From Speech Therapy to Audio-Psycho-Phonology

Article by Elizabeth Dorignac*, speech therapist, communication presented within the framework of the works of the* Société d’Audio-Psycho-Phonologie (SAPP), Amiens.

From Speech Therapy to Audio-Psycho-Phonology. Why, as a speech therapist, did I turn towards Audio-Psycho-Phonology? How can I reconcile my initial training and the contributions of APP? Such are the questions to which I shall try to respond, limiting myself to the treatment of dyslexia and to the concrete contribution of a professional experience with its limits, its doubts, its hopes.

Let us briefly recall what Speech Therapy is. In France, it is a “speciality whose object is the study of language and the treatment of its disorders”. The speech therapist is, by consequence, the one who performs, outside the presence of the physician, acts of re-education of the voice, of speech, of oral and written language.

I. Dyslexia for the speech therapist

How does this dyslexia present itself?

It is essentially detected by the symptom. It is commonly thought that it can only truly be diagnosed at the appearance of the letter, that is to say around 6 or 7 years of age. In reading or transcribing, one observes:

inversions of letters or syllables;
omissions bearing particularly on inter-syllabic consonants;
substitutions by confusion between m/n; p, b, d, q; f/v; ch/j; etc.;
difficult, hacked reading, with many hesitations and sometimes whole word substitutions;
a consequent dysorthography: faults of phonetic transcription, poor splitting of words, confusions of parts of speech, errors of agreement and of vocabulary, defects of punctuation, etc.

The examination we have the child undergo — followed or preceded by an interview with the parents — provides us with information on the psycho-motor level, the perceptive aptitudes (visual and auditory), the aptitudes for the structuring of space and time, the bodily experience, sensory memory, orientation, laterality and oral expression.

The tests used are, among others: the Borel-Maisonny test of orientation and judgement, the Lefavrais reading test, the Borel-Maisonny spelling test, the E.O.S. 64 — to which may be added the Wechsler or Rey psychological tests.

In the course of this examination, we detect either a nominal dyslexia (impairment at the elementary level of the letter), or a semantic dyslexia (impairment at the level of syntax). The interview with the parents and the attitude of the child often reveal a certain instability, nervousness, inattention — or else inhibition, immaturity, marked disinterest.

How is dyslexia to be explained?

The difficulties evidenced in the tests provide a few leads. They show in general, but inconsistently:

poor structuring of space and time;
disorders of visual and auditory perception;
a speech disorder or language delay;
a dyslaterality;
disorders of the bodily schema;
a certain disturbance of mnemonic activity and of attention;
psychological problems;
the non-acquisition of the symbolic function.

It is agreed that it is above all a difficulty in acquiring automatisms, in mobilising schemata.

The Borel-Maisonny method

The training that I personally received at the École d’Orthophonie of Bordeaux — claiming to follow the techniques of Mme Borel-Maisonny — has as its method:

to attack the disorders by numerous exercises of manipulation, classification, reconstitution, comparison, imitation;
to establish a relationship of confidence with the subject;
to seek to resolve the problems of written language properly speaking, through the elaboration of this relationship of confidence and communication.

To avoid the confusions, inversions and numerous errors of which the dyslexic child is bearer, recourse is had to the association of several symbols: the phoneme will be linked to a specific gesture. The differentiation between phonemes will thus be easier, operating at several levels: visual, bodily and auditory. The gesture will likewise be evocative in signifying the flow of time, the succession in space.

The letters will systematically be studied not according to their name but according to the sound they represent. Their association in syllables or in words will be performed very slowly, always insisting on a coming to consciousness of time and space.

The speech therapist will try to facilitate reading — generally hacked and slow — then will turn to spelling, proposing to the child the association of grammatical categories with other symbols: colour, for instance. To each category (noun, verb, adjective…) will be given a particular colour, allowing a rapid reflex of recognition. Recourse will also be had to a reflex by presenting to the child tables of dysorthography representing, generally in the form of drawings, rules of grammar, agreements, conjugations, etc.

Results and criticisms

An appreciable improvement is noted at the level of reading and spelling during exercises bearing on precise points. But this improvement requires of the child a great concentration of energy, and these acquisitions are often little used as soon as the child leaves the framework of the exercises to engage in a written expression still poorly desired.

One sometimes comes up against the child’s lack of motivation and against technical difficulties:

difficulty in inducing a structuring of time and space;
difficulty in refining sensory discrimination, particularly auditory;
difficulty in establishing a notion of bodily schema — the latter may become only named and not lived;
difficulty in bringing about the recognition of categories and the differentiation of homonyms;
difficulty in establishing schemata;
difficulty in maintaining the child’s interest and attention — he being generally fatigable.

The whole of these exercises does not allow the child an approach to written language in full freedom. It leaves him stuck in details, prisoner of “mnemonic” aids and of conditioned reflexes.

It appeared to me that this kind of re-education acted essentially at a surface level, that of the signifier — in the sense of Saussure. The exercises proposed address only very slightly the signified; now the dyslexic has not yet entered into a dynamic allowing him to grasp from within, and to situate himself in relation to, what we wish to have him discover. These signifiers refer only to evasive signifieds.

