Is my child lazy...Or is it 'Output Failure'?Noted pediatrician offers a new kind of diagnosis
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“Laziness is in the mind of the accuser….When you say someone is lazy, you admit that you don’t understand him.” Dr. Levine concludes, “What appear to be dysfunctions during childhood may transform themselves into assets as individuals mature. If we are able to preserve their self-esteem, their optimism about the future and their motivation, children with output failure can grow up to become tremendously productive people.”
Resources: • The Myth of Laziness by Mel Levine, M.D. (Simon and Schuster)
• A Mind At A Time by Mel Levine, M.D. (Simon and Schuster)
• Getting Our Kids Back on Track: Educating Children for the Future by Janine Bempechat (Jossey-Bass)
• All Kinds of Minds, a non-profit institute founded by Dr. Mel Levine that develops products and programs to help parents, teachers, clinicians and children deal with differences in learning; www.allkindsofminds.org
Children Can’t Always Listen As many as one in five children may have an auditory processing problem, making listening and learning almost impossible
By Anthony Ebersole
“OK, class, before we begin today’s review of chapter nine in your science book for tomorrow’s test, please take out your math homework and put it on top of your desk for me to pick up; then we’ll get started.” David takes out his science book and just stares into space. What’s the problem? Wasn’t he listening to the teacher’s directions? Distracted? Poor attention? Hearing loss? There might be another explanation. Perhaps David is able to hear the sound of the teacher’s voice, but has a problem processing or understanding what was said — particularly when the language used is complex, spoken rapidly, or is lengthy, and when there are a lot of visual or noisy distractions in the room. This inability to fully understand spoken language in the absence of a normal hearing loss is called a central auditory processing problem. Research indicates that up to 20 percent of school age children have some form of auditory processing disorder (APD). This means they can hear, but their brains may not be able to effectively process sounds. Undiagnosed, APD in children can frustrate parents and teachers for years, since only a trained audiologist can detect the disorder. Children (and adults) afflicted with APD often demonstrate a reduced ability to read, spell, comprehend and communicate with others. To them, spoken words may become jumbled, often making any communication or understanding impossible. Left untreated, these difficulties can lead not only to academic failures, but to increased anxiety in social settings, the inability to make and keep friends, and a damaged sense of self. While APD is treatable, it is often a disorder without any surefire cure. The earlier it is detected in children the better, and there are a variety of strategies to help overcome listening and processing difficulties. In the classroom and at home, interventions can help students with APD learn and achieve. Success depends not only on early detection, but also on a consistent team effort by the child, his parents and his teachers.
“What?” With children, a tip-off that APD is present is his or her tendency to ignore a speaker when engrossed in something, or constantly replying, “Huh?” or “What?” whenever spoken to. This stems from their hearing not only the sound of a voice, but also all kinds of other background noise, and being unable to discriminate between all the sounds. These children are usually extra sensitive to loud noise, have a tendency to confuse similar sounding words, or get confused if several directions are given in one sentence. The origins of the disorder can be traced to any number of factors, including frequent ear infections as a young child, under stimulation during a child’s early years, dietary and environmental issues, allergies, even family history.
A child should be tested for APD if they display any number of symptoms, including misunderstanding directions, delays in responding to instructions or questions, or problems understanding in the presence of background noise. APD children often have poor expressive or receptive language skills, and can lag behind in spelling, reading, and other academic problems. Socially, these children also have difficulty forming or maintaining friendships, because they lack the processing skills that allow them to pick up non-verbal social cues, like humor, sarcasm or subtleties of speech. “Many children with APD become masters at hiding their disorder,” writes Teri James Bellis, Ph.D., in her book When the Brain Can’t Hear, Unraveling the Mystery of Auditory Processing Disorder. While they may actively try to participate early on in classroom or other activities, Dr. Bellis says these sensitive children often become guarded when they are repeatedly ignored, even ridiculed, because their responses are slow or seem to lack understanding of a topic. “After years of (feeling outcast or ignored), some (APD) children simply withdraw from communication altogether…But this is merely a mask that allows them to protect their vulnerable, hidden inner selves and to retain some semblance of power over the daily situations in which they feel powerless,” Dr. Bellis writes. Since APD is not commonly recognized or understood by parents or teachers, a child can go years before a proper diagnosis is made, and only then by a trained audiologist able to go beyond a routine hearing test to examine how a child’s central nervous system is functioning.
