Friday, March 26, 2010

A Rant, If I May

Doing my blog rounds this morning has been rather frustrating, to say the least. I mean I guess it's my fault that I subscribe to so many angry feminist type blogs, but today has been more demoralizing than most.

First, there's Amanda Palmer's Godwin-fail (NB: the link at the bottom of that post has very graphic images of KKK lynchings, do excercise care if you decide to click over) [Edit: I just realised that Godwin has to do with Nazis and not the Klan. Whatevs, it's Friday...], which breaks my heart not because I have been any fan of hers at all but because of the chorus of people in comment threads everywhere (pretty much since the Evelyn/Evelyn debacle) talking about how she was such a feminist role model for them. And feminist role models are far and few between. And when one of them fails this hard and this consistently it's heartbreaking.

Next, there's the studies done on campus rapists about how, contrary to the dominant narrative of the decent, upstanding boy that just made a mistake, a small percentage of repeat predators are responsible for a staggeringly large proportion of rape cases. The follow-on from that, of course, is how rape culture works to preserve this myth and allow these serial predators (who are well aware of the machinations of rape culture and how it will protect them, even if they don't explicitly know what it's called) to keep raping women. All the while college-aged women are constantly given daft "rape prevention tips" which completely obscures any and all perpetrator responsibility.

Finally, there's the post that hits close to home (and what I intended to spend the meat of this post discussing, apologies for the lengthy preamble) about the dismissal of needs.

I'll wait while you go read it. The comments on the post are worth your time as well.

The reason this issue bothers me so much is that I do hearing tests on children who are having academic issues at school, or behavioural issues at home, or both. The idea is that before any of the other developmental services can swoop in and do their thing, sensory deficits have to be ruled out in case the "fix" (which is a problem I'll leave for another post, another day) is as simple as hearing aids or properly fitted glasses (not that hearing aids are analogous to spectacles because in many cases they don't restore normal hearing, but again, another post, another day, probably another blog too).

But what many parents in my clinics fail to understand is the difference between hearing and listening. You can have perfect hearing but if your brain can't parse and process the sounds your ears are so perfectly delivering to it, then there's no way you can make sense of the soundscape.

The world is a noisy place. Where there are computers, there's the tapping of keyboards and the whirr of processor fans. Where there are people, there are the shuffling-fidgeting noises, multiple conversations, footsteps. Then you have the sounds people don't even notice: hums of fridge motors or air conditioners, the low babble of conversations in the next room, that ubiquitous piped music in retail stores that are supposed to sublimnally enjoinder us to slow down, look at the displays and buy buy buy. That's all sounds that a neurotypical brain can filter out. Those are the same sounds that mix and mumble and tumble through things these children with processing issues actually WANT to listen to, but cannot.

I have met so many parents that cannot wrap their heads around this. When I explain that while the hearing is fine, that the problem the child likely has is a listening one, they smirk and nod and say to the child, "See! I knew you were just not listening to me!". And the hurt I see on kids faces really breaks my heart. I want to be their ally. I want to explain to their carers, the people on which their world depends that they do WANT to listen, but they cannot. I want to explain that there are many things they can do to make it easier for their child to listen, to parse that confusing, jumbly, noise their brain is presenting to them - without making it sound like concessions you have to make for a willful and "broken" child. To let them know that needing captions on TV is a valid and sound strategy and that they should encourage their children to assert themselves and ask for what they need from this noisy world of ours in order to make sense of it. Like asking for repeats. Like asking for repeats even if they get teased about being deaf, or get chastised for not paying attention the first time, or any of the other terrible things that happen when you ask for something already once given.

I suppose it's a little like trying to explain to a fish what water is, exactly. Most people don't have to think about listening. It's easy. Their brains filter all "irrelevant" sounds out before they've even noticed them. They can tune into speech and know exactly what words that stream of uninterrupted phonemes translates into. Not everyone can do that. Don't dismiss the needs of others just because you don't have those same needs.


  1. Hi there, I am a writer for Here there be dragons, and I really appreciate this post. I am an adult who recently had a hearing test that stated I have more than perfect hearing, I hear better than most people. there was no discussion that my issues hearing may be related to my Autism and other sensory processing issues.

    I think you may try saying, instead of a listening disorder a processing issue. Then describe the difference, and try and point out that being overwhelmed by sounds does not mean that the child isn't trying. You can also try talking to the child first.

    That was smomething I longed for with medical professionals for a long time, and even with a caregiver present as an adult at times I have had to remind people to speak to me.

    The fact that you are trying also makes a difference. Not everyone will figure it out or get it, a lot of parents in my experience are seeking an excuse to blame the child so that they don't HAVE to make concessions to their child's well being. Please do NOT give up. You are making a difference by just trying.