Faced with these partial successes, the speech therapist is led to think that these disorders of written language draw their roots from an unsuitability much deeper, even of psychological origin.

II. The study of dyslexia by an audio-psycho-phonologist

Why APP attracted me

Initially, in my first readings on Audio-Psycho-Phonology, I was attracted by certain points. Tomatis proposed:

an interesting explanation of the cause of dyslexia — he brought its roots to light;
the setting at distance of the symptom. This setting at distance did not seem to me, at that moment, absolutely necessary; but I knew by experience that to approach it directly very often only led to becoming stuck in it with the child;
the taking into consideration of the problem of listening. The person who approaches the dyslexic child’s confusions of sounds in detail comes up against listening difficulties that appear considerable and apparently inexplicable. He very often ends up by having an audiogram performed — which he reads as an audiogram — finding, of course, no deafness;
finally he linked in a functional unity all the points and disorders of which I only observed the existence: dyslaterality, atonic, stooped, inattentive attitude; disorder of the bodily schema; defective oral expression; incapacity to situate oneself at every level.

A learning difficulty of auditory origin

Schematically: from before birth, the child engages in a relationship made principally of contacts and noises with his mother. He perceives above all her voice. After birth, the dialogue is established by means of gestures, noises, laughs, phonemes and a few words, always addressed to the mother; then this language structures itself, normalises itself, to address itself a little later to the father — the one who initiates into the language of society, the one who leads to socialisation.

Such is the path it is given to the child to follow. There occurs a difficulty, a delay, a defect in the progressive structuring of his relation to others: we witness a harmful repercussion on the elaboration of oral and written language.

The dyslexic has remained fixed at stage two — that of the dialogue with the mother. He has not truly attained syntactic organisation, and one need only listen to a dyslexic speak to find in his words confusions, imprecise terms, incapacity to translate his thought and to formulate it correctly. He has not entered into an adequate relation with the outside, the other, himself.

Auditory laterality

The laterality that every speech therapist or psychomotor specialist has learned to measure reduces to motor laterality (hand, foot) and sensory laterality (sight). The one that most concerns us to know and to study here is essentially addressed to audition, or the audio-vocal monitoring of the subject. We say that there exists — depending on whether self-listening is effected through one ear or the other — a right voice or a left voice.

To speak on the right is to respond to the physiology of one’s body, where this lateralisation of language appears to be induced by the difference in the paths and lengths of the two recurrent nerves responsible for the motor function of the larynx. It is to allow a normal relational structure to develop. It is, in a manner of speaking, to leave the mother, early childhood, to reach the father, the verb, the other.

Directivity on the right does not signify weakness or atrophy on the left. Each part has its function; the body, its unity. Directivity on the right signifies the power to use all one’s dynamics and all one’s energy; the power to inhabit and organise one’s body; the power, finally, and this in a broadened perspective, to situate oneself, to master oneself.

The left-hander is the one who refuses this passage to the right; the dyslexic is the one who cannot achieve it.

Mechanisms of reading and of dyslexia

The learning of written language demands the coordination and superposition of audition and vision. The eye sees the letter; the letter represents and signifies a sound. There is created an image/sound association which progressively becomes encrusted in us, and which itself must take account of a third factor: time.

In the case of too great an infidelity in the sound/image association, we observe:

errors due to the factor time: confusions of p, b, d, q which differ by their unfolding in time. Confusions of voiceless/voiced. Inversions in consonantal groups or in syllables.
errors due to the frequency factor: in particular, confusions of letters corresponding to phonemes rich in high frequencies (s, z, f, v, ch…) and elisions in consonantal groups.
other errors, numerous and varied, resulting from the accumulation of these two factors.

Written language could not be reached without the setting in motion of the unity of the subject’s functions — unity aroused by listening and gathering within itself audition, vision, the body, laterality, language, communication.

The listening test

The listening test consists in investigating the thresholds of minimal intensity perceived for each frequency (by air conduction and bone conduction), in establishing the capacity or incapacity to situate the different pitches of sounds in relation to one another, and in noting the possibilities for the ear to locate sound.

This test, which would at first sight be easy to confuse with an audiogram, in fact pertains in its interpretation to a wholly different domain. The audiologist, in his discipline, is concerned to know whether the subject hears; the audio-psycho-phonologist is concerned to know whether he listens*, and in what manner.*

Schematically, dyslexic subjects often present jagged curves whereas the normal curve is ascending with a slope of 6 dB/octave from 125 to 3,000 Hz, before descending again. Their perception of low frequencies is much too pronounced, leaving them fixed to the material approach to the world. Selectivity — that is, the recognition of the different frequencies in relation to one another — is often impossible, or partially successful, but rarely in the high frequencies.

We see here a refusal of opening to the surrounding world, a non-surpassing of the past, of the mother, a non-accession to language, to communication.

