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  • When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder
  • Teri James Bellis Ph.D.
  • Anglais
  • 24 November 2019
  • 0743428641

Teri James Bellis Ph.D. Ö 2 Download

Free read When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder Download ´ When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder Ç PDF, DOC, TXT, eBook or Kindle ePUB free He cortical level of his brain Although his young age may have affected these findings to a degree that he was awake and alert during testing combined with the presence of some response over the right side of his brain was conclusive physiologic evidence of an auditory processing deficit In essence although his ears were fine his brain couldn t hear certain sounds So he s deaf after all his mother asked after the testing some relief in her voice This was not surprising because as frightening as the presence of deafness in a child may be for a parent at least such a clear cut diagnosis would be understandable and would provide a definitive reason for Clay s speech delays Even a diagnosis of deafness might be preferable to the endless lack of closure and understanding that results from never knowing why a child is having difficulties No not exactly I explained He s not deaf in the traditional sense In fact his ears are functioning just fine He hears sounds He knows when the phone is ringing or someone is knocking at the door He responds when the dog barks He can hear your voice and it comforts and calms him The problem is in the way his brain deals with sounds It s probably hard for Clay s brain to interpret most of the sounds of speech Even though he can hear someone talking to him he can t really tell the difference or discriminate between the speech sounds themselves He might hear everything muffled like he s underwater Or some speech sounds might sound just like others to him He might not even truly understand that speech has meaning It might all just be noise to him like the dog barking or the knock on the door That s why he doesn t understand what s said to him It s also why he doesn t speak clearly because our ability to speak is closely tied to our ability to hear It s because he had so many ear infections when he was a baby isn t it Clay s mother asked The doctor told me they wouldn t affect his development but I was always worried about them I explained that although a link has been shown between a history of early chronic ear infections and auditory processing problems in some children there was no way of knowing how much these infections had contributed to Clay s difficulties Certainly if ear infections occur freuently enough at a very young age the child often misses some of the speech and language input during those periods that are critical for language development On the other hand many children have a history of severe ear infections throughout their childhood and exhibit no lasting effects whatsoever Further for many children ear infections may be silent that is without evidence of pain or fever and thus go undetected for a long time In these children it is difficult to determine in hindsight to what degree the infections may have affected the child s language and learningWe simply do not know why the vast majority of APD cases occur That is one of the hardest things for a parent of a child with an APD to accept the realization that the underlying cause the why of it all will likely never be identified We do know however that many cases of APD are present very early in life probably at birth They don t just develop suddenly unless the child has had some type of head injury illness or other trauma that can affect brain functionOver the summer Clay underwent intensive auditory training both computer based and interactive focusing in tandem on both discriminating telling the difference between and producing speaking speech sounds Most of these games reuired Clay to imitate consonants vowels syllables and words presented by animated characters on a computer screen When he responded correctly the characters rewarded him with music and dancing By the end of the summer his ability to imitate syllables words and even short phrases had improved remarkably His spontaneous expressive vocabulary began to increase as well When he returned to the clinic in the fall after a short hiatus he surprised all of us by greeting me in the hallway with the words Hi teacher When I wrote the first draft of this chapter Clay s story stopped here I knew that Clay s student clinicians would continue to work with him on speech and language production as well as auditory skills during the fall semester I knew that some progress would be seen but I couldn t predict just how far he would go or whether he would ever exhibit normal speech and language skills However those two words Hi teacher had given us all reason to hopeNear the end of the fall semester Sue once again pulled me into the observation room to watch a therapy session On the other side of the one way glass I saw Clay and his clinician playing a game that used blocks and action cards to help put words in their correct order in sentences I watched as Clay spontaneously produced four word sentences imitated eight word sentences and laughed and chattered with the clinician clearly enjoying his newly acuired ability to communicateJust a few short months ago this child had been virtually nonverbal Now for the first time Clay was able to communicate his true nature Witty affectionate funny and bright his delightful personality shone through in his words and actions It was as if he had finally become aware that sound had meaning and because of that awareness the floodgates had opened allowing language to flow through him We stood in the darkness Sue and I watching this miracle and cried And we thought This is what it s all about This is why we do what we do One child like this just one makes everything we do worthwhile A few weeks later I reevaluated Clay s brain responses to sound They looked entirely normal for a four year old child He still needed therapy to improve his pronunciation or articulation of speech sounds and to build his language skills But his accomplishments in a very short period of time were nothing short of remarkableRRY MILD APD IN AN ADULTNot all people with auditory processing deficits exhibit obvious and severe difficulties during early childhood In some cases APD does not manifest itself until much later in life and even then sometimes not until the conditions are precisely right I never had any problems in school Not that I was a star student or anything but I got by just fine Got my MBA but after a few years in the corporate world I got bored Guess I neededaction I d done some investing over the years mostly on line and I thought the whole stock market thing was fascinating So I went for it During our training we were allowed to go down onto the trade floor what an exciting place I couldn t really understand a lot of what was going on but I figured that I just had a lot to learn When it came my turn to take my spot on that floor I was really nervous People were waving papers and yelling things at me I couldn t understand anything My boss told me that it wasn t unusual for someone to freak out the first time or two they re in the action like that But the problem wouldn t go away I ve got all the skills I know what to look for I know how and when to trade damn it But down there when they re all yelling at me like that and I m supposed to react fast I just can t do it I can t seem to make sense of all the noise and the chaos They pulled me off the floor and I m at a desk job now They re even talking about firing me I ve never been fired in my life I really thought I d like this field really looked forward to being where all the action is But how will I ever know if I can t even do it if I m stuck behind a desk I might as well go back to corporate management LarryLarry was referred to me by his employer after another audiologist had determined that his actual hearing acuity was normal and suggested the possibility of an APD By the time I saw him he was frustrated and somewhat defensive because of the treatment he had been receiving lately from his supervisor Although his boss had been understanding at first Larry was now becoming a liability to the company and was on the verge of being fired He was forty three years old and was looking at being unemployed with a wife two children and a house in the burbs It was a potentially volcanic situationLarry s testing revealed a very mild auditory processing deficit specifically in his ability to fill in missing pieces of a message a process we refer to as auditory closure He also had difficulty with messages in general when they were presented in competing conditions such as when different information was given to each ear at the same time It was unclear whether Larry had had this mild disorder all of his life or if it was adult onset What was clear was that his deficit was so mild that it would have been nothan an occasional mild annoyance in typical situations The only environments in which Larry would have noticed his mild deficit would have been those where the background noise level was extremely high such as on the floor of the stock exchangeLarry s case illustrates that even a very mild auditory deficit can nevertheless be extremely disruptive depending on the uniue circumstances of a person s life Larry would have been successful in virtually any other job as he had proven prior to his career change However when he paired his auditory deficit with the