Understanding Auditory Processing: How to Help the Brain “Hear” Better with Dr. Jody Jedlicka

On this episode of the Brainy Moms podcast, Sandy speaks with co-host Dr. Jody Jedlicka, an audiologist who specializes in the diagnosis and treatment of auditory processing disorders. Dr. Jody explains for listeners the difference between hear loss and an auditory processing disorder, as well as some of the other skill deficits that can be present with auditory processing challenges, such as memory issues, processing speed, and attention. She touches on ADHD, autism, and behavioral issues, as well as things like IEPs and classroom accommodations that can help. You’ll also learn how interventions like brain training can help target and train weak auditory processing to make reading easier and faster. Listeners can also get a better grasp of the different sub-types of auditory processing disorders that fall under the larger umbrella term, including how they are diagnosed by audiologists. If you or someone you love struggles with auditory processing challenges, you won’t want to miss this important conversation!

ABOUT DR. JODY:
Dr. Jody is an audiologist who specializes in the diagnosis and treatment of children with auditory processing disorders. She is also a certified success coach and trainer, and the Director of Support at LearningRx World Headquarters in Colorado Springs. Originally from Wisconsin, Jody has been married for more than 33 years, is mom to 3 adult children, grandma to 5 grandchildren and dog-mom to her rescue, Mikey. She spends her free time with family – traveling, biking, exploring breweries and restaurants and cheering for Milwaukee Brewers baseball. She also co-hosts another podcast, The Sisterhood of Success, with her sister.

ABOUT US: 
Brainy Moms is a parenting podcast hosted by cognitive psychologist Dr. Amy Moore. Dr. Amy and her rotating co-hosts bring listeners conversations with experts on topics in parenting, child development, education, psychology, mental health, and neuroscience. Listeners leave with tips and helpful advice for helping moms and kids thrive in life, learning, and relationships. This episode is hosted by Sandy Zamalis.

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Transcript

SANDY: Hi, smart moms and dads. We're so happy to have you join us for another episode of Brain Moms brought to you by LearningRx brain training centers. I'm Sandy's Zamalis, stepping in for Dr. Amy today to continue our series on cognitive skills and their impact on thinking and learning. Our topic today is auditory processing and who better to help us dig deeper into this topic than our very own co-host, Dr. Jody Jedlicka, who is a doctor of audiology and has specialized in the diagnosis and treatment of auditory processing disorders. Good morning, Jody. 

DR. JODY: Good morning. And this one of my favorite things to talk about. 

SANDY: I'm just super glad to get you to myself this morning. So we're going to have some fun. So a quick recap for our listeners. We've been doing a whole series on cognitive skills because we want people to understand just how the brain works and what skills are needed to have efficient thinking and learning. And we've hit a just cognitive skills in general. We've hit attention, working memory and also long-term memory. We've hit processing speed. We did this episode on logic and reasoning. And I feel like this is one of those big episodes because auditory processing is a big topic. It affects a lot of different things. So let's start there. What is auditory processing and why is it important for our overall ability to communicate and understand speech?

DR. JODY: I love that. Our auditory processing is kind of the term that most people definition that most people say is, “it's what you do with what you hear.” And so people think of a hearing problem as difficulty actually perceiving sound, but there's so much that happens once that sound gets past the ears. So it's what's happening in the brain when you are hearing something. People think that you hear with your ears. You don't hear with your ears. You perceive sound with your ears, but you really hear with your brain. And so when we talk about auditory processing disorders, they can affect a whole host of different behaviors and developmental things in kids. But there's … auditory processing is like in an umbrella term, and so it refers to a lot of different things. And there's different types of auditory processing disorder that kind of fall underneath that umbrella. And I'll just kind of touch on the three most common. And if we need to, we can bring in some of the less common ones. But an auditory decoding deficit is something is when a student. It can be a child or an adult. I always call them students. But when a student has difficulty hearing those sounds of speech clearly. And so everything for lack of a better term sounds a little muddy to them. And it's almost like they feel like they're talking with their hand over their mouth or something like that. And so anything, it requires a lot of concentration to be able to hear. That type will affect things like reading and spelling and writing, things like that. Because they're not hearing the sounds correctly, they have a hard time pairing those sounds to the correct codes that are required for reading. A prosodic disorder is one that we don't think about very often. A prosodic disorder happens in a different part of the brain, a different part of the auditory system. And what that is, is it's difficulty understanding the inflection or tone of voice or sarcasm, they'll have difficulty with. Kids who have that difficulty will think everybody's mad at them all the time because they just have a really hard time not hearing the information but rather understanding kind of the feeling behind it. Does that make sense? 

