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E40. The Auditory Processing Disorder/ ADHD Connection
Show notes and time stamps:
“Auditory Processing is what the brain does with what the ear hears.” ~Jack Katz, Ph.D. Auditory Processing Disorder (APD) shares many traits with ADHD, and this causes confusion amongst professionals (as well as the general public). How do we know if difficulty sustaining attention has to do with auditory processing or attention regulation? Can you have both APD and ADHD? Today we chat with Dr. Christa Reeves and Dr. Megan Reeves, a mother-daughter audiologist team who specialize in APD and will help answer some of our questions! In this interview. we'll cover the following (and more!):
How do we determine if APD is playing a role in our difficulty sustaining attention?
What treatments are out there for those of us who have an APD diagnosis?
Do children and adults have the same treatment for APD?
Is APD genetic?
What school and work accomodations can help support APD?
We'll also learn:
An effective treatment for Misophonia
How uncorrected hearing loss can increase cognitive decline in adults (PSA: correct hearing sooner rather than later!)
Why the "huh habit" can damage relationships
Some great resources for connecting with APD specialists, no matter where you live.
Time Stamp Short Cuts
4:11 How is hearing loss and APD different?
5:43 Can adults treat APD?
7:24 what does the treatment for APD look like?
15:49 Misophonia and sensory defensiveness
18:52 Compensation vs remediation for APD
24:20 The hidden danger of delaying hearing aids
26:19 Types of assessments and specialists for APD
28:57 ADHD vs APD
31:52 IGAPS information (International Guild of AP specialists)
32:54 Insurance coverage for APD tx
36:29 accommodations you can ask for
40:58 Appropriate Communication repair strategies
46:57 Self Advocacy and APD
Podcast Transcript
Donae 0:00
Welcome to ADHD Crash Course! Today I have a few guests with me. I have doctors Reeves, two Reeves; we have Dr. Christa Reeves and Dr. Megan Reeves. We also have Saundra Brodkin who is an ADHD coach, executive functioning skill expert, and a friend. She's here with us as well, because she is also an individual who has been diagnosed with ADHD and auditory processing disorder and was willing to come weigh in and ask some questions and join us.
Donae 0:31
So, thank you, everyone for being here. Let's jump in to some of the questions... what I found I when I was researching auditory processing disorder, it was tricky because I was doing this for some clients. And the same week, I had two different clients say to me, "How do you know what's the difference with auditory processing disorder and ADHD? How can I tell if that's a factor?" And I was like, "I don't know. Let me let me go do some research and see if I can find out".
Donae 0:58
It was very hard to find out. I couldn't. I spoke to speech therapists, several that I knew and I tried to do my own research. It was really hard to figure out what the differences are, how to decide, how to even know; do we go deeper in the auditory processing path to see if that is a factor?
Donae 1:19
Luckily, my daughter's a drummer and when we were getting her hearing tested for something else, I met someone that told me about Dr. Reeves and Dr. Reeves and their practice.
Donae 1:29
So, that's how we're here today. They were generous enough to join us and help us clear up some of this ADHD/ Auditory Processing Disorder overlap. So, welcome, both of you. Tell me a little bit; how you got into this field, it's kind of cool to see a mother-daughter pair, that's pretty awesome.
Dr Christa 1:50
Yeah. It's surprising. Actually, in the audiology world, which is really small, I have I have met other mother-daughter pairs.
Donae 2:02
Really?
Donae 2:03
Yeah. And if not, audiology, they might be audiology and speech pathology or audiology and OT, so they're very linked professions. And yeah, I think if you'd asked either of us 10 years ago, if she was going to become an audiologist, we both would have laughed!
Dr. Megan 2:23
Absolutely not.
Donae 2:24
It's good. You made it look that good that she's like, "Okay, I'm gonna do it".
Dr Christa 2:28
Yeah, it was an interesting... I came about it just, I mean, a very short and sweet story; I wanted to teach. I was fascinated with the deaf culture, I decided to go into deaf education. And then because of that, learned about audiology, which I had no clue about that and no experience with it. I never had any hearing issues. I know I had APD as a kid, but it just went undiagnosed.
Dr Christa 2:49
But I, because I just got around it, and I was wiley and motivated and just kind of pushed through my struggles. But I learned about audiology and just thought it was fascinating. So that's how I kind of got into audiology and then getting into APD, I was just kind of forced into it by one of my jobs. But her story is, you know, probably a little more interesting, just because she did know about audiology and rejected the idea for so long.
Donae 3:22
So what was it? What was it that...?
Dr. Megan 3:24
I started out with wanting to be an art teacher, and then realized art was not for me, and then realized, "Oh, I could probably do something similar to what my mom does". Thought about occupational therapy and then they were like, Why don't you just do audiology? And so, it was kind of that kind of steps to get me into audiology.
Dr. Megan 3:45
And I've enjoyed the adult portion more than working with children, like she specializes in.
Donae 3:51
Then you're our girl, that's awesome!
Dr. Megan 3:56
I do a lot of fitting hearing aids and helping, you know, some of the APD clients who need that extra assistance in their day to day world and need to have devices as kind of a crutch until we can get them into therapy.
Donae 4:11
Okay. And that was a question that someone sent me; differentiating between hearing loss and auditory processing disorder, like what that relationship was as well, because I put this question out there. And that was one of the questions that we received. So, if you wanted to speak on that?
Dr. Megan 4:31
Yes, so most patients with auditory processing disorder do not have a hearing loss. It's considered a "hidden hearing loss". There's actually a really great article about it. That's called Hidden Hearing loss.
Donae 4:45
I can link that too.
Dr. Megan 4:46
Yeah, it's a great article, and it talks about how they have all the characteristics and all the traits of someone who may have a hearing loss, a mild hearing loss.
