add that the foetal ear perceives the mother’s voice remarkably well. There thus exists an inter-communication, a true communion between the mother and her child. Mothers know this very well. They speak with the child they are carrying. They sing songs to him, they hold dialogue with him.

Against this intimate, daily, permanent relational background, from which the overly visceral noises are happily eliminated by the filtering action that the cochlea performs in suppressing the low-pitched sounds, the foetus already lives the wonder aroused by the streaming of his mother’s voice. There, and nowhere else, begins the desire to listen.

If for some reason, unsuspected, this desire to listen does not take shape, or if it dies in the egg, profound disturbances of communication will appear. Their consequences are known.

What, then, will our action be?

It will consist in attempting to awaken this desire to listen. How shall we proceed?

When it is possible, we record the mother’s voice, and we prepare this voice by filtering it so that it may be received in the manner in which the embryo-foetus knows how to perceive it.

An elaborate technique of progressive filterings has led us to establish in detail the various stages of this perception. From then on, the messages collected and thus prepared are recorded on tape recorders of high professional quality, then injected into electronic systems called “Electronic Ears”.

These assemblies are models that function as the human ear itself does when it decides to pass from hearing to listening.

For indeed, a muscular play at the level of the middle ear triggers this volitional decision through a play of adaptation. So much so that the message which has sensitised the ear is not only felt but also perceived, that is to say appreciated, decoded, analysed in its different parameters. It is no longer noises that the foetus detects, but the whole dynamic of discourse.

It is astonishing to see with what ease autistic children, so strongly inclined not to accept the linguistic universe, are immediately seized by the desire to perceive this new message, which is liable either to recall to them a “thing already lived” (which is what the word “desirium” signifies etymologically, I would remind you) or to bring forth this desire to listen upon which communication will be built.

This may seem obvious, in so far as one accepts the importance of the awakening of the faculty of listening, doubtless the most astonishing of acquisitions among the dynamic structurings of the human being.

It must be added that, if the mother is able, we propose to her that she carry out accompanying sessions, which will allow her to become an integral part of the programme.

For indeed, when an autistic “inclusion” is seated within a family structure, it is the entire relational dynamic that finds itself strongly disturbed, since there exists no normal means of communicating. Any intervention at this level is in fact immediately blocked, rejected, sometimes even with particular violence.

So we ask the family, and more especially the mother who has agreed to make the gift of her voice for her child, to submit herself too to an education of listening. This commitment thus makes it possible to bring back, to re-solicit, that immense desire to listen upon which all communication finds its foundation.

The course therefore consists in having the child listen to his mother’s voice in the foetal manner, through the Electronic Ear.

Certain reactions reveal that we have reached the sought-after level. Before approaching them, let us note that the child generally accepts the filtered maternal sounds with enthusiasm, something which certain adults, and in particular certain specialists, have great difficulty in conceiving. It is true that we proceed in a progressive manner. We shall see how later on.

The reactions observed

Among the reactions observed, those of neuro-vegetative life are generally the first to manifest themselves, and this in a very perceptible way:

• sleep becomes peaceful, tranquil, while everything that gave a foreboding of disturbance through nightmares disappears.
• the appetite becomes normal; the child who previously ate little begins to “devour”, while the one who was a bottomless pit asks for less food. In fact, the child quickly seeks a position of equilibrium.

Let us note in passing that sleep and food are, on their own, a whole set of profound communication with the mother.

Then a great many things are modified on the behavioural plane. But here, the mother must be helped to accept these changes — she who for a very long time had grown accustomed to atypical, unusual reactions on the part of her child.

• As a general rule, he becomes affectionate with her, seeks contact, likes to sit on her lap, to caress her. He himself accepts that she touch him. One must, of course, proceed gradually so as not to trigger too quickly acquisitions which must in fact establish themselves slowly, naturally, as though coming of their own accord.

• Sometimes, on the contrary, the child’s rejection of his mother is more marked, more powerful, without one understanding its causes, and above all without the child himself knowing the reason.

