Let’s Look at Therapeutic Listening® Research

Research Team

To the untrained eye, it is often difficult to assess listening skills. Since we cannot directly observe internal listening processes, we must infer listening function through behavioral clues. This task is especially difficult due to the extremely wide range of behaviors associated with poor listening skills and the fact that the behaviors are not always linked to listening in an obvious way, such as cupping one’s hand behind the ear.

“The present study produced encouraging findings to support the use of Therapeutic Listening as part of an overall sensory integrative approach to occupational therapy in elementary school-age children. Therapeutic Listening, along with sensory diet strategies, can be effective in reducing many behaviors associated with sensory integration disorder.”

(Hall & Case-Smith, 2007, p. 215)

Evidence Brief on the Effectiveness of Therapeutic Listening®

The existing body of research on Therapeutic Listening presents positive findings regarding the use of Therapeutic Listening as a treatment tool embedded in a sensory integrative treatment approach.  The studies identify multiple positive gains including improved attention, handwriting, ability to perceive and move through space, enhanced interaction with peers, greater ability to attend to and follow directions, improved sleep and wake cycles, and enhanced communication. The current research on Therapeutic Listening does support continued clinical use. Future well-controlled studies would expand and enhance the existing research.

Level III: Quasi-Experimental/Repeated Measure Design/Pretest-Posttest Design
Hall, L., & Case-Smith, J. (2007). The effect of sound-based intervention on children with sensory processing disorders and visual-motor delays. American Journal of Occupational Therapy, 61, 209–215.

The purpose of this study was to examine the effectiveness of a sensory diet and Therapeutic Listening on a group of children with sensory processing disorder and visual-motor delays.  Study participants included a convenience sample of 10 children; ages ranging from 5 years, 8 months to 10 years, 11 months.  In the first phase, participants took part in a 4-week sensory diet, followed by an 8-week sensory diet and Therapeutic Listening phase.  Each participant was assessed on sensory responsiveness using the Sensory Profile both before, and after, both intervention phases.  Participants were assessed on visual-motor performance using the “Draw-A-Person” test, the Developmental Test of Visual-Motor Integration (VMI), and Evaluation Tool of Children’s Handwriting (ETCH) before and after each intervention phase.  During the 4-week sensory diet phase, each participant was provided with specific activities to be completed at home with their parents.  The activities selected by the occupational therapist were based upon the initial Sensory Profile and the individual needs of the child.  In the second 8-week phase, the families again met with the therapist and a Therapeutic Listening protocol was developed to meet the needs of the child.

Participants’ scores on the Sensory Profile indicate a remarkable improvement in sensory processing following the 12-week intervention (scores increased an average of 71 points from pre- to post-test).  Following the Therapeutic Listening intervention, participants demonstrated mixed results on the improvement of temporal-spatial skills.  Participants demonstrated a significant improvement in scores on the VMI visual subtest and writing lowercase letters (ETCH).  Handwriting total legibility improved significantly from initial pre-test to post-test.  Parent interviews at the end of the second intervention phase also indicated an improvement in participants’ behavior.  Parents reported they observed improvements in their child’s attention, enhanced interaction with peers, improved transitions, greater self-awareness, decreased nightmares, enhanced listening, improved communication, greater regularity following directions, and improved sleep patterns.  Overall, the results of this study provide promising support for the use of Therapeutic Listening as an intervention tool to support occupational therapy with sensory integrative treatment approach.

Bazyk, S., Cimino, J., Hayers, 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.

