The ABCs of APD: Live from AuDacity 2022

Dawn Heiman 0:18
Good morning, everybody. Okay, if we let’s get started, we could probably even close the door. My name is Dr. Dawn Heiman. I’m an audiologist and I have the privilege of moderating today for a lovely panel and it includes three excellent clinicians and researchers. We have Dr. Matthew Barker, and we have Dr. Mary Anne Larkin, and we have Dr. Gail Whitelaw Dr. Gail Whitelaw is remote right now she is on Zoom, she will be coming in live for the q&a at the end, she has pre recorded her portion of the presentation. The way we will be structuring this today is we will have three different perspectives on the ABCs of APD. Each one will be a 20 minute segment for each. And then we open up the floor for a question and answer more group discussion so you can ask all your burning questions. So to begin, I would love to introduce you to them so you have an idea of where they’re coming from. Dr. Matthew Barker has received his ad in 2004. He has been adjunct professor at the University of Canterbury in New Zealand, and the Texas Tech Health Sciences Center in Lubbock, Texas. Having taught around 10 semesters of psycho acoustics, advanced amplification, auditory processing disorders, and introduction to audiology. He developed the world’s first touchscreen pre Apple iPad, automated hearing threshold screening still in use in Australia, and has started since started a research and development company focusing on auditory processing improvements and school hearing screenings. He has multiple peer reviewed publications in the field and has presented internationally on auditory processing work with collaborations in research in multiple countries. Welcome, Dr. Barker. Dr. Mary Anne Larkin has been in the audiology profession since 1983. I think she’s like she received her doctorate degree in audiology from the University of Florida. She is a fellow of the Academy of Doctors of Audiology board certified by the American Academy of Audiology in a fellow of the South Carolina Academy of Audiology. She is also a member of the International guild of auditory processing specialists known as IGAPS. For most of her career Dr. Larkin has tested diagnosed and provided management strategies for children and adults who present with central auditory processing issues. After retiring from her full time auditory or audiology practice five years ago, she founded Low Country Listening Lab, where she now devotes her professional time to specializing only in the area of auditory processing. Dr. Larkin has served on numerous audiology committees and boards on a state and national level. She has served as past president of the South Carolina Academy of Audiology, and now has been on the board of directors of the Audiology Foundation of America. She has been a public speaker at various regional and national professional conferences. She has also published numerous articles on audiology private practice issues, Dr. Larkin actively participates in hearing health issue issues on a local state and national level in has received awards for her work promoting better hearing in the community. Dr. Gail Whitelaw is an audiologist who is a clinical associate professor and clinical director at The Ohio State University in Columbus, Ohio. Dr. Whitelaw is also the audiology faculty member on the LEND grant, a maternal and child health training grant, and has been for the past two decades. She earned her BS in speech and hearing at Bowling Green State University and an MA degree in audiology from Michigan State University, a PhD in hearing science from The Ohio State University, and a master in healthcare administration from The Ohio State University. She is a past president of the American Academy of Audiology, and the Ohio Academy of Audiology, and past chair of the Board of Governors of the American Board of Audiology. Dr. Whitelaw has a broad range of clinical interests including pediatrics, tinnitus, assessment and management and super threshold auditory disorders. She provides direct patient care. And also precepts AuD students students in clinical rotations, including those in tinnitus, hyperacusis and misophonia. Dr. Whitelaw teaches courses on tinnitus and hyperacusis pediatric audiology, ethics and evidence, professional issues in audiology, and hearing aid issues for the speech language pathologist. She holds the pediatric audiology specialty certification, and is a certificate holder in both tinnitus management and auditory precepting from the American Board of Audiology. She received the Outstanding Educator Award from the American Academy of Audiology in 2019. Currently, she serves on the board of the accredit Accreditation Commission on audiology education, and on the honors and awards committee of the American Academy of Audiology. So we have a very well versed panel today.

So what we’re going to do is start by having Dr. Whitelaw present.

