How Auditory Deficits Affect Children’s Academic and Social Skills

Episode Transcript

Dr. Nicole Beurkens: 

Hi everyone, welcome to the show! I’m Dr. Nicole and today, we’re going to be talking about auditory processing and how it can influence behavior and so much more for children of all ages. When people typically think about the word auditory, I find that they think about hearing, but there is so much more than just being able to hear things. One of the most under-recognized issues I see in children at my clinic is problems with them being able to make sense of what they’re hearing, and that’s what we’re going to talk about today: Auditory processing. It can be a major contributor to behavior, learning and mood challenges for many children, but it often doesn’t get addressed. Several years ago, I read a book on this topic, called “The Sound of Hope”, and it was really helpful for me in understanding and exploring this topic further, and I am so honored that Lois Kam Heymann, the author of that book, has joined us on the show today. Let me tell you a little bit about her.

She is a Speech and Language Pathologist with more than 30 years in the field, specializing in diagnosing and treating children with auditory language deficits, auditory processing disorders, language processing disorders, hearing loss and listening challenges. To meet the needs of parents, teachers as well as students, Lois does trainings nationally and internationally. Her programs include “Sounds Fun!” for kindergarten and preschool, “Teacher Talks, Listen, Love, Play”, and Lois is the Founder of the Listen, Love, Learn, a private practice, evaluation and treatment of auditory processing disorder and language processing deficits, and lots of resources available there. Her approach to auditory processing disorder has been really helpful to me as a clinician and also to the colleagues that I work with here at my clinic, so I’m so happy to have you on the show today. Welcome, Lois!

Lois Kam Heymann:

Thank you so much, thank you for inviting me. 

Dr. Nicole Beurkens: 

So I love to start by having you share a bit about how you got started doing the type of work that you’re doing with children and professionals today. 

Lois Kam Heymann: 

Sure! So a very long time ago — I’ve been in practice for more than 30 years. I worked primarily with auditory problems like hearing loss. And this was children that had defects within the ear, the mechanism of the ear, and they either had a hearing loss or they were deaf, and the method that I was using was working with children through auditions, to listening, to lead to listening, language and speech production. And that was very satisfying work, and I was there for the time when cochlear implants first came about, and made some programs for myself there in New York City. And then I started getting children that were referred to me that could hear perfectly normally, but presented as if they may have a hearing loss. And that got me very interested, and I started really researching this idea of auditory processing and how that affects language processing, since I’m a speech language pathologist.

Now, I started working very closely with audiologists and really understanding the impact of processing, which is very different from hearing. 

Dr. Nicole Beurkens: 

Absolutely. And such important work, because, as I mentioned in the intro, I find that a lot of people don’t understand the differences in those things, and it’s a really important distinction. So let’s dive into what actually is auditory processing? When we’re talking about auditory processing, and then when we use the term “auditory processing disorder”, what do those really mean?

Lois Kam Heymann: 

So when we are talking about hearing, it happens within the ear mechanism. But when the sounds leave the ear through the 8th cranial nerve — I know it’s a lot of information, but there are two pathways called the auditory pathways. And the right ear’s pathway goes to the left side of the brain, and the left ear’s pathway transverses and goes to the right side of the brain. During that transmission, where the sounds are being sent up for speech and language, there are six points of processing that happen to those sounds before they are language. So they could be the differences between the way sounds sound, a buh and a duh. It could be the way how quickly the message gets to the brain. There are many different ways to process the sound, once the sound gets there, if it has processed well, it gets turned into language, and then into speech and expression. But if it doesn’t process well — in one or both of those pathways, you have a child who has received information that was not what was said. And therefore, their brain can not hear the differences. It’s not that their ear doesn’t hear, but we really hear language and speech with our brains, and that’s the difference. 

Dr. Nicole Beurkens: 

And that’s so important because often, parents will say, “Oh, my child’s passed all their hearing tests. These things can’t be an issue.” If they went to the pediatrician and they had the hearing test or at school, and it’s this idea that actually, the making sense of what our ears are hearing happens in the brain. We’re not talking about just passing a hearing test, right? 

Lois Kam Heymann: 

Exactly. Exactly. And the audiologist who tests the child’s hearing, a pediatric audiologist will test hearing, and that tells us about the brain mechanism, but if we are looking at auditory processing disorder, then we are looking at a different test from the audiologist, called a the CAP test: Central Auditory Processing. And they actually diagnose auditory processing disorder, but my method really takes the auditory processing, whether it is a disorder or just a defect, and looks at the language impact, all the reading, spelling, understanding in the classroom, and really looks at that piece as the speech language pathologist, and the speech language pathologist is the person that actually does the treatment. 

