Is it possible to have 'good enough' hearing but still not be able to listen?

[amistillsexy]

Hi all. I posted this in Children's Health but Pag suggested I posted here instead. i'll just cut and paste the original...

My 5YO DS has complained for years that his ears don't work very well. He says he can hear that someone is talking but not what they say.

His language skills are great and he could speak very well in full sentences very early (people used to remark on it!). he also picks up on accents very well, and can mimic them, so he doesn't seem to have hearing problems in the traditional sense.

He is currently having a lot of problems at school because his teacher says he isn't listening to her. He says he is trying to listen, but his ears don't work, and he can't hear her properly. The teacher is getting annoyed with him and telling me he's being naughty and not doing as he's told. I know from his reactions that this isn't the case. He's not even aware that he's being told to do anything!

At home, we regularly have to get down on his level and get eye contact before he 'hears' and responds to us. He is 'dreamy' and daydreams alot. He gets very upset if he feels badly done to or left out by his brothers and is very sensitive.

He failed his school hearing test, but the nurse thinks he had heard the sounds, just not rfesponded to them. he had a follow up test at hospital audiology dept (soundproof room, headphones on, clap when you hear a noise test). This test was again hard to administer as he was very distracted and he ended up scoring just within the accepted levels, which the nurse said was fine.

I'm not convinced his hearing is fine at all.

I'm just wondering if anyone has any experience of this type of problem? Any advice at all?

[davidsotherhalf]

my dd was like this for many years and she got dx with auditory processing disorder (apd)

[beautifulgirls]

I'm sure dolfrog will be along with lots of information shortly as our resident expert here, but there is a problem known as auditory processing disorder in which the hearing can be just fine, but the brain processing of the sounds can be confused and therefore understanding what has actually been said especially in the presence of other sounds can be hard to actually interpret. There is a bit of information out there on the net if you googld and dolfrog has a website which he runs www.apduk.org/ which has some info on. Diagnosis would usually be by referral to great ormond street hospital.

[IndigoBell]

As well as discussing APD with Dolfrog, you could try this Auditory Discrimination Test

Auditory discrimination problems is a different problem to auditory processing problems.

[PeachyWhoCannotType]

Does sopund like APD but that can exist independently or as part of another issue- I've come across people with an ASD with same issue (DS3 has perfect eharing but failed hearing test numerous times), ADHD / ADD and indeed it can be as simple as an attention problem. I'll be honest: I am AS (though undiagnosed, have 3 spectrum kids and a whole team of professionals who know LOL) and I find I do the same thing on occasion: I am so busy dealing with absics such as working out sensory issues, appropriate facial expresions that the meaning ahs evaporated- though that is relatively rare and when stressed mainly.

I'd start with PAed appointment and get them to check for ASD (wide spectrum, incredibly so) and if cleared for that referral to GOSH or whatever your appropriate palce is (knowing note veryone here is in England).

BTW I know I scare people when I mention ASD: it's, as I said but worth reiterating, a huge spectrum. There's something called the triad of impairments worth looking at that should give you a clue if it relates or not.

[amistillsexy]

Thanks to you all for your input. General concensus seems to be APD as a road to explore. Looks like I should be talking to dlfrog. If anyone sees him, could you give him a shout for me please?

indigo, I'll do the test with DS2 as soon as he's finished watching Iggy Arbuckle!
Peachy, I'm not scared of ASD-DS1 has PDA and DH has AS. "We're livin' the dream, baby!" . I'm certain that DS2 would not be diagnosed ASD/AS/HFA as he just isn't anywhere near, although I can see 'traces' in both DS2 and Ds3 (Ds3 has been having speech therapy for a while now as his pronunciation is very imprecise).

Ds2 used to be very sociable and friendly with all, but recently has become very withdrawn. I'm wondering if this is related. He has had a hard start in life due to his coming along just when DS1's troubles really started to show. For years and years (in fact, until about 4 months ago), Ds1 took all his frustrations and anger out on DS2.

[Pagwatch]

See amistillsexy, I told you this was where all the smart people hang

[amistillsexy]

{Grin} I know Pag, I lurk, truly I do, but I've been through such a WRINGER with DS1 and the horrible schools round here and PDA being such an impossible shitty thing that I just tend to post crap and the odd pearl of wisdom on other threads!


It was only a matter of time, though....