unusual and extreme auditory demands of working on a trade floor he was unable to perform Larry couldn t have made a worse career choice given his particular auditory disorderLarry was forced to accept that he could never compensate sufficiently for his mild deficit to be able to perform in an environment like the stock exchange He has moved back to the corporate business world and last I heard was doing uite well But I am sure he still thinks occasionally about the color and excitement of the world he left behindLarry s situation brings to light one unfortunate but very real factor that must be considered in any discussion of APD Although treatment may remediate the disorder some residual difficulty may well continue for the remainder of the person s life When we develop a management program for APD we address these issues and suggest methods of compensating for the residual disorder as well as strategies for changing the listening environment to make itfriendly for the person with APD However even with such strategies in place the individual may simply have to accept that he will have difficulty in some situations This was precisely the case with Larry and the stock exchange The very nature of his job setting made any environmental changes impossible and rendered his compensatory strategies virtually ineffective He was forced to make a realistic life choice to change his job setting entirelyIndividuals with APD must realize that just as with other disabilities some activities will continue to be difficult or impossible depending on the severity of the disorder Although we do not wish to dampen anyone s dreams or to encourage individuals with APD to limit themselves unnecessarily we must also be practical When one considers the frustration and self flagellation that is almost unavoidable when one sets unattainable goals and continually without exception fails then perhaps it is time to choose a different objective one that is no less enticing but islikely to be within reachJASON RIGHT HEMISPHERE DISORDER AND APDAll three of the cases presented thus far have focused on the effects of auditory processing disorder on the perception of speech sounds The dysfunction could be localized generally to the language dominant or left hemisphere of the brain where speech sound analysis and representation takes place However not all auditory processing disorders arise from left hemisphere dysfunction Nor do all auditory processing disorders affect the perception of speech per se The auditory manifestations of dysfunction in the right side of the brain can freuently be just as pervasive and harder to pin down as those of left hemisphere dysfunction Further in many cases right hemisphere dysfunction can lead to other disorders and difficulties that have a devastating impact on the individual s social communicative and psychological well being Jason doesn t have any friends I mean that No friends at all No one likes him He doesn t do anything that I see other little boys do He doesn t like puzzles never played with LEGOs or blocks Half the time he just sits there It s like he s drugged or something We try to joke with him but he just looks at us with that stony face like a robot Sometimes he ll laugh a little like when he s watching a Three Stooges movie or something I love it when he laughs But most of the time he just seems so depressed He does all right in school and all of the testing says that his learning abilities are normal that there s nothing wrong with him So they won t even do anything They just said that he has emotional problems like his brothers and leave it at that Maybe it s us maybe we ve done something wrong You know his older brother is in a special home for kids with emotional problems And his oldest brother well you probably already know about him from the report I don t know I just don t think I can take this any What are we doing wrong Jason s motherJason was a handsome little eight year old boy He lived in a small state where no auditory processing services were available and I was brought out to assess several children suspected of auditory deficit Jason was a last minute addition to my assessment list His referral to me resulted less from any obvious auditory difficulty than from desperation on the part of the private psychologist working with him to uncover any information at all that might help explain this enigmatic child Unlike with most of the children I assess I hadn t had much opportunity to review Jason s records and frankly I was a little unsure as to the appropriateness of the referral Despite my misgivings I agreed to test himThe little information I had been able to glean from his records indicated no obvious learning or language difficulties The speech language report did say however that he exhibited mild pragmatic concerns or concerns regarding his use of language particularly relating to social communication Jason didn t seem to understand uite what to do or say in a social situation He might interrupt or show other signs of inappropriate turn taking behaviors Although his contributions to a conversation were generally related to the topic of discussion he would stray from the key point and end up talking about something that really wasn t the focus of the conversation For example during a conversation about endangered species Jason might begin talking about the bald eagle but somehow work his way around to a discussion of his pet cat He often failed to laugh at jokes overreacted to perceived insults or sarcasm and ignored social conventions such as making expected responses to salutations Hello how are you I m fine thank you How are you or saying good bye appropriately It was good to see you Have a nice dayFurther his speech language pathologist stated that Jason s expressive speech was not abnormal exactly but was a little well unusual She couldn t uite put her finger on it but his rhythm and cadence were subtly wrong somehow Just a little off in some indefinable way He didn t speak in a monotone exactly but he didn t seem as animated as most boys his age More obvious was his lack of facial expression This latter finding was also characteristic of depression something that was prevalent in Jason s family Both of his older brothers had been diagnosed with depressive disorders The middle boy had attempted suicide when he was ten years old and was currently living in a group home for children with emotional disturbances The oldest boy tragically had killed himself at the age of fourteenJason was under the care of a psychologist when I saw him but he wasn t receiving any special services in school because he didn t exhibit any documented language or learning deficits that would ualify him for special education in those areas He wasn t great at math but fell loosely within the low end of the normal range His nonverbal I scores were lower than his verbal scores but not significantly so He was however classified as emotionally disturbed and received some accommodations in the classroom due to thatDuring testing Jason offered none of the chitchat that typically accompanies my evaluations with children even though he understood all of the directions easily and was entirely compliant On some of the testing Jason performed just fine well within the normal range for his age Yet he had a good deal of difficulty with certain tasks when competing messages were delivered to both ears at the same time More revealing he could not perform at all during a task that reuired him not to repeat speech sounds but to perceive subtle pitch and duration differences in seuences of tones or beeps This reuired the right side of his brain to hear the pattern or acoustic contour of the tones Jason understood the task could describe the patterns easily when the differences between stimuli were large or when I sang them in my own voice But when the differences were subtle he reported that the tones all sounded the sameThis pattern of performance indicated an auditory processing disorder but Jason s specific type of APD was not in discriminating speech sounds or other left brain auditory skills Rather his difficulty like my own was in those right brain auditory abilities that are responsible for perceiving nonspeech or musical aspects of the signal including those cues that convey tone of voice and assist us in understanding what is meant in relation to what is said People with this type of auditory disorder freuently misunderstand the intent of others communications often complain of hurt feelings and may themselves speak in a monotone or with little expression Often the cadence or rhythm of their expressive speech is somewhat distorted as was Jason s This type of deficit may affect a person s ability to appreciate humor or sarcasm to engage in socially appropriate conversational exchanges with others and to read between the lines These abilities come naturally to most and they help to make communication the many layered enjoyable activity it usually is But for a child or adult with right hemisphere based APD communication is far from enjoyable It can be a painful freuently embarrassing or confusing experienceAnd yet Jason s auditory processing deficits were without uestion the least of his concerns My testing had uncovered merely the auditory piece of what was clearly aglobal right hemisphere deficit that affected Jason s functioning in many other areas Jason s symptoms made me suspect a disorder that is sometimes referred to as nonverbal learning disability or NVLD NVLD can lead to a wide variety of symptoms including social difficulties depression difficulty with nonverbal.