Dr. Nicole Beurkens: 

Right. And I want to get into — now that we differentiated this piece of between what’s going on with the ears and the hearing and then what’s going on with the brain and the making sense of it. I know probably the next thing that a lot of our listeners are wondering about is, what are the red flags or what are the things then that could indicate that maybe this is a problem for my child? Because certainly, the ability to make sense of what we’re hearing, the ability to process that appropriately has impacts on every part of our life, right? So what are some of the things that stand out to you in all the years that you’ve been doing this work that really are good indicators that maybe this is something that should be looked at closer for a child?

Lois Kam Heymann: 

Right, so we’re looking at children both between the ages of birth — you really can’t diagnose it, and 5-7, because at 7 is when they can have the auditory processing test. You can’t have that test from the audiologist until you’re 7, because your pathways are growing from birth until 15 years of age. So the test has to wait until you have mature enough pathways to test. But we can start recognizing difficulties in children before that. So one would be that background noise seems to really bother the child. So whether it’s music or it’s people talking or you go into a restaurant and the child starts holding their ears — not because it’s too loud, but because it’s so confusing. So background noise is one big indicator. A note that it may be auditory processing. Another is that they misunderstand often. So they say, “That’s not what you said!” And we get that from a lot of kids, and we often think, “Oh you just weren’t listening”, behaviorally. But that’s not true. With many of the children, they just didn’t get it. They didn’t get the meaning.

Also, we look at children that are having difficulty following step directions. So realizing that by the age of 3, a child should be able to follow three-step directions. Go upstairs, get a book, put on your pajamas and I’ll read to you. And I have children, 10 year olds, that can only follow one-step directions. So we think, “Oh, you’re just not listening again!” But that’s not true. That’s called auditory sequential memory. They can’t hold on to the information and then act on it. Another one is saying. “Huh” and “What” a lot and asking for clarification often, because they missed it. So very often, people think, “Oh, that’s ADD — Attention Deficit Disorder”, and we really have to pull those two apart, because they could coincide, but they are very different things and treated in very different ways. 

Dr. Nicole Beurkens: 

It’s a great point, there’s a lot of overlap with these, and that’s part of what I get into as a clinical psychologist with looking at — I often see kids who have been given multiple diagnoses or been given a diagnosis, but the treatment is not working effectively. And often, it is a kid who has been labeled with ADHD, and then you start to pull apart the pieces, and you realize that there are things like these processing deficits there, and it’s not that they’re not paying attention, it’s that they are making sense for what’s going on, or almost as if they are paying attention to too many things at once, as you said, like with the background, that they struggle to filter that out, and it’s not part of the piece — I wanted to jump back to the piece of kids who seem really overwhelmed by background noise, things going on, is that because it’s difficult for them to take it and make sense of lots of different things at once, it’s almost like too much for their brain to manage?

Lois Kam Heymann: 

Yeah, it’s overwhelming, but it’s actually the process, again, in those pathways. For people that are processing well, one of our ears or pathways takes over listening to the signal, the words that the teacher is saying, or the word that the parents are saying — and then the background noise is pushed away by the other ear. It’s sort of a function of the way we process, but for many, many children, that distancing of the background noise doesn’t happen. And when that doesn’t happen, the sound is overwhelming what the person is saying. Or with noise, it goes in and out. So if a child is sitting in the classroom and another child is moving their chair back and forth or coughing, and then gets up to throw something away, all of a sudden, they look distracted, but it’s actually that they missed what was said. And can I give you a little example of that? 

Dr. Nicole Beurkens: 

Please do, yes!

Lois Kam Heymann:

So if we think about a child sitting, let’s say in third grade. And the teacher said, “And then the girl went to bed.” And our kid thought they said, “And then the girl went to dead.” Because the “Duh” and the “Buh” share the same acoustic or sound properties as each other, so it’s an easy difference to make, or similarity to make. And so now, the teacher keeps talking, of course, but our kid, if they are making a repair, will say, “Oh, she’s talking about pajamas and night time, so it must be ‘bed’.” But while she’s done that, she’s missed the next three words that the teacher said. So now, the comprehension is lost. Not because she doesn’t understand, but because she lost vital information. And if it’s a child that doesn’t bother to do the repair, then they’re completely lost, and what are they going to do? Look out the window, start poking their friend — we have a lot of behaviors that come out when we don’t understand. 