[PeachyWhoCannotType]

Ah you see ami those disorders inh family genetics should really red flag your son for referral on a JIC basis as lots of researchers think they share a genetic link.

rarely happens- ds4 didn;t even get a standard check from HV until I screeched lously- but they should

[amistillsexy]

What does JIC basis mean?

I joke that they could do a whole study on just us alone (and I daren't have another baby...God knows what might happen! ). I have face blindness and possibly a bit of dyscalculia as well. I'm sure they are linked too.

Poor kids. They never stood a chance did they?

[PeachyWhoCannotType]

Ah just in case basis

IE raised risk of ASD or related disorders


They are doing a study on us alone- we are off in November! And I am doing my MA Autism dissertation based on something I have noted in our family.

We have:


DS1- AS, attents AS Base
ds2- School say dyslexic, dyspraxic, ADHD: GP says 'I don't beelive in all that wooly stuff' (he ticks every box but we have no local ed psych and ahven;t for eyars, and school has only 2 referrals per annum as a result and ds does not kick off enough to get one of those)
ds3- fairly severely autistic, attends Base, adorable but won't ever be independent
ds4- ebinga ssessed, has already been dx'd with speech delay so can't be AS but pretty sure HFA


then:

Dh and FIL0- severely dyslexic
MIL- OCD
Grandad- obviosuly autistic but too old now really to do anything about (90+)
Mum- dmits full well she has AS even if no dx
Me- see as per mother!

[amistillsexy]

Wow Peachy, you should write a book!

You've just reminded me about ds3's burgeoning OCD traits-washing his hands by counting 1,2,3,4 as he rubs his hands on the soap 4 times, then 1,2,3,4 as he rubs the fronts, both backs and in-betweens under the tap!

It's not looking good for a settled future is it

[PeachyWhoCannotType]

You never know ami- MIL made her fortune through her OCD, successful cleaning business!

Plenty of people have suggested the book. One day I might.

[amistillsexy]

Indigo, I tried the auditory dicrimination test.

This is from the table of results:

Your child may have Auditory Discrimination Problems if they made the following number of errors:
For 5 year olds > 6 errors.
For 6 year olds > 5 errors.

DS is 5 and a half and he scored 5 errors, so borderline I'd say (this is similar to his audiology test result). We also did a test on the RNID website, which has a voice with a background of rushing noise (to simulate trying to listen in a noisy environment). That said he had no hearing loss, although I noticed he didn't hear quite a few of the number strings.

So if there is a problem, it's more likely to be auditory processing. Does anyone know if this can be exaccerbated by stress/anxiety? I know DS1's autistic 'symptoms get more noticable the more stressed and anxious he gets. Is this the same?

[dolfrog]

amistillsexy

Auditory Processing Disorder (APD) is a listening disability,  or about not being able to process all that you hear. It is possible to have both a hearing impairment and APD. Which is why you need the results of a recent hearting test so that these issues can be calibrated into an APD assessment. APD is one of the underlying causes of the dyslexic symptom, and can be one of the multiple issues which can contribute to ASD.

APDs who have a high IQ are very able at developing alternative compensating abilities to work around their auditory processing deficits to fill in the information gaps, and can develop good lipreading skills and become very good at reading body language. Skills most others do not need to develop so much. 

Some who have APD can at times have problems processing some specific sound frequencies which can blend into low levels of background noise, and this can happen with some female speech sound frequencies, especially if the speech sounds bounce off solid objects walls, doors etc. APDs can have problems with low levels of background noise (pink noise), or competing sound sources. We also have problems with processing the gaps between sounds which can cause problems processing rapid speech, and using phonics impossible. 

Those who have APD can be miss diagnosed as having ADD and even ADHD, although it is possible as it is with all of these issues to have have co-existing conditions, of which ASD is a prime example. 

All of our family (3 DSs, my DW, and me) have some degree of APD, we all have different subtypes of APD, and different severities, and different alternative abilities to help work around our individual APD issues. I am the work case Scenario regarding APD in our family, but I also have the best natural coping strategies, as I am a natural visual-spatial learner, I naturally think in pictures. 

The APDUK web site has been designed to demonstrate hwo many who have APD prefer text to be presented using multi - coloured fonts, and extra spacing. And if you want to see how I prefer a links web page to be set out and designed have a look at my old dyslexia links web page. 