SANDY: Yeah, that totally makes sense. 

DR. JODY: Yeah, and then there's another one called integration disorder. And what that is, is it's the two sides of the brain talking to each other. Can I put it all together? And probably my best example of that one. So those kids will have trouble just kind of doing more than one thing auditorily at the same time. So they may have difficulty like looking and listening at the same time, or doing something while they're listening like copying off the board, but a good example of that one would be. I had a little guy in my office and when he talked to me, he would look over my shoulder. And the mom said to him, “Look her in the eye when you talk to her. It's really important to make eye contact.” And it clearly was something they'd been working on. And he looked at her and he said, “Yeah, but I can't hear her when I look at her.” And so, you know, kids will always tell us what's going on. Right? So three main types, the types we see the most, and then there's some that occur a little less often. 

SANDY: Well, you talked about some of the common challenges and those different diagnostic sub pieces of auditory processing. How do you typically assess and diagnose auditory processing disorders for your clients or students?

DR. JODY: Sure. Auditory processing disorders need to be assessed by an audiologist. And not just any audiologist, they really have to have some specialized training in that area. And so they will do a hearing test just to rule out a peripheral hearing loss. But the tests that go along with auditory processing diagnosis will dig deeper. And what we're trying to do in the testing environment is really stress the auditory system, really push it to kind of the boundaries of what it's capable of doing. And we're looking for when do things break down for that student. Kids who have auditory processing disorders will clearly break down earlier than, kids who don't. If you kind of pick apart or look at how the different tests kind of fit together, that's what allows you to put that diagnostic label on that. So if you want to call it a decoding deficit, they're going to struggle or break down in one test or a different test if they're struggling with a prosodic disorder. And so you're just looking for number one, is that breakdown happening? And number two, where are they breaking down and what is that telling me? 

SANDY: Okay. So, just to reiterate what you said, first you always check for hearing loss, right? To make sure there's no hearing loss issue. But for individuals who struggle with auditory processing, do you typically see that hearing loss or no, the hearing is fine. It's just how the brain is processing the sound that is glitchy. 

DR. JODY: Right. That's a really good way to say it. You actually do need to rule out peripheral hearing loss before you test for auditory processing because people with hearing loss also have weak auditory processing. It's just due to a peripheral hearing loss. So it's not really an auditory processing disorder. There's a different underlying cause for that. And so we're going to treat it a little bit differently. 

SANDY: How does auditory processing different differ between children and adults? How does that, how does that impact your approach to what you're doing?

DR. JODY: That's a really good question. I would approach them much the same way as far as the testing goes, but I think what differs is people who are adults just struggle with different kind of outcomes from that. So they, kids live in a different environment a lot of the time. There are a lot of times in school or in the car or at a soccer practice or things like that. Adults will have difficulty like sitting in a meeting and listening to a speaker while there's other noise happening in the room. Or they may have difficulty in social situations, you know, feel awkward or feel like they can't pick out one speaker from the rest of the people who are standing around with them talking. We actually call that “the cocktail party effect” because you, you know, you've been to a cocktail party where you've been trying to focus on one speaker and it's hard to tune in.

People with auditory processing disorders have a much lower threshold for when they can do it. So, also because they've been dealing with that problem much longer than kids do, I think it affects them emotionally more too. It's, they don't have the confidence that some people have because they don't trust themselves in those social situations or work situations. And so that can affect that too. 

SANDY: This is a random story. I just thought of this. So what I know they don't do this anymore, but when I was little I had to have tubes put in my ears because they weren't draining. I don't, like I said, I don't think they do that anymore as a procedure. But I remember I remember specifically when they took the tubes out that I was sitting in the car and I had my hands over my ears and my mom was like, “Are you okay?” And I just kept saying, “It's so loud. It's so loud. Everything is so loud.” And it, what made me think of that is what you just said, but, you know, with kids, you get used to your world as a kid, that's all, you know and all of a sudden when that input comes in and you're able to catch those sounds and things that, you know, it can just impact you. And I guess it happens in the reverse too. Right. So as we get older, we get less confident. I know my husband is having that issue, that cocktail party effect, where it just frustrates him when he's in a situation and he can't focus because there's just too much stimulus. 