Dr. Nicole Beurkens: 

It’s such a great point, and that just behavior, especially in the classroom, in general is often rooted in overwhelm and not understanding. I know so many kids with auditory processing issues who, exactly what you described, at a certain point, they just sort of give up or tune out because it’s exhausting. I have to imagine, and I really have empathy for kids who struggle with this or people who struggle with this, because what you just described there, that one little example of that needing to intentionally think to repair that and then move on, I mean when you have to do that all the time through the day, that is an emotionally and just mentally draining thing to have to do. 

Lois Kam Heymann: 

Right. And so many of the kids will hold it together during school, and then they’ll come home and fall apart. And the parent says, “How can they do it at school and they can’t do it at home?” And it’s really that they’ve tried so hard all day, it’s just exhausting when you are not hearing it and have to constantly repair what other people are saying, or not understand. And then the self-talk the child has is “I’m dumb, I’m stupid, I can’t do this.” The self-esteem goes down. So hearing and listening are so much a part of who we are in our communication and our interaction with other people. And so, this idea of self-esteem, I think, is really based on how well we can integrate into the world through listening as well as other sensory. 

Dr. Nicole Beurkens: 

Absolutely, and that has such an impact on just broader mental health for kids too, not just their behavior, but as you said, their self-esteem, their mood, their resilience, their emotional regulation — all of these pieces become so tied into that. 

Lois Kam Heymann:

Yeah. 

Dr. Nicole Beurkens: 

Let’s talk about how — you touched on this with that example of how an auditory processing disorder can impact a child academically, socially — we’re talking about all these ways that this weaves in, but I really think the examples are so helpful for parents to understand: Here is how this impacts every part of the child’s functioning. 

Lois Kam Heymann: 

Right, so when I look at auditory processing, I am looking at a bottom-up and top-down evaluation. We’re looking at the skills that it takes in order to sit in a classroom, listen to the teacher, hold it together, later be able to take notes — all the things we have to do in school that really are based on listening. So when we think about it, we think auditory attention. How well can the child attend to the speaker? And then we look at noise and background noise.

But we also look at things like gap detection. So the audiologist gives two sounds. Beep, beep, and the child has to say when they hear two sounds or one sound. Beep, beep, beep, beep — and all of a sudden it gets closer and closer. And they have the standard for each age. But if a child fails that, what does that mean? Well, that’s going to impact their phonological development, which is leading to reading. Because if you can’t hear pauses well, everything starts meshing together, and you’re lost just because of the rate of a person’s speech, but also, you’re not going to be able to count syllables. You’re not going to know when is the end of one word and the beginning of another word.

So these little pieces of listening that we’re always doing impact school. Auditory memory: How much information can we hold on, not only over time, but also sequentially? Well, that impacts history. Learning history in order, math problems that you have to follow in a certain way. And then we think about language. If the auditory signal has impaired the way we hear and deal with language, then we’re not getting the same vocabulary as the other children sitting in the classroom. And that’s not a matter of people not presenting vocabulary or of IQ, but just that they haven’t heard it right to store it effectively for later retrieval. So it affects word retrieval. So there’s this complicated, but actually straight line to whether it’s understanding what was said, being able to sequence what was said, and then understand, being able to put it all together and then be able to follow directions, answer questions, get the main idea, all of those things that are language, are based on how we’ve processed the auditory message to turn into language. 

And that’s what I think is missed very often by the people working with auditory processing, is the link between those two. We get people working on language, and we get people working on apps or something to build auditory skills, but it’s actually the transfer of the skills that’s necessary. 

Dr. Nicole Beurkens: 

As you’re talking, one of the things that just strikes me is how much we take for granted, that this stuff just generally works without us thinking about it. We often don’t think about all of the steps that go into this, and yet, as you’re piecing this apart and describing this, I’m going, “Wow, there are so many components of this, and a breakdown in any one of those areas can really impact kids,” as you’re saying, academically across the board. And when we have processing skills that work well, we don’t think about these things. So I think it can be hard for adults who don’t have these issues to understand how this can be happening for kids. 