Unfortunately APD is relatively new in the UK, although the medical research council estimate that 10% of children have some degree of APD. Which taken to the wider population means that 6 million people in the UK have APD. Most as yet have never heard about APD let alone be aware that is the cause of many of their differences or communication deficits, which can explain why they may have been unintentionally setting themselves up to fail in the work place and are continually under achieving in all walks of life.

[PeachyWhoCannotType]

dolfrog is there an adequate dx of APD in teh pipeline for teh new DSm do you know? i've seen the new ASD one, it's OK- some improvements some omissions- but wondered if APD was being addressed?

[dolfrog]

PeachyWhoCannotType

The UK Medical Research Council won their first government funding for an APD research program back in 2004, and their first aim was to devise a new universal battery of APD diagnostic tests using sound frequencies to replace the old US langauge based tests.
The Medical Research Councils Institute of Hearing Research is based at Nottingham University, and they have been working UK researchers, and especially the consultants as Great Ormond Street Hospital with regard to children and National Hospital for Neurology and Neurosurgery
(Queen Square London) for adults who have APD. The clinical trials for the new tests happened during 2009 - 2010 and now it is about gaining official approval, recognised diagnostic tests for a recognised disability. To this end there is a international symposium being suggested for next year, at which the new IMAP Test Battery will become part of the Gold Standard diagnostic process for APD globally. There has also been some increased research paper activity in various research journals over recent months regarding APD, covering many issues. Whether this will all be agreed in time for DSM 5 is another issue, but changes are always made after each DSM publication inline with current research, as they have been in the past.

[PeachyWhoCannotType]

Hope it does get in though, Yes they issue revisions but those take a few years to come out. Plus from a purely academic POV it will be interesting where they aplce it, just in terms of how close to ASD- I;d hazard a guess APD is a more complete understanding of one of the rpesentations of teh genetics that can contribute to ASD. ADHD, SPD, Dyspraxia, OCD, verbal Dyspraxia etc but long way off a very complete understanding of that yet.

[amistillsexy]

Hi dolfrog thanks for stopping by!

I'm very confused about the link between APD and dyslexia.

Is it because they are both to do with a neurological difficulty in processing the messages? Ie. the ears can 'hear',and the eyes can 'see', but the brain can't process and make sense of what's heard or seen?

Is it a co-morbidity type of thing-APD often comes along with dyslexia-or is APD a form of dyslexia?

My little boy reads very well for his age-he's suddenly surged ahead over the summer (he's just gone into Y1). He just seems to 'switch off' when he gets through the school gate!

I spoke to him about this last night and he told me that he can't hear because his ears don't work properly . Sometimes he says his ears are blind (grin) . He said he can hear me because he's used to my voice, but he can't hear his new teacher because he doesn't know her voice.

He often complains about the noise level at school, and regularly used to cry when going to pre-school because it was 'too loud'. He is very sensitive to people shouting. He gets very shocked and scared when people shout and will comment on it (ie. 'Mummy, you shouted 3 times today...' ).

Does any of this sound like APD to you? Or just over-sensitivity?

If there is anything else that might point towards APD, please let me know so I can see if it fits. Also, how would I go about having him assessed? We are in West Yoorkshire, so a bit of a back-water when it comes to 'new' things!

[dolfrog]

amistillsexy

Dyslexia is a man made problem,a Social Construct. Dyslexia is about having cognitive problems accessing a man made communication system, the visual notation of speech, or decoding and recoding the graphic symbols society chooses to represent the sounds of speech.

There are two types of Dyslexia:- Developmental Dyslexia which has a genetic origin, and Alexia, acquired dyslexia, which results from a brain injury, substance abuse, stroke, dementia, or progressive illness.

Developmental dyslexia has three cognitive subtypes:- auditory, visual, and attentional. So an auditory processing disorder (listening disability), a visual processing disorder, an attention disorder, or any combination of the three can cause the dyslexic symptom.