DR. JODY: Yeah, right. I also feel like people start to avoid those social situations then. And we all know how important social interaction is for cognitive health in general, as you get older. And so it really is affecting so much more than just that event, that social event. And then when people go to those events and try and tough it out, if you will, they don't participate. They tend to be the person sitting in the corner, not talking to anybody or, and maybe singling somebody out and pulling them aside for a conversation. So it does affect them in a lot of different ways. Your random story. They do do tubes still in, and I'm a huge, huge fan of tubes because if kids can't hear, absolutely, they're going to have speech and language delays. So, my daughter when she was almost two. Had her first set of tubes put in and was not saying even a single word that I could understand as her mom. Six weeks after she got her tubes, we had been keeping a journal of what words she could say, we were at over a hundred words just in six weeks that and she was putting two words together. It's like, you know, it really helps. 

SANDY: It’s that input. 

DR. JODY: Yeah. Yeah. Yeah. And kids who have frequent ear infections are actually at risk for auditory processing disorders because they haven't had the auditory exposure for their auditory system to develop. If you don't use it, you can, I wouldn't say lose it, cause they probably didn't have it to begin with, but it doesn't help the matter any. 

SANDY: So, so let's talk about that. What are some signs and symptoms that parents can look for, for their kids that there might be some auditory processing difficulty?

DR. JODY: I know this one would be a hard one because kids don't listen to directions for different reasons, but if they have trouble following directions, if they need to look at you in order to be able to follow directions. Sometimes I'll have parents say if my son is sitting in the backseat and I'm sitting in the front seat talking to him he can't hear me. Because you use your visual skills, whether you realize it or not. People tell me all the time that they hear better with their glasses on. And so, if they're sitting in the back, they're not looking at your face. They'll have a lot more trouble hearing with background noise, just like adults do. And I would say that in a typical classroom, it's much noisier than what most of us realize. Those kids are just really sensitive to, to the noise in the background. So difficulty …  I think the biggest, most impactful one for me is learning to read. It's really difficult to learn to read if you don't have a good clear idea of what those sounds should be sounding like. And so, when you see kids who have trouble just with that initial instruction and learning how to read, those are always kids that would throw up a red flag for me.

SANDY: Okay. Would you include like speech and language delays in that as well, obviously? 

DR. JODY: Yeah. Yeah. Very good. So they may do things like, well, have articulation issues that go beyond or last beyond the time that they end for other kids. So those would be great kids to refer for a speech evaluation. They may say their sounds out of order. Like we all expect kids to say “buschetti,” or as my grandson will always say—and I think it's so cute, but, we have auditory processing disorder that runs in our family too—but he'll say, instead of tomorrow, he'll say “tumrano.” And he just, he's convinced that that's what it sounds like. And so, yes, speech and language issues too. Those are always a red flag for me. 

SANDY: My brother's was “celery.” He called it “ricely” for forever. He just could not get it turned around when he was younger. What about, what if it flies under the radar a little bit as sometimes these things do. What would it look like for, say, a middle school or a teenager if auditory processing that may be an issue that we need to address?

DR. JODY: Yeah, I think a lot of the same behaviors, but they've been dealing with them for so long, so their self-esteem, their confidence really starts to take a hit the older that they go. On the other hand, though, it is never too late to address this problem. And so, I would say that as soon as you do have concerns or worries about that, just get it checked out and see if you can't start on the road to better performance. And so I think, same things. It's just that some of those, the way that they see themselves, the way that they feel about themselves, the way that they approach challenges. They just don't trust themselves all the time. :Gosh, I swear I thought I heard her give me this direction, and she said, do this, and I can't do anything,” you know, and so we're tough on ourselves, and it just gives them one more reason to be tough on themselves, right?

SANDY: Yeah. One of the things I tell parents is, even if they're great readers, if so, like example of reading has flown under the radar, usually it shows up in spelling too, right? Like having a really hard time breaking words down and figuring out spelling is kind of a little bit of a red flag. Like, “Hey, there might be an auditory processing concern area here.”