    Kat Fury

  2. "When I explain that while the hearing is fine, that the problem the child likely has is a listening one, they smirk and nod and say to the child, 'See! I knew you were just not listening to me!'"
    The whole thing with "listening" is that in this situation, the adult is understanding that word to mean paying attention and paying respect. From what I perceive of this situation, you meant "listening" to mean making an effort to hear something and understand it. Therefore, when you said that the child had a problem with listening in that they were trying to hear, but couldn't get anything out of it because they couldn't process it. The adult in that situation literally took it to mean that the child was deliberately disrespecting them by not trying hard enough to listen. But then again, that goes back to the issue of the dominant figures in the situation not being able to understand the disabled person's needs. It must also hurt for the child to be spoken of that way because of the way the parent-child relationship is set up. Basically, a child has to live with their parent until they reach the age of majority and they are also supposed to love their parents unconditionally. Therefore, being spoken to and about that way can hurt a lot.

  3. Thanks for dropping by Kat and Sadderbutwiser.

    I definitely do talk to the kids in the soundbooth before I bring them out to explain the results to their parents. That way I feel that I can give them a few strategies they can use without saying so in front of parents that will think that now they have strategies, what's the problem.

    I will start trying to use the word "processing" instead of "listening". I always thought listening was the more accessible word but the connotations outlined by Sadderbutwiser are getting in the way of a good explanation.

    Thanks again for stopping by :)

  4. @Cat in the Cream: How would you go about explaining the difference between processing and hearing to parents, though? I know that those issues are most likely foreign to them, but I think that if you're going to mention processing, then an explanation, put in layman's terms, of how it is separate from hearing is necessary.

  5. @Sadderbutwisergirl:

    That's basically the crux of my problem. The spiel I've been using up to this point is:

    "There are two parts to hearing. The hearing part, which is whether your ears can pick up high sounds and low sounds that are very quiet and the listening part, which is whether your brain can make sense of what it's hearing."

    Which is admittedly very clumsy and is giving rise to the problem you've eloquently outlined above - with the parents thinking this is somehow volitional.

    I'm going to think carefully on how I can make this clearer. Maybe with an example of how there are alot of background noises that we don't notice because our brains are doing a good job of filtering it out, but that their kids' brains haven't developed the skills to allow them to do it (and depending on pending diagnoses and therapies, may never develop the skills to bring them to their parents' level of 'listening').

    Still thinking on it though!

  6. @Cat in the Cream: Due to my involvement with choir, I have gained some skills at filtering out background sound. The reason for this is that each voice part is assigned a different set of notes and sometimes a different set of words to sing. To succeed in this setting, I had to learn to focus only on what the people in my voice part were singing and filter out the others. However, filtering out background sound or tuning it out is still a difficult thing for me, especially outside of a choir setting.
    On the explanation, I would suggest also bringing up syllables and how those can be harder to process than simple sounds.

  7. I spent some time volunteering with kids with sensory-processing disorders, and it's definitely a real thing, and distinguishable from laziness or stupidity. You only have to spend time with the kids to notice that they're bright, good kids. I wouldn't refer to it as "listening" because that implies an act of will. "Processing" is good.

    The thing is: it actually is fixable, or at least improvable. At the school where I worked there were special headphones that played a background noise tape, I believe to train the children to listen "through" the noise for the teacher's words.

    Most people (myself included) can't wrap our heads entirely around the disabled-rights stuff. It's usually simpler, I think, to just take that out of the picture and say, "It's not your child being bad, it's an anomaly in his brain, and we can help him to work on overcoming it."

  8. I have ADD. My coping strategies have gotten much, much better, but as a child noise as a stimulant that I couldn't deal with. I could either hear ONE thing, or EVERYTHING. And if I was listening to ONE thing, it was probably the most annoying sounds in the room (but not necessarily the loudest).

    To me, life is a series of constant forgettings. When I hear the clock tick, I can't remember that the noise is the clock, so I have to check every. single. time, because what is it? What is that light? What is it again? What is that smell? What is that feel? I know I just identified it a minute ago, but now I have to identify it again, because I know it changed somehow, and I have to make sure it's still the same.

    If you want my advice, (and I don't know if you do) tell the parents that little Timmy has perfect hearing in his ears, but his brain hears everything at the same volume. So, the clock, mom's voice, the TV, the clicking of keys, and Dad's breathing are all equally loud. (This isn't true, but it's the analogy that most helps other people understand what my sensory world is like).

    When I was a child, my mom used the touch-repeat-three system. If she wanted me to do something, she'd touch me on the shoulder (not yank or grab, but touch), tell me to look at her face and concentrate on her mouth, and then tell me to do something in a set of three. (Get your coat, put on your shoes, and meet me at the door.) Then she'd ask me to repeat back what she'd said, and I'd have to do the request immediately.

  9. Thanks for all the advice. This is really going to help me improve my feedback in clinic.

    Keep them coming! :)

  10. Perhaps a use of analogies could help some parents understand? Identifying situations in which neurotypical adults have different levels of ease/difficulty processing sensory information might give them an understandable image to latch onto for explaining the child's difficulties, something that can rival the easy-to-understand image of the "difficult, disrespectful child."


    1) If you play a radio, especially with lyrics or dialogue, while speaking to them at approximately the same volume and distance as the radio, they will have difficulty picking out your words from the din, and understanding them. Follow this up with the explanation of brains' differing ability to filter out sounds based on importance---i.e. their brains don't know how to filter out the radio from the speech, and their child's brain might have the same problem with a computer, refridgerator, air conditioner, et cetera.