Free read When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder

When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder

Free read When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder Download ´ When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder Ç PDF, DOC, TXT, eBook or Kindle ePUB free Tasks including math calculation and visual spatial activities expressive and receptive prosody or tone of voice difficulties allocation of attention and the like All of these symptoms appeared to be present to some degree in Jason s case Certainly however his depression was of primary and immediate concern particularly given his family history It is possible that Jason s depression was exacerbated by his lack of success in socialization and communication But because depression freuently co occurs with right hemisphere dysfunction it is difficult to determine just how much of Jason s emotional difficulties were linked to his auditory processing deficitI referred Jason to a university center where cutting edge research into NVLD was being undertaken They confirmed othersubtle diagnostic indicators of right hemisphere dysfunction such as that Jason exhibited a lesser degree of visual scanning to the left of center as compared to the right of center as measured by infrared tracking of his eye movements Auditory and related testing eventually completed on Jason s older brother revealed the same patternJason is currently undergoing therapy for both visual spatial abilities and auditory perception and production of prosodic aspects of speech He and his brother are being closely monitored by a team of psychiatrists and trials with antidepressant medication have been initiated When he entered the fourth grade and the learning demands increased Jason began to exhibit clear difficulties in mathematics so he is now receiving special services for these and related academic difficultiesI don t know that it s accurate to state that Jason exhibits a primary auditory processing disorder Certainly his performance yielded clear patterns consistent with an APD however this was just one small factor contributing to Jason s overall difficulties Of farconcern were the emotional and psychological manifestations of Jason s and his brother s right hemisphere involvement Importantly the results of central auditory testing provided information that allowed us to explore further and ultimately uncover the underlying problemI also don t know to what extent therapy will be effective for Jason s difficulties Most of the research into auditory and related therapy efficacy has focused on speech sound training and left hemisphere disorders I hope that he can learn ways in which to compensate for his difficulties I also hope that psychiatric and pharmacological interventions will address his emotional and depressive disorders sufficiently But Jason may always have some difficulty judging communicative intent and comprehending the subtle prosody related and social aspects of communicationJason s situation emphasizes some important principles of APD that should be understood First not all auditory processing disorders are speech sound related A person may be able to tell the difference between speech sounds well be able to spell and write fluently yet still exhibit auditory processing problems More important even if a child exhibits a clear auditory processing deficit that deficit may not be the only or even the most important factor contributing to his or her learning or communication problemsMany disorders either mimic APD or can coexist with APD such as attention deficit hyperactivity disorder AD HD autism NVLD and similar conditions Confirming the presence of an APD in these cases is important however the diagnosis of an APD as a coexisting condition should not be taken to mean that all of the individual s difficulties can therefore be attributed to the auditory disorder Instead it isoften the case that the auditory disorder is merely one piece of the overall picture As in Jason s case APD may not even be the most important piece when one considers the individual as a whole We must consider auditory processing in the context of largerglobal disorders that can affect a person s daily life skills and coping strategies in a variety of waysFurther as Jason s case illustrates APD diagnostic services may not be available in a given geographic locale In recent years the increased attention and education devoted to APD has resulted in increased APD services throughout this country and abroad However not all audiologists are educated or trained in diagnosis or management of APD nor should they be expected to be APD reuires a specialized degree of expertise that goes beyond that provided in our typical audiological training programsEVELYN APD IN THE ELDERLYIf it hasn t already been apparent it should be pointed out that all of the preceding stories have dealt with males Auditory processing disorders like learning disabilities occur in malesfreuently than in females but they can and do occur in females Further although the cases discussed so far have exhibited normal hearing sensitivity auditory processing disorders can coexist with hearing loss which can make management of the hearing lossdifficult Don t like them Take them away I can t hear any better with the dang things than I can without them Everything s just noise Noise noise noise Gives me a headache trying to make sense of all that noise EvelynEvelyn was a small white haired seventy four year old woman who had absolutely no compunctions about expressing her true feelings She had a pretty typical age related hearing impairment that led to difficulties understanding speech especially in noise or at church She had recently been fitted with hearing aids in both ears after finally being convinced by her daughter in law to do something about her progressive hearing lossBut the hearing aids didn t seem to help Evelyn Nothing did Whether she wore her hearing aids or not Evelyn complained that she still couldn t understand what people were saying The problem she insisted wasn t hearing it was understanding The hearing aids just made everything louder not clearerEvelyn was referred to me because the standard hearing testing done before she was fit with hearing aids didn t explain why she was having such significant difficulties In fact her ability to hear and understand words was uite good when she was tested one ear at a time using headphones This suggested that Evelyn would be an excellent candidate for binaural amplification hearing aids in both ears Although some tests of auditory processing reuire that the listener s hearing be normal some do not I administered those central auditory tests that were appropriate for people with hearing impairment to get an idea of what other factors not related to Evelyn s hearing loss might be contributing to her listening difficultiesEvelyn had far greater difficulty than other women her age during tasks in which competing messages were delivered to both ears at the same time She also had difficulty with the tonal patterns tests described in the previous case but unlike Jason she could hear the differences among the stimuli just fine and was able to hum them with the conviction of a church choir leader which incidentally she was She could not however label or verbally describe them eg high high low or long short long when asked to do so Memory was not an issue here Evelyn was and still is sharp as a tack and can repeat entire strings of numbers or words on demand as long as the numbers or words are presented in noncompeting conditions No Evelyn s difficulties stemmed from the fact that these dichotic listening and tonal patterns tests relied on the ability of both hemispheres of the brain to communicate with one anotherRecent research into auditory processing and aging has indicated that the ability of the two hemispheres of the brain to cooperate interhemispheric integration decreases significantly as we age Further the data suggest that this integration deficit if sufficiently pronounced may well affect our binaural listening abilities including the benefit we receive from binaural hearing aids Evelyn s pattern of findings on central auditory testing confirmed that she exhibited just such a pronounced integration deficit As she had insisted the problem really wasn t her hearing It was her ability to understand especially when both ears and therefore both hemispheres of her brain were being forced to work togetherAlthough most people do hear better with two hearing aids a situation that most closely resembles normal hearing we discovered that Evelyn heard much better when she wore only one hearing aid in her right ear She returned the left hearing aid and marched away happily right hearing aid in place and turned up good and high It s a Sunday morning as I write this and I m certain that at this very moment Evelyn is singing happily in the church choir or listening to the minister s sermon uite satisfied with herself that she hadn t paid for two hearing aids when she does just fine even better with oneEvelyn exhibited a third type of auditory processing problem one in which the issue is neither left brain nor right brain but rather the way in which the two hemispheres of the brain interact This common type of APD occurs in children as well as adults In Evelyn s case most of her difficulty was auditory in nature However many people with this type of integration deficit have difficulty with virtually any task that reuires cooperation between the two halves of the