DR. JODY: I have yet to have a parent come in and not have other concerns like that, you know? Auditory processing doesn't exist in a vacuum, just like all the other cognitive skills. And it's really important, I think, to look at the whole big picture. 

SANDY: Well, why don't we do that? How does auditory processing impact cognitive skills like attention, memory, and just overall learning?

DR. JODY: Yeah. So auditory processing actually can mimic attention problems. So that might be the thing that a parent comes in saying, you know, “He's just not listening. He, you know, he's got attention problems. I give him a direction. He can't remember the directions.” Well, did he hear them? Or is it a memory issue? Or is it a behavior issue? I think that if kids can do well, they do do well. Right? So, I always think that if there is a consistent complaint or behavior that you're seeing from your child, I think it's worth checking it out. Because nobody wants to feel like they're just not, just never getting it right, right? So I think it's important to separate out what the issue is and what the surrounding issues are. And so I can't stress enough that looking at auditory processing in a vacuum, while it'll still help, it exacerbates all those other issues that might be present in the child. So you really do need to look at memory. You really do need to look at processing speed. You really do need to look at the other things that make up that child. Because every time there's a piece that's weak, it makes the problem look bigger. Does that make sense? 

SANDY: Yeah, exactly. And I love how you talked about it mimicking ADHD sometimes because, you know, I talk about just that selective attention piece when we did our series on attention or a podcast on attention, we talked about that selective attention piece. Well, if you have weak auditory processing, having selective attention, being able to prioritize sound is really hard, which is kind of what you described at the beginning. 

DR. JODY: Yeah. And I think that kids learn what they can do and learn what they can't do. And then they don't actually even put forth the same amount of effort if they don't think they can do it. So, for example, I was sitting in a classroom one time doing an observation of a student who had auditory processing disorder and the teacher, like great teachers do, was wandering around the classroom while she was lecturing and talking and giving directions and things like that. And you absolutely could watch that student. And if the teacher was in a, within about five feet of her, she was focused. She was on. She was with them. As soon as that teacher either turned her back or walked away from her, you could just almost see when she crossed that line, the attention was gone. Because she understood that when she's over there, I can't hear her.

So when she comes over here, I'll make sure I'm really paying attention. So it was funny. Kids do what they have to do to survive, right? 

SANDY: They do. They do. Let's talk aboutother diagnoses that tend to have auditory processing in their panel, right? So we mentioned ADHD. What are some other conditions that tend to have that comorbid piece of auditory processing weakness?

DR. JODY: Yeah, definitely dyslexia. Or reading issues, because, again, I've said this before, but you have to have a really strong internal feeling for what those sounds sound like in order to be able to map those to the codes that we're asking them to use for reading and spelling. And so kids who struggle with that, almost always there's some piece or component of auditory processing in there. I also would say that, we've talked about auditory processing disorder, one of the things that I really strongly feel is that you can have disordered auditory processing and that's going to cause issues. You can also have weak auditory processing and that's also causing issues. So a clinical diagnosis of auditory processing disorder, they have to score between, they have to score lower than two standard deviations below the mean on this many tests or this many subtests. And while I think that is awesome, there's this whole group of people who scored 1.5 standard deviations below the mean. And that doesn't mean that they don't have issues stemming from their auditory weakness and they also should be addressed. 

SANDY: Okay. What about autism? 

DR. JODY: Autism, kids with autism, I do think have disordered auditory processing because they can also be hypersensitive to sound. They have difficulty focusing on what's being said and tuning out the rest of the things around them. And so by improving their auditory processing, you might improve some of those things, but there are generally other comorbid issues or comorbid behaviors that go along with that. And so by tuning into their auditory processing and treating it, which is the good news about auditory processing disorder, is that it's treatable. It's something that you can always make better than what it is. And so by doing that. Improving that piece of it, you're pulling one thing off of kind of their plate, their load of things that they're having to work around or deal with. 

SANDY: Okay. Well, let's talk about what typically happens if you do get a diagnosis of auditory processing disorder, or if you do some testing and notice that you have auditory processing weakness. What are typical strategies that we work on to help get, build that skill or compensate or accommodate for that skill?