Dr. Megan 4:56
But then on the physical test, when we do the subjective tests, there's no hearing loss. They're normal.But then when you go a little bit further, then their processing is different. They're processing words different, the signal gets jumbled in the brain. And then it's a processing disorder.
Dr. Megan 5:17
There are some cases, though, where we've had patients that have hearing loss, and we've done auditory processing disorder evaluation and treatment for them, and it looks a little bit different. They don't progress quite the way that a child with normal hearing would. And then that's kind of where I come in and can help, you know, with their hearing aids and fit them hearing aids. That kind of thing.
Donae 5:43
One of the things that that I ran into was this information, whether or not it's true, let us know, but that remediation or building new skills would happen with kids, but not with adults that have auditory processing disorder. Is that true, part true?
Dr Christa 6:02
No, it's not true, I mean, the brain is very plastic. Neuroplasticity goes the entire lifespan, you can take somebody in their 90s and still, you know, impact the way their brain processes information. So, we can, we can make a difference in how people are processing central information at any age.
Dr Christa 6:23
It's just more challenging with adults. Beyond the age of 18 our processing skills start to slowly decline. And then beyond the age of 50, our cognitive skills also start to decline.
Dr Christa 6:34
Yet hearing loss to that beyond the age of 50, the hearing loss because it's causing sensory deprivation can actually speed up that cognitive decline. Yeah, so for any adult, we're fighting against that kind of downhill slope.
Dr Christa 6:48
So, we might be starting to make progress, and then they're still going to continue to decline. So, with adults, it looks different, because we typically have to do frequent booster sessions to kind of restore, get them back up.
Dr Christa 7:01
So, they might find some benefit from the very beginning. And then that might wane a little bit, and then we have to revisit and do some more booster sessions. So something they have to kind of revisit every now and then.
Dr Christa 7:13
For kids, we hop on that developmental milestone train, you know, that developmental train, and so we can get them where they need to be qnd then they kind of take off on their own. So it's very, very different.
Donae 7:24
And so when you talk about get them where they need to be, because a lot of people, really, I don't have a lot of familiarity of what that kind of treatment looks like. I want to talk about both treatment and accommodations. So, the treatment that is addressing auditory processing disorder, what does that look like? It's a little different for adults versus children, also?
Dr Christa 7:45
Yes, yeah. And mostly because of, I think, just time and motivation and realistic expectations of what adults are going to be willing to do. You know, kids are used to having homework and having to do things every single day in order to reinforce skills that they're learning, and adults are kind of like, "I'm not a kid anymore, and I'm not in school anymore".
Dr Christa 8:07
So, you know, as therapists, we have to kind of meet people where they're at. So, if we try to tell an adult that we want to do 30 minutes of listening exercises and some, you know, rhythm exercises, in order to help with the skill, it's not going to work.
Dr Christa 8:24
So, we have to, we have to approach that very differently. So, a lot of it, again, if it is mild hearing loss, or any kind of degree of hearing loss, we want to first clean up that signal before he even hits the brainstem and it starts to traverse through the brain.
Dr Christa 8:41
We want to get that as clean as possible, but then we do a lot of what we call "learning to hear again" kind of exercises: teaching them about the listening environment and appropriate communication strategies with other adults and people in their lives. And just thinking about their environments when they're listening and appropriate ways to ask for clarification.
Dr Christa 9:03
But we can also... there are a lot of the activities we can do that are similar to what we do the kids. It's just that we have to do those more in clinic with dedicated therapy visits first versus expecting them to do homework.
Donae 9:16
Okay. Okay, that's been your experience that it's just hard to get the follow through with that. I can see that
Dr. Megan 9:22
It's hard for them to understand "Well, I'm, you know, paying you to do this therapy with me, why do I have to do homework? Like, shouldn't you be doing that work for me?"
Dr. Megan 9:34
So, for kids, I feel like they get it, but with adults there has been some pushback where, you know, you kind of hit this brick wall of progress without doing the homework. And we've told them time and time again, the homework is important, keep up with the homework, your progress will go further. And, it has happened many times with our older clients that they don't buy in to the homework.
Donae 9:34
That's funny. Yeah, I can see that, though, you get out of that groove of busting out homework and you have other things going on, but assuming that they are doing the work, then with the neuroplasticity, then they can make the gains with auditory processing?
Dr Christa 10:15
Absolutely. Yeah.
Donae 10:17
That's exciting. That's exciting, I know that Saundra has some questions, too. And one of the big ones is... I think.. Well, Saundra, I'll let you ask yours because that ADHD / auditory processing overlap, I'm sure you have some specific questions.
Saundra 10:32
I do. And the impulsivity in me has really been holding back.
Donae 10:36
I know, girl,
Saundra 10:37
At one point (laughter). So, I'm actually very curious because as a child, when I was diagnosed with APD, I, as far as I remember, I didn't really receive any therapy for it, or remediation or treatment, it was more just accommodations in the school setting.
Saundra 11:00
Now, I went to a wonderful school, and I had a very supportive mother, who was educated on APD, however, couldn't necessarily deliver the treatments. So, as an adult who has auditory processing and ADHD, what kind of treatments are available?
Dr Christa 11:24
So, amplification would be a potential option for you.
Saundra 11:28
Okay. What is that?
Dr. Megan 11:30
Oh, hearing aids. Yeah.
Dr Christa 11:32
Yeah, and even though youhave normal hearing, hearing aids are an option for people with normal hearing.
Dr. Megan 11:36
For sure.
Dr Christa 11:37
Some audiologists flinch at that. So, if there's any audiologist watching this, they might, you know, be like, "What are you doing?" It's mild gain amplification and it's mostly in order to put ear level sound...