Getting the Right Diagnosis Even though a child may have passed a school-screening program, only an audiologist — one who is familiar with APD — can rule out all degrees of peripheral hearing loss and check out the integrity of the auditory system. While children with this disorder often show good hearing results on routine screening tests, at the core of their difficulty is an inability to integrate information when it gets to the brain. “Integration is basically synthesizing information in terms of how the two sides of the brain work together, so that you can take in more and more stuff,” according to Jeanane Ferre, Ph.D., an audiologist who specializes in APD. “Your output skills reflect how well you can organize, sequence it and get it out again. Any type of breakdown in any of these areas is going to cause a processing problem,” Dr. Ferre says. Auditory processing in children affects their ability to solve problems, to reason things through. The breakdown can begin when sounds (words) aren’t getting through properly, so they don’t hear a lot of the information needed to solve problems in the first place. These children can be inflexible. That’s because in their attempts to overcome their difficulties in understanding sounds, they cling to a narrow, black-and-white view of the world. They aren’t able to see the subtleties, the gray areas in words or relationships, like irony or sarcasm. They interpret things literally. Because of this, they often have difficulty thinking logically, or seeing the consequences of their actions. In other words, they can’t see the trees for the forest. They need help not only in seeing the big picture, but all the steps and parts that go to make up that picture. APD children can seem younger and less mature than other kids their age. In their ability to synthesize information, they actually are younger, and have to be thought of as such. They can be very sensitive to criticism, often hearing anger in adult voices when none is intended.
Strategies for Learning and Teaching with APD Once a qualified audiologist makes a determination of APD, a number of strategies can help improve processing. They include various therapy programs, managing the listening and teaching environments, and learning more active listening techniques. Some children can catch up through this remediation and can grow out of the problem. Still others will have processing difficulties throughout their lives. The degree of success can depend on the extent of the disorder and types of interventions.
—In the classroom. The learning environment needs to be modified to help the child with APD. These changes should include paying special attention to classroom acoustics to reduce reverberation or distractions, and preferential seating to maximize benefits from a teacher’s auditory and visual cues. An open, unstructured teaching environment should be avoided.
—Teaching modifications. There are numerous improvements that can be made in teaching APD children. According to Dr. Dorothy A. Kelly, an audiologist who specializes in teaching the hearing impaired, they should include: • Organization – these include regular routines and schedules that increase predictability and decrease listening and memory demands. • Repetitions/Restatements – when a direction is not understood or not completed, wait a little while, then restate it in a different way. If the direction is still unclear, repeat the direction, slowly, a bit louder. Some children have slower processing time. • Visual Aids – these can reinforce auditory information. • Eye contact – it always helps to say the child’s name before speaking to him or her, and maintaining eye contact, which helps speech reading and attention. • Pre-teaching new material – it is often helpful for someone (a parent, an aide) to go over new vocabulary or critical concepts before they are delivered to the rest of the class. These can be presented in writing, so the student is familiar with the words and ideas that will be presented.
—Strategies for the child/student. Children with APD can learn to be better listeners, but it takes work and patience. According to Dr. Kelly, these involve: • Requesting clarification – whenever words seem unclear, the child should be encouraged to ask the teacher for additional information or to restate what she just said. • Take accurate notes – to listen for key words, summarize in bulleted form, restate the lecture aloud using notes. • Follow directions accurately – a student should try to be aware of “what” he or she is doing throughout a task. • Proofread – this is a way to check written work, and can include listening to how the voice changes as words are read aloud.
There are a number of therapies available for people with APD, including audiotapes, music lessons, exercises that force the two halves of the brain to work together, and computer-based therapy programs. These should be employed only after a thorough diagnosis by a qualified audiologist and should be directed toward the specific type of APD in a child or adult.