• From time to time, and this stage is important, the autistic child begins to weep despairingly. He must be allowed to do so. He must be allowed to cry his fill. He does not know why he is weeping, just as one cannot explain such behaviour. But the weeping will enable him to overcome a painful state. He may weep for hours… even for a day or two. He must be allowed to do so, and not be helped to find consolation. He consoles himself by the very fact of weeping.

After the storm and the weeping, laughter and vigilance appear, in so far as the mother knows how to accept them. This is not always the case. For indeed, by their disconcerting attitude, autistic children have become the objects of their mother, who herself has become their thing. And the web of tension thus installed can prevent the child’s reinsertion into a normal life from coming about.

The role of the father

We then bring in the father. It suffices to explain to him the role he must play with regard to his child. His action must indeed be redefined towards this child who was never his own, one might say, since he had no benefit of semantics. For it is language that makes the child become his father’s son. But a very specific language, by which information must pass and upon which the law must be erected.

The father is not the one who scolds. He is the one who explains, the one who enunciates the law until it is truly accepted. It is for him to ensure its application.

The summit of articulation at the level of the family relational dynamic is, to be sure, difficult to attain. It will first lead the child to truly meet his mother. He will have to grow up in order to discover her. He will have to become an adult in order to love her.

And it is by no means certain that there will be acceptance of this relational impulse in the heart of a mother who for so long remained the prisoner of a foetus she carried both within her and outside her.

If one wishes the child to be a becoming in potential, if one wishes therefore for him to grow up, the mother and the father must each play their respective roles, the stakes being, of course, the child. In this instance, the mother offers him her heart and the father offers him language. The mother alone has a right to the love of the child who is making his way towards an ever more adult state, while the father sees his action realised in the becoming of the child.

What does a treatment in the pedagogy of listening consist of?

First of all, an audio-psycho-phonological assessment is carried out with a view to gathering everything that has been done or said beforehand, and to noting eventually what there is of the lesional, the psychological, or perhaps nothing at all…

Next, we propose the following course:

A first mother / child treatment is undertaken over a fortnight, at the rate of two hours per day, that is to say four sessions per day, each session corresponding to a recording of half an hour. This treatment is, in fact, a sensitisation to listening and to communication, both for the mother and for the child.

For the autistic child, it is simple: he refuses to listen to all that is verbal. But for the parents, certain signs may translate the anguishing difficulties they undergo permanently in such a family context.

Be that as it may, it serves no purpose to improve the child, to lead him to listen, if one is not assured of arousing a similar attitude in the mother. If she refuses to commit herself to the same approach, it is towards failure, and towards total failure, that we are surely heading. In that case, we do not take the child into our charge.

So mother and child come to the Centre for a fortnight in order to learn to listen and to listen to one another mutually. The stay generally goes very well, all the more so as certain reactions arouse both appeasement and energy.

During the treatment, some children grow drowsy while others are seized by a frenzy of drawing or writing. What it is important to note is that all those who are invited to hear certain similarly prepared sound sequences pass through the same themes.

The first phase of this course is called the “sonic return” and is carried out against a Mozartian musical background. It leads, in fact, from normal hearing to the listening of sounds according to the mode of embryo-foetal perception. This last can sometimes seem unusual and may, for that reason, be poorly tolerated. That is why it is better to carry out this preparation by means of the sonic return, and this with discernment and prudence. According to the opinion of the clinical psychologist, this first stage will be more or less long depending on the elements of anxiety gathered during the initial assessment.

Next comes the imbibition in the foetal, embryo-foetal sounds. It is advantageous to pursue this imbibition for as long as one observes modifications, and for as long as it is accepted by the child. It is necessary to remain on this base of filtered sounds as long as the desire to listen is not yet developed.

This desire to listen is, in fact, none other than the desire to be born. The child, as one can see, completely changes his attitude with his mother. He becomes more teasing, more noisy, but babbling. And one thus often has the opportunity to witness the genesis of a language taking shape, through the “goo-goos”, the babbling, the “papas”, the “mamas”, and so on.

There, and there more than anywhere else, the mother and the father will have to be helped to master their desire to see the stages rushed through.

The desire to listen is fragile, slow to structure itself. It must arouse the desire to communicate. But nothing must be hurried, nor must one seek to accelerate the mechanisms of crystallisation of this phenomenon. Should the parents be in the slightest bit pressing, should they wish in the slightest to hear words, to have others repeated, they risk compromising everything that has been acquired.