Dr. Megan 11:53
It's like an ear level FM system, like what you would have heard of in schools. So, they've got the technology now to reduce background noise in hearing aids. So, I normally recommend an advanced or premium level technology. I have not done this on any children younger than 18. Because I kind of want to keep the peds world with the peds world.
Dr. Megan 12:18
So, it's really our older patients who aren't quite ready to commit to day to day therapy, we put them in low gain amplification, and it clears up the signal. It helps them in that background noise. It gives them that background noise reduction, where a lot of those struggles come from.
Dr. Megan 12:34
And we've got some really positive, amazing feedback about them wearing these hearing aids. I even have some incredible feedback today where she told me, she's got a diagnosis of ADHD and she no longer feels like she needs the medication when she wears her hearing aids.
Donae 12:51
Wow.
Dr. Megan 12:51
So, that's a pretty cool impact. Her friends have noticed, her teachers have noticed. So, I literally got that today from her.
Donae 12:58
That's awesome.
Dr. Megan 12:59
So, it clears up the signal, helps them with noise reduction. However, it's just a bandaid. It's not a permanent help, it doesn't attack, you know, the internal processing in the brain.
Dr. Megan 13:12
It doesn't help that as much it just is kind of, I like to call it a crutch. So, I'm always, always, always telling them, "Hey, you need to address the processing that's going on in the brain. This seems great right now, but it's not going to help you in the long run quite like the therapy does".
Dr Christa 13:29
We'll use the analogy with parents and say, you know, doing the amplification or the hearing aids is going to be like giving a child with a sore throat a Tylenol. Just to kind of make things better, temporarily bandaid the situation until you get to the doctor and get that throat swab, get the strep diagnosis and get the antibiotic to treat it from the inside out. So, the APD therapies more like the antibiotic, the hearing aid is the tylenol.
Saundra 13:57
So, APD therapy and adults, you were mentioning before a few different options that you use, generally,with children. What kind of APD therapies would you recommend for adults?
Dr Christa 14:11
They're very similar. So, we do rhythm training, we use a commercial product here in the clinic that helps to improve processing speed, sensory processing, memory, and attention. It's called Interactive Metronome. Their website is interactivemetronome.com.
Dr Christa 14:27
Every child that comes here for therapy gets an IM home unit and does Interactive Metronome here in the clinic. That is a really critical piece for synchronizing our sensory and motor systems, which the sensory system kind of teaches the motor system how to respond to that sensory information, verbally or non verbally. So, we need to have that synchronization and that, kind of, you know, cohesive functioning in the brain. And it's really good.
Dr Christa 14:52
It's a neurofeedback tool that synchronizes the auditory visual, vestibular, and motor systems and it's very effective, but only if it's done.
Dr Christa 15:02
And that is something that we will prescribe to do adults, because it's 15 minutes a day and they will comply with that. They're super motivated to, for the most part.
Dr Christa 15:15
Yeah, but we've had most success with it with adults with sound sensitivity called Misophonia, it's a debilitating issue. They're super motivated to reduce those trigger responses. So, they will respond to that.
Dr Christa 15:33
But yeah, I mean, if I had, you know, if I had you come into my clinic and say "I have ADHD and APD, and I just want to improve my ability to communicate and function..."
Saundra 15:43
Yeah, there's even more to my background there with the sensitivity to sound and stuff.
Donae 15:49
I was going to ask about that, when you said the Misophonia, the whole sensory defensiveness is another that... sensory processing disorder, in a more general sense, often overlaps with ADHD. And so, what is your experience with teasing those two things out? Are they always one in the same are usually one in the same or...?
Dr Christa 16:13
A lot of that is diagnosis by case history intake, just really being thorough and asking specific questions to try to understand. But, for the most part, you have to... when we look at treatment, we want to kind of peel back the layers of an onion, let's use that analogy. And so, your more foundational skills are kind of your outer layers of that onion, and you need to kind of address those first. So, if there are sensory processing issues, then that needs to be addressed. Because that can cause a busy brain, a tired brain.
Dr Christa 16:46
And if you don't manage that, then you can do all the executive function and attention interventions and language and cognitive and reading and all these higher order, you know, learned skills, interventions, but they're not going to be effective if your sensory processing is super disorganized, and just causing a tired brain.
Dr Christa 17:10
You're just going to have all these mismanaged and misfiled file drawers of all this sensory information coming in, and there's nowhere to store that higher order information.
Donae 17:20
Yeah, that makes sense.
Saundra 17:22
That sounds like my life. I mean, I'm thinking like, my husband will sometimes, I'll be answering an email or writing something. So,like Donae, I have an Instagram account that I post educational material on, and sometimes it's not educational, it's more just like, validating that this is experience of life.
Saundra 17:48
And so, I'll be writing something and then my husband will just come up and either put his hands on my shoulders or just come close to me, and I'll freak out, not just from the feeling of him, but also just like the noise of his hand brushing on my shirt, or the air, the change in the noise of the air as he approaches me. Like these are things, sensory processing that I'm sure are related to the auditory processing. And by freak out, I'll impulsively just yell, like, "Get away!" He's like," I can't even go near you, what's wrong?".
Donae 18:30
A lot of people that struggle with that, though, with the really heightened sensitivity to sound and some of them use the Loop, those Loop ear phones or ear buds, whatever, they are trying to decrease input. A lot of compensation. That's what , you know, my exposure to auditory processing disorder has been, up until now.
Donae 18:52
It's just a lot of how do we change the environment, give ourselves tools, but not necessarily remediating the skills. What role does the compensation play with the remediation. Working together? One...
Dr Christa 19:09
Compensation is just kind of a bandaid, you know? It's a temporary, not just temporary, it can be long term, but it is an immediate...something you can do immediately to have relief while you're waiting for that long term neurological change to happen. It just gives them something to immediately do.