DR. JODY: So there's, number one, I think one of the challenges of going and getting a diagnosis is that audiologists can diagnose it, but there are very few audiologists that treat it. They may give you this nice long list of recommendations and I've been guilty of that myself, but they would be things that are accommodations things that they could do in school, like preferential seating. If you're sitting closer to the teacher, you have a better chance of having a good visual view of her face while she's talking and proximity to her. However, most teachers wander around the classroom while they're teaching and they can't be tied to—

SANDY: Well they have to, right?

DR. JODY: I know survival, right? Yeah, they have to and any of us would suggest that to a teacher. Make sure you're wandering, you know, But anyway, so preferential seating is a good one. Another one is pre-teaching things that the student is going to hear in a new lesson so that they're familiar with the vocabulary with the concepts, things like that. There's technology that can be involved. So we might recommend something like an FM system, which the teacher wears a microphone, the student wears an FM receiver. It kind of looks like a little mini radio. Sometimes they're over the ear. They look like a hearing aid. But then no matter where the teacher is in the room, the student is hearing like they're that far away from the teacher. So, close to the teacher. And they always have a clear teacher's voice is louder than the rest of the class. So she has her back turned or things like that. They're able to hear everything. And then beyond making accommodations and technology, there's also auditory training. And so auditory training is much like we would do with somebody who has a hearing loss. But what you're doing is you're training them to hear the sounds, recognize the sounds clearly, hear them in the right order, hear them accurately, be able to play with and manipulate those sounds. And not only is that a good way to treat an auditory processing disorder or weakness, but it is also one of the key critical skills kids have to be good at in order to have reading and spelling come more easily to them. And so we have the added benefit of kind of hitting a couple different directions.

SANDY: So for an audiologist who does treat auditory processing, that's what they would do. They would have ways that they would be initiating sound and the student would have to work with that, with those skills and be able to do, you know, isolate sounds, those kinds of things and do it quickly.

DR. JODY: Yeah. Yeah. And then depending on the child, there may be say working. memory issues with that child too. So, ideally they'd be looking at the whole picture and looking at what other skills are contributing to their behavioral challenges. And when I say behavior, I think I don't mean bad behavior. I mean, just what are the manifestations of that in the classroom or in their real life? And addressing all of those things together so that they don't have so many things they have to work around. 

SANDY: Okay. That's what we do at LearningRx. So what, let's talk about that a little bit. What is it that we're, that we do specifically that addresses this auditory processing weakness that's different than what you may find, for example, in an office?

DR. JODY: Yeah. So auditory processing is actually what brought me to LearningRx. And so, I did have a private practice. I did do testing and diagnosis for auditory processing. I did write really great reports that I sent back to the schools with all accommodations and technology suggestions and things like that. But I always kind of felt like when a parent came into my office, they had been looking for a long time for what's the answer. And I could diagnose the issue, but I felt like I was giving them a report and saying, “Good luck with this.” You know, like it wasn't really fixing anything. So I was always on the lookout for what can we do to make this better? And we as audiologists know auditory training would make that better, but there's a lot of time and energy and effort that goes into creating a good auditory training program. And there are some out there, but I feel like they're very few and far between. So what we do is, our auditory training piece of our program is so far beyond anything else that I've ever seen. Because we're doing metronome training and because it is so targeted, we can make improvements so quickly with our kids. The other thing I really love is the way that it's put together allows a trainer to be on the lookout for what that student's errors are and to adjust their target sounds that they're working on on the fly. And it can happen so quickly that there's not even a pause in the action that we're doing. And so, it just, they've thought of all the different little pieces that could possibly happen during a training session. And because speed is a part of our training, we're also working on processing speed, but we can get so many more opportunities to the student that's sitting in front of us. Listening opportunities, items that we're covering in a session, we can probably multiple times, we can get multiple times the items that we cover in a session done because of the way or the methods that we're training. And we're always pushing the limits. So, always working on what a student can do. So we'll work really hard. They'll get good at that level. And then we challenge them. And then they work really hard at that level. And then we challenge them again. And it's that space where we're challenging them, that's where the growth happens. That's where the improvement happens. And then again, we're looking at things like memory and processing speed and all those other skills that need to work kind of in coordination with auditory processing, and I think that's the biggest difference between us and any other, any other option that I have seen.