The APP treatment: changing the structure

The aim of APP treatment is not to provide aid to the subject — compensatory aid for his handicap — while leaving him fixed in his dyslexic structure. It is to change this structure, to awaken him to communication, to the desire to enter into the dynamic of language. It is not a matter of forcing a learning of the letter; it is a matter of engaging mechanisms allowing the child — through the elaboration of a normal relation — to desire and to approach written language.

The stages of the programming

Musical Sonic Return: phase of preparation, a kind of progressive return to intra-uterine listening.
Intra-uterine listening: by maternal voice filtered at 8,000 Hz. If we cannot obtain this voice, we use Mozartian music, filtered in the same way. Note: it appeared to me that the mothers of dyslexic children that I record often speak on the left, possess a very poor voice, and willingly choose texts perfectly uninteresting to the child or far too infantile.
Sonic Birth: passage from audition in a liquid medium to audition in an aerial medium, by progressively modifying the filterings (from 8,000 Hz to 0 Hz).
First active phase — approach to language: filtered sounds; the child reaches out towards dialogue with the father. We train him in this through repetition exercises (words and sentences) under the Electronic Ear. As the words and short sentences will be increasingly filtered (obliging listening to select only the high frequencies), we privilege the right ear.
Second active phase: we essentially introduce texts, reading and singing.

Reactions and progression

I have personally observed a much calmer and more peaceful behaviour during the listening of the filtered maternal voice. At the moment of sonic birth, there appear in some reactions of aggressiveness, panic, anxiety. This is a difficult passage that we must accomplish with gentleness and care. The children easily express their feelings by gestural or verbal acting-out — they also express themselves very well through the sudden appearance of psychosomatic illnesses.

In the repetition phase, there awakens a desire to learn and to understand, correlatively with the appearance of a certain stepping back, of a certain independence.

Positive points of the treatment

It leads the child to realise his own personality through the elaboration of a normal relation and a listening to the world. It does not offer him supports or aids of any kind; it offers him to find again in himself all the relational and structuring dynamic of language. There follow:

a less dependent behaviour;
a certain tranquillity and the awakening of an unexpected tonus;
the satisfactory development of memory, of attention;
interest in reading;
a more precise vocabulary, a richer syntax;
a better grasp of time and space;
the refinement of visual and auditory perceptions;
the recognition of categories and of relations between words.

All this preparing for the disappearance of the corresponding errors. Reading also proves more supple, better punctuated, faithful to the text.

Difficulties encountered

I sometimes come up against parental opposition. In the first place, fathers and mothers bring me their children for difficulties of reading and spelling. They crystallise their desires for improvement on this precise point and accept ill that I should attempt to intervene at another level, which is for them of a wholly different domain.

In the second place, in permitting the child — during the treatment — to allow his true personality to bloom forth, in giving him the tonus necessary to assure him a better autonomy, I act by jolting the family equilibrium.

In order to avoid such opposition, we ask the mother — the one who carried him and welcomed him into this world — to herself undergo a course of treatment under the Electronic Ear. I generally obtain a favourable response to this request. These mothers are however so little motivated that very quickly they abandon the initial pace.

III. Reflections and conclusions

At the beginning, the practice of Audio-Psycho-Phonology slightly disoriented me:

this system imposes indeed an approach to the child, a relational mode that was unfamiliar to me;
the evolution of the symptom — that is, of reading and spelling — is less easily monitored, and doubtless I remained too long attached to my initial training not to regret this;
the intermediary of the machine modifies the child/therapist relationship and establishes a less gratifying contact;
I sometimes encountered the problem of private lessons: the parents considering that, since their children do nothing else with me than listen to music, they must also have them given private lessons by tutors.

After having disoriented me, this practice reassured me — on the one hand by the positive results of its cures, on the other by its teachings:

it taught me to set the symptom at a distance, to consider it only as the reflection of a deeper unsuitability. To grant it less importance allows one to see further.
it taught me to consider more the dyslexic than the dyslexia, to attach myself to the person of the subject, to the study of his psychology.
it offers me a synthesis and an explanatory unity between the disorders of the dyslexic’s written language, his attitude, his body, his aptitudes, his psychology, and so on.
it opens me, personally, to the fascinating universe of listening.

The experience of Borel-Maisonny type re-education and of audio-psycho-phonological treatment has led me, through observations, cross-checks and comparisons, to think:

on the one hand, that it proves useless, tiring and perhaps harmful to attack directly the faults and errors committed by the child;
on the other hand, that dyslexia has, above all, an origin of a pathological order at the relational level. The personality of the parents and the balance of their couple very often prove to be the inducers of this dyslexia.

I am less and less inclined to believe in the existence of what is called pedagogical or specific dyslexia. That there should be degrees of impairment and disorders of written language of differing severity is incontestable. But whether minor or considerable, they all seem to me to belong to the same unsuitability: difficult access to a normal relational structure, to opening towards communication, dialogue and the verb, to the grasping of one’s own identity, of the other, of the world.

— Elizabeth Dorignac, speech therapist, Société d’Audio-Psycho-Phonologie (SAPP), Amiens.