The purpose of the study was to further expand the current evidence on Therapeutic Listening by examining the results of listening with a group of preschool children with developmental disabilities.  The participants included a group of 15 children, ranging from 3 to 6 years of age, who attended one of four similar preschool classrooms.  Each displayed difficulties with sensory processing as demonstrated by their scores on the Sensory Profile. All received occupational therapy services, primarily related to enhancing school performance. Participants engaged in a Therapeutic Listening protocol, which was developed and monitored by an occupational therapist. Assessments were administered pre-intervention at the beginning of the school year (October) and post-intervention at the end (April and May) in the following areas: fine-motor, visual-motor, language, social skills, nonverbal intelligence, and sensory processing.  The pretest and posttest assessments included the Peabody Developmental Motor Scales-Second Edition (PMDS-2); Developmental Test of Visual-Motor Integration (VMI); Preschool Language Scale-3 (PLS-3); Draw-A-Person (DAP); Social Skills Rating System (SSRS); and the Sensory Profile. The length of intervention ranged from 6 weeks to 5 months depending on the child’s individual needs. Participants engaged in Therapeutic Listening one to two times a day, for 5 days a week, for duration of 20 to 30 minutes.

The results of this study indicate that participants made statistically significant changes in visual-motor, fine-motor, language, non-verbal, and social skills from pretest to posttest.  The mean of each pretest assessment significantly increased at posttest, with the exception of the SSRS problem behavior standard score and the PLS-3 language standard score. Participants did not demonstrate any significant changes on any of the subtests of the Sensory Profile. In addition to improvements in standardized assessments, both teachers and parents noted encouraging changes in their children’s behavior. Parents reported transformations in their children’s execution of activities of daily living. Teachers stated positive improvements in group activity participation, overall attention and processing, increased number of verbalizations, more positive social interactions, and greater ability to attend to and complete directions.  The results of this study indicate that for a group of preschool students, Therapeutic Listening in conjunction with traditional occupational therapy services resulted in a statistically significant improvement in a number of critical performance areas (fine-motor, visual-motor, language, non-verbal, and social).

Cipriani, N. (2010). Using evidence-based practice and pilot programming to explore emergent treatment strategies.  Unpublished pilot study.

The purpose of this pilot study was to explore the use of Therapeutic Listening in a group of eight elementary-age students.  The study participants all had varying degrees of impairment with motor, visual, ocular, and sensory processing skills. Study participants’ caregivers and teachers completed the Sensory Processing Measure (SPM) and the Conners 3 Short Form. Additionally, the Developmental Test of Visual Perception- 2nd edition (DTVP-2) was administered in December and June.

Study participants demonstrated improvements in both behaviors in the classroom and at home.  Within two weeks of initiating the Therapeutic Listening protocol, four of the most emotionally labile students were spending more time in the classroom, as compared to previous time spent saddened in the hallway.  Teachers noted that participants were more engaged in classroom activities. One parent reported that their child was now sleeping through the night and open to trying new foods. Other parents reported that their children were more regulated, less frustrated, and less anxious. All parents reported an increase in attention and emotional flexibility. All but one teacher, who responded neutral, reported that were likely or very likely to use this program again. The participants’ parents responded positively to the implementation of Therapeutic Listening, and some even requested a continuation of this program for their child. Overall the results of this study support the use of Therapeutic Listening with elementary school students and the use of this tool within a school setting.

Level V: Case Study
Frick, S.., Young, S., Huecker, G. (2007). Therapeutic Listening: listening with the whole body. S.I. Focus Magazine, Autumn, 6-7, 14-18.

This article presents a case study on a 4 ½ year old girl, who had recently been adopted from Russia. Upon referral to occupational therapy, parental primary concerns included poor safety awareness and lack of impulse control. Sara also demonstrated increased activity level, difficulty regulating sleep patterns, postural insecurity, and difficulty with interpersonal interactions. She exhibited adverse responses to light touch, noise, bright lights, and environmental smells. Sara became easily frustrated and had difficulty coping with transitions. In the clinic, Sara presented with poor trunk strength and quickly fatigued while sitting or standing. To compensate for poor trunk strength, Sara would quickly move through all gross-motor activities.

Sara participated in bi-weekly occupational therapy for duration of 60 minutes, for a total of 15 direct treatment sessions over seven months.  Sara participated in a Therapeutic Listening program and a sensory diet home program including the TheraPressure Program, How Does your Engine Run?, and postural and muscle coordination activities.