Lois Kam Heymann:

Absolutely. And even in playgrounds, we talk academically, but in my book, I talk about a little girl that wanted some chips from another girl, and the girl thought she was saying “ships”. Well, they started having a fight and an argument. “You said ships” “No, I said chips!” “Yes, said ships!” And all of a sudden it becomes a poor interaction that leads to feelings being hurt and maybe a child’s stride gets out. You know, behaviorally, what are kids going to do when they don’t understand? When they can’t hear — when they don’t understand what they thought they heard, right? It just doesn’t make sense. They’re either going to act out or they’re going to withdraw, but no matter what, they’re going to become frustrated. And that’s what we’ve got. 

 

Dr. Nicole Beurkens:

That frustration tolerance, that was a word that kept coming to me when you were talking too, just about the frustration and how many kids tap out then. Even kids who have a fair amount of resilience at a certain point — that sense of just, “Ugh, I give up”. And I think the social interaction piece is such an important part because that’s such an important part of development for kids, and as you said, the playground, the social interactions that happen in the classroom, at girl scouts, at the baseball team, all of these different things, and this is not just something that impacts kids academically in the classroom, but it’s impacting all of their relationships at home, with their peers —

Lois Kam Heymann:

Yes. As kids move from second to third grade, we know that there is a big change in what’s expected of them in the classroom. But it’s not just the reading and the writing. It’s really what they have to listen to. And so, all of a sudden, we get inferencing, that you have to hear between the lines as well as read between the lines. And for kids with auditory processing, this becomes very difficult. As kids get into middle school, everybody is using sarcasm and humor. So for instance, if I say to you, without changing my facial expression, “Nice shirt!” versus, “Nice shirt” — and there is something called suprasegmentals that we test for, for example, pitch patterns, pitch pattern changes: You think it’s all just one meaning and it just sounds the same. So you’re not going to understand sarcasm or humor, and all of a sudden, socially, you’re being left out because you don’t get it. 

Dr. Nicole Beurkens:

Absolutely, and boy, nowhere is that more evident than as kids get into middle school, right? All of those dynamics, most of us wouldn’t relive those years for anything, anyway. But then you throw something like auditory processing challenges on top of it, and what you just shared was a great example of how that really compounds the social challenges of that phase of development even more. 

Lois Kam Heymann:

Yeah. 

Dr. Nicole Beurkens:

So this is all so helpful for parents to start to think about and maybe recognize some of their own child in this, and I’m sure that we’ve got people who are thinking, “Okay. Boy, nobody has ever mentioned this, but I can see where this is really potentially an issue for my child.” Let’s delve into how we diagnose this, what are the steps? If a parent is thinking, “Oh, this really sounds like my kiddo.” How does that process work?

Lois Kam Heymann:

Well, unfortunately, the schools, some schools in some districts are much more aware of this and aware of getting testing for the children because the testing has to be done outside of the school, so it’s very often a difficult to get the school to do that. So I’m going to give you a couple of ways to go about it. The first of course is bringing the attention to the CSE or the Child Study Team at the school’s district and following that path. But if a parent is not getting satisfaction there or they want to take it on themselves, then visiting a pediatric audiologist — which means that they have to be centered in child testing, not for adults — not the same as we would go for hearing aids for an adult, and they would do a hearing test first to state the child hears perfectly normally. And then they would go on to make the auditory processing evaluation that can be given at the age of 7 to 7 and a half. They can test some of the areas at age 5, but they would only get — that’s a screening. But the diagnosis can be made. And then those areas of difficulty are noted, because there are many different factors, and mixing and matching what’s going on for a child auditorily.

Then, very often, a speech pathologist will be doing their testing, but very often, the language processing testing that the speech pathologist does, does not center on auditory skills. So finding a speech language pathologist that works with an audiologist or understands that auditory impacts language and how that happens — I give many, many conferences about that method, and there are many people that really understand that link. So working with somebody that understands that link and can take the information from the audiologist and blend it into language and then work with the child based on that diagnostic. 

Sometimes, they can not get that kind of testing done, based on where they live, or very often audiologists take insurance, so that’s of course — looking for that especially at hospitals, but very often, at the school, there maybe somebody that can give the scan C, which a speech pathologist can give, or a psychologist can give and look at — Oh, there are some processing difficulties here, a screening, and then working with a speech pathologist that’s going to work on those areas. That’s the diagnosis. 

There are many computer programs out there, and for me, I believe that auditory processing is a language interaction skill and it needs to be dealt with with a person. I think that home listening and some of these listening programs can be wonderful to boost what you’re listening for and how to listen, but the actual intervention, I believe, needs to be done with a human voice and a human face, because language is so much more than just the words.

