Special Book Review

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

When the Brain Cant Hear Could you imagine being able to hear, but not being able to really hear what was being said to you? People with APD, Auditory Processing Disorder, know exactly what it's like. APD is the brain's inability to process sounds...and it affects a person's ability to listen. There are many people who struggle with APD every day, and many aren't even aware that they have this disorder.

The book, "When the Brain Can't Hear," by Dr. Teri James Bellis, aims to help readers learn more about this puzzling disorder. People of all ages can get APD - children and adults alike. In children, it can be mistaken for hyperactivity and ADHD, and adults may think they are suffering from hearing loss as they grow older. This book explains APD; if you should tested; what you should do if you are diagnosed with APD; and how to live with APD. The book also discusses various treatments for those suffering with APD, and has helpful checklists to help guide you in your quest for answers. The book also lists resources for those looking to find more information and support, and a glossary so you can become familiar with related terms.

My ParenTime highly recommends the book, "When the Brain Can't Hear" - it is an informative and helpful resource for those wanting to learn more about Auditory Processing Disorder.

* Bellis, Teri James. When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorder. c.368p. ISBN 0-7434-2863-3. $25. ea. vol: Pocket. 2002. MED

Auditory Processing Disorder (APD) occurs when the brain cannot process or understand correctly the sounds the ears hear, even though the ears might be functioning properly. It is rarely recognized, often misdiagnosed, and poorly understood, yet the effects can be devastating. Pocket is simultaneously releasing two complementary texts on the subject that are definitely worth some notice. Foli's Like Sound Through Water is a mother's account of her family's struggle with APD in her oldest son, Ben. Her … 

Some drugs can cause serious damage such as a  hearing or balance problem.  such as ssus OOOtotoxicity  or "ear poisoning." The earlier a child is diagnosed with ototoxicity, the sooner treatment can begin.  

An amplification device called an FM system can help reduce background noise. FM systems, sometimes called "auditory trainers," may be provided in the classroom to improve hearing in group or noisy environments and also can be fitted for personal or home use. Other assistive listening or alerting devices may help older kids.

If balance problems are an issue for kids, they will undergo balance therapy (also called vestibular rehabilitation) with a physical or vestibular therapist. Therapy may include training exercises that help strengthen balance skills and coordination. Exercises may involve bending down, standing or walking with eyes open and then with eyes closed, or having a therapist reposition your child's head at different angles to move fluid or debris out of certain parts of the ear.

"Ototoxicity ("ear poisoning")  What is Ototoxicity:
 it is due to drugs or chemicals that damage the inner ear or the vestibulo-cochlear nerve, which sends balance and hearing information from the inner ear to the brain. Ototoxicity can result in temporary or permanent disturbances of hearing, balance, or both.

Many chemicals have ototoxic potential, including over-the-counter drugs, prescription medications, and environmental chemicals."
- Source:

What is auditory processing?

Auditory processing is a term used to describe what happens when your brain recognizes and interprets the sounds around you. Humans hear when energy that we recognize as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. The “disorder” part of auditory processing disorder means that something is adversely affecting the processing or interpretation of the information.

Children with APD often do not recognize subtle differences between sounds in words, even though the sounds themselves are loud and clear. For example, the request “Tell me how a chair and a couch are alike” may sound to a child with APD like “Tell me how a couch and a chair are alike.” It can even be understood by the child as “Tell me how a cow and a hair are alike.” These kinds of problems are more likely to occur when a person with APD is in a noisy environment or when he or she is listening to complex information.

APD goes by many other names. Sometimes it is referred to as central auditory processing disorder (CAPD). Other common names are auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness, and so-called “word deafness.”

What causes auditory processing difficulty?

We are not sure. Human communication relies on taking in complicated perceptual information from the outside world through the senses, such as hearing, and interpreting that information in a meaningful way. Human communication also requires certain mental abilities, such as attention and memory. Scientists still do not understand exactly how all of these processes work and interact or how they malfunction in cases of communication disorders. Even though your child seems to “hear normally,” he or she may have difficulty using those sounds for speech and language.

The cause of APD is often unknown. In children, auditory processing difficulty may be associated with conditions such as dyslexia, attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive developmental disorder, or developmental delay. Sometimes this term has been misapplied to children who have no hearing or language disorder but have challenges in learning.

What are the symptoms of possible auditory processing difficulty?