brain and may exhibit what are commonly called sensory integration issues From an auditory perspective not only may they have difficulty with understanding speech in noise and telling where a sound is coming from but they may have difficulty in linking the left brain speech sound and language functions with the right brain tone of voice or prosodic cues resulting in some confusion and miscomprehension of what is being said and meant The auditory manifestations of integration deficit may be extremely disruptive or they may be relatively mild when compared to the sensory integration symptoms Therefore once again we must consider the whole person to determine the degree to which a given APD may be affecting someone s life for it is this picture that should guide our treatment effortsIF A TREE FALLS IN THE FOREST DEBATING THE EXISTENCE OF APDIt is not always possible to demonstrate objectively the presence of an APD In fact in many cases of APD physiologic tests such as brain scans electrophysiology and magnetic resonance imaging MRI fail to reveal any obvious structural or functional damage or dysfunction This not only poses a difficulty for audiologists in diagnosing APD particularly in the case of very young children who cannot yet participate in behavioral testing but also leads to denial on the part of some medical and other professionals that APD exists at all Tragically the assertion If you can t see it it isn t there has led some to conclude that APD very simply is not realIf a tree falls in the forest and no one is around to hear it fall does it make a sound Although people love to debate the two possible answers to this uestion it is not really a philosophical uestion at all And there is only one correct answerThe definition of sound is a propogation of vibration through a sound conducting medium Therefore unless the tree is in outer space or in a vacuum in which there is no sound conducting medium such as air of course it makes a sound That no one is around to hear it fall is completely irrelevant and thus should not even enter into the euationCase closed End of discussionStill some continue to debate this issue just as some contend that if no one is around to understand test for or treat auditory processing disorders or if they do not show up on our brain scans or other physiologic tests then they likewise do not existOn the face of it this argument seems reasonable logical even Logical that is until we consider the limitations of current medical procedures and technology in detecting subtle abnormalities in function as well as structure of anatomical organs The brain is highly complex with infinitesimal biomolecular and neurochemical influences that shape the function of the nervous system It is not at all surprising that physical evidence of specific damage or dysfunction is lacking for the majority of APD cases Indeed it would besurprising if all of these difficulties had a clearly evident easily defined underlying causeFor years professionals and scientists have looked for the specific physiologic causes responsible for such conditions as autism schizophrenia learning disabilities mental retardation language delays dyslexia attention deficit hyperactivity disorder and many other disabilities And for years those visible documentable signs have eluded all of us But we continue to search We don t simply refuse to acknowledge their existenceNot so with auditory processing disorders From the first proposal of the term APD to describe these hearing deficits in the s the existence argument has raged Some have said that auditory processing deficits are merely a manifestation of a specific learning disability or attention deficit or language disorder Some have said that the freuent coexistence or comorbidity of auditory deficits with these other disorders render them merely one characteristic of a largerglobal disability Some have even said that there is no way in which an auditory based deficit of any type can have the kind of far reaching implications hypothesized by the pro APD campMany of these arguments have arisen no doubt from at least some degree of professional territorialism and defensiveness After all many professionals in the field of speech language and learning had been working with these difficulties long before they ever had a formal label Why now after all these years should we suddenly invent a new label for an old set of problems that may well just be manifestations of other disorders already understood and diagnosable When confronted with the existence argument from fellow professionals I offer the following response derived from current research into APD Some children and adults exhibit extreme difficulties in primarily if not solely the auditory modality that affect their day to day communication and learning abilities For the majority of these individuals hearing loss simply cannot account for their difficulties These individuals exhibit specific patterns of findings on tests of central auditory function that precisely mirror those of known pathologies involving the central auditory nervous system and nothing else which cannot be ignored or put down merely to coincidence A growing body of evidence obtained from new technological measures of auditory processing is demonstrating that the neural representation of sound in the higher brain stem or brain pathways of many of these individuals simply is different from that of other nondisordered individualsIn short the battle over the existence of auditory processing deficits has begun to abate under the pressure of such overwhelming evidence Although it is still possible to encounter someone in the fields of medicine or psychology or education or speech language pathology or even audiology who asserts APD doesn t exist and even if it did there s nothing we can do about it anyway this statement is thankfully far less freuent today than even just five short years agoAsinformation becomes available assharing of findings and ideas is fostered among professionals in many different disciplines and as new technological advances continue to support the existence of auditory deficits that can indeed impact a wide variety of functional areas it is my fondest hope that this futile debate will endIn the meantime if a tree falls in the forest and no one is around to hear it fall does it make a sound You betYou ve met several people each of whom exhibited an auditory processing disorder that affected his or her life in vastly different ways I hope that their stories have convinced you that not only are auditory processing disorders very real but that they may occur in anyone at any age and may manifest themselves in various manners The stories you have read do not even come close to representing all of the possible combinations of gender age central auditory findings and impact on life skills that are possible They serve merely to illustrate the heterogeneous complex nature of the disorderIn the early days of APD a definition of auditory processing was proposed by Dr Jack Katz of Buffalo New York He stated that auditory processing could be defined as what we do with what we hear Over time we have tried to hone this definition to render it scientificallytechnical to narrow it down to specific auditory mechanisms Also because of the difficulty in developing a precise definition of what APD is and what it isn t we have argued endlessly over what to call it and by the time this book goes to press our label for this disorder may have changed yet again But despite our best efforts the heterogeneous and interactive nature of auditory processing deficits has eluded our grasp so that no specific definition of or label for auditory processing and its disorders has successfully captured its true essence Therefore we now are witnessing a re evolution in which we are acknowledging that auditory processing does indeed consist of what we do with what we hear In a sense we have come full circle but now we are armed withammunition with which to analyze and fight the beastHowever despite our increased knowledge our ever improving tools and measures and tests we still have much to learn In truth what we do not know about auditory processing far outweighs what is in our current realm of understanding In this fascinating frustrating and complex area we still have in the timeless words of Robert Frost miles to go before we sleep Copyright copy by Teri James Bellis PhDIn this landmark book Dr Teri James Bellis one of the world s leading authorities on auditory processing disorder APD explains the nature of this devastating condition and provides insightful case studies that illustrate its effect on the lives of its sufferersMillions of Americans struggle silently with APD For many of them holding a simple conversation can be next to impossible As sound travels through an imperfect auditory pathway words become jumbled distorted and unintelligible As Dr Bellis notes the most profound impact of this highly specific impediment to auditory comprehension may be on the young Facing a severely reduced ability to read spell comprehend and communicate children with APD are subject to anxiety academic failure and a damaged sense of self Often they are misdiagnosed Discussing the latest and most promising clinical advances and treatment options and providing a host of proven strategies for coping Dr Bellis takes much of the mystery out of APD If you or anyone you know has difficulty comprehending spoken language or if your child is struggling in school this important book may have the answers you nee.