Dr. Megan 19:30
Like, we've suggested, we had a kiddo who was very sensitive to being in music class and his mom asked if we thought it was a good idea if he wore earplugs while he's in music class, and he was actively going through therapy with us. So, that was something we were like, "yes, absolutely", to kind of avoid those meltdowns in music class and also kind of encouraging him that music class is good. It's good for your brain.
Dr. Megan 19:57
There's a lot of encouragement, cheerleading from us. You try to get them to advocate for themselves, even though he's itty bitty, because it will get better. That's our hope, is that he'll feel better. Give him that, you know, short term relief. But then long term, our goal would be that he can sit through music class without those headphones.
Donae 20:18
Right.
Saundra 20:19
Would that be the Interactive, um, sorry, interactive metronome, I wrote that down. Is that one of the tools that you would use?
Dr Christa 20:27
Yeah, a lot of the feedback we get from parents who comply, which we have plenty of parents who don't, but when we get the compliance and the carryover at home, is, you know, they tackle their homework better, they come home happier and less tired from school, the teachers say that they're focused and attentive and completing their assignments.
Dr Christa 20:48
You know, more on task, even just some social things. We also get, you know, "he's playing better in baseball", or "his tennis game is improved".
Donae 20:58
I knew that's one thing, too, that they have marketed that for is just general coordination, general attention. So, I know that interactive metronome has been used in a lot of different capacities. So, it's kind of cool. It's a cool tool.
Dr. Megan 21:15
We recommend it to lots and lots of people.
Saundra 21:17
I will be looking into it after...
Dr. Megan 21:19
I have to tell her she needs to send you one.
Saundra 21:25
It's...what you were just saying, like, being tired and just slower at the end of... like, I know, after I've had a certain amount of Zoom calls in a day and usually that means, like, one, max two calls. I'm so exhausted because I become so... I try so hard to focus. I hate getting on the phone, because processing information, especially when I can't see the person is a lot harder. Like, masks...
Saundra 21:58
They've made things so challenging. I have a five year old who's diagnosed with ADHD, but my husband sees very...and my parents, see very big similarities to the APD struggles that I have and had as a kid.
Saundra 22:13
So, we haven't had her tested for that., but I wouldn't be surprised if it was diagnosed. She comes home from the end of the school day completely depleted. Exhausted. And she has noise cancelling headphones that she wears and it's... The same struggles that she has as a five year old, I still have as an adult.
Saundra 22:41
Then I'm thinking, "Oh, my God, if only I knew about this stuff". So, as a 35 year old, you mentioned previously, the age of 50 is when things start to get a little more challenging. Would it be something that, for people listening who are in that 35 to 50 range are even younger than 35, Is this something that you would say can give those long term lasting effects? Without having to continuously use that, say, the interactive metronome? Does that makes sense?
Dr Christa 23:19
I think so. I mean, the main goal, the main thing is like what we mentioned earlier, is that for adults, you are just realistically going to have to just revisit from time to time. And whether it was...
Donae 23:33
The booster things?
Dr Christa 23:34
Yeah, you have to do, we talk about this, our mentor in our group our processing group, he has APD, he has mild hearing loss, he had language issues when he was younger. And he talks about how he periodically has to put himself through therapy and he just knows he needs to do that every now and then.
Dr Christa 23:52
Then once you reach the age of 50, one of the main things we drive home with anybody we meet here that's in, you know, kind of middle aged to getting into the older age category, is just making that connection of you've got to, don't just say "oh, my hearing loss doesn't bother me, and, you know, my wife complains about it, but she can get over it. It's, you know, it's no big deal. I don't wear those big clunky things on my ears".
Dr Christa 24:20
And when we mention the fact that you're causing sensory deprivation to your brain, you are already in the phase of life of cognitive decline, that's natural and now...
Dr. Megan 24:32
It increases it.
Dr Christa 24:33
Sensory deprivation increases that. So, we really preach, you know, don't get stuck in your rut, in your routine. Don't always drive the same way, don't always do the same routine every day.
Dr Christa 24:44
You've got to have new experiences because when you... I think, Donae, we've talked about this... that Remember book?
Donae 24:51
Yes.
Dr Christa 24:52
Talking about that if you get into your rut and you just do the same thing every single day, it's not anything novel or new and you're not likely to remember it.
Dr Christa 25:01
And so then you start to wonder, "Oh, am I becoming demented? Is my memory slipping?" No, you're just, you do the same thing every day, there's nothing novel or new to remember. So, you have to attend to something you need to remember and if you have an attention deficit, that's even harder to do.
Dr Christa 25:17
So, if you're sensory overwhelmed, then it's going to be hard to attend. So, there's this whole, just, compounding effect. You know, when you think about it, just as order of treatment, you really need to determine, are there some sensory processing weaknesses and address those. And that can be how you visually process information. Are you visually impaired?
Dr Christa 25:41
You know, are there some things that are affecting the way you perceive the visual world? The auditory stuff? But, then also, just, sensory wise... I mean, what you describe, as far as just even the change of the air when he walks in the room, or just a soft touch on your shoulder is kind of sending you through the roof? That's a sensory processing disorder.
Dr Christa 25:59
That's not... that is purely, just, you're not handling that change of your sensory environment well.
Saundra 26:07
Yeah.
Saundra 26:07
Your mind is over, your brain is over reacting to it. So...
Saundra 26:11
Right.
Dr Christa 26:12
And, you know, there are OTs for adults. you can manage sensory processing issues.
Saundra 26:19
So, that was going to be my, well, part of my next question is, for people listening to this, that are thinking, "Oh, I'm...this sounds like me", what type of assessments? Or what kind of specialists would you recommend that they go to? Or if someone who's experiencing what I am, how would I get assessed for stuff, to know what what therapy or treatment would be best in line with my struggles. And for those listening, these types of struggles...
