Angela Alexander Discusses Auditory Processing Disorder

“The ability to understand and remember what you hear can affect your ability to have a good life” quotes Dr. Alexander.  Join me today in an energized episode with Dr. Angela Alexander as she shares her personal and professional expertise in the area of auditory processing.  Angela Alexander, Au.D., CCC-A, MNZAS, graduated from the University of Kansas in 2010 with a Doctor of Audiology degree.  Angela was privileged to have been mentored by Jack Katz, Ph.D., a world-renowned expert on APD. Angela worked with Katz for seven years between 2004 to 2012, building her knowledge and expertise. Dr. Angela now owns APD Support, which is a private organization dedicated to helping patients and professionals as well as providing a wealth of resources. Most recently, Dr. Alexander started her own podcast called BetweenTwoEars.  Today’s episode takes a deep dive into some of the myths about auditory processing, Dr. Alexander’s top 5 for audiologists and other professionals to remember, and take home messages to remember about “what we do with what we hear”.  

​On-demand Auditory Training | Auditory Processing Disorder APD Support

https://podcasts.apple.com/nz/podcast/between-two-ears/id1562388215

For more information about Dr. Carrie Spangler- check out her LinkedIn at https://www.linkedin.com/in/carrie-spangler/

For transcripts of this episode- visit the podcast website at: https://empowearaudiology.buzzsprout.com

Transcript

Announcer: [00:00:00] Welcome to episode 19 of empowEAR Audiology with Dr. Carrie Spangler.
Carrie Spangler: [00:00:16] Hi, everyone. Welcome to the empowerEAR Audiology Podcast. I am really excited to introduce this podcast with Dr. Angela, and I hope you enjoy this conversation as much as I did about auditory processing and auditory processing deficit. Dr. Angela has so much personal and professional knowledge to bring to this topic.
And I think you're just gonna feel her passion and purpose come through. When you listen to this podcast conversation, Since we have had this conversation a couple of weeks ago, I wanted to let all of you know that Dr. Angela has just released her own podcast called Between Two Ears. And she's also active on clubhouse, the social media app.
And you can join her moderated conversation on Monday nights in the room, talk nerdy to me. So again, I hope you enjoy this conversation with Dr. Angela about auditory processing. All right. Welcome everyone. Let's get started with today's episode of empowEAR Audiology.
I am really excited to introduce our guest today. Dr. Angela Alexander. She is a doctor of audiology and she graduated from the university of Kansas in 2010 with a doctor of audiology. She has a passion for the treatment of auditory processing disorders. Angela was privileged to have been mentored by Dr. Jack Katz, who is a world leading expert on auditory processing disorders.
She worked with Dr. Katz for seven years, between 2004 and 2012 in her knowledge and expertise. Now Angela works as an audiologist in Australia. She has what is called the auditory processing institute. And she's looking to train her peers in the skills needed to provide effective APD diagnostic and therapeutic options.
She aims to double the number of SLPs and AUD professionals providing effective auditory processing services through the app online APD masters course by 2022. Welcome Angela to the podcast. And thank you for being here.
Angela Alexander: [00:02:44] It is my pleasure.
 Carrie Spangler: [00:02:47] I'm really excited to have you today that you won't be the first person that I have on the podcast of what you're talking about, auditory processing, so I'm really excited to have you!
Angela Alexander: [00:02:58] Well, congratulations on finally talking about the most interesting stuff.
Carrie Spangler: [00:03:03] Well, it was bound to happen sometime. So I'm so glad that you are here. And I just wanted to say I'm so excited that we got connected on an online platform.
Angela Alexander: [00:03:15] Yeah. Who saw that coming?
Carrie Spangler: [00:03:18] It's so amazing how I could meet someone on the other side of the world and through a closed Facebook group and then clubhouse as well.
Angela Alexander: [00:03:27] That's exactly right. Yeah. It's amazing. I love it when social media does good things and meeting you is one of those good things.
Carrie Spangler: [00:03:39] Yes. So I just knew when I heard you talking on clubhouse talk nerdy to me a group, and you had so much passion for APD. And so I knew I needed to immediately reach out to you to see if you would be a guest.