Children with auditory processing difficulty typically have normal hearing and intelligence. However, they have also been observed to

  • Have trouble paying attention to and remembering information presented orally
  • Have problems carrying out multistep directions
  • Have poor listening skills
  • Need more time to process information
  • Have low academic performance
  • Have behavior problems
  • Have language difficulty (e.g., they confuse syllable sequences and have problems developing vocabulary and understanding language)
  • Have difficulty with reading, comprehension, spelling, and vocabulary

How is suspected auditory processing difficulty diagnosed in children?

You, a teacher, or a day care provider may be the first person to notice symptoms of auditory processing difficulty in your child. So talking to your child’s teacher about school or preschool performance is a good idea. Many health professionals can also diagnose APD in your child. There may need to be ongoing observation with the professionals involved.

Much of what will be done by these professionals will be to rule out other problems. A pediatrician or a family doctor can help rule out possible diseases that can cause some of these same symptoms. He or she will also measure growth and development. If there is a disease or disorder related to hearing, you may be referred to an otolaryngologist—a physician who specializes in diseases and disorders of the head and neck.

To determine whether your child has a hearing function problem, an audiologic evaluation is necessary. An audiologist will give tests that can determine the softest sounds and words a person can hear and other tests to see how well people can recognize sounds in words and sentences. For example, for one task, the audiologist might have your child listen to different numbers or words in the right and the left ear at the same time. Another common audiologic task involves giving the child two sentences, one louder than the other, at the same time. The audiologist is trying to identify the processing problem.

A speech-language pathologist can find out how well a person understands and uses language. A mental health professional can give you information about cognitive and behavioral challenges that may contribute to problems in some cases, or he or she may have suggestions that will be helpful. Because the audiologist can help with the functional problems of hearing and processing, and the speech-language pathologist is focused on language, they may work as a team with your child. All of these professionals seek to provide the best outcome for each child.

What current research is being conducted?

In recent years, scientists have developed new ways to study the human brain through imaging. Imaging is a powerful tool that allows the monitoring of brain activity without any surgery. Imaging studies are already giving scientists new insights into auditory processing. Some of these studies are directed at understanding auditory processing disorders. One of the values of imaging is that it provides an objective, measurable view of a process. Many of the symptoms described as related to APD are described differently by different people.

Imaging will help identify the source of these symptoms. Other scientists are studying the central auditory nervous system. Cognitive neuroscientists are helping to describe how the processes that mediate sound recognition and comprehension work in both normal and disordered systems.

Research into the rehabilitation of child language disorders continues. It is important to know that much research is still needed to understand auditory processing problems, related disorders, and the best interventions for each child or adult. All the strategies undertaken will need to be suited to the needs of the individual child, and their effectiveness will need to be continuously evaluated. The standard for determining if a treatment is effective is that a patient can reasonably expect to benefit from it.

What treatments are available for auditory processing difficulty?

Much research is still needed to understand APD problems, related disorders, and the best intervention for each child or adult. Several strategies are available to help children with auditory processing difficulties. Some of these are commercially available, but have not been fully studied. Any strategy selected should be used under the guidance of a team of professionals, and the effectiveness of the strategy needs to be evaluated. Researchers are currently studying a variety of approaches to treatment. Several strategies you may hear about include:

  • Auditory trainers are electronic devices that allow a person to focus attention on a speaker and reduce the interference of background noise. They are often used in classrooms, where the teacher wears a microphone to transmit sound and the child wears a headset to receive the sound. Children who wear hearing aids can use them in addition to the auditory trainer.
  • Environmental modifications such as classroom acoustics, placement, and seating may help. An audiologist may suggest ways to improve the listening environment, and he or she will be able to monitor any changes in hearing status.
  • Exercises to improve language-building skills can increase the ability to learn new words and increase a child’s language base.
  • Auditory memory enhancement, a procedure that reduces detailed information to a more basic representation, may help. Also, informal auditory training techniques can be used by teachers and therapists to address specific difficulties.
  •  Auditory integration training may be promoted by practitioners as a way to retrain the auditory system and decrease hearing distortion. However, current research has not proven the benefits of this treatment.

