By Dr. JJ
A few months ago, I wrote a blog about the controversy surrounding auditory processing disorders and why it may be hard for some to get straight answers from professionals about:
(a) what auditory processing disorders are, and
(b) whether anything can be done to help those struggling with concerning listening behaviors.
As mentioned, this controversy is primarily surrounding the fact that there is currently no gold-standard way to test for or treat auditory processing disorders. What batteries exist can be confounded by behaviors related to other conditions, including Autism and ADHD. Many skeptics of auditory processing disorders are skeptics because they want auditory processing deficits to fit their own, isolated mold. They don’t seem to be comfortable with the overlap that tends to happen with symptoms of other learning differences.
While disagreement is good and does a lot to propel the field forward in finding a stronger evidence base for the assessment of (and treatment for) auditory processing disorders, there is an alarming proposal that children with suspected auditory processing disorders simply be categorized as children with unspecified language and/or literacy delays and “throw them back” to the school-based speech-language pathologists for (in my opinion, rather directionless) help.
The purpose of today’s blog is to discuss what “evidence-based practice” means and argue for the need to have audiologist input for children with suspected listening difficulties.
Defining Evidence-based Practice
When I was getting my PhD, I learned quickly – as any clinical scientist does, I hope – that evidence-based practice for clinical professions is far more than just practicing based on peer-reviewed data. Now, don’t get me wrong, peer-reviewed research is fundamental to scientific inquiry, and without it our world would make very little progress. However, in that same spirit, scientific evidence does not constitute “proof”. The whole point of science is to question everything, even when compelling evidence is presented. Therefore, we use a peer-review process to share research. We want external eyes looking for any critical flaw in the study being designed, or the results being interpreted. Scientific inquiry, after all, is a human-based system. And humans always make mistakes. (Have you heard about the replication crisis in psychology research?)
When it comes to the study of human behavior, as it does in the context of research related to auditory processing disorders, quality research becomes trickier. Human behavior is a galactically wide variation of thinking and action and can be described or observed from so many lenses of personal and professional experience. Thus, generalizing research findings from research to a whole population of humans can be hard to do. At the statistical level, it seems like it’s a straightforward case; however, just like with testing for auditory processing disorders, there are confounds left, right, and center that are sometimes unaccounted for or simply justified and ignored (I just reviewed a study wherein the researchers found that women had a significantly more difficult time with hearing loss than men, and they dismissed this finding as common theme found in general healthcare, as if the data didn’t matter at all, and offered no suggestions for clinical improvement).
Because of all this, there are two other prongs to the idea of evidence-based practice that I think many forget about. Beyond the best, peer-reviewed, and available evidence, evidence-based practice includes:
- Decision making based on strong clinical experience, and
- Patient values.
No clinician should ever think they know everything, just because they’ve been practicing for whatever amount of time they have. At the same time, no clinician should ever be totally dismissive of the insight they have gained from their experience working with patients – especially if they are a specialized clinician seeing similar cases day-to-day. Clinical experience and insight are invaluable. Oftentimes, clinicians see patterns emerge in cases that lead them to question and propose standards of practice that lead to this peer-reviewed research discussed.
Patient values should always be the priority in healthcare. Patients are experts of themselves. When clinicians engage in a partnership relationship with patients, outcomes can improve significantly. Gone are the days when providers dominate the dynamic between themselves and patients. When they do, trust is hard to establish, and patients might move somewhere else for help.
Audiology Matters When There Are Listening Concerns
It’s interesting to me when professionals are dismissive of auditory processing disorders because they want auditory processing deficits to fall into their own diagnosis, separate from all other diagnoses. Hearing and cognition have always been deeply tied together, so I really don’t think research will come out and say that auditory processing disorders can be an isolated diagnosis with no other learning or developmental disability. We hear with the brain, so it only makes sense that if there are listening concerns – even with a typical audiogram – then there may also be concerns for memory, language, reading, or writing (just to list a few). Hearing and speech-language development are completely intertwined. So, when professionals tell me that children with suspected auditory processing deficits should just be assessed for language and literacy delays and intervened solely by speech-language pathology, I strongly disagree.
Audiologists with a good background and understanding of auditory development and neuroscience can provide a lot of good, clinical input. Addressing the learning needs of children from a multidisciplinary approach – including an approach representing audition – will do a lot more than just treating children from the singular lens of speech-language development. Audiologists are the recognized experts in hearing disorders.
Hope For the Future of Auditory Processing Disorders
Sometimes, skeptics surrounding the topic of auditory processing disorders make the whole idea of auditory processing disorders seem gloomy and helpless. But this is far from the truth. Many experts are on the case of improving clinical practice and producing research that looks at the neurological underpinnings of auditory processing disorders. As new data emerge, audiologists who specialize in this area of clinical practice can pivot and add new test items to the test battery that have higher specificity in identifying cases of auditory processing deficits. In the meantime, while no gold standard exists, there are clinical guidelines based on the best available evidence. You can bet that here at Little Heroes, we follow these in good faith!
Mostly, it’s about not letting your child struggle just because there’s no great study out there telling us how to help (although, there are actually a lot of great studies). Part of being a good clinician is using the best available evidence, clinical experience, and your values to make sure that your child is in good audiologic hands. That’s why here at Little Heroes our mission is to provide timely and proactive intervention for concerning listening behaviors, even when you’ve been told nothing more can be done.
Something can most certainly be done.
If you are thinking your child has an auditory processing disorder, call today!