Dr Christa 26:55
The first line of defense is, if you have hearing loss, age or hearing loss, if you have visual problems where you need to wear glasses or contacts, you need to address the visual issues. So, if the just the input of sensory information is distorted, that has to be corrected first.
Dr. Megan 27:12
And if you're 50 and above, get your hearing tested, doesn't matter if you don't think you have struggles, just get your hearing tested. Have a good baseline moving on.
Dr Christa 27:24
It should be an annual, just part of your annual physicals. Having your urine checked; hearing loss can creep in very gradually. Yeah. And you may not even realize that it's happening. And by the time you're your sensory aware of it, it's probably caused enough sensory deprivation to your brain to go ahead and start causing those processing declines.
Dr Christa 27:52
So, you know, like she said, just at the age of 50, at the minimum, and really anybody in the adult age who hasn't had a hearing tests in the last five years, should go get a hearing test done.
Donae 28:03
And you're going to need to go to an audiologist for that not necessarily your general practitioner, or is that screening enough?
Dr. Megan 28:09
No, I would recommend just getting a baseline audiogram at like an ENT, an audiologist, make sure it's an audiologist. Not like a hearing instrument specialist. But um, yeah, just to have a good baseline, might as well, and then if anything tragic happens, you lose your hearing in your ear suddenly overnight, you have something to compare it to. You have something, you know, have a baseline, which is always important. Make sure it's an audiologist.
Dr Christa 28:38
A lot of people don't realize that hearing instrument specialists are just basically a certificate degree. They...
Donae 28:45
So they're more of like a technical...?
Dr Christa 28:47
They're apprenticeship trained. An audiologist are doctoral level or master's level professional, so they're, we have more of the medical background. And...
Donae 28:57
Yeah. So, I have a question. This is, you know, one that probably is hard to answer, like a lot of these ones are, but... what would your advice be to someone who is trying to weed out and figure out what's ADHD? What's auditory processing? Like, which symptoms will overlap for those two?
Dr Christa 29:18
A lot. Almost all of them. So, it's kind of a, it's one of those peel back the layers again. So, if you have attention deficit characteristics, go get your sensory processing assessed first.
Dr Christa 29:31
If you have, like I said, you can see an OT for sensory processing disorder. OTs, it's also within their wheelhouse to screen for visual processing issues.
Donae 29:40
Right.
Dr Christa 29:41
So, you know, see a an adult OT who is familiar with sensory processing, sensory and visual processing, have that assessed by them and then see an audiologist who's familiar with APD. And not all of us are familiar with APD.
Donae 29:57
That's interesting. Tell us more about that, because I think you would assume that if you went to an audiologist, you're a specialist and they would have that knowledge, But, no?
Dr Christa 30:05
No.
Dr. Megan 30:07
it's a very, we like to say it's a very niche part of audiology. I recently graduated last year, I only had one course in it, and like six different classes within the course. And she (Dr. Christa) taught one of them. (laughter)
Donae 30:22
Oh, wow.
Dr. Megan 30:24
And like, the information we got from her was, you know, I felt more accurate than what I had been taught otherwise. But it can be kind of, it's a lot different than what audiologists do daily, the run of the mill audiologists. You see them working in ENTs, they're fitting hearing aids, and this is very much therapy based, which, kind of, you know, is a gray area with speech therapy.
Dr. Megan 30:50
So, a lot of audiologists are trying to determine if they want to go speech therapy or audiology and if you want to do more of the therapy, working with children, creating a progress note and a plan of care and those kinds of things, they lean more towards speech therapy, and they're in the audiology world to do more of the diagnostics.
Dr. Megan 31:09
And the fitting of hearing aids and the diagnosis of hearing loss and vestibular and cochlear implants and that kind of stuff, that's more medical, and this is more in the rehab therapy. Not a lot of audiologists are in this field for, to specialize in.
Donae 31:26
Okay, so, it might be a little harder to find someone who is knowledgeable?
Dr Christa 31:31
But I will say, and you can put this, maybe tag this as well, we have a international processing group. So, it includes audiologists in New Zealand, Australia, and Canada, Puerto Rico, all kinds of just more international, and we have a international referral map.
Donae 31:50
I'll link that, so people have that. For sure.
Dr Christa 31:52
The group is called the international guild of auditory processing specialists, the short acronym for that is IGAPS. So, our website is IGAPS.org. And it is an inclusive group, so it's not restricted just to audiologists, so it's with for anybody who's interested in learning more about APD, treating APD or just having the resources so when they come across somebody with that they have the group to go to to say, "Hey, I have this client in Minnesota that needs to see somebody, where can they go?" And to able to find a reliable resource to have treatment for that. So...
Donae 32:33
That's awesome. That would have saved me some time a few months ago. But I'm glad I have it now.
Dr Christa 32:38
We have meetings and educational meetings and we are now starting to do some, just training workshops. So, for audiologists who want to learn more about it, since it's not taught really well in grad school, they can take these workshops to learn.
Dr Christa 32:54
That's great. Now, what has your experience been with whether insurance... since this is, you know, in between two worlds of education and medical, or could be considered that, is insurance tending to touch this, not touch this in the US?
Dr Christa 33:11
The classic example is that when... Medicaid for instance, Medicaid will pay for the therapy but they won't pay for the evaluation. And you can't get therapy through Medicaid without an evaluation. And the only reason that even works that way is that the therapy code that we use for auditory training is the same code that's used for speech therapy. It's defined as auditory or speech therapy by an audiologist or speech pathologist.
Dr Christa 33:40
So that's, their intent is not to pay for auditory training for APD. But, you know, if you can get an evaluation or pay for the evaluation yourself, and the therapists can turn that evaluation in to Medicaid to show that there is a valid auditory processing issue, then it can be paid for through Medicaid, but then the reimbursement for those sessions is so low...