And here you are. So thank you for being here all the way from Australia. Early in the morning where you are, late in the evening for me here in the United States. But I thought before we kind of take a deeper dive into APD, I would love to ask you, how did you get involved in Audiology?
Angela Alexander: [00:04:17] Oh, wow. So when I was born, my mom was a home healthcare worker. She would go, she's a nurse and she would go to different homes to make sure that the children were like developing appropriately. And she noticed that I wasn't responding to sound. So she she took me, she had an audiologist come check me out and you know, this is back in the 1980s. And they noticed that I wasn't startling and I just wasn't responding in ways that she thought were typical.
Fast forward and I had audiograms constantly done when I was a kid. There were some complaints that I wasn't paying attention or I wasn't following instructions. And so they gave me a diagnosis of ADHD. So now looking back on things, I wonder if I may have had a bit of auditory processing disorder. I had been specializing in APD for about four years before I really realized that it probably applied to me as well.
So I'm wondering if I had, yeah, some processing difficulties growing up. I've been able to achieve, you know, fairly well, but I wonder if that could have been easier sometimes.
Carrie Spangler: [00:05:40] Yeah. I'm sure. So you kind of have this personal connection to your professional drive and passion.
Angela Alexander: [00:05:46] Yeah. One of the regrets that I have is not having an APD evaluation prior to getting started with this work.
With the courses that I run online, the very first thing I do for an audiologist is I put them through the central test battery. That's Jack Katz's battery of tests for auditory processing disorder. So, I run a test over zoom, and we check what an audiologist’s processing looks like. And you'd be surprised how many audiologists actually have difficulties with auditory processing disorder.
It's amazing.
Carrie Spangler: [00:06:24] Yeah. Well, it's definitely an important topic to explore and I'm excited to explore it today with you. So before we go a little bit deeper, I just want to ask, how did you end up in Australia too?
Angela Alexander: [00:06:37] My husband and I moved New Zealand 10 years ago, and we love New Zealand. In fact, a majority of my close friends live there.
But New Zealand is colder than Australia. Like it's cold at night and you know, we love the ocean. Right now being in Australia is a really nice blend of the USA and New Zealand. You get kind of like the New Zealand culture, some cultural components of New Zealand, and then commercial aspects of the U.S. It's a really cool a place to live. We live on the sunshine coast, which is, I mean, if you look at Australia in comparison to the us, it's like, New Jersey area.
Carrie Spangler: [00:07:24] I got ya. I have a picture in my head now.
Angela Alexander: [00:07:28] Yeah.
Carrie Spangler: [00:07:30] Oh, wow. So that's exciting. Maybe someday I'll get to visit you all the way in Australia.
Angela Alexander: [00:07:36] Hey, the spare bedroom has the bed made and ready to go.
Carrie Spangler: [00:07:43] How did you really, I know you kind of touched on it, but what kind of drove you into really diving into APD?
Angela Alexander: [00:07:51] Oh, so it was 2004, April of 2004. And I was in my last semester of undergrad, and I had bowling class. Right after bowling class was my speech perception class with Dr. Sarah Ferguson.
And I wanted to bowl one more game that day. And so I was really late to my speech perception class. When I got in there, I looked up and there was a man teaching and I thought, oh no, I didn't realize we had a guest lecture. There was only one seat left and it was front and center of the room. So I went and sat down and I tried to figure out what this guy was talking about.
And he was talking about auditory processing disorder, and it blew my mind like. I, my eyes must have been huge, because it felt like I was learning about something I had always known. And I didn't, like I said at the time, I didn't realize the relevance to my own life, but I just couldn't believe it.
And at the end of the lecture, I went up to him and I said, I have got to see how you test for this, how you treat it, because I cannot imagine it. And he said, come to my clinic any time. I work in Kansas City, and I said, sweet, okay, let me email you. And he was like, okay, it's my name@buffalo.edu. And I said, what's your name?
