Auditory Processing: When the Brain Can’t Hear

By Kathy Kuhl       Book review of When the Brain Can’t Hear by Teri James Bellis, Ph.D.

“My child can’t have an auditory problem. His hearing is just fine.”

When the ears work great, but the brain has trouble understanding, then the child—or adult—may have an auditory processing disorder (APD). It is also called a central auditory processing disorder (CAPD).

I first heard of auditory processing disorder while interviewing parents for my first book, Homeschooling Your Struggling Learner. Two knowledgable parents told me I needed to read Teri James Bellis’ book, When the Brain Can’t Hear. They were right.

Dr. Bellis is uniquely qualified to write on APD. First, she is an audiologist who specializes in APD and has lots of experience with diagnosing and helping people with this disability. Second, after years working with APD, she suffered a head injury in a car accident. She developed an auditory processing disorder herself. Third, from the same accident, her husband developed a very different APD. So she brings training, professional experience, and personal experience to her book.

She writes not for audiologists, but for those who need a solid introduction to the world of APD. Her book is clear and well organized. On very rare occasions her writing is technical, but overall she is very helpful. For any parent or teacher wanting to understand APD, she provides a good background, interesting case studies, and many practical suggestions. It is also clear she wants to help people, and she does so with care and intelligence.

APD: not one kind of learning disability

The first point Dr. Bellis makes is that auditory processing disorder is not one kind of learning disability: it is a group of them. Because different parts of the brain are involved in turning sound into meaning, problems in different brain regions create different difficulties. For example, the left hemisphere is involved in breaking down sounds into their parts, such as hearing “chat” and understanding the three phonemes “ch,” “a,” and “t.” One kind of difficulty in the right hemisphere might cause a problem interpreting symbols such as “ch” or sight words like “blue.”

Some kinds of APD make it hard for a person to distinguish a voice in a crowd. The many case histories in the book bring these different problems to light and engage the reader.

Expertise combined with personal experience

After the author’s head injury, she developed a kind of APD that made it difficult to hear different tones of voice. Since the accident had injured her in more obvious ways, her doctors first just thought that stress was making her touchy. She thought her doctors and husband all sounded cool or unsympathetic. Two years later she accidentally discovered why they sounded that way to her. While training an intern how to place scalp electrodes for auditory electrophysiologic testing, she let the intern practice on her. They  discovered the electrode over the right temporal lobe of Dr. Bellis’ brain was recording little response.

She thought it was an equipment failure. Instead, it was the first evidence that explained why Dr. Bellis had trouble discriminating between different tones of voice. The part of the brain that interprets tone of voice was underperforming. Therapy helped her recover some of this ability. She also learned some ways to compensate.

Second, Dr. Bellis is careful to explain that auditory processing disorders are a range of challenges. (She even explains why if anyone has all the symptoms of APD, they probably don’t have APD.) She stresses if a child or adult has trouble understanding what he or she hears, it could have many causes. It could be attention deficit disorder, autism spectrum disorder, developmental disability, an APD—or a combination. That’s why she thinks it takes a team effort to evaluate an APD, though an audiologist trained in diagnosing APD would make the final call.

So this book will not enable you diagnose your child. There are too many kinds of APD, and too many other learning challenges that can create similar difficulties for anyone, even one trained audiologist, identify an APD. But it’s a great book to read to help you discover if your child might need an evaluation and help you make the most of an evaluation.

Useful features of the book

• Informal test you can give at home to show professionals to spot some reading problems that might be related to an APD
• List of milestones in auditory development
• Advice on where and how to have your child evaluated, and by whom
• Many ways that APDs can affect children and adults academically and socially
• Remediation: therapies that may help
• How to modify instruction to help kids with different kinds of APDs. (For instance, repetition helps people with some kinds of APD, but not all. Rephrasing will benefit some with APD, but those with other kinds will be frustrated, processing another set of words for the same idea.)
• How to modify the environment to help someone with an APD
• How APDs affect adults
• Ways to help compensate for an APD

I recommend When the Brain Can’t Hear for any parent who thinks their child or loved one may have an auditory processing disorder.

But if you’d like to learn more about APD before you buy the book, here are some helpful links:

• The author, Teri James Bellis, has written an article on APD for the American Speech and Hearing Association website, so you can sample of her writing.
• LDOnline.org
• Understood.org has a shorter introduction.

What books and tools have helped you help a child or teen with an auditory processing disorder? Please answer in the comments section below.