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Other Reviews

"CREATIVE BRAINS: Gifted, Talented, Dyslexic" produced by the Southwest Branch of the International Dyslexia Association.
Reviewed by Dorothy Ungerleider

Misdiagnosis and Dual Diagnoses of Gifted Children and Adults by James T. Webb, Ph.D., Edward R. Amend, Psy.D., Nadia Webb, Psy.D., Jean Goerss, M.D., M.P.H., Paul Beljan, Psy.D., and F. Richard Olenchak, Ph.D., reviewed by Sandra Mosk, M.Ed., BCET, FAET

The Curious Incident of the Dog in the Night-Time by Mark Haddon reviewed by Jeri I. Burzin, M.Ed.

When the Brain Can’t Hear: Unraveling the Mystery of Auditory Processing Disorder by Teri James Bellis, Ph.D., reviewed by Susan Grama

Understanding Women with AD/HD edited by Kathleen G. Nadeau, PhD, and Patricia O. Quinn, M.D., reviewed by Cynthia Landes

Different Minds, Gifted Children with AD/HD, Asperger Syndrome, and Other Learning Deficits by Deirdre V. Lovecky, and Jessica Kingsley, reviewed by Vicki Zale Berghoff

The Bipolar Child: The Definitive and Reassuring Guide to Childhood’s Most Misunderstood Disorder by Papolos Demitri, M.D., and Janice Papolos, reviewed by Pamela McGranahan, Ed.D.

 

Book Review: When the Brain Can’t Hear…

When the Brain Can’t Hear: Unraveling the Mystery of Auditory Processing Disorder by Teri James Bellis, Ph.D., Atria Books, New York. Copyright 2002 (Paperback 2003).

Reviewed by Susan Grama

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The study of auditory processing disorder (APD) has been controversial since researchers first described the condition in the 1960s. Though some of the debate over the existence of APD has lessened with the emergence of new physiological and behavioral testing protocols, broad acceptance of the disorder as a unique diagnostic category has not been achieved. Nevertheless, evidence continues to accumulate which supports the presence of central auditory deficits in children and adults who demonstrate extreme difficulties in communication and learning which are specific to the auditory modality, but do not involve peripheral hearing loss. Defining and describing the nature of those difficulties, their diagnosis and treatment, and the lifestyle adjustments necessary to live successfully with APD is the focus of this book.

Dr. Teri James Bellis is a clinical and research audiologist, a professor of audiology at the University of South Dakota, and the author of a comprehensive text on the assessment and management of APD for clinical and educational audiologists. Aside from her extensive professional credentials, Dr. Bellis ironically became the victim of adult-onset APD when she suffered head trauma subsequent to a car accident. The breadth of her personal and clinical expertise is reflected in the scope of this book. While it summarizes most of the concerns a parent or spouse might need to address, there is sufficient detail to provide educational therapists with a basic primer on diagnosis and management. Case studies are used liberally to expand and elucidate the descriptions of each clinical profile and key indicators are supplied at each developmental stage to help narrow the focus.

The author describes her model of APD (three primary subtypes and two secondary subtypes) with the caveat that it still remains a theoretical view that has yet to achieve universal approval. Auditory Decoding Deficit, the classic type of APD found in most of the research literature, is hypothesized to involve the primary auditory cortex of the language-dominant hemisphere of the brain. Symptoms are most closely aligned with those of peripheral hearing loss and there may be additional clinical evidence of left-hemisphere dysfunction. In Prosodic Deficit, the individual exhibits difficulty in interpreting the paralinguistic or suprasegmental aspects of language such as intonation, stress and timing. Since signs of a more global, right-hemisphere dysfunction are often present, Prosodic Deficit may be only one symptom of a more pervasive functional disorder. Integration Deficit presumes an impairment in the way the right and left hemispheres interact with each other. Symptoms are often variable due to the complexity of the processes that are mediated across hemispheres, and the auditory component of the functional difficulty may be only one aspect of the entire profile. The two secondary subtypes of the author’s model, Associative Deficit and Output-Organization Deficit, overlap with the clinical symptoms of two other well-known conditions – receptive language disorder for the first secondary subtype and impairment of executive functioning for the latter. For each diagnostic subtype, Dr. Bellis outlines possible listening complaints, language-related symptoms, learning or academic-related symptoms, cognitive findings, associated symptoms, and results of central auditory testing.

Throughout the book, the author emphasizes that the clinical signs of APD frequently occur in many other cases of language and learning problems. Furthermore, comorbidity with conditions such as attention deficit-hyperactivity disorder, specific language impairment and hearing loss is common. Therefore, diagnosis of APD can only be accomplished within the context of a comprehensive multidisciplinary approach to assessment, which involves the evaluation of language, cognition, and social/emotional adjustment as well as specific tests of auditory functioning. In addition, the protocol for behavioral testing of central auditory processing requires that the individual possess a mental age of at least seven or eight years and the ability to sustain attention. The presence of an asymmetrical hearing loss (significant discrepancy between the hearing sensitivity of right and left ears) can also confound the results of central auditory tests. Prior to referral for testing, it is important to consider whether the diagnosis of APD will add any significant information to an understanding of the individual’s current learning or communication difficulty. If the impairment in auditory processing is only one symptom of a more pervasive disorder such as right-hemisphere dysfunction or autism, the diagnosis of APD may contribute little useful clinical information. It is also significant that an APD diagnosis is not included as a qualifying condition under the Individuals with Disabilities Education Act (IDEA), though it can be considered when advocating for access to services or accommodations in the workplace or learning environment under the Americans with Disabilities Act (ADA).

The last two sections of the book address the important issues of treatment (including therapeutic interventions and environmental modifications) and lifestyle adjustments that can be implemented to improve listening skills. Dr. Bellis emphasizes that techniques must be adapted to suit each client’s individual needs. For example, an assistive listening device (ALD) used in the classroom to selectively amplify the teacher’s voice may be accepted and tolerated by a child in elementary school. However, when the same student reaches middle or high school, rejection of the ALD due to concern regarding negative peer evaluation may require the implementation of alternative classroom modifications. The author’s discussion of treatment describes the emotional impact of the disorder on the individual and his family and provides specific strategies for minimizing conflicts due to listening difficulties within the settings of home, school and the workplace. Educational therapists who work with clients who demonstrate APD will find many of these strategies extremely helpful. They can be applied within the therapeutic context, but can also be used to guide management of the disorder by the child’s parents and teachers.

In summary, this book provides a comprehensive description of the essential characteristics that define an auditory processing disorder, and offers an insight into the diagnosis, treatment and management of APD. The material is extensive enough to expand the understanding of educational therapists who want to learn more about the disorder, but is also accessible to parents seeking a more thorough understanding of their child’s disability. The index, glossary and list of resources are also useful supplements.

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Susan Grama, MA, CCC-SLP, worked as a speech-language pathologist for several years before leaving the profession to manage the audiology and hearing aid practice she owns with her husband. As a student in the educational therapy certificate program, she is currently interning at the Northpoint School and Day Treatment Program in Northridge, California. Her goal is to establish a private practice that provides both educational therapy and speech-language therapy services to children and adolescents.