And he said, my name is Jack Katz. And here I'm like holding his book and I'm like this guy. Right. But if anyone knows Jack Katz, you know, he's humble, he's kind, he's hardworking. I mean, he just turned 87 last month, and he's still working clinically. All right. So I think a lot of people don't realize the level of ingenuity he has built into his evaluation and treatment methods.
Like you see a client you're able to categorize the difficulties. They're having you do a test, and then you can categorize the problems on the test. And then you treat based on those different categories. It's like, I cannot believe what an ingenious set up he's made. And he just, I think that, I think that the profession of audiology is about to realize that we have to be so much more than dispensers.
And one way to do that is to look at the specific difficulties a person is having and have us treat it. Why not?
Carrie Spangler: [00:10:35] Right. Essentially you had this amazing teacher, Dr. Katz. Can you just give us like a 360 degree definition of APD, but people that might not have all of the knowledge that you have.
Angela Alexander: [00:10:51] Absolutely. So, first of all, I like to put it on the same continuum as hearing loss, because I think when we do that, it helps people who work with dispensing feel a little bit more comfortable with this. So the way I like to put it on the same continuum, is looking at Erber’s model of auditory skill development.
So think about it as a staircase with four steps on it. The very first step is awareness. If a person isn't aware of sound, they may have hearing loss or auditory neuropathy or hidden hearing loss. We deal with issues of awareness with amplification, with devices. With cochlear implants, things like that.
So what we want to do with awareness is we want to boost that signal. The second level, after we get past awareness is called discrimination. Can you hear the difference between two sounds? Can you hear the difference between mm/ng. And now you've gone through the cochlear implant process, and you know that you had to learn how to do that.
You had to teach yourself how to hear the difference between these two things. Once you get past discrimination, which is step two, you have to get to identification, which is step three. Not only do you know the difference that there's two sounds that are different. Do you know that that is M and that is N you need all three steps to get to comprehension, to understand what is said.
And I think a lot of audiologists think we can go from awareness and jump to comprehension and. We miss out the important part, which is the brain. And so I think a lot of us as audiologists and dispensing have had a client come in and based on their kids' case history, we're like, wow, this person has like a moderate hearing loss.
They've never had hearing aids. I'm going to change their lives. That's right. We do. We put them in the booth and, and behold, their audio gram is within normal limits. Then it's confusing. Wait, it looked like this person had a problem with awareness, but it was actually potentially with discrimination.
It's because it's at such a low level that it looks to us. Like it's actually hearing loss. We've also had clients who come in who have hearing loss. We put hearing aids on them and they still don't go from awareness to comprehension. So I'm going to say something really crazy. It is possible to struggle with auditory processing.
Even if you have a hearing loss. In fact, it's amazing that more people with hearing losses don't have auditory processing problems. So auditory processing is what the brain does with what your ears hear. People will say, does my child have auditory processing? And I hope they do because auditory processing is the function.
Auditory processing disorder is the dysfunction. So, so if to me, and this is a different definition than most people would use to me, auditory processing is where auditory skills effect Well-being. all right. Is your ability to understand what understand and remember what you're hearing, affecting your ability to have a great life.
Carrie Spangler: [00:14:41] I like that, but it puts everything into real life perspective, right? It's about the whole person. And if something, if you're not processing information and you know, As human being that's communication is key. So if we can't communicate with others, then your wellbeing is going to be impacted.
Angela Alexander: [00:15:00] Absolutely. And so for me, like, I like to use the HHIA, which is the hearing handicap inventory for adults in particular. I don't like to use that second age cause it's just lame. So I like to call it the hearing inventory for adults, but just in case anyone's looking that up, it's a free tool and it's 25 questions and you answer yes sometimes or no, and at the end of it, you get a score. And so if you see a person who has a normal audiogram, but their HHIA score is really high.
This is a red flag that there's something else going on. Or if you have a client with a hearing loss and their AHI score is really high and you put hearing aids on them and the score stays high yet again, another red flag.
Carrie Spangler: [00:15:54] Yes, that hearing aids and cochlear implants, aren't just going to fix it. There's gotta be some steps in between, right?