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Free read When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder Download ´ When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder Ç PDF, DOC, TXT, eBook or Kindle ePUB free Chapter OneThe Many Faces of APDJeff was seventeen years old over six feet tall and outweighed me by at least a hundred pounds He was a big kid Tough too He was one of the starring offensive linemen on his high school football team Word had it that he could cut through the other team s defense like a knife through butter scattering smaller players in all directionsYet despite all of his toughness he had a gentle polite manner and a heart of gold When Jeff and his mother arrived at the clinic he greeted me with a shy smile He was extremely cooperative during testing and apologized whenever he made a mistake or missed an item He even called me ma am I m not too fond of that generally but coming from him I found it uite endearing Which is probably why I felt as if my heart were breaking when halfway through my explanation of his test results he dropped his head onto his folded hands and began to cryMy voice stuttered to a stop I laid my hand lightly on Jeff s shoulder and he grasped it in his large meaty palm and sueezedIn a choked voice he whispered I thought I was just stupid What do you mean He lifted his head and met my gaze There was relief in his eyes but also anger embarrassment and just a little defiance You know dumb jock I just always figured I was stupid That s why I couldn t get it I was just a big dumb jock A joke These were astounding words coming from a boy who had just been elected most popular in his junior class and was a sure bet for prom king in his senior yearJeff had experienced academic difficulties ever since he had begun school He had had problems learning to spell and read and still struggled with those subjects in his junior year in high school He liked the idea of losing himself in a book of journeying to far off lands or reading about historical people but he rarely opened a book unless forced to Jeff had a difficult time sounding out the words so his reading was slow and laborious As he described it by the time he figured out what the words were he had lost the thread of the storyBut Jeff loved to spin tales He would make up stories about princes and dragons life in the circus and travels to outer space and tell them to his younger brother who would sit spellbound in wonder as the stories unfolded Creative as he was Jeff never wrote his stories down As with his reading spelling was a struggle so much so that even if he focused on telling the story and just coming close enough to the spelling of the words so that he could return and correct them later he was unable to understand his own writing when it came time to polish what he had set to paper As a result his English composition and creative writing papers were short poorly organized and contained only simple language and elementary vocabulary They exhibited no hint whatsoever of the imaginative mind of the boy who held the penJeff came from a rural school district and special education services were scarce Nevertheless during his elementary school years he did ualify for reading remediation and tutoring under the classification of learning disability Since junior high school however he had not received any services primarily because he consistently earned A s and B s in all of his classes Therefore the school based special education team had decided that his reading problems were no longer affecting him academicallyf The reason for Jeff s apparent educational success was unfortunately all too common As a student who excelled at football in a town where football was all important he had been passed through every class since he was in the ninth grade No academic probation or C s for our boy no sir In fact his good academic record combined with his amazing sports ability had already resulted in offers of full ride sports scholarships from several major universities before he had even begun his senior year in high schoolAny other kid in his shoes would have been turning cartwheelsBut Jeff was different He was acutely aware that he hadn t earned the grades he had been given In fact despite putting several hours into his studies every night after football practice he knew that he should by rights barely be passing subjects such as social studies history and English compositionHis mother had initiated Jeff s referral to me for central auditory processing evaluation Because she saw Jeff still struggling so hard with reading she had arranged for independent private testing by a specialist in learning disabilities This testing had confirmed that Jeff exhibited low average to borderline abilities in reading decoding eg sounding out words or word attack skills general fund of knowledge and auditory discrimination abilities Other symptoms leading to the suspicion of auditory processing deficit were his difficulty following information presented in lectures and particularly illuminating his inability to hear the uarterback of his football team call plays during the huddle I can t ever hear him he told me But I don t let on I just keep my eye on where the ball is I know what I m supposed to do so I just go out there and do it In this manner Jeff had succeeded in football without anyone being aware of what he had secretly come to call his hearing problem In social situations he freuently smiled his shy smile and nodded rather than jumping into the conversation furthering others perception of him as the sweet strong silent type And when he was unable to answer uestions posed directly to him or answered as if he hadn t been paying attention he took the ribbing of his friends still with the same shy smileBut inside Jeff was hurting You re not stupid Jeff I told him You never were You have what we call an auditory processing disorder Basically what this means is that your hearing itself is fine but what gets into the ear somehow gets jumbled by the time it gets to the brain Because of this different letters may sound the same to you making it hard to tell the difference between different speech sounds Or you might hear what someone is saying but it s distorted or muffled like the person is mumbling especially if there s a lot of noise around If you can t hear the speech sounds clearly it s hard to learn how to sound out words when you re reading or to spell them when you re writing That s why you have to work so hard With that Jeff released my hand nodded once and listened while I explained the rest of the test results and what I thought we should do to help him overcome his disorder A disorder that had a name for the first time One that could be addressed confronted and although maybe not completely fixed one for which he could at least learn ways of compensatingThat was when Jeff shared his dreams for the future with me It wasn t enough for him to be popular to be a football star and to have a college education virtually handed to him on a platter It wasn t enough that there was already talk of his possibly not needing to finish college of being picked up by a farm team or even a pro team before he even reached his senior year at whatever university he choseJeff had bigger plans I m happy about the whole scholarship thing sure he admitted I mean that ll get me there pay for everything And I like football It s fun He shrugged But I really want to do well in college I want to learn I don t want to be a football player for real not after college I mean that s not what I want to do with my life What do you want to do with your life I inuired gentlyHe dropped his head just a little almost apologetically and color rushed to his cheeks I want to be a lawyer he said very very uietly Like my dad And at that his mother began to cry tooJeff was facing a uniue set of difficulties On the one hand he was virtually assured a college education On the other hand for him to reach his goal he would have to actually perform in college Football might get him through with a general liberal arts degree but to be a lawyer he would have to go beyond that He wouldn t be able to hide behind the misguided albeit well meaning protection of his coaches or teachers He would have to meet high academic expectations just to get into law school then perform at an evenadvanced level to succeed once he was accepted He wouldn t be able to rely on his good looks and charming personalityJeff was aware of all of these things Just as he was excruciatingly aware that his problems with reading and writing his hearing problem would pose substantial barriers to his ever being able to meet those expectationsBut at least now the disorder had a name He could take comfort in the fact that he wasn t stupid as he had always feared Instead his difficulties had a very real physiologic cause And we had agreed on an intensive plan of attack including therapy techniues environmental modification suggestions and ways for him to compensate for his difficulties When he left my office he was once again smiling This time it was a smile full of hopeAfter intensive computer based therapy Jeff s reading decoding and auditory discrimination skills improved significantly Acknowledging his disorder and giving it a name helped him to gain confidence in himself and his abilities So too did teaching him to become an active listener and providing him with strategies to compensate for his disorder Right now Jeff is a sopho in college