Gail Whitelaw 6:15
Hi, I’m Gail Whitelaw. And I’m excited to be part of this eight ABCs of APD session with Matt Mary Anne. And I am going to do a little bit of an overview of incorporating APD into your practice. I’m really excited about auditory processing disorders, because I’ve been doing it for a significant part of my career, actually, for almost 40 years of doing APD. And I’ve seen it change and grow. And there seems right now to be a renewed interest, I will assure you that there is a renewed demand. And if you want to offer this in your practice, I have lots of thoughts about how you might want to go about doing that. So I think I’m the one that’s kicking this off, and talking about how we start looking at APD. So a little bit about me, I work as a university audiologist and a clinical preceptor. In that part, I fell in love with APD. When I was an undergraduate student, I wanted to be an audiologist from the time I was 11. And as an undergrad, one of my professors one day talked about APD. And I was like, Oh my gosh, I love that even more than I thought I would love audiology. I work with both children and adults I have for my entire career. I teach coursework to APD students at Ohio State and in other universities. And I get lots of opportunities to talk about this to people like like everybody that’s at the ADA meeting. And I can tell you that the demand for APD services far outstrips the supply that’s available right now. So when you’re thinking about how am I gonna diversify, or is this the right thing for me, I’m going to give you hopefully, some practical things you can think about to set you up for success on an APD practice. So the first thing in setting up a program is obviously, you’re going to ask the question, Who do you want to serve? Do you want to do children? Do you want to see adults? What ages do you want to see? Right now you probably know that there aren’t really any good assessment protocols before the age of about seven, which is why most audiologists do seven and above in children. Seven is when the variability in listening skills tends to reduce a bit and want to point that out to you for the reason of if you build this, like I said in yesterday’s presentation, they will definitely come and you will get a lot of calls from parents who are concerned about their children’s listening. I think this is a wonderful opportunity for us to educate people about hearing. Let’s face it, newborn hearing screening, and kindergarten are a wide range apart. And a lot of parents are concerned about their kids between birth and five. And remember that hearing and hearing loss and children parental concern is often one of the first things so I want to make sure that we’re not just saying, Oh, it’s auditory processing, but recognizing that it could be a peripheral hearing loss that a child is experiencing also. And adults. What ages do you want to see? I always joke that in my practice, anybody over 50 is elderly for me, although I do see older tinnitus patients and I do see older hearing aid patients in the world of APD. I don’t see a lot of older adults. We have a lab that does that. At Ohio State Dr. Christina rube slab does is a fantastic job of looking at aging and auditory perception. Clinically, I will do some of that. But as for I sent my cut offs, you may feel very differently. And I can tell you that as soon as you set up an APD program, and for those of you who have one, hopefully you’ll chime in on this. It’s very, very- people want to know more information. And they will call you with all kinds of things. I get requests all the time for working with people who are non native speakers of English, who have had really interesting life experiences that bring them to the point of thinking they have something going on that have progressive neurological diseases. So what specific patient populations Do you want to work with? Do you want to work with people who are neuro divergent? It’s interesting because autism and audiology have a really significant way that they work together, and for many audiologists, they’ve never thought about working with patients with autism are as many of the people I work with now call themselves Autistics, and that they don’t see the role of audiology, whereas many of the people on the autism spectrum, and their families are looking for services from us. And there’s a lot of controversy around this. But if you want to get into APD, you’re going to get into some of that controversy to begin with. Do you want to work with people who’ve had traumatic brain injuries? Do you want to provide services to people that have had neural- neurological or neural or logic issues going on? Do you like being that diagnostician that Dr. House that can look up some of these things and figure out some of these things. So how much of that are you willing to do in your in your practice? With whom do you want to partner, school districts really want these services. And at least in Ohio, where I live, there are not enough educational audiologist to provide these services. There’s not enough children’s hospitals services to go around for APD. So some school districts are really, really want us to do these as part of the IEP as part of a 504. And they are willing to pay you to do those things, and to partner with you. And I know that because I’ve done that for many, many years. They are willing to contract with you to do in services, they are willing to contract with you on an ongoing basis to support their clinical staff. So school districts are places that you might want to take a look at our speech language pathology colleagues, who are always looking for APD are always reaching out to our clinic. And I have speech pathologists to reach out to me from all over Ohio to say, Can I send patients to you, I can’t find anybody closer. Physicians, especially with adults are very interested in this. Because if an adult comes in and says, gee, I’ve always had this listening issue since I was a kid. And a it seems to be getting worse. or be it seems to be really problematic for me from an attentional perspective, or from an anxiety perspective. They want to do what they can to