Angela Alexander: [00:16:00] Absolutely. And we need to partner with those clients to help make that a faster, more efficient process. Yes,
Carrie Spangler: [00:16:10] I like that. So I'm going to like put a little twist in the conversation just to hear what you have to say. So I work in the schools and, and then talking to other people too.
But I think within my profession at some different universities and even a lot of outside of our profession, there is belief that maybe APD does not exist. So can you, what is your take on that? If someone says, you know, that doesn't, that's not a
Angela Alexander: [00:16:43] real thing as healthcare professionals. We need to do no harm.
And you know what, I'm going to honestly say anyone who pushes the idea that auditory processing disorder, isn't a legitimate issue is doing harm. So just because it's funny, I, I actually had a professor once who said auditory processing doesn't exist. Cause that stuff happens to me all the time. So it it's it's comments like that, where you see a lack of empathy in a profession that's supposed to be the one who advocates for people with hearing disorders.
I don't understand where we fell off the bus with this one, but I think that there is we actually have C ABR complex ABR that can pick up difficulties with auditory processing with, with this equipment. And that is going to change the conversation from, is this a thing too? Oh my God, this is a thing we need to treat it.
I can't tell you how upset. The clients that I work with feel after they've been to hearing test after hearing test and have been told that there is no problem when these people have an HHIA score, 88 out of a hundred and a hundred is the worst you can be. And they're at 88 with a normal audiogram and people have told them.
There is no problem. And my, my university was very skeptical about auditory processing disorder. And I'm going to actually say something here that I have not said publicly. But my. I applied to get my master's in speech, language pathology from a really highly
Angela Alexander: [00:18:36] respected university after my AUD to become dually certified.
And I was rejected because of my interest in APD.
Carrie Spangler: [00:18:45] Wow. Yeah, that's it that's alarming. But I think your point of patients coming in and saying, I have difficulty. Processing with auditory information and you give them a questionnaire and they have a normal audiogram. We, we can't just ethically and morally be like, see ya, because there's obviously something that they are experiencing.
Angela Alexander: [00:19:13] Exactly exactly. It breaks my heart. It's so funny because you know, if we look at hearing loss, we say, Oh, the client has so much denial, you know? And so we have to prove to the client, they have a problem. A lot of these people who have an auditory processing disorder come in and they have no denial.
They're like, I am really struggling. And for some reason, the clinician has more denial. But then if we look at other things like with tinnitus, the clinician has no denial. The clinician agrees and believes that the client has a problem with Misophonia. The clinician understands and believes that the client has a problem.
But with auditory processing disorder, a majority of clinicians do not believe that there is a problem.
Carrie Spangler: [00:20:04] Yeah. That's so hard. So what do you think audiologists can do to help people who come into the clinic or into the school? Start and say, they're struggling with auditory processing. What could they do and what would you do as an
Angela Alexander: [00:20:20] audiologist?
There are two things that you should do depending on the population. If you're working with adults, bring that HHIA form into your clinic. And I start utilizing it immediately. If I don't have it, I feel like I'm flying blind, honestly. So you need to see what that score looks like. And if it's below. 14, maybe things are about within normal limits, but if it's higher than that, that person may need an extra referral.
The second thing that I was going to mention is knowing who in your area does this work? So if you don't, so if you don't know who's doing this work, you can go to an online searchable map that I've created, where you can put in your address and find out the closest specialist in APD. And if you can't find one become that specialist, we've just added the very first APD clinician in Las Vegas and Nebraska in the last three months.
Wow. Unbelievable. Yeah.
Carrie Spangler: [00:21:29] And is that because of your course and everything, or they found another
Angela Alexander: [00:21:34] way? So, so when I, when I started this map in 2008, I added everybody who said they were specializing in it. And there were 250 people on the map. You know, if 5% of the population have APD, that's 300 million people worldwide who speak English and 250 of us doing the testing, then I.
I didn't update in 2018, still 250 people. That's all that we're doing. The testing or treatment. I did another update. I'm trying to do two different things to increase the number of professionals I'm running those online courses. And then I'm trying to search out people who are doing the work, who aren't on the map yet.
So our current numbers are 376. So we've gone from 250 to 376 feeling really good about that. But I've got my eyes on 500.