Dr. Nicole Beurkens:

Such a great point. It’s really the context, right? It’s all about all of those contextual pieces, and processing is really about being able to bring all those pieces together into a meaningful whole, so I appreciate that you said that, because I think in an era where there often is a tendency to look at what kind of computer program or app or whatever, those can be helpful for some things, but when we’re talking about bringing all these pieces together, there is no substitute for that real, in-person kind of interaction. 

Lois Kam Heymann:

Can we talk about technology for just a moment?

Dr. Nicole Beurkens:

Of course, absolutely!

Lois Kam Heymann:

Okay, so, you know, I get the question about screen time for kids, and especially for young children, and everybody has their philosophy or their reason for doing things. So I’m not talking about how much screen time a child should have, but rather the fact that when young children are on screens, what they’re not doing is interacting with other people in a listening-speaking dynamic. What we find is children that are on screens early predominantly and not having those social interactions, conversations, activities that require listening and language, have lower vocabularies, have less listening stamina. Because the screen gives you a lot of visual information, but absolutely no auditory information. And if it is auditory information, it’s disembodied voice like Dora. So the listening activities aren’t happening. And our processing gets built by the auditory input that’s based on it. So a child might not develop an auditory processing disorder because of screen time vs. actual time, but they may have listening challenges and poorer vocabulary and language because of that balance. So I always tell parents: Spend 15-20 minutes reading to your child, playing with your child, and then they can have some screen time. That’s my deal that I make with parents. 

Dr. Nicole Beurkens:

I love it and I’m so glad you raised that because I think what we’re seeing across the board now is research coming out to support what people like you and I, who have been in the field for a long time have seen anecdotally, which is the impact that overuse of screens can have. I just was reading some studies recently connected to what you were just talking about, especially in young children, the deficits that we see then in language, in comprehension, in communication development — and it’s not even, I mean, we’re not talking about kids spending half the day on these things. We’re talking about overuse as being defined as even more than an hour or two a day, and the activities then that they aren’t participating in as a result, which is your point that they need to be engaged in those interpersonal moment-to-moment communication kinds of interaction, so I’m really glad that you raised that because proactively, that’s something that we can all be doing as parents to support the development of these skills in our kids. 

Lois Kam Heymann:

Yes. Absolutely. And in my book, I do give activities for parents. The second half of the book is all about what you could be doing during those moments together. Rhyming, reading together, playing together, singing together, all those things that are auditory language activities.

Dr. Nicole Beurkens:

Well, let’s get into that a little bit, because now we talk about the diagnostics. I did want to circle back. Does somebody just need to look for any pediatric audiologist? Or are there pediatric audiologists that specialize in this? Can anybody who has a specialty in PEDS and audiology diagnose this?

Lois Kam Heymann:

I can’t say for all, but what I know is that they are the ones that will give this test. So that’s a question to ask. “I want my child’s hearing tested, I’m thinking it’s auditory processing disorder. Can this audiologist give that kind of further testing?” And then you know right away. If they say yes, we test for CAP or Central Auditory Processing, then great! And if not, find another one. But most hospitals, especially children’s hospitals have that availability.

Dr. Nicole Beurkens:

Okay, fantastic. So let’s talk about treatment. We’ve got kids with these issues, they get diagnosed with this — is this just something that kids have to live with for the rest of their life? What are effective ways of addressing this? 

Lois Kam Heymann:

So it’s really about — first of all, it’s based on which areas are most effective. Let’s look at phonological because we get a lot of children that are not learning to read. And reading has two components to it. It has decoding, actually knowing the sounds, and the sounds blending together and forming a word. And then it’s the meaning, encoding, which is the comprehension of what you read. So delineating which one the child is truly having difficulty with, and then looking at — if it’s the decoding, then you have to go down a hierarchy of “Where is the breakdown?” So my belief is that when you are looking at the treatment, you have to know the lowest place of breakdown in order to work up. And so, with many children, they don’t have sound simple. They learned it, but they don’t know that B makes the “Buh” sound, and they don’t know that the short A is the “Aa” sound. So then, how are they going to do the things that are being expected of them in the first and second grade? So treatment would then look at that, if that’s what we saw from both the types of testing.