Donae 34:08
Right. So you probably have a hard time finding providers who can do it? At that, I imagine.
Dr Christa 34:12
I used to take Medicaid, and then I got to a point where I just couldn't afford to do it anymore.
Donae 34:16
Right. And that's been my experience with things that fall in... if it in any way can be considered educational. It's like, "Oh, we're not going to we're not going to cover this. We're not going to touch this" and that ends up being, you know, an investment you need to make yourself, but...
Dr Christa 34:29
It's like, I have a contract which children Medical Service and the Early Hearing Detection and Intervention program with public health. And so, with CMS, you can qualify for testing, they don't pay for any therapy, but they they will qualify you for testing and just for monitoring medical needs, if it's a medical diagnosis, but if it's all considered a developmental diagnosis, so speech delay, auditory processing, dyslexia, attention issues, all of those are considered more developmental diagnoses, and so they're excluded.
Donae 35:03
Oh, wow. Yeah.
Dr Christa 35:04
You have our medical diagnoses.
Donae 35:06
It's always a game. Insurance is always a game...
Donae 35:11
Don't even get me started I had to give that up a long time ago.
Donae 35:15
I know, we could go for a while on that. Saundra, did you have more questions? I have others from people, too. But I know you had a few more, probably.
Saundra 35:22
I think the questions that I had, I mean, I asked a couple, of course. And then you asked one that I had been thinking about, like the overlap. Right? I'd love to hear what your audience is curious about.
Donae 35:38
Yeah, we've covered a lot of them. This one from from Vivian T, about whether or not it was genetic? Is auditory processing disorder genetic?
Dr Christa 35:47
We see a lot of siblings.
Dr. Megan 35:51
Potentially, even parents, there are a lot of parents who, when she goes through, you know, their kid's deficits, the parents are like, "You know, actually, I kind of struggle in these situations as well". And then it kind of piques their interest to want to look into it, or they get accounts added to the Interactive Metronome, and they do them at home. And so they do.
Dr. Megan 36:15
That's how a lot of us roll, when our kids start and we're like, "Oh, yeah, that wasn't normal? Was it? Okay". So yeah, so there is a genetic link, then. Like so many things. So yeah, that makes sense.
Dr. Megan 36:29
This is from Rachel L. What kind of accommodations can I ask for with school or work? And whatt are common ones?
Dr Christa 36:39
I mean, the most common is preferential seating. So, just understanding the basic physical science of how sound travels: the further your ears are from the source of the sound, the more high frequency information is going to be lost. Low frequencies travel further than high frequencies.
Dr Christa 36:57
So, if you're sitting further away, you know speech is going to become more muffled, because all frequencies are trailing off. High frequencies give us the clarity of speech. So, get as close as you can.
Dr Christa 37:11
Why mild gain amplification on normal hearing people with struggles processing information can really help is because the sound is always right in their ear.
Dr Christa 37:22
So, right from the speaker's voice to their ear, if they're wearing some sort of Bluetooth, or FM mic, if the speaker has a mic, it can connect to the hearing aids, it goes straight in. So, preferential seating or FM is really important.
Dr Christa 37:39
And understanding, you can go into this, but understanding the ADA law, so where assistive devices are required to be available.
Dr. Megan 37:49
I did a whole presentation on, I'm a big movie person, I love going to the theater, I did an entire presentation on what is offered to you if you need assistive devices in a movie theater. So, you can ask them for, you know, closed captioning. It's like, this little device that sits in a cup holder, and you've got captioning for...
Donae 38:10
Oh, that's great, because I know a lot of people who are diagnosed ADHD that need captions, I don't know that I've ever seen them as an option at the movies.
Dr. Megan 38:19
There's a little symbol that you can look for, that tells you that they've got assistive devices for hearing loss. But, even for auditory processing disorder, I mean, technically, they're not allowed to ask if you have a hearing loss.
Dr. Megan 38:33
So, if you go up and ask for a closed captioning device at the movie, they're not going to say no and they should have them, legally. And I've actually gone to the movie and seen people use them before.
Dr. Megan 38:44
So, one of them that I know for sure is there. Some states have called telecoil. Where some auditoriums, churches, that kind of stuff, they're looped. This is only something that would be available for someone who has hearing aids with the telecoil. But, looped means it's basically an FM system. So, the speaker, the music, the show is going to be directly to the ears. So, those are some that I can think of off the top of my head.
Dr Christa 39:19
You should be able to, we can check to see what the link would be to this, but the Americans with Disabilities Act is what ADA stands for, you should probably go to their website and just do a search on which facilities, which venues are required to follow certain ADA laws and provide assistive devices for people.
Dr. Megan 39:40
Look for that symbol.
Dr Christa 39:41
Like she said, they can't ask you if you're hearing impaired.
Donae 39:44
So, they're required to have it.
Dr Christa 39:46
It's not required for you to say "I need this for my ADHD" or "I have a hearing loss" if you ask for it, they're required to provide it.
Donae 39:53
Okay.
Saundra 39:55
Where I live in Ontario, I'm not sure about all of Canada, but provincially, I know we have disability acts. So, it's ODA, Ontario Disability Act here.That is very easy to find online and just research the same things that you you said what's available, where and...
Dr. Megan 40:19
And they always have a symbol that is easy to see. So, you always know which places you're going that will have...I mean, surprising places. Like, if you go to a concert, they probably have something, a device to help you, but they have that symbol everywhere. And once you see it...
Saundra 40:34
Are you, you're referring to that, like black and white CC symbol?
Dr. Megan 40:38
Yes. Well, there's two here. Yeah, there's one with an ear.
Saundra 40:43
Right? Okay, so it's an ear or the CC, both of those are? Okay.
Dr Christa 40:49
So, anything you can do to clear up the signal or to just visually augment what you're trying to hear auditorily, like with closed captioning, that is really going to be important.