support their patients. The role of audiology and reading is so significant. And for those of you who are aware of this, some of you might not be that dyslexia and APD often can go hand in hand. And reading is a huge thing for both children and for teenagers. So it’s a great place for audiologists to have a role. I’m working with parent advocates, who may be helping a parent or a family guide through a school process, and really need the services of an audiologist, who can do a great APD assessment, looking at psychology and psychiatry, PTs and OTs and families will be searching for the services, they’ll be asking for us to be involved with them. So the question I think you need to ask also is who’s your audience? If you do school districts, for example, they need an apples to apples comparison. So how do you compare auditory processing skills, to language skills, cognitive skills, etc. This is one of the reasons I like the standardized tests, like the SCAN and the mappa because of the way that they present the results. So if you have a kid who’s got 100 on APD skills, and 100 on language skills, and 100 cognitively or their IQ scores 100 You know what you’re comparing. That’s not to say there’s other models, not other models out there. Matt’s going to talk about that a bit too. The medical model of doing electrophysiology is fantastic. And if you’re working with neurology or or you’re working with a traumatic brain injury team, you may find that very useful. I will tell you that unless it’s a situation like auditory neuropathy, most school districts are not going to find that information very useful. And as a matter of fact, I’ve had school districts who sent me reports to say this was garbage. I don’t know what it means not my report. They may do that to other audiologists, and send my report to them. But they’ll say I don’t understand what any of this means. It’s because it’s an audiology jargon. And it’s confusing to them because they don’t understand or see the value in electrophysiology, unless we spell it out very carefully. So our value is audiologists, again, practicing at the top of our scope and what we bring with APD. I saw a 14 year old patient last week or two weeks ago, two weeks ago. And I believe she has undetected auditory neuropathy. She was referred by one of my favorite otologist. He and I work together very, very carefully. And she has a normal audiogram. And her mom has been talking for at least the past seven years, that something is unusual about her key point, speech in quiet her word recognition skills, were in the 70s with an audiogram, that’s five, zero and five straight across. That’s not typical, her speech noise testing was terrible. The otologist and the mom were thrilled with what we did. And I’m very well aware of who my audience is at that point in time, and how I present the results to market to them. And we hear varying recommendations for evaluation, you’ll hear lots of things on our panel here. And there is no gold standard for clinical evaluation of APD. For so many years that scared people off. There’s no standard and almost anything that we do you guys, we know that and even when there’s a standard of care, it’s not always carefully followed. I would say to you that auditory processing disorder is in our knowledge and skill as audiologists it is our scope of practice, and we should own it. And if you’re comfortable doing tests that tax the auditory system, you don’t have to use the same test battery, as Matt or Mary Anne or me, you just have to do it and have something that you find as defensible and meets the needs of the audience that you serve. And I don’t know how, how many more times I’m going to say that, in at this point in my career, I think it’s really important for us to get over all of the controversies, every time a new paper that comes out that points those out. I always think it’s kind of funny, because I’ll get asked to go somewhere and comment on it. And I’ll read the paper and say, this is nothing new, we do have to move ahead and we are starting to move ahead. And we’re starting to find some really interesting things in frequency selectivity and temporal processing. If you go and you read things in the Journal of the Acoustical Society of America, and if you go and look at some of the research journals, from Asha, and AAA, and other places, you’ll see some great underlying research that hasn’t made it to us clinical yet, but it’s coming. And you can establish what we’ve got right now, and not wait for it to come. So I would, I hope that you’ll think about that. So what will you do? It’s important to get pre appointment information. There’s lots of questionnaires you can use. You might want to know who you want this information from? Do you want it from the patient? Do you want it from the family, the classroom teacher, allied professionals, and adults, I use that apps. In children I use the chaps the sifter and the Eclipse. It all I use the Vanderbilt fatigue inventory, which looks at functional issues. The Vanderbilt fatigue inventory has a child’s version and an adult’s version, you’re going to need to take a careful case history that keeps in line with who you want to see. And so you have no surprises. You want to know, you want your front office staff to ask about the age of the person because you don’t want an 18 month old are coming in for auditory processing disorders, unless you really do. And if you do, I want to talk to you because I’ve done that. I did a favor for a friend once. And I will discourage you from doing that. You want to know about the native language that the person speaks? You want to know if they fall into a neurodiversity category. And that could include things like attention deficit disorder, you want to know about their cognitive function. And then in your evaluation, you want to think about how Will you tax this auditory system? What is your plan? What’s the speech noise testing you’re going to do? What tests battery? Are you going to do? And is it going to address all the areas of auditory processing that you want to take a look at? You can look at both the ASHA or the AAA, or the European or the British.