SANDY: It's more of a whole-brain approach. 

DR. JODY: Exactly. 

SANDY: We're trying to get the whole brain to work together more efficiently. You mentioned the metronome and just how powerful that is. Why is that so impactful for auditory processing? 

DR. JODY: Yeah, because timing issues like my grandson who says “tumrano,” he doesn't hear the order that those sounds go in. And sounds and words happen in milliseconds. I mean, tiny. And so, the metronome training helps them speed up their thinking their ability to recognize those sounds and to hear them in the right order. Which again is another thing that our training does, is it helps them to hear them in the right order. It helps them to play with and manipulate those sounds so that they can get better at that.

SANDY: What advice would you give to educators or caregivers working with individuals who have auditory processing difficulty in terms of supporting that student's cognitive development? 

DR. JODY: Yeah, I think because I think kids do well if they can do well, it's looking for how is that affecting them. So if you know that your child has difficulty paying attention when the TV is on, if you have something important to tell them, turn the TV off first. So look for ways to be empathetic about what's going on with your child. And don't give them important information if it's not an ideal situation. The other thing is is, the best thing about having that concern is there something that can be done about it. So it's not a, “Here's a diagnosis. Good luck for the rest of your life.” It's, “Here's a diagnosis or a weakness. And let's work on that.” I think we can make it better than what it is. So we can take, especially with what we do, Sandy, we can take somebody from a weakness and make it better than what it is. We can take somebody from disordered and make it better than what it is. And while there's lots of things that can be done within the school day, what we're doing is different. We're not working on the information that they're learning; we're working on the skills that they need to be good learners. And also school people, bless their hearts, they are the most committed, loving, caring people in the world, right? But they're constrained by numbers and they're constrained by the time that they have. So they may have a caseload of 40 kids and have to figure out how do I get all of those kids in for speech therapy twice a week or whatever it says in their IEP. And if you count the time they spend walking to the class and getting them back, you know, it absolutely doesn't hurt and often helps a lot, but we just have that one-on-one opportunity to really focus on that student for much more time. So we can make progress faster. 

SANDY: I was going to highlight that too. You know, teachers really don't have that capacity to do one on one. And a student, or an adult for that matter, to anyone who struggles with auditory processing weakness or deficits really needs the one on one, right? They're having to battle, you know, competing auditory information. So having that one-on-one component is helpful to them because they can, they can build confidence quicker. 

DR. JODY: Yeah. I always worry too about a parent who is going through like the IEP process. It just takes time in order to do it right and get all that testing. And they are looking at the whole picture. But it takes time. And so it might be the beginning of the school year. And now we're at the middle of the school year before anything even happens. And now we've got to implement all of these things and they have to have qualified under an appropriate diagnosis before they're by law allowed to provide any accommodations or treatment for a student. And there's just so much time lost. And what if your child is the one who scores 1.75 standard deviations below the mean, then we all know they're still struggling. Right? But the state says I can't see this student because they didn't hit some benchmark. They didn't do poorly enough. And we hear that all the time. So those “falling through the cracks” kids are the ones I worry the most about. 

SANDY: Yeah, we are about out of time, Jody. Is there anything that I didn't ask you about that you want to kind of help us wrap up with today? 

DR. JODY: Oh, goodness. Oh, goodness. I wasn't expecting that question. I think, just my takeaways and I've said these before is that if you're concerned about it, look for help because there's a lot that can be done to improve that. It's not necessarily a life sentence. We can mitigate the effects of a disorder like that. If they have weakness versus a disorder, that's okay. Both of those things can be treated. And again, really important to look at the whole picture, to look at the whole student, be able to address all the other things that tend to go along with an auditory processing disorder.

SANDY: Well, we are out of time and need to wrap up, but this has been such a fantastic conversation. Thank you, Dr. Jody. Thank you so much for listening today. If you like us, please follow us on Instagram and Facebook at the Brainy Moms do it now, before you forget, if you liked our show, we would love it. If you would leave us a five-star rating and review on Apple podcasts so that we can reach more parents just like you. If you would rather watch us, you can subscribe to our YouTube channel. That's all the smart stuff we have for you today. Catch you next time. 

DR. JODY: Yeah. Have a good one. Everybody.