If it’s in auditory memory, then it’s story-telling, and it’s story-telling using pictures. So for me, the most important cue about auditory processing treatment is that we always pair auditory plus visual, the children with auditory difficulty usually are so much more visual. And then we fade the visual to leave them with auditory alone. So very often, I’ll walk into situations where the therapist is just working with auditory, auditory, auditory, and the child has no anchor. They have no way of knowing what they’re talking about because that’s their problem. So now, if we show a picture, once upon a time there was a little girl who wore a red cape and a red hood. And we lay it down, knowing that before I do that, I have to make sure that every word I’m going to be saying in that story, this child knows. So previewing the vocabulary and then sequencing the story with pictures and then having the child re-tell it and slowly turn over the pictures, but don’t take them away, because the child then tells the story based on their auditory memory of what was on those pictures. So it’s a very method-based on success, and always starting where a child is successful and then adding things. So this visual plus auditory, fade the visual, leave the child with auditory, to me, is the key. 

Dr. Nicole Beurkens:

I agree, because for any successful intervention, kids need to feel like they can do it. They need to feel successful at it, otherwise, they just give up with it or it becomes something else that’s overly frustrating and that they feel like they can’t do. 

Lois Kam Heymann:

Part of this intervention really should be the building of confidence. So every time the child hears it correctly and understands it: “Great! Let’s keep going!” “Awesome! I loved the way you listened!” And it’s just building that, because the praise piece, the child needs to be accountable: I did hear it right, I did understand it. We’re training that as well as what they’re doing. 

Dr. Nicole Beurkens:

Yeah. So important. What are some things that you do encourage parents to do? One or two things that you think are helpful that they can do to strengthen this or to work on this in the home environment?

Lois Kam Heymann:

Reading, reading, reading. Reading picture books, reading to your children, even after — I get a lot of parents of third grade kids, and they say, “Well, they can read themselves!” And I say, “But they’re not reading vocabulary words that are higher than their understanding.” And so, we should always be listening to things that are above what we can do ourselves at that point. So by reading to children, no matter what type of book it is, but reading chapter books, or reading — even if a child can’t read Harry Potter yet, reading Harry Potter with them, you’re starting to build visual pictures for the children, which is what children with auditory difficulty don’t do. They don’t visualize the same way that the sound comes in, we visualize something, and then the sound goes out, but we’re left with something. With children with auditory processing disorder, it very often doesn’t form a picture. And that’s why they can’t hold on to the information.

So the more we read to them — and then it’s discussion! It’s having discussions rather than question answers. It’s really engaging.

Dr. Nicole Beurkens:

Taking that time to sit and engage with your child, even for 15 minutes, and probably not for a whole lot longer if your kiddo has struggles with that, right? It’s like keep it short, don’t be reading forever and ever but that engagement around having them listen to something and then talking about it — and I like how you said not just this peppering them questions about it, but actually talking about what we were thinking about it or we were picturing in our head, and then what they were picturing, that dialoguing. 

Lois Kam Heymann:

Right, and I love open ended questions like, “I wonder what would happen if _______” or “I wonder what they’re thinking, I’m thinking it’s this: _________”. Predicting in a story, “What do you think might happen? I think this might happen, let’s see who is right.” Really giving kids this opportunity to listen in certain kinds of ways. You know, with young children, taking children on listening walks outside. “Oh, what do you hear? I hear the horn beeping.” This is young children. There are so many things we can do to boost this activity of intentionally listening.  

Dr. Nicole Beurkens:

So helpful for people to think about all the opportunities, really, that they have to strengthen this for kids. What do you find is the prognosis for children where this is actually identified as a disorder for them: What should parents expect as the prognosis or how their kids can do it — should they expect improvement with the right kind of treatment?

Lois Kam Heymann:

Well there are two things to talk about. First of all, the pathways are going to matter over time. The problem with not doing intervention, of course, is their language and their reading will be affected, and so they can’t catch up. So you have to really work on intervention. In my practice, I find that based on the severity, how many areas are really affecting the child? And is it a coexisting condition? Because 60% of the time, auditory processing coexists with something else, maybe a sensory processing disorder, that the child needs occupational therapy, or it does have an attentional disorder. So it’s all going to help complicate it, but I find that I usually am seeing a child to get them over the specific areas of problems for a year, and sometimes with the severe kids, two years. I do not believe in lifetime speech therapy. I call them lifers. If that’s what’s going on — unless the child has a severe developmental disorder, the targeted therapy should be able to work this through in a year to two years. I’ve got a lot of parents that don’t want to leave intervention. They think that’s the magic. But it isn’t. It’s really doing the targeted intervention and then sending the kids off, because we want to make them as independent as possible. 

