(Note: A different
topic is presented each month, usually coordinated
Recognizing Auditory Processing Disorders Most physician encounters with patients are limited to ten or fifteen minutes. The patient describes the reason for the visit, the physician evaluates, prescribes treatment and the patient is on his way. Consequences of missed or misunderstood information are not great. For more serious illnesses, however, the physician spends more time conversing with the patient. It is at this time that clear two-way communication is essential. Most physicians do a good job of adjusting their speech to the common language of laypersons, minimizing the use of medical jargon and terms uncommonly used outside of the medical setting. Too often, however, the patient leaves the doctor’s office understanding very little of what was said to him. True, a certain amount of anxiety is present that inhibits detailed recall of the encounter with the doctor, particularly when there is a new and sobering diagnosis. And, true, some persons are characteristically anxious and may not recall enough of the conversation with the doctor later, even when it is a minor illness being treated. And true, persons of low ability and with little education often do not fully understand what is being said to them. But persons with central auditory processing disorders (APD) are accustomed, in any setting, to “hearing” only part of the information and retaining only the part that made the most sense to them at the moment they heard it. Normal rates of speech typically proceed too quickly for the person with APD to decode all of the words and their contextual meaning. Consequently, they tend to grasp for “sound bites” that fit their own cognitive set, and then apply larger meaning to the sound bites. Consider the following exchange: Physician: “Your labs were mostly normal, but we do have a relatively low platelet reading, so I would like to do a few more tests. I want you to discontinue your medication until after the tests are completed. My nurse will make all the arrangements before you leave and I will give you a call after we have results. Are there any questions?” Patient: “Stop my medication now?” Physician: “Yes.” Patient: “And your nurse will call me?” Physican: “That’s right.”
The patient goes home and his wife inquires about the visit with the doctor. Patient: “I don’t have to take my medication anymore. My lab tests were normal. But he wants me to take some other tests.” Wife: “So, he doesn’t know what is wrong? Was he treating you for the wrong problem?” Patient: “I guess so.” Wife: “What other tests are you going to have done?” Patient: “I don’t know, his nurse is going to call me.”
The patient did not fully grasp his doctor’s communication and left the office before seeing the nurse. His medical complaint will not be discussed here; rather, this is presented as an example of a typically healthy adult with a developmental central auditory processing disorder. He is 41 years of age, with 18 years of education and is working as a computer programmer for a prominent maker of computer software. He has remained quite healthy until his current complaint and denies history of injury, substance abuse or toxic exposure. He does not complain of memory problems and his job performance evaluations have been exemplary.
Consider:
· He frequently misunderstands verbal messages. · He is likely to ask for others to repeat much of what is said to him, saying “huh?” or “what?” frequently. · When in high school the patient learned that, to be successful, he needed to take notes of all verbal instruction, or he would not recall it later. · He excels in visual, hands-on activities and remembers these in detail. · He has difficulty attending to verbal information and soon loses interest or becomes distracted. Is able to attend better in a quiet environment. · His significant other complains that he never listens to her; the relationship has been shaky because of her perception that he is not interested in what she has to say. · Socially, he talks very little. He is unable to follow conversation in a group where several people are talking. Sometimes he misses the point and chimes in with an irrelevant statement. Finding he is “out in left field”, he is embarrassed, becomes quiet and is soon bored. · He is observed by others to substitute common words when a more descriptive word is appropriate, such as “bucket” for garbage can, “bucket” for flowerpot, and “bucket” for salad serving bowl. · He may start sentences in the middle of a thought, without introduction. He tends to ramble on when explaining an event and uses vague language. · He takes longer to respond to two-way oral communication because he needs more time to process the information before speaking. · He may have difficulty memorizing verse or popular sayings. · He may have poor musical and singing skills. May have difficulty localizing sound. May be easily distracted by sound, but unable to recognize/identify the source. · Additionally, he may have associated reading and spelling problems. · And he is likely completely unaware of his deficit. He is likely to admit a struggle with grades in high school, but explains this as simply a “dislike” for literature, composition, and other courses taught by lecture and requiring written and oral reports.
Clues for recognizing such a patient will not be readily apparent in most cases. The astute physician will become suspicious when the otherwise healthy patient requires repeated explanations or forgets instructions soon after they are provided. A close family member may accompany the patient to “listen with a second set of ears” and ask questions. This may appear odd to the physician, who recognizes the patient’s relative good health, young age and high level of functioning. If, after further inquiry, the physician is satisfied that the patient may have APD, he will then take care to provide the patient with visual aids to medical explanations and written instructions for treatment. He will speak a little more slowly and in short sentences, addressing one concept at a time. He will not speak louder, as the patient is not deaf. He will not speak too slowly, or use infantile terms, as the patient is intelligent and educated. He may ask the patient to “Tell me if I am speaking too fast or too slowly and I will try to adjust.” He may ask the patient, “Would you mind repeating back to me what you understand thus far?”--and then providing any necessary clarification. Finally, he will convey to the patient that he has the time to review and answer questions. Since most adults with APD are not aware of the existence of the disorder, they see themselves as relatively normal, although they may experience a low self-esteem with regard to academic achievement. Therefore, the physician is advised to take a covert investigational approach at first. A thorough evaluation by a rehabilitation audiologist will provide detailed diagnosis and lead to a more detailed treatment plan that may include a hearing device or noise screening device, but will surely provide specific compensatory strategies for routine use. Simply addressing the problem in a collaborative fashion will likely lead to improvement in treatment adherence and improvement in the physician-patient relationship.
Medical
Counseling Center
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