Those who have APD have problems processing what they hear, or have problems processing the meaning of what we hear. So our Ears work perfectly well, but our brain does not process what the ear hears, or more usually bits of what our ears hear, so we have to best guess the bits we miss to try and make sense of what is going on around us. It sounds like he is trying his best to describe APD which is a very complex set of issues, and he seems to be doing it better than I did when I was his age. APDs have problems with low levels of background noise, so speech just blends into the background noise and becomes part of the background noise, and the background noise becomes very irritating and distracting when we are trying to focus on something.
There is an online description of APD at
Auditory Processing Disorder (APD)
What is Auditory Processing Disorder?
Ideas to be Considered Prior to Creating an IEP for an APD
and a USA definition
APD Evaluation to Therapy: The Buffalo Model

Problems with loud noise can sometimes be co-morbid with APD, the condition is called
Hypercusis.

The coping strategies we develop to work around our deficits or disabilities are run in the working memory, and we priorities how we use our working memories subconsciously, s o we can not switch the coping strategies on and off when we need them. we have to anticipate what will happen tomorrow and hope that our coping strategies will be there when we need them. And our coping strategies have to take second place to coping with stress or illness, which have a higher coping priority.
The Medical Research Councils Institute of Hearing Research which has been researching APD since 2004 is abased at Nottingham University, and the first APD clinic was based at Sheffield University, run by Dilys Treharne.

I hope this helps

[IndigoBell]

Are you aware that hypersensitivity to noise can be cured by auditory integration training?

[dolfrog]

IndigoBell

AIT can help quite a few auditory related issues, but is a cure for none. AS we have discussed before, many of these issues remain unexplained, as we still do not have the technology to provide a full understanding of all of the issues, and how any program can help some and not others, which includes AIT, and until such time that we do have the technology to fully understand all of the issues it will not be possible to define when AIT will provide a positive effect a so called cure, or when AIT will provide no benefit, or when it could cause cause some harm. And it is the lack of understanding of how the neurons et inbrain work, and how thye may react to various types of auditory stimili that makes using these types of programs so hit or miss, and usually with no long term outcome.
So all are always very welcome to try these programs but you can not call the cures, as there is no scientific evidence to support any claim for a cure and that there are some risks involved as well.

[IndigoBell]

Dolfrog - I have the before and after audiograms for DS and for DD.

Before AIT they had hypersensitive hearing, after they don't. It's clear as mud on an audiogram.

It cured their hypersensitive hearing.

[dolfrog]

IndigoBell

You do not seem to understand is that a program which has had a beneficial affect for your children does not have the same results for all children, so you were lucky that AIT work for your children, there are many others who have also tired AIT and it has provided no benefit, or has done some harm. As I keep on saying the program providers and the leading researchers do not yet have sufficient understanding of the issues to predict for whom the program may work and provide a beneficial outcome, and for whom it will provide no benefit and no harm and for who it will harm.
And until they can accurately predict the outcomes of using the program for each individual the n the risks remain. You were lucky.

[IndigoBell]

dolfrog. You know nothing about AIT. Nothing.

I won't reply to anymore posts you make because you upset me too much.

I said hypersensitive hearing can be cured. I then provided proof that my kids had been cured. My kids have been cured of hypersensitive hearing by AIT (as has becaroos, loueytbgs and blueshark that I know of). So therefore my claim that AIT can cure hypersensitive hearing is totally correct.

I didn't say it can cure all kids. I have no idea if it can or not. I suspect so, but can't prove that and didnt claim that. It would be impossible to prove that anything cured 100% of the population. Impossible.

[dolfrog]

IndigoBell

You seem to be missing my point. I have never said that your DC have not made a great improvement after using AIT, which you describe as being cured.

"I didn't say it can cure all kids. I have no idea if it can or not. I suspect so, but can't prove that and didnt claim that. It would be impossible to prove that anything cured 100% of the population. Impossible."

There are research procedures which are be used to clarify whether a program is a cure for a specifically defined and diagnosed condition. The results of clinical trials can clarify if a program is a cure or not, and highlight any possible side effects etc. and only when that is done can you use the word cure.
AIT has been on the market for over 30 years and so far there is no research that supports AIT as a cure. AIT does have a history of providing some benefit for some who have used it, similar to the results you have experienced. Bu there have others who have no benefit from using AIT, and some who have been harmed by using AIT.

I suspect that you would be equally emotional if you were one of the parents of child for who AIT did not provide and benefit, or for whom AIT was harmful. So all I am saying is that you need to provide a balance between your very successful results from using AIT, with those who do not benefit from using AIT so that other parents can see that they can either get some benefit, while at the same time they may not get any benefit at all.