Bellis begins the book by introducing her readers to “The Many Faces of APD” to illustrate that it looks different in people of all different ages. In this first chapter she does an excellent job of demonstrating the complexity of the disorder identified as Auditory Processing Disorder. As often is the case some remain unconvinced of its existence so Dr. Bellis addresses those concerns.
From there Bellis discusses how auditory processing relates to spelling, reading, receptive language, speech production, problem solving and socialization. Truly auditory processing affects so very much in how we relate in life and in learning. Each of these complex processes requires many sub-skills. For example, problem solving requires that one can read the problem or understand it orally, have all the essential information, understand all of the words and concepts, remember them, identify which operation to use, know the sequence of steps and perform the computation accurately.
APD can occur anytime in life, but occurring early in life greatly impacts learning as this is the time when we receive so much new information. Some of the many possible factors of APD include early neonatal intensive care, syndromes, hearing loss in family, abnormality in head, maternal infections during pregnancy, jaundice, neurological disorders, chronic ear infections and delays in hearing, speech, language or development.
Bellis goes into detail listing normal development throughout the ages and red flags when there are delays. If a young child behaves as if he cannot hear or becomes confused, APD (as well as ADHD) should be considered. Delays in developing language including articulation, syntax, semantics and pragmatics also raise flags. Individuals with APD can lose the thread of thought or tune out. When multisensory cues appear to confuse or overload an individual, there may exist a lack in interhemispheric (between the two sides of the brain) communication.
Middle and high school students with APD may have increased difficulty because of new demands of changing classes, multiple teaching rooms, more information given in lectures, puberty and peer pressure. Later, college students may have increasing difficulties due to large lecture classes and more freedom / less structure. Adults may first experience these same difficulties later in life. Men tend to experience it earlier (late 30s and early 40s) than women (post-menopausal years). Trauma to the head can occur at any time in life causing these difficulties.
Then, after the author takes the reader through the long, laborious process of
diagnosing APD she goes into the treatment of APD. Treating APD, at this time, according to Bellis is a three way process:
1) Environmental modifications.
2) Direct Therapy – training skills.
3) Compensatory strategies.
As I read this book, I recognized my clients in some of her descriptions and I tried to reconcile the
two approaches. I applaud Dr. Bellis for her work in this field with her great perceptive skills. As I thought, this is what I imagined: The phone rings and a parent describes the difficulties her child experiences. If one of Dr. Bellis’ trained staff answers the phone, the parent will get a description of the process of finding a diagnosis and treatment plan. If on the other hand the phone is answered by an individual trained in the neurodevelopmental approach, the parent will get a description of the evaluation process and the resulting individualized neurodevelopmental plan. In the first instance, a diagnosis will be the first step. In the second there will be no diagnosis, but a discovery of missing pieces of development which point to areas of the brain that need to be stimulated in order to encourage development and removal of the targeted behavior. While the parent has many questions, essentially, she wants to know one thing – “Can you help my child?” Personally, I would to see mostly direct therapy given by parents with instruction and support by the neurodevelopmental team and very little environmental modification and compensatory strategies. Certainly, the parent should understand the process and determine which approach best fits the needs of her child.