majoring in political science and playing football on a full ride scholarship He receives some special accommodations related to his disorder through the university s office of disabilities services and he is earning solid A s and B sIt wouldn t surprise me at all if Jeff did indeed finally make it to law schoolJeff s story is somewhat typical of the children I see with APD Many of them complain of difficulty with spelling and reading inability to understand what is being said especially with noise in the background and inner feelings of inadeuacy and ignorance Children with APD gradually become aware that something is wrong because they find themselves having to work so much harder at certain tasks than their friends do Many children with APD like Jeff perform near enough to the normal range in school to disualify them for special services However even those children who achieve some academic success usually come home from school at the end of every day exhausted from having to spend so much effort just listening Then they are faced with severalgrueling hours of effort to finish homework that might take their friends less than half that time to complete Over time they may learn to compensate to some degree for the disorder But many children with APD continue to have problems into adulthood especially if the disorder goes undiagnosed and untreatedAlso like Jeff many children with APD become masters at hiding their disorder In their early years they may try to participate in conversations or classroom discussions however because their input is freuently off topic or shows a lack of comprehension of the topic they may be ridiculed laughed at or even worse simply ignored After years of this some children simply withdraw from communication altogether Some become sullen and sit in their chairs with arms folded and hands fisted belligerent scowls on their faces daring anyone and everyone to attempt a connection But this is merely a mask that allows them to protect their vulnerable hidden inner selves and to retain some semblance of power over the daily situations in which they feel powerless Although this freuently leads to social isolation it is a self imposed isolation and appears farpreferable and less humiliating to the child than the inevitable overt exclusion by others that they have experienced throughout their livesOthers like Jeff continue to participate in life to accumulate friends and join in extracurricular activities This is particularly true for those children who exhibit some special talent in other areas such as sports music art or theater This special talent gives them an outlet for their need to connect with others while at the same time providing them with at least one environment in which they feel safe and can succeed But even these children must deal with the freuent and often unintentionally cruel barbs from friends and teachers the perception of them as somewhat slow the teasing that accompanies their freuent social and communicative faux pas Jeez what are you stupid or something So they too wear a mask of smiling tolerance and become the good buddy who ll put up with anything And they freuently withdraw in their own way becoming uiet followers in the parade of life seemingly happy sometimes even popular but all the while bleeding insideAY SEVERE APD IN A PRESCHOOLERWhen he was really little just a baby Clay made all the same sounds that his sister made We kept waiting for that first word to just pop out But it never did At first we thought Well maybe it s because his sister is talking for him I mean she really does talk a lot But he s four now Four years old And he doesn t understand us and we don t understand him Sometimes when he s frustrated because he isn t getting what he wants he just screams and screams and screams At first they said he was autistic then they said he was retarded Now they just don t seem to know at all We re starting to use sign language with him What do you think I ll learn sign language I ll use it if that s what it takes I just want to be able to talk with my baby You know sometimes I feel like screaming too Clay s motherWhen I first saw Clay he was four years old and had been in speech and language therapy for two years His therapists and parents were working on basic skills such as teaching Clay to respond consistently to his name repeat simple consonant vowel syllables with visual cues maintain appropriate eye contact and follow simple commands They were also augmenting his speech language therapy with sign language which he was beginning to pick up and use The speech language pathology supervisor Sue pulled me into the observation room one day to observe a therapy session Except for his language development everything about Clay argued that he was a normal little boy He was curious exhibited good motor skills and played appropriately with toys For example when playing with a toy farm he would place the farm animals where they belonged in their stalls or walk the little plastic cows around the pen outside the barn He could put together puzzles build things with blocks and make toy airplanes fly He was affectionate and giggled when something amused him Because of these behaviors Clay s mother and Sue didn t think Clay was autistic or retarded Beyond that however they had no idea what was causing Clay s speech and language delay A developmental pediatrician had ruled out any medical or pathological cause for the delay as wellBut Clay had virtually no receptive understanding or expressive output language He was simply in our terms a nonverbal child He did not turn his head when his name was called He did not follow even simple directions or answer uestions like How old are you or What s your name He didn t name pictures in a book He communicated only by gestures grunts and unrecognizable gibberish He did not seem to have the basic understanding that speech has meaning and is important As a result he rarely even looked at the person who was talking to him When I observed Clay for the first time I was struck by how similar his behavior was to that of a deaf child He rarely responded to his name He occasionally repeated portions of words or syllables but he was neither consistent nor accurate with this skill For example if the speech language pathologist said pig and pointed to a picture of a pig Clay might respond with ik ig just the vowel itself or nothing at all On the other hand when looking directly at the therapist and watching her mouth emphasize the p sound complete with a dramatic release of air which made him laugh he would say pig But his spontaneous expressive communication consisted solely of grunts points and as his mother described screams when he was displeasedClay wasn t deaf In fact his hearing sensitivity was well within the normal range He had been tested using what we call conditioned play audiometry a test in which the child drops a block into a bucket in response to sound By teaching Clay to drop a block whenever he heard beeps or tones of different pitches and loudness we were able to determine the uietest sounds he could hear or his hearing thresholds We had obtained a complete audiogram a graphic representation of Clay s thresholds from the low pitches all the way up to the high pitches His hearing was entirely normal in both ears Therefore although he behaved precisely as we might expect a deaf child to behave hearing loss was not the causeYet watching Clay that first time I was convinced that despite normal hearing sensitivity for tones he was for all intents and purposes a deaf childBecause of Clay s young age and lack of expressive abilities we were unable to perform standard tests of auditory processing function with him These tests reuire a mental age of seven or eight years and the ability to repeat things such as numbers words and sentences Diagnosis of APD is very difficult in children younger than about seven however there are other ways of determining how well a young child s auditory system and brain are able to cope with sound One of these procedures uses auditory electrophysiology For these tests small electrodes are taped to various locations on the child s head sounds are fed into the child s ears and a computer screen records the brain s response to the sounds The child must sit very still or be asleep for this testing Unfortunately deep sleep may abolish some of the responses from higher cortical regions of the brain that are dependent on consciousness To get an active four year old to sit still while electrodes were applied to his scalp and sound was presented to his ears I had Clay lie back in a chair with his mother and watch a favorite video Because we were looking at brain related responses to sound that don t reuire any conscious listening on the part of the child the video did not interfere with the testing in any way We obtained a clear picture of what we call the neural representation of sound from various portions of Clay s central auditory nervous systemResults of Clay s testing indicated that the lower parts of his central auditory system such as his brain stem responded exactly as they should to sound However as we moved higher in the nervous system the responses to sound began to diminish Finally at the level of the brain itself or the cortical level Clay s responses to sound were extremely reduced especially over the left hemisphere of his brain where actual speech sound processing takes placeAll of this suggested that Clay exhibited a condition affecting