Carrie Spangler: [00:22:30] Well, that seems like you've had a good jump so far. So that's a good, positive thing too. We're trying to think some of it has to do with the undergraduate graduate AUD programs as well, where, you know, people aren't either they're not learning enough about it or they don’t spark nterest.
Angela Alexander: [00:22:53] 40% of graduate programs do not have a course in auditory processing disorder. And if we think about the fact that out of a thousand children, right, we may have one to five with permanent hearing loss, whereas. Out of a thousand children, we have 50 to a hundred children who may have auditory processing disorder.
So it is much more prevalent even in the, you know, early childhood education then than hearing loss. Yet we have very few clinicians doing it. The latest ASHA Survey said that 1.4% of audiologists routinely test auditory processing disorder. That is just insane. And I mean, there's a lot of, there's a lot of things that we have to undo from our profession.
Like there was this old school belief we couldn't test before seven years of age. Because the system wasn’t fully mature, what system do we wait until it's fully mature to help it develop. That is just crazy. Early intervention is the wave of the future. How is that different with auditory skills?
Carrie Spangler: [00:24:13] So what kind of testing with screenings do you do with some of the below seven kids?
Angela Alexander: [00:24:21] That's a really good question. Okay. So for screening, like you want to have a really good conversation with the parents because it is fairly obvious when it's child should have a referral for an auditory processing test because these parents come in, they, they say, Oh, I really feel like my child has a hearing loss.
You do a hearing test. And it's like, okay, actually that doesn't seem to match up with what the parent was saying. That should be an immediate referral. Also you can use acoustic pioneer, feather squadron. So Matt Barker created this wonderful software and it's an app that helps to assess some auditory processing abilities.
You know I would say that I really liked the app. It doesn't necessarily always catch all of the children who are having processing difficulties. And I've talked to him because. I think his idea was let's, let's kind of take the speech language portion out of it, but the speech language portion is the most important reason why we should do an auditory processing evaluation.
Matt and I are really good friends. I have no conflict of interest saying that I absolutely use his products constantly for me. It's great because I can do an evaluation with his testing. And then in addition to my battery, and then I can do post-testing using that iPad as well. And I can get an unbiased behavioral data from that as well, some pre and post testing.
So it's brilliant for me, as far as screening is concerned. One of my main concerns that I've got with almost all of the screenings Software and. Materials that we've got, is that not all of them are very sensitive. They're more specific. And I think with auditory processing, we need to go more sensitive because we need to make sure that we are absolutely not rejecting someone for a further evaluation, if they need our help.
Did that answer your no, it does.
Carrie Spangler: [00:26:28] Yeah.
Angela Alexander: [00:26:30] Yeah, we're also trying to create this HHIC like so that the parent can answer these questions, but it's just being created, but I can share that for me.
Carrie Spangler: [00:26:39] No. So that would be like the children version that the HHIA then, so yeah, I was going to ask you if there was some kind of a checklist or, you know, screening instrument that you could.
Have parents fill out that would give indicators, like you said, that, you know, above 14 or 20 and this form, then this is a red flag to say, Hey, we need to look a little further into it.
Angela Alexander: [00:27:06] Yeah. And, and like this, there are a lot of different APD screening forms. I want people to have access to something that's free.
Okay. All right. That will help identify things. And what I think the HHIA does really well in adults is it picks up on psychosocial issues. It picks up on issues of wellbeing due to hearing problems. Now. One thing that I should say is that there's also the Buffalo model questionnaire. Jack Katz created that Buffalo model questionnaire.
And that is a really good functional questionnaire to get an idea of, okay. Are there potential red flags here that for auditory processing as well, but just looking at it. What can a majority of clinicians do something like the HHIA, maybe the HHIC, the problem with the AJC that I've got so far as parents are sometimes, sometimes have a hard time understanding how much difficulty their children are having.
Yeah,
Carrie Spangler: [00:28:08] especially the younger ones. When they get a little bit older, they can, you know, to the questions and they can,
Angela Alexander: [00:28:15] but then, then when let's say the child is a teenager, it's really easy for parents to be like, Oh yeah, my kid doesn't care about anything. Oh my kid's not as intelligent. You know, like they can apply different labels to what they're seeing.