Sara presented with significant behavioral changes within the first few weeks of Therapeutic Listening.  She began to tolerate and seek out touch (i.e. hugging her grandmother), and started to notice sounds for the first time (i.e. birds chirping). In the final weeks of Therapeutic Listening, Sara’s teachers reported improvements in overall attention and visual-spatial skills.  Parental report indicated that Sara more frequently engaged in a quiet alert state, demonstrated improved eating, and is now able to fall asleep independently. Sara also displayed significant improvements in four subscales on the Sensory Profile.  This case study supports the use of Therapeutic Listening with individuals with modulation and self-regulation difficulties in conjunction with other sensory integrative techniques.

Frick, S., Young, Sally. (2009). Listening with the Whole Body: clinical concepts and treatment guidelines for Therapeutic Listening. Vital Links; Madison, WI.

This book includes a compilation of case studies of individuals who participated in the Therapeutic Listening program. Case study subjects range in age from 10 months to 59 years of age, with a variety of diagnoses, and levels of sensory dysfunction.  Individual case studies provide specific detail that pertains to each individual’s detailed occupational therapy program and progression through Therapeutic Listening.  While participating in Therapeutic Listening, many individuals also received ongoing occupational therapy services based on a sensory integration treatment perspective and recommendations for home program activities.

Participants in the Therapeutic Listening program demonstrated a range of positive results and improvements in everyday activities. Individuals displayed improvements in overall self-regulation, ability to fall asleep and stay asleep, enhanced ability to engage in social interactions, improvements in ability to perceive and explore space, and increased ability to engage in movement. Younger participants demonstrated improvements in communication, ability to tolerate transitions, enhanced safety awareness, ability to function in noisy environments, and advanced fine- and gross-motor skills. Improvements related to Therapeutic Listening were observed at home as well as in school environments. Participants demonstrated improved academic performance, enhanced attention, and ability to focus on homework.  The results of these case studies substantiate the use of Therapeutic Listening, used within a sensory integrative treatment context, with a broad range of individuals, ages, and sensory integration dysfunction.

Over, K. (2011). Effect of Therapeutic Listening on the occupation of play. Unpublished case report.

The purpose of this case report is to describe the impact of Therapeutic Listening on the play skills of a four and half year old boy (“Andrew”) diagnosed with autism. Prior to implementation of Therapeutic Listening intervention, Andrew previously participated in two years of traditional occupational therapy with a sensory integrative treatment approach. However, both Andrew’s parents and occupational therapist felt as though he had not made any progress in his play skills and still did not tolerate change well.  Subsequently, his therapist suggested augmenting his current occupational therapy treatment plan with Therapeutic Listening.

Andrew’s play skills were evaluated, using the Revised Knox Preschool Play Scale, prior to and following a 10-week long Therapeutic Listening intervention. Andrew’s play was videotaped over a one-week baseline period at a familiar clinic setting and at a novel playground setting. Following the intervention, play was again videotaped at the clinic and at another novel playground. Videotapes were reviewed by Andrew’s occupational therapist and another occupational therapist blind to the study.

Andrew listened to five albums during his 10-week Therapeutic Listening intervention period. All albums were selected based upon anecdotal evidence that supports their use for self-regulation.

Following the 10-week intervention, Andrew demonstrated 32 additional play skills according to the Revised Knox Preschool Play Scale. Andrew displayed progress with visual-motor skills, increased attention, awareness and exploration of his environment, began sleeping through the night, and overall improvements in self-regulation and behavior. The results of this case report substantiate the use of Therapeutic Listening, used in conjunction with sensory integration, for young children with autism.

Vital Links Practitioner Survey

Vital Links also conducted a practitioner survey in 2005. The survey questions focused on attention, self-regulation, and sensory modulation. Clinicians reported seeing widespread improvements in these areas: more than 87% of all respondents (N=1053) and 95% of those who had taken the Advanced Therapeutic Listening course (N=246) reported that Therapeutic Listening increased the rate of improvement in more than half of their cases. Improvements were reported in sound sensitivity, energy level, sensory defensiveness, transitions, attention, focus, and mood.