basic neurophysiologic representation of sound at t. La France a table n°81 decembre 1959 anjou voice stuttered to a stop I laid my hand lightly on Jeff s shoulder and he grasped it in his large meaty palm and sueezedIn a choked Le Guide de l'Anjou voice he whispered I thought I was just stupid What do you mean He lifted his head and met my gaze There was relief in his eyes but also anger embarrassment and just a little defiance You know dumb jock I just always figured I was stupid That s why I couldn t get it I was just a big dumb jock A joke These were astounding words coming from a boy who had just been elected most popular in his junior class and was a sure bet for prom king in his senior yearJeff had experienced academic difficulties ever since he had begun school He had had problems learning to spell and read and still struggled with those subjects in his junior year in high school He liked the idea of losing himself in a book of journeying to far off lands or reading about historical people but he rarely opened a book unless forced to Jeff had a difficult time sounding out the words so his reading was slow and laborious As he described it by the time he figured out what the words were he had lost the thread of the storyBut Jeff loved to spin tales He would make up stories about princes and dragons life in the circus and travels to outer space and tell them to his younger brother who would sit spellbound in wonder as the stories unfolded Creative as he was Jeff never wrote his stories down As with his reading spelling was a struggle so much so that even if he focused on telling the story and just coming close enough to the spelling of the words so that he could return and correct them later he was unable to understand his own writing when it came time to polish what he had set to paper As a result his English composition and creative writing papers were short poorly organized and contained only simple language and elementary Topo-guide des sentiers de randonnées - GR 26 GR 224 - Vallées et forêts de l'Eure : Evreux / Vernon / Pont-Audemer / Bernay / Verneuil-sur-Avre vocabulary They exhibited no hint whatsoever of the imaginative mind of the boy who held the penJeff came from a rural school district and special education services were scarce Nevertheless during his elementary school years he did ualify for reading remediation and tutoring under the classification of learning disability Since junior high school however he had not received any services primarily because he consistently earned A s and B s in all of his classes Therefore the school based special education team had decided that his reading problems were no longer affecting him academicallyf The reason for Jeff s apparent educational success was unfortunately all too common As a student who excelled at football in a town where football was all important he had been passed through every class since he was in the ninth grade No academic probation or C s for our boy no sir In fact his good academic record combined with his amazing sports ability had already resulted in offers of full ride sports scholarships from several major universities before he had even begun his senior year in high schoolAny other kid in his shoes would have been turning cartwheelsBut Jeff was different He was acutely aware that he hadn t earned the grades he had been given In fact despite putting several hours into his studies every night after football practice he knew that he should by rights barely be passing subjects such as social studies history and English compositionHis mother had initiated Jeff s referral to me for central auditory processing evaluation Because she saw Jeff still struggling so hard with reading she had arranged for independent private testing by a specialist in learning disabilities This testing had confirmed that Jeff exhibited low average to borderline abilities in reading decoding eg sounding out words or word attack skills general fund of knowledge and auditory discrimination abilities Other symptoms leading to the suspicion of auditory processing deficit were his difficulty following information presented in lectures and particularly illuminating his inability to hear the uarterback of his football team call plays during the huddle I can t ever hear him he told me But I don t let on I just keep my eye on where the ball is I know what I m supposed to do so I just go out there and do it In this manner Jeff had succeeded in football without anyone being aware of what he had secretly come to call his hearing problem In social situations he freuently smiled his shy smile and nodded rather than jumping into the conversation furthering others perception of him as the sweet strong silent type And when he was unable to answer uestions posed directly to him or answered as if he hadn t been paying attention he took the ribbing of his friends still with the same shy smileBut inside Jeff was hurting You re not stupid Jeff I told him You never were You have what we call an auditory processing disorder Basically what this means is that your hearing itself is fine but what gets into the ear somehow gets jumbled by the time it gets to the brain Because of this different letters may sound the same to you making it hard to tell the difference between different speech sounds Or you might hear what someone is saying but it s distorted or muffled like the person is mumbling especially if there s a lot of noise around If you can t hear the speech sounds clearly it s hard to learn how to sound out words when you re reading or to spell them when you re writing That s why you have to work so hard With that Jeff released my hand nodded once and listened while I explained the rest of the test results and what I thought we should do to help him overcome his disorder A disorder that had a name for the first time One that could be addressed confronted and although maybe not completely fixed one for which he could at least learn ways of compensatingThat was when Jeff shared his dreams for the future with me It wasn t enough for him to be popular to be a football star and to have a college education Les Mauges : Présentation de la région et étude de la prononciation virtually handed to him on a platter It wasn t enough that there was already talk of his possibly not needing to finish college of being picked up by a farm team or even a pro team before he even reached his senior year at whatever university he choseJeff had bigger plans I m happy about the whole scholarship thing sure he admitted I mean that ll get me there pay for everything And I like football It s fun He shrugged But I really want to do well in college I want to learn I don t want to be a football player for real not after college I mean that s not what I want to do with my life What do you want to do with your life I inuired gentlyHe dropped his head just a little almost apologetically and color rushed to his cheeks I want to be a lawyer he said Saumur, terre d'Anjou very Guide de Généalogie - en Anjou et Poitou-Charentes-Vendée very uietly Like my dad And at that his mother began to cry tooJeff was facing a uniue set of difficulties On the one hand he was Anjou insolite virtually assured a college education On the other hand for him to reach his goal he would have to actually perform in college Football might get him through with a general liberal arts degree but to be a lawyer he would have to go beyond that He wouldn t be able to hide behind the misguided albeit well meaning protection of his coaches or teachers He would have to meet high academic expectations just to get into law school then perform at an evenadvanced level to succeed once he was accepted He wouldn t be able to rely on his good looks and charming personalityJeff was aware of all of these things Just as he was excruciatingly aware that his problems with reading and writing his hearing problem would pose substantial barriers to his ever being able to meet those expectationsBut at least now the disorder had a name He could take comfort in the fact that he wasn t stupid as he had always feared Instead his difficulties had a Patois et parlers d'Anjou very real physiologic cause And we had agreed on an intensive plan of attack including therapy techniues environmental modification suggestions and ways for him to compensate for his difficulties When he left my office he was once again smiling This time it was a smile full of hopeAfter intensive computer based therapy Jeff s reading decoding and auditory discrimination skills improved significantly Acknowledging his disorder and giving it a name helped him to gain confidence in himself and his abilities So too did teaching him to become an active listener and providing him with strategies to compensate for his disorder Right now Jeff is a sopho in college majoring in political science and playing football on a full ride scholarship He receives some special accommodations related to his disorder through the university s office of disabilities services and he is earning solid A s and B sIt wouldn t surprise me at all if Jeff did indeed finally make it to law schoolJeff s story is somewhat typical of the children I see with APD Many of them complain of difficulty with spelling and reading inability to understand what is being said especially with noise in the background and inner feelings of inadeuacy and ignorance Children with APD gradually become aware that something is wrong because they find themselves having to work so much harder at certain