They may think it's a behavior issue or an intelligence issue or something like that, which is really sad.
Carrie Spangler: [00:28:36] Yeah, which kind of actually brings me to another question. So. Do you see APD coexisting with other conditions a lot. And what, what do you see it mostly co-existing with
Angela Alexander: [00:28:52] any kind of neurodivergence can have a higher potential for auditory processing difficulties.
So ADHD, autism dyslexia. I mean, I think. Jack Katz said that if you look in any specific population, you're going to see a high incidence. He said, for example, people with large noses have a high percnetage, people, auditory processing disorder. So basically what we're saying is it is highly prevalent, prevalent.
If you've got any kind of neurodiversity going on, there is the potential that a, person's going to have a hard time understanding what they hear, but in a lot of these cases, Where a person is multi-factorial and has a lot of different issues. We can work with auditory processing and make that better, and we can see improvements in other areas.
So for example, I've had a couple of clients recently that I've been working with who have. Anatomical anomalies in the brain. One has no Corpus callosum. And we're like halfway through her therapy her round of therapy. There's also a child that I'm working with whose mum could not get testing done for auditory processing.
Cause she had low IQ. Why shouldn't we be helping that? Like, would we, would we say we wouldn't do a hearing test or put hearing aids on a person with low IQ? That's absolutely ridiculous. Becoming a parent has made me realize that here's this child. We want them to have the best chance in life to be the best person that they can be.
What can we do to help that child get there?
Carrie Spangler: [00:30:37] So, Kind of playing a devil's advocate for that part of it. If you have a student who may not be able to participate fully in the testing, how do you do that? Do kind of quantify that a little differently or do you kind of have a, I don't want to say a disclaimer, but just kind of some wording that says, you know, that they weren't able to fully participate.
Angela Alexander: [00:31:04] Yeah, we get as much baseline as humanly possible. All right. So we go in there, we gather as much data. We see what that data is telling us, and then we do therapy and then we do a retest. So for example w there was a child that was only able to do there's 40 items, 40 items on the SSW test. I was only able to do 10 on them.
Last October. And, and now we're just at the retest. We're about to retest him. And and I actually expect that we'll be able to do the full test. Now, Jack Katz likes to use this wording. He'll say we're going to use auditory processing disorder as a working hypothesis. You know, ASHA and AAA had these position statements that came out that said a person had to fail two tests by two standard deviations or a single test by three standard deviations and even national acoustic lab national acoustics laboratory came out and said, those numbers are arbitrary.
We cannot say that a person does not have an effect on their lives based on these arbitrary numbers. Because if a person fails a test by one standard deviation, it means that 85% of the population, it could mean that up to 85% of the population, their same age does better than they do. On a particular task.
If 85% of the population is doing better than me at something, I'm probably going to feel like this is affecting my day-to-day life. So watch this space because it's a, it's an argument that's just kind of slowly started and now it's working itself into a fever
Carrie Spangler: [00:32:53] and I you're a part of that fever.
Angela Alexander: [00:32:56] You better believe it.
See, I don't, I, you know, I don't actually care about. Auditory for, I don't think auditory processing disorders, one thing. And I don't think that people need to like lock onto that disorder. Parents need that name to know what to call it, but it's more important to find out is this person a good candidate for therapy?
Can we treat this? Yeah.
Carrie Spangler: [00:33:19] And I think in the schools, I love. That we can work with the school psychologist and work with the speech language pathologist and kind of see what testing have, you know, have and, and see. And when you do your testing and you're able to put some of these pieces together, it makes so much sense of like, what are the, what the next step needs to be and what accommodations need to be put in place as
Angela Alexander: [00:33:45] well.
Yeah, absolutely. Completely agree. I completely agree.
Carrie Spangler: [00:33:51] So what do you wish more audiologists would realize then? You kind of said it, but I just want you to highlight it again.
Angela Alexander: [00:34:01] Yeah. Yeah. Oh my God. So many things. All right. I'm going to pick five things.