CAPD (Central Auditory Processing Disorders)

A Central Auditory Processing Disorder (CAPD) is defined as an observed deficiency in one or more of these behaviors: sound localization and lateralization, auditory discrimination, auditory pattern recognition, and temporal aspects of audition. These include, temporal resolution, temporal masking, temporal integration, temporal ordering, auditory performance decrements with competing acoustic signals, and auditory performance decrements with degraded acoustic signals. (ASHA, 1996)

Behaviors of children with APD

Behaviors of children considered "at risk" include:
Adapted from Cohen(1980)and Fisher (1985)

  • Frequently misunderstands oral instructions or questions
  • Delays in responding to oral instructions or questions
  • Says "Huh" or "What" frequently
  • Frequently needs repetition of directions or information
  • Frequently needs requests repetition
  • Has problems understanding in background noise
  • Is easily distracted by background noise
  • May have problems with phonics or discriminating speech sounds
  • May have poor expressive or receptive language
  • May have spelling, reading, and other academic problems
  • May have behavioral problem


In the "Sound of Hope," authors Lois Heyman and Rosie O'Donnell offer a guide for parents to improve the language and listening skills of children with auditory processing disorder.

The Sound of Hope"The Sound of Hope" by Lois Heymann and Rosie O'Donnell

 Read an excerpt from the book below, and then head to the "GMA" Library to find more good reads. Chapter One

When Hearing Isn't Listening: The ABCs of APD

Margaret's beautiful baby boy Billy Ray was six months old when she began to sense that something wasn't right. Why didn't Billy Ray look at her, even when Margaret took him in her arms and murmured his name? Margaret had a powerful sense that the sounds her little boy made, so different in pitch and tone from her first child's coos and giggles were just, well, wrong. And Margaret rarely had any sense that her son was making his baby sounds in response to the things his mom said or did.

Her doctor assured her there was nothing to worry about. "Boys start to talk later than girls," he explained. "Besides, Billy Ray is the second child in the family. His need to communicate with you is not as great." Well, he's the doctor, Margaret thought. Yet in her heart, she just couldn't accept these reasonable-sounding explanations. Margaret felt deep down that Billy Ray should be responding more to her and her husband's voices and the sounds and noises in their home. Based on her experience with her first child, she sensed that the pre-speech vocalizations Billy Ray made should be different from what they were. Reaching for a box of rice one afternoon at home, Margaret impulsively rattled it behind Billy Ray's head. When he again failed to react, Margaret knew what she had to do. The following day, she had Billy Ray's hearing checked, fully expecting that her child had a hearing impairment.

The results came back normal.

Undeterred, Margaret arranged for consultations with two separate pediatric neurologists. After a battery of tests and examinations with Billy Ray and a lengthy interview with Margaret, both doctors concluded that Billy Ray had pervasive developmental disorder (PDD). Margaret had never heard of PDD, a condition involving developmental delays of socialization and communication skills. She tried to be as upbeat as possible as each neurologist explained what PDD was and described a therapeutic preschool and the necessary therapy that would accommodate Billy Ray's special needs. Margaret was grateful for the diagnosis—having one gave her something new to focus her efforts on—but worried that the doctors were sentencing her beautiful little boy to a life of isolation. Nevertheless, Margaret did the research, fought with her insurance company, and adjusted her family's budget so that Billy Ray could attend the school and receive the therapy that both doctors recommended.

But by age two Billy Ray was still uncommunicative. Worse, as he grew from infant to toddler, Billy Ray's inability to listen began to be an educational and social ball and chain for him. Frustrated by an invisible wall that complicated and confused nearly everything he was asked to do, Billy Ray cried and acted out a lot. Unable to state his own needs or understand what other boys and girls asked for, he pushed and grabbed for toys, upsetting his peers and testing his teachers' patience. As his mother looked on helplessly, Billy Ray increasingly retreated into a world of his own. Instead of each new day offering a chance to grow, develop, and interact more meaningfully and happily with the world around him, Margaret, Billy Ray, and their family faced a daily struggle simply to cope.

Margaret could see how much it hurt and confused Billy Ray when he misunderstood and was in turn misunderstood, but she was at a loss as to how best to help her son. It felt as if Billy Ray was on the other side of a door, knocking for her to unlock it, and Margaret simply didn't have the key. Increasingly Margaret worried that if she couldn't find a way to open the door and lead Billy Ray out into the full, rich world of experience, her little boy would never be able to play and connect with his sister, make friends in school, fall in love, go to college, or live on his own. Margaret redoubled the hunt for the key. There must be something she'd missed, someone she hadn't consulted. She made calls, quizzed other parents, scanned parenting websites and chat boards, and read and reread everything she could find about Billy Ray's diagnosed disorder, PDD.  CLICK ON VIDEO


Rosie O'Donnell on her crusade to help kids with auditory processing disorder. 

Test for CAPD (Central Auditory Processing Disorder) http://www.youtube.com/watch?v=WzubxSqBR6Y&feature=related  http://www.youtube.com/watch?v=WzubxSqBR6Y&feature=related