There, there are guidelines that are out that say, what should you be looking at in an auditory processing evaluation? And I will tell you, creating a test battery around that isn’t really that difficult. If you want to work with this population? Will you do audiologic evaluation and APD in the same session? Or will you split those up? That’s a question you may want to ask based on your time, based on billing based on the patient population, you choose to serve all of that, on treatment. There’s a lot for me to say about hearing aids and its success with this population. And I’m gonna say it in the next slide. But I will tell you that one of the things that you can do to extend your your services to this population is these are people, when you talk to them about hearing aids, that will do whatever they are not reluctant Tryer’s of hearing aids, and they are not reluctant buyers of hearing aids, remote microphone systems, consultations with school workplace family. So you may participate in educational meetings, you may bring your knowledge to working with the ADA or BVR for these folks, and how you choose to build that you might need to work out and think about in your practice, auditory training, which I’m Don Heiman did a talk on yesterday. And Mary Anne is going to talk about today, and how we do this and who’s providing it and how it’s mediated in your practice. And do you provide it in your practice? Or do you refer out, those are all questions you want to address, who will pay the contract with the school district is a great way to do this. School districts tend to be great payers. We’ve never had a problem with the contract that we set up with them. They’ve never balked at what we’ve asked them to pay. And they pay every month on time, you’re going to tell you that we’ve done a lot of school contracting for many years, part of an independent education, evaluation an iee as we call it in Ohio, with the school district and they’re willing to pay you for that, as an independent practitioner, third party payments, looking at some time based codes, which is what APD allows us to do vocational rehabilitation. We work with them regularly in Ohio, it’s called opportunities for Ohioans with Disabilities, but they do a great job of providing services and hooking up both for diagnostic and treatment, folks that will do private pay. And we have had success with both public and private payers, and explaining hearing aid coverage to them. One of my adult patients works for a hearing aid manufacturer, and she uses hearing aids for treatment of APD and was a great person in working with that. Why are these services needed. And I think it’s important, I want to talk a little bit more for just a second about hearing aids, somehow I have a slide that’s missing. And I’m going to tell you that if you’re interested in working with hearing aids in this population, I would encourage you to do so there’s an education curve on this for letting physicians know why we’re doing it. Many of the physicians that I work with at first were very dubious, especially in children, a couple of my pediatric otologist told me that they would come after me if I damage their children’s hearing. And there’s a whole basis of research. If you guys ever want to have these conversations outside of ABA, you want to email me you want to set up a time to have a call. Happy to do so I love talking about this stuff. And we’re finding out more and more. We have a protocol for fitting hearing aids and people who have normal peripheral hearing acuity. And I can tell you everything we do, I always get medical clearance because I want physician buy in. And I want them to know that this is really a thing that we can do. And that hearing aids are a really appropriate product for our treatment for some of our patients. We have a lot of demo hearing aids and allowing a patient to demo this is often amazing, and it’s really fun to work with that population. If you haven’t done this, I was just at the Canadian Academy of Audiology last week. And I’m seeing more and more people and hearing more and more people Talk about this, which is really exciting. There’s going to be pediatric protocols that come out. But I can share with you everything that we do, from relayer, to other verifications to using questionnaires to collecting data from patients, and what our success has been in working with third party providers. So why would you want to do APD services? why would why is this something that’s needed? It’s what we offer in addressing communication issues. It is on the same continuum as hearing loss. And we are the experts in Hearing and Communication. So we really need to have this as an option. And the thing I can tell you the most, and I didn’t put a lot of cases in here, I gave you, Andy, and then the gentleman that I saw last week, the quality of life for these folks, is so significant. Anything that we can do, in terms of giving them better ability to hear in noisy situations, whether it be at school, at work, socially, makes a huge difference to them. If we can do auditory training with them, if we can give them counseling, and how to be better communicators, all of this makes a difference. And is so much better than the happy talk of, Oh, your audiogram is fine. You know, peace be with you come back when you’re 60 years old. That’s really not cutting it for this patient population, because they will keep shopping until they find an answer. And I would love for all of us to be the answers and raise the perspective of audiology, for at least all those patients out there that are seeking APD testing. Thanks so much. I look forward to participating in the questions and answers. And thank you for your attention.

audience 26:51
Thank you. Dr. Whitelaw.

Mary Anne Larkin 26:54
All right. So I’m Dr. Mary Anne Larkin. So excited to be here today and see all of you all interested in auditory processing. And what I was told when they asked me to be a speaker, was to talk about my APD journey. So that’s what I want to start out with. So during my clinical fellowship year was the first time that I started doing auditory processing assessments back in 1983. And this was at a Speech and Hearing Center in Florence, South Carolina. I was there for four years. And then my husband and I moved to Charleston, South Carolina, where I worked with two different Ear, Nose and Throat groups. Now, I tried to convince the ENTs to let me do auditory processing testing. And they basically said no, it took too much booth time and there was no return on investment. So for six years of my career, I did not do any auditory processing testing. So in 1993, I decided I’d had enough with the ENTs I moved down the street started my own private practice, Advanced Hearing Care, I resumed starting to do auditory processing, testing, along with adult hearing aid fittings, adult aural rehab and then later on tinnitus assessment and management. I retired and sold that practice in 2017. And the next month in 2018, I opened up another practice and that is Lowcountry listening lab. And I am semi retired. I have a part time practice but I only specialize in auditory processing. And I will have to admit, at the end of my audiology career with Advanced Hearing Care, I was pretty professionally burnout and starting low country listening lab. I will tell you, I have found a newfound love for my profession I enjoy going to work I love what I’m doing. So I’m excited to be able to share some of the nuts and bolts of how I operate my practice, and why I find it so rewarding. Gail pretty much did a very nice summary of why you should add APD services to your practice. But I always learned that repetition and redundancy helps you to remember information. So I’m going to tell you some of my little ideas. So there are very few audiologists in the country that provide this type of testing in their practice. I’ve heard numbers such as 300 up to maybe 1000 audiologists across the country that do any type of auditory processing testing, there is a great need. It is your opportunity to