I
Carrie Spangler: [00:34:09] love it.
Angela Alexander: [00:34:11] Five things. Number one, we can test for auditory processing down to three and a half years of age.
There's also neurological testing that can identify children at birth. Number two. Middle ear disorders potentially have greater impacts on life than what we had anticipated. So take those abnormal tympanograms seriously. Number three, we can test for auditory processing when there are other things going on in a person.
Sure. They can have auditory processing secondary to Other things that they have problems with, but if we can treat this and make their lives better, let's do it. Number four. We need to make sure that we are actually listening to what our clients are saying. If they say that we have, they have a problem, we need to believe them in the famous words of Gail Whitelaw Audiograms don't talk patients do.
And number five, auditory processing disorder is treatable. We can do auditory training and we can make this better hearing AIDS are not the only solution to every problem. And the moment that audiologists can realize this, we will have better job satisfaction, lower cost of goods, and we are going to change a lot more lives.
Carrie Spangler: [00:35:37] That's a good
Angela Alexander: [00:35:37] top five. I just made those up. I believe them.
Carrie Spangler: [00:35:43] Yes. And that's important. I can tell. So why not the question about like what you said, you know, that we can definitely improve out auditory processing. So can you share just a little bit more about what your training looks like and also maybe more the accommodation piece of how you can help someone in their day-to-day
Angela Alexander: [00:36:05] lives.
Oh, where to start. Okay. So, so first of all, with Jack Katz's Buffalo model, we do therapy. We do rounds of therapy, the very first round of therapy, which is about 12 to 14 weeks. We do. Four different exercises in each therapy session. The very first part is something called phonemic training and it's actually training people to quickly and accurately like recognized.
Speech sounds. So, for example, I might hold up a hoop visual filter without being an auditory filter. And I would say a sound like D D D and every time a person hears that sound. They have to tap a card on my table. Okay, then I bring in another sound in that same session, like the eh. Now you can hear that there's a big difference between D and F right?
So then we have the D and the air next to each other on a table, the short E and the D. And I have them distinguish between discriminate between the two. Then we bring in a third sound like that. We put that one in and they discriminate between those three. The next week we have them come back in. We refresh them on the D the short E the M.
And then we bring in another three sounds. Let's say B, ah M. We don't ha we don't mix those with the D the short ENM, because there are some sounds in there that could fight with each other. We don't want that. So we, what we do is we slowly try to layer a person's understanding of these individual speech sounds.
And while it seems like it is not rocket surgery, it is absolutely necessary to start at this very basic level. I even do this work with adults and adults with cochlear implants. To help them go from discrimination to identification. So that's that goal. We want to pull them up. Erbers model of auditory skill development.
The next thing we do is something called words in noise training. They listen to words. Noise starts with no noise and slowly increases until the noise is even with the words and it's multi talker, babble noise. So it does have a bit of relevance there. The third thing we do is short-term auditory memory work.
Just rote memory work. We want to increase a person's digit span by one. And then the last thing we do is a speech sound blending game. So if I said Sh E you would put them together and say, she, right? Yeah. So that's, that's what one of therapy looks like, and it starts off really basic and it gets more complicated.
But the fundamental changes that I see in a person's auditory skill abilities after it is. Incredible.
Carrie Spangler: [00:39:18] And eventually with some of your patients, if they go through a therapy and they have different supports, do you find them when you retest that they, I was scoring within normal and then that their inventory improved.
Angela Alexander: [00:39:34] Oh my God. Yes, you, you get it. You get it. So. So, yeah, quite it's quite common to watch a person go from having some severe, having severe scores to scores that are within normal limits. But remember what I said earlier, normal limits could still mean that 85% of the population are doing better on a task than you are.
So, so that is something to keep in mind. Isn't it. But. But what we do see is that AAHI , I want to see how low that score can go. And there's one client. Jackie who's offered to be a case study for me. And she started off with a normal audiogram and a score of 88. After one round of therapy, her score was 30. Hmm at retest a couple months later, she was at 24 and I called her as a six-month followup and her scores at 14.