    (These next are perhaps less accurate as analogies, but still put an understandable image to "difficulty processing.")

    2) Speak, in English (assuming it's their dominant language), a few quick words all strung together, then ask them to repeat back what you said. Then speak, in another language (not one they speak), a few quick words all strung together, and ask them to repeat back what you said---brains which are accustomed to the sounds of the one language but not the other will find it harder to remember all the syllables.

    3) Show them text with a few font styles, contrasting easy-to-read fonts such as Times New Roman with ones that require a bit more effort to decipher, such as the Olde English-style ornate upper-case letters that only get used as accents, or heavy script types. Our brains recognize letters easily in most fonts, but some are enough different that it takes more mental effort to recognize them. Reading a note typed out in Comic Sans is easier than reading a handwritten note by someone with bad handwriting.

    An image like "your brain prints out the words you hear in Times New Roman 16 pt font for you to read, and your child's brain scribbles the words in really messy cursive with a pen that leaks inkblots all over" might maybe be more readily understood.

  11. Another way might be to rephrase it, and say that there are two parts to listening: hearing and understanding. If either one doesn't work, listening doesn't happen, no matter how hard one tries. Hearing is obvious -- if the sounds never reach your brain, it doesn't have anything to work with. Understanding is a little more subtle... [go on from there as relevant to the person]

  12. I think that 'processing' would be the right term to use... If you have the time to spare, it may also be worth doing some research into neuro-psychology, especially with regards to sound processing, and possibly aphasia, as well.
    As for examples, I'd like to suggest trying the McGurk Effect - this is where if a person hears one sound, but sees another on someones lips (almost everyone has an small amount of innate lip-reading skill), it is interpreted by the brain as a third, entirely different sound...

  13. Thanks for writing this. It perfectly describes the way I've been living for years. I had a lot of middle ear infections as a kid (and I'm still prone to eustachian tube blockages as an adult) and to this day I still have problems filtering out ambient noise from relevant content. Okay, I've learned a few strategies to cope over the years, but most of them revolve around concentrating really hard on the person speaking (there's at least a little lip-reading going on as well, to give structure to the noises they're making), and spending as much time as possible in largely noise-free environments. If I'm watching a DVD or playing a game, I'll generally have the subtitles turned on wherever possible (particularly with games, because often the lip-synching isn't accurate, or at least it isn't accurate in English - it's probably fine in Japanese). If I want to go out for the evening, I'll try to pick somewhere which is as quiet as possible (preferably not a restaurant with a lot of hard surfaces) because the alternative is getting overloaded by the noise and the effort I have to make to understand what's going on around me by the end of the first course. This means I need at least a week's warning, so I can stockpile a little extra mental energy for processing, and take things easy on the day of the event in order to have the energy available by the evening. It means I'm the one sitting close to the front of the lecture theatre, so I can get a good look at what the lecturer is saying - and I'll probably be sitting on my own because that way the chatting of the bored or the distracted won't be sidetracking me. I'm also the one wearing the headphones on the bus, the train, or just wandering around campus, because that automatically makes people accept I might not have caught all they said to me the first time around - I can blame it on the music from the mp3 player.

    It's possible to live like this, but it can get a bit aggravating after a while.

  14. Although I only taught for a short time, I can see the childrens' look you describe only too well. I used to try to explain it in educational terms: that, just like there is more to reading then just being able to identify the words/letters, there is more to listening and hearing then just being able to identify the sounds. The way your brain is able to process that information is JUST as important as the fact that you can see the letters, or hear the sounds. It didn't always work, but I did get one or two parents who seemed to understand what I was trying to get across.

  15. Hi everyone and thanks for all the comments.

    It's so invaluable to read about how all of you would explain it because it gives me all these different angles from which to approach the explanation when I sense that the parent isn't quite getting it.

    @Anonymous (31.03.2010 6:55am): I adore the McGurk effect and love running the video at parties (I'm a nerd, I know). I never thought of it as a good example of how brain and hearing intersects!! :) So much more than a party trick!

    @megpie71: Many of the kids I see have had chronic ear infections when they were younger. Like you, they never had the opportunity to develop the same listening skills a child with normal hearing would have. I'm glad that you've got an arsenal of strategies to help you go about life, and am sorry that the rest of the world at large doesn't really realise that there's just that extra component to hearing.

  16. I agree with others that "listening" has too many other connotations (including the implication that "listening" is something that a person consciously chooses to do or not do)

    Perhaps one analogy you could try (in addition to the others suggested here) is something like this:

    "Think of it as if you were listening to the radio. The radio is at perfect volume. But the signal is not coming in very clearly so there is a lot of static and white noise mixed in with the sound of people talking. Or perhaps the sound is simply very fuzzy so it is hard to identify anything you're hearing. You listen and listen very closely but you can barely understand anything because the sound is so badly garbled. You try to turn up the volume, but all that does is make the static or garbling worse -- it doesn't make the voices any clearer. No matter what volume it is at, it is very difficult to understand anything because everything is so horrendously garbled."

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