tasks than their friends do Many children with APD like Jeff perform near enough to the normal range in school to disualify them for special services However even those children who achieve some academic success usually come home from school at the end of every day exhausted from having to spend so much effort just listening Then they are faced with severalgrueling hours of effort to finish homework that might take their friends less than half that time to complete Over time they may learn to compensate to some degree for the disorder But many children with APD continue to have problems into adulthood especially if the disorder goes undiagnosed and untreatedAlso like Jeff many children with APD become masters at hiding their disorder In their early years they may try to participate in conversations or classroom discussions however because their input is freuently off topic or shows a lack of comprehension of the topic they may be ridiculed laughed at or even worse simply ignored After years of this some children simply withdraw from communication altogether Some become sullen and sit in their chairs with arms folded and hands fisted belligerent scowls on their faces daring anyone and everyone to attempt a connection But this is merely a mask that allows them to protect their Petit Futé Châteaux de la Loire : Anjou Berry Sologne Touraine vulnerable hidden inner selves and to retain some semblance of power over the daily situations in which they feel powerless Although this freuently leads to social isolation it is a self imposed isolation and appears farpreferable and less humiliating to the child than the inevitable overt exclusion by others that they have experienced throughout their livesOthers like Jeff continue to participate in life to accumulate friends and join in extracurricular activities This is particularly true for those children who exhibit some special talent in other areas such as sports music art or theater This special talent gives them an outlet for their need to connect with others while at the same time providing them with at least one environment in which they feel safe and can succeed But even these children must deal with the freuent and often unintentionally cruel barbs from friends and teachers the perception of them as somewhat slow the teasing that accompanies their freuent social and communicative faux pas Jeez what are you stupid or something So they too wear a mask of smiling tolerance and become the good buddy who ll put up with anything And they freuently withdraw in their own way becoming uiet followers in the parade of life seemingly happy sometimes even popular but all the while bleeding insideAY SEVERE APD IN A PRESCHOOLERWhen he was really little just a baby Clay made all the same sounds that his sister made We kept waiting for that first word to just pop out But it never did At first we thought Well maybe it s because his sister is talking for him I mean she really does talk a lot But he s four now Four years old And he doesn t understand us and we don t understand him Sometimes when he s frustrated because he isn t getting what he wants he just screams and screams and screams At first they said he was autistic then they said he was retarded Now they just don t seem to know at all We re starting to use sign language with him What do you think I ll learn sign language I ll use it if that s what it takes I just want to be able to talk with my baby You know sometimes I feel like screaming too Clay s motherWhen I first saw Clay he was four years old and had been in speech and language therapy for two years His therapists and parents were working on basic skills such as teaching Clay to respond consistently to his name repeat simple consonant Authion, jardin d'Anjou vowel syllables with Les guides bleus val de loire maine-orléanais touraine - anjou visual cues maintain appropriate eye contact and follow simple commands They were also augmenting his speech language therapy with sign language which he was beginning to pick up and use The speech language pathology supervisor Sue pulled me into the observation room one day to observe a therapy session Except for his language development everything about Clay argued that he was a normal little boy He was curious exhibited good motor skills and played appropriately with toys For example when playing with a toy farm he would place the farm animals where they belonged in their stalls or walk the little plastic cows around the pen outside the barn He could put together puzzles build things with blocks and make toy airplanes fly He was affectionate and giggled when something amused him Because of these behaviors Clay s mother and Sue didn t think Clay was autistic or retarded Beyond that however they had no idea what was causing Clay s speech and language delay A developmental pediatrician had ruled out any medical or pathological cause for the delay as wellBut Clay had La défence et illustration de la langue françoyse. édition critique publiée par henri chamard. virtually no receptive understanding or expressive output language He was simply in our terms a nonverbal child He did not turn his head when his name was called He did not follow even simple directions or answer uestions like How old are you or What s your name He didn t name pictures in a book He communicated only by gestures grunts and unrecognizable gibberish He did not seem to have the basic understanding that speech has meaning and is important As a result he rarely even looked at the person who was talking to him When I observed Clay for the first time I was struck by how similar his behavior was to that of a deaf child He rarely responded to his name He occasionally repeated portions of words or syllables but he was neither consistent nor accurate with this skill For example if the speech language pathologist said pig and pointed to a picture of a pig Clay might respond with ik ig just the Architectes en pays basque 1920-1930 vowel itself or nothing at all On the other hand when looking directly at the therapist and watching her mouth emphasize the p sound complete with a dramatic release of air which made him laugh he would say pig But his spontaneous expressive communication consisted solely of grunts points and as his mother described screams when he was displeasedClay wasn t deaf In fact his hearing sensitivity was well within the normal range He had been tested using what we call conditioned play audiometry a test in which the child drops a block into a bucket in response to sound By teaching Clay to drop a block whenever he heard beeps or tones of different pitches and loudness we were able to determine the uietest sounds he could hear or his hearing thresholds We had obtained a complete audiogram a graphic representation of Clay s thresholds from the low pitches all the way up to the high pitches His hearing was entirely normal in both ears Therefore although he behaved precisely as we might expect a deaf child to behave hearing loss was not the causeYet watching Clay that first time I was convinced that despite normal hearing sensitivity for tones he was for all intents and purposes a deaf childBecause of Clay s young age and lack of expressive abilities we were unable to perform standard tests of auditory processing function with him These tests reuire a mental age of seven or eight years and the ability to repeat things such as numbers words and sentences Diagnosis of APD is Bateaux et gens du bassin d'Arcachon very difficult in children younger than about seven however there are other ways of determining how well a young child s auditory system and brain are able to cope with sound One of these procedures uses auditory electrophysiology For these tests small electrodes are taped to Pyrénées, Aquitaine, Côte Basque various locations on the child s head sounds are fed into the child s ears and a computer screen records the brain s response to the sounds The child must sit Sud-Ouest, porte des outre-mers : Histoire coloniale & immigration des suds, du Midi à l'Aquitaine very still or be asleep for this testing Unfortunately deep sleep may abolish some of the responses from higher cortical regions of the brain that are dependent on consciousness To get an active four year old to sit still while electrodes were applied to his scalp and sound was presented to his ears I had Clay lie back in a chair with his mother and watch a favorite Présence de l'Allemagne à Bordeaux : Du siècle de Montaigne à la veille de la Seconde Guerre mondiale video Because we were looking at brain related responses to sound that don t reuire any conscious listening on the part of the child the Guides géologiques : Aquitaine occidentale video did not interfere with the testing in any way We obtained a clear picture of what we call the neural representation of sound from Objectif Français : Le guide malin pour réussir ses devoirs various portions of Clay s central auditory nervous systemResults of Clay s testing indicated that the lower parts of his central auditory system such as his brain stem responded exactly as they should to sound However as we moved higher in the nervous system the responses to sound began to diminish Finally at the level of the brain itself or the cortical level Clay s responses to sound were extremely reduced especially over the left hemisphere of his brain where actual speech sound processing takes placeAll of this suggested that Clay exhibited a condition affecting basic neurophysiologic representation of sound at t.