So we can see someone go from feeling quite depressed about their hearing abilities to having hearing wellbeing that's within normal limits. And that's just from auditory training. That's no devices whatsoever.
Carrie Spangler: [00:40:43] Wow. And do you find like, Maybe two years down the line that they still feel that they're at that 14 level or the,
Angela Alexander: [00:40:54] yeah.
Good question. So I've just been using, I've just recently started using that HHIA to help guide what we should do for intervention. And now my thought is. Oh, wouldn't it be cool for, I, for me to have an automated email process that would automatically send them that survey to have them fill those in, you know, quite regularly
And really to get some more long-term data. Yeah, I would anticipate because I think some research has shown that there can be further improvements in auditory skill abilities, up to six months, post therapy. Jack Katz has a belief that if we're working with short-term auditory memory at the same time, as we're doing this other auditory training, it's going to stick for longer.
But it's a little bit like working out. Like I play roller Derby and, and I roller skate a lot right now. I've done a lot of that work. And so I'll never go back to how I was pre roller Derby. You know, like if I put skates on, even if it's been six months, I still have abilities that are higher than the average person.
And I can also fall down more often, like I did last night, but that's fine. So, so, you know, my baseline has changed quite considerably and it's the same thing. Like you can work out by listening to audio books and things like that. Audio books. Are a great way to maintain things, but it's not necessarily the best place to start off.
As therapy
Carrie Spangler: [00:42:30] does that makes sense? Oh, it does a hundred percent. Like I agree with you from a more the cochlear implant journey perspective where I'm kind of in the maintenance phase, but I needed to start what you said with the more fine tuning discrimination and just telling the difference between.
The ling sound and things like that. And then doting up to more minimal pairs and then listening and noise and that kind of thing, but it didn't happen overnight. And it definitely took a lot of coaching and determination to get to that point. But I agree with you, like there's times where I'm like, okay, I just need to sit down and refresh my brain with.
I'm listening because you get lazy, like you said, it's like wiping out. Like you, you know, you're not going to go run a marathon when you haven't done any training previous, so it just doesn't work. So Before we wrap up. Is there anything that you would like to share that I didn't
Angela Alexander: [00:43:38] ask you? No, I don't think so.
I think, I mean, just to kind of talk about the cochlear implant stuff for just a moment, you know, I, I just recently started doing some auditory training with adults who have cochlear implants. And one woman said to me, she goes, I don't feel like I'm really struggling. Her HHIA score is really low. It's like.
So it's really low. She has bilateral cochlear implants, but she said her first implant took her over a year to learn how to process with it. And she said, you know, it was really interesting. It was interesting for me. To talk with her because when I talk with an auditory process, a client with auditory processing disorder, who is an adult, they may have a hard time believing that it can, that auditory processing can change.
But if I talk to a person who has had a cochlear implant and who has successfully trained themselves, how to process. Over a long period of time. They know that auditory processing can change and they're interested in finding out how we can make that happen in a more efficient way so that their life doesn't have to be impacted so much.
So it's really interesting to talk to a person with a cochlear implant. I had one. One man that I talked to and he said, wait, I can actually hear everything now are you're saying I have an auditory processing disorder. Now we don't actually have to give a person a diagnosis of an auditory processing disorder.
Hearing loss is enough of a diagnosis. Let's just see if we can treat things and make it easier. So, yeah. I've yeah, it's, it's I'm, I'm currently wanting to expand how we see auditory processing. And I hope that others come along for the ride.
Carrie Spangler: [00:45:24] Yeah. Well, I just want to say thank you for being here today, Angela, because this is such a engaging conversation conversation, and I'm so glad that we were able to have it today.
And then for our listeners, I will make sure that in the show notes out, put a link to your website. I'm sure you have one and you can share that with me and any other resources that you want to share with anyone too. But again, I just want to thank you for taking your time and being a part of the empowerEAR Audiology Podcast.
Angela Alexander: [00:45:58] It is my pleasure. You asked amazing questions and I enjoyed the conversation too. I thank you. You're welcome.
This has been a production of the 3C Digital Media Network.