It is to be noted that, before an infant who is eager to bury himself in babbling and then in language, everyone is respectful of the fact. Everyone is full of admiration. By contrast, towards the autistic child or the child who has entered a path of refusal or delay, one never ceases to tease him, to ask him to say things again and to repeat them. He is harried so as to see him react like a circus animal.

Now, in this circumstance, it is the animal who wins! If the child gets wind of all this distorted dynamic, he does not let himself be caught up in the game. And it is he who, willingly, will subjugate the whole family by letting fall the words he wants when he desires, or by refraining from speaking and refusing to do what is asked of him.

The child wins at this game. That is true. But he dies anew to the desire to communicate.

What must be done with an autistic child who is beginning to desire to speak is to gather silently and with love all his utterances, to note his progressions, to take stock of his acquisitions.

The start is the most difficult. Afterwards, there is acceleration. As language kindles, vigilance appears. The gaze becomes expressive. The words begin to follow one another, and later the sentences come.

Such is the process of the unfolding of a treatment during the first fortnight. One then observes three to six weeks of rest. One cannot, in fact, go faster than the nervous system involved in this whole approach.

The second series, which lasts eight days, is carried out in foetal hearing. Then, depending on the reactions and the results, we ask that it be pursued at the rhythm of eight days every six, eight or ten weeks, until language is normally structured. During these consecutive series, new phases are crossed in the form of sonic birth, of pre-language with songs and nursery rhymes, Mozartian music, Gregorian melodies. Then appears the last stage, that of language.

Is there any need to specify that, if the institution in which the child is placed is cooperative, everything is singularly facilitated and unfolds more rapidly.

The results

When they are positive, they allow the child to become normalised. The work is all the easier the younger the child is, as one can well conceive.

But what is certain is that, in the cases we call positive, we obtain a restitution of the desire to listen and to communicate, together with an improvement of language as one advances through the treatment. These cases are of the order of 40 to 60%. There are failures, at least 40%, without one often knowing why. For indeed, certain assessments give us the certainty of an easy unfolding, whereas what follows proves far more complex and far longer. At other times, we set out pessimistic, thinking we are undertaking the treatment merely by way of indication, and the responses prove good.

It is here indeed that we must confess ourselves powerless to know the depth of the “lesion” — affective or not — that motivated this famous rupture of listening, or the non-blossoming of this faculty, which amounts to the same thing. However, in all cases, we are not authorised to consider ourselves beaten or powerless. So we are always inclined to attempt to begin an approach under the Electronic Ear, in order to know the child’s reactions.

It is obvious that these treatments have disadvantages, major disadvantages. They are costly and frequent.

• Costly through the implementation of considerable electronic equipment and of qualified personnel.
• Costly through the obligation of a stay at a specialised Centre.
• Costly too because not yet integrated into the treatments of an institutional therapy capable of taking everything into its charge.

For indeed, for the parents, to present themselves at a Centre, to make such a commitment, to accept the investment of a total family dynamic — all this already has in itself a certain effect. Moreover, the routine humdrum lived within an institution has nothing to do with all that forms the affirming environment from which the child benefits in the course of a treatment at a Centre.

It is also true that this new technique requires the presence of qualified personnel, ready to invest themselves wholly in the ethics of such a method. The latter, indeed, gives results as positive as these only because, within the very Centre where it is applied, all the members of the team work in one and the same direction.

Each one does not do as he pleases at the moment it seems good to him to do it. Everything is centred on listening, on the demands that the latter introduces.

One does not enter into the dynamic of listening as one strolls idly down a corridor.

It is a matter of taking into one’s charge the one who is in difficulty and who knocks at the door. It is a matter of knowing that he exists and that he is. It is a matter of letting oneself be penetrated by the refined consciousness that one belongs to the human group.

To enter into the domain of listening constitutes a true human commitment, since it leads from the existential plane to the plane of the Essence.

Alfred Tomatis

Source: Alfred A. Tomatis, “Information on Autism”, Paris, 1986. Transcription from the facsimile.