Dr. Nicole Beurkens:

Well, I do think that’s helpful for parents to have a sort of an idea in mind of what to expect with that, but also that power of the right kind of targeted intervention, that these are things, the brain is constantly growing and changing, and when we give kids the right kind of targeted information, intervention, these things really can improve for them.

Lois Kam Heymann:

Oh my goodness — absolutely. I’ve only seen improvement. And it’s also consistency. It’s not just two years or a year, but is the child missing a whole lot of intervention? Well, then, we’re not getting — consistency is really the name of the game. And the more the parents are involved with the intervention, the less I have to do. 

Dr. Nicole Beurkens:

Absolutely. You talked about the co-occurring piece and I’m glad you raised that, I was going to ask about that because I do see that there can be significant overlap of auditory processing deficits with things like ADD and ADHD, the sensory processing, those kinds of things, even kids with Autism Spectrum disorders. You said around 60% of kids that there can be some overlap diagnostically?

Lois Kam Heymann:

Yes. That’s a very old number. But because there isn’t a whole lot of research being done on auditory processing, but I think we also have to be careful in diagnosing children on the autism spectrum. We will see auditory processing difficulties, and the tools that we have to treat it, we can treat it, but very often, children on the spectrum can sit for the test with the audiologist and get a false. And also, I think auditory processing can be part of the ASD picture, but not be the real diagnosis. So kids that are always covering their ears may have sensory difficulty, not necessarily auditory processing. And that’s important, because we see a lot of kids that can’t tolerate noise, but it’s not always processing. 

Dr. Nicole Beurkens:

Yeah. And I would say the converse too. Sometimes people have been through years and years of the sensory-based intervention and it hasn’t gotten better, and then we look at it through the auditory processing lens and go, “Oh, maybe that’s the issue.” So I think it just points to: If you have a child with these challenges, just being aware of or looking into all the possible angles, because there can be lots of different root issues that can cause similar-looking types of symptoms, right? 

Lois Kam Heymann:

Right, exactly. And the big case also is separating out what’s auditory processing that affects language and what’s pure language processing. For a speech and language pathologist or a therapist that are going to be the ones working with that, that’s their job. 

Dr. Nicole Beurkens:

Absolutely, so finding a good speech language pathologist to understand the nuances of this and can really tailor the treatment interventions to what’s going on for this specific child. 

Lois Kam Heymann:

Exactly. 

Dr. Nicole Beurkens:

Such a wealth of helpful information. I want to make sure, as we wrap up here, that we have a chance for you to talk about where people can learn more about you and your practice, the resources that you have available and what you’re doing.

Lois Kam Heymann:

Sure. So I do have my book, “The Sound of Hope” that you mentioned, and that’s available on Amazon with a very fun introduction by Rosie O’Donnell, because I was her son’s therapist. He’s all grown up now, but I also have a website listenlovelearn.com and there, it talks about where I’m speaking. I also have a little video about what the process is like in diagnosing and treating the child with auditory processing disorder. I have these programs also that I’m doing for kindergarten and preschool called “Sounds Fun!” Which are listening, language and preliteracy that a speech pathologist or a teacher can do, so I’m holding workshops and have that. And I’m an invited speaker to schools and around the world. I’ve spoken around the world, but now it’s mostly U.S. I’m staying homebound, but I speak for parent groups, teachers and I do a variety of workshops. I’m on Instagram @listenlovelearn, I’m on Facebook, Listen Love Learn. Where else? Did I miss something? LinkedIn… 

Dr. Nicole Beurkens:

So you’ve got so many great resources when I checked out your website and your social media, I really encourage people to go check all of that out, and of course, if they can come to an event where you are presenting, all the better, but definitely just want to put in another plug for the book, “The Sound of Hope”, a really, really helpful read, a doable read, it’s not overly dense. You have a way of getting right to the information and giving practical things, which I think is so valuable, and it’s what people really need. So definitely check out the book. 

Lois, this has been such a pleasure having this conversation with you today, thank you for spending the time with us. 

 

Lois Kam Heymann:

And thank you so much, Nicole. It was wonderful. Thanks. 

 

Dr. Nicole Beurkens:

And thanks to all of you for listening, we’ll catch you next time for our next episode of The Better Behavior show.