Dr Christa 40:58
You know... and then beyond that, for adults, I would say, just really understanding appropriate communication repair strategies. So, your worst enemy as somebody with attention deficit, auditory processing disorder, hearing loss, or all the above, is the "huh?" or "what?".
Donae 41:17
I knew you were going to say the "huh?" ! When she said appropriate, I was like, "What's inappropriate? The "huh?"
Dr Christa 41:22
It's the worst. It's so frustrating to the speaker who's trying to communicate with you, and it gives them absolutely no information about what you have heard or not heard. Yeah.
Dr Christa 41:33
Tell us more about that. Because this, probably for both categories, whether you have ADHD, whether you have auditory processing disorder or both... So, what would be a little bit more about than the"huh?".
Dr. Megan 41:43
Yeah, I love this! (laughter)
Dr Christa 41:47
Right up her alley...
Donae 41:47
Hit it! (laughter)
Dr Christa 41:48
The most important thing is to make sure that your communication partner gets your attention if they're trying to talk to you, first and foremost. So, if they're in the kitchen doing dishes, they need to say, for me, "Megan..." and then whatever they're asking me.
Dr Christa 42:07
If I'm not paying attention, I'm not going to hear them. That is especially a crutch if you have ADHD, but also, if you have normal hearing. I could be on my phone. I don't know you're talking to me until you're halfway through your sentence.
Saundra 42:21
I'm laughing because that's... we all we know...
Donae 42:25
My whole family knows, it's at least, like, three "moms" is what I usually need. And then it's like, "oh, yes, I'm here".
Saundra 42:31
I need a physical touch, sometimes.
Dr. Megan 42:34
Just something to grab your attention, because you're not going to pick up on everything if your attention is elsewhere. Another thing, as the person who maybe is misunderstanding, the best thing to do instead of saying "what?" or "huh?", because those are used as kind of a processing crutch. So, you're processing slowly. There's a lot of times where she'll (Dr. Christa) say, "What are you doing for lunch?" I say "What?, but as she's repeating the question to me, I answer, she's already...
Donae 43:03
My daughter does that all the time. Like, I won't answer right away. I'm like, Just wait...
Dr. Megan 43:07
Exactly. You've got to kind of give yourself that time to wait. And if you're still not getting it, the best thing you can do is repeat what you think you heard. So, she might have said, "What are you having for lunch?" and I'd be like, "Sorry, did you ask what I was having for dinner?" and then she could say "No, actually, I was wondering what you're having for lunch."
Dr Christa 43:26
Or you could say, "I heard something about lunch". You know, just give them what you did hear.
Donae 43:32
This is really interesting and cool advice... one of my daughter's deals with this, whether it's, I mean, she's diagnosed with ADHD, I've never considered the auditory processing. But her friends will get frustrated and sometimes the communication just breaks down. I think that the "what?" or the "hcuh?"omes out right away. It causes some frustration.
Dr. Megan 43:56
Yeah, and something I'm always telling people to, say you're dealing with someone who's not catching what you're hearing. So, it's very frustrating as a communication partner. You want to try to not repeat what you were saying in the same fashion. So don't say "What are you having for lunch?" Be like, "Oh, do you want blah, blah, blah, for lunch?" Like, rephrase what you were trying to ask.
Donae 44:17
So if you're getting the "huh? or if you're getting the "what?", then try to word it in a different way. So, for me with my daughter, I'm going to try to say that in a different way when I answer.
Dr. Megan 44:27
Yeah.
Donae 44:27
Okay.
Dr Christa 44:27
Here's an example. My husband is notorious for just repeating the same thing. He'll say, "Did you get the thing?" and I'm like, "What thing?" He says "The thing." "What thing?" He says "The thing!" and I'm like, ok..
Donae 44:40
You're like "Make an effort."
Dr Christa 44:43
You need to use different words to ask me this question. So, a classic example of what she's saying.
Dr Christa 44:49
Don't just keep repeating. You know, sometimes it's not that you didn't hear the words. It's just that you don't understand the context or you're not organizing the language properly. So, you know, maybe repeat it once and if they're still not getting it, change the way you ask it.
Dr Christa 45:06
Yeah, tell us what the thing is, come on...
Dr Christa 45:09
What thing?
Saundra 45:10
The thing that I use, which is in line with what you said is, I always apologize when I don't hear something. I'll be like, "Oh, sorry. Or, excuse me, can you repeat that?" And then if they repeat it, and I still can't process it, it's like, "Oh, can you elaborate on that, please?"
Dr. Megan 45:29
Yeah, absolutely.
Saundra 45:30
Those are things that I was taught from a young age. So, I come from a family where APD is probably in four out of the six of us. Very interesting household. ADHD is there, too. And, my mom was very good at, like, I don't think training is the right word. Maybe it is, but, like, teaching us to say, instead of, if we said "what?" or "huh?", she would stop us and go, "Say, excuse me or sorry" so that that has helped me immensely throughout my life.
Saundra 46:12
It's allowed me to develop the strategies in those relationships because it did get in the way with friendships, and I got into trouble and into arguments and fights. Those things that kids with ADHD and APD do get into unintentionally, far from intentionally, because you know, you don't want to get into a fight with your friends.
Dr Christa 46:36
Honestly, what you're saying is, you know, just making sure if you know, what are the responsibilities on you, as the hearing impaired or the processing delayed, or attention deficit listener is to communicate your needs and advocate for yourself.
Dr Christa 46:57
So, self advocacy is really important. You know, I'll be in the other room, my husband will start talking and I'll say, "Whoa, hold up. I can't hear you. Just stop talking, let me come closer to you or you come closer to me". So, just not even letting it get started. Like, I hear a voice, I know he's speaking to me. Let's change this, this situation.
Dr. Megan 47:17
And that's where the attention grabber comes into play is that he really should say, "Christa", and then he's got her attention.
Dr Christa 47:24
And when one of the greatest things I've ever seen, I was at a JC Penney or something, and I walked up to the counter and the lady that was standing there had her back to me, and, you know, I set my clothes down and my keys jangled on the counter and she just kept her back to me. And I was starting to get really annoyed. And she turned around, and when she did above her nameplate was a little, just engraved on her plate that said, I am hearing impaired. And so, it immediately changed my frustration, I wasn't frustrated with her anymore. "Oh, got it", you know?
Donae 47:58
That's that interpretation piece that happens so much with ADHD, too, is that we have traits or behaviors, and they're going to land, often not the way we want them to, and people are going to interpret them so that self advocacy is big.
Saundra 48:13
Self advocacy with respect for yourself and the other person.
Donae 48:18
Right.
Saundra 48:18
Even if you feel that they've wronged you, treating someone else with respect, when you're trying to communicate is so important. And that's, that's something that I work on with my clients, because we can easily get frustrated, especially with our spouses, or partners and they're the first person that we will scream at or be rude to. So, remembering that respect piece is big because it decreases and diffuses that frustration that can be so quickly exploding all over the place.
Donae 48:55
Right.
Dr. Megan 48:55
And patience, having patience with yourself. Especially in our therapy, we are constantly just, we're a cheerleader, we really cheerleader, all of that. But I'm always telling like, be patient with yourself, like, the brain is this really cool organ, it's us. But it can be slow. And it can be slow even when we're older, too, especially when we're older.
Dr. Megan 49:19
And so it doesn't mean tha,t you know, this progress is never going to happen, but it's just it's different for every single kid. It's not linear. And just trying to tell the parents, the patients and their families and their friends; just have patience. It's going to happen. We've seen it happen. I don't think there's ever been a patient or it doesn't happen
Dr Christa 49:39
To some degree, yes, but it's not going to happen overnight and it's not going to happen if you dabble.
Donae 49:45
Yeah, yeah. Like all the good stuff, right? All the good stuff takes time and some actual effort, you know, which is yeah, you know, it's nicer to have it immediate. That's lovely. We love that, but...
Saundra 50:00
Rome wasn't built in a day. I think that that is so relevant to any treatment or therapy.
Donae 50:06
Absolutely. Both pieces. I mean, I love what Dr. Megan said about that, being kind yourself, being patient with yourself because a huge piece with ADHD work, also, it's just that compassion of like, "Okay, I'm making progress", but keeping patient, keeping at it. So yeah, I love that.
Donae 50:27
Thank you. I feel like we've gotten a ton of good information here. I'm sure I'll have more questions coming. But we are going to link all the things that we talked about, how can people get a hold of you, Doctor? Doctor?
Dr Christa 50:44
So, I'm Dr. Christa Reese, and I'm the pediatric audiologist here. But I do auditory processing testing on all ages. So, even though my company is called Little Listeners, so the website is littlelisteners.com.
Dr Christa 50:59
We help big listeners, too. So, I do most of the auditory processing assessments. Megan is trained and highly capable to do it, but I do most of that. And so, therefore I do mostly work with pediatrics. And then, Dr. Megan works mostly with adults, veterans, hearing loss, hearing aids, and then assisting me with any assistive technology or amplification needs that, you know, my clients might need. I haven't dispensed a hearing aid in 20 years. So...
Donae 51:36
She's our person for that.
Dr Christa 51:38
I don't even know how to connect them. So, I don't want to deal with them and I just love the pediatrics. So, that's kind of my clientele. But yeah...
Dr. Megan 51:48
My website is helixaudiology.com
Donae 51:53
We'll have this linked.
Dr. Megan 51:54
Yeah. And then, you know, we can give you our phone numbers and email addresses and all that good stuff.
Donae 52:02
Perfect. We'll have all of that in the show notes. So, if somebody, if you want to get in touch with doctors Reeves, I pluralized both of them, then you can get those links and get a hold of them easily with any questions or if you if you need to explore the auditory processing piece with them. So, thank you so much. Thank you Sondra, for joining us, too.
Saundra 52:22
Thank you. I actually did have one last question for Doctors, Reeves and Reeves. Are your services exclusively in person? Or do you offer anything virtually?
Donae 52:34
Good question.
Dr Christa 52:34
We have, we like to do the testing in person, that really does need to be done in person. But, over the quarantine, when we were all locked down, I did develop some teletesting techniques.
Dr Christa 52:48
So, you know, say it was somebody in Canada that really wanted to work with us, I could either find somebody local that they could go see for the testing and then we do have telehealth treatment options and home treatment options.
Dr Christa 53:02
And then, of course, if anybody's interested in interactive motronome or both, I am trained. I am an IM home provider and that is something we can set somebody up with remotely and monitor remotely.
Saundra 53:15
Awesome. That's great information because I know that there's listeners on the ADHD Crash Course from all over. I found Donae's podcast from Canada. And we met through other another group. Yeah, so yeah,
Donae 53:37
It's true and that's great to know. You're right, because there are lots of different countries represented.
Saundra 53:42
I'm going to probably be contacting you.
Donae 53:45
And actually, you can come stay with me because I live really close, so you can come hang out here in Atlanta. Well, perfect. Thank you, all three of you, so much. And we really appreciate Dr. Reeves, both of you, your time and your information and getting us somewhat caught up, a little further caught up about this pretty complicated subject. So, thank you so much.
Dr Christa 54:09
Absolutely. Thanks for having us.
Helpful links: To find specialists near you: International Guild of Auditory Processing Specialists
Dr. Megan Reeves
Helix Audiology Dr. Megan Reeves (adults)
Dr.Christa Reeves
Little Listeners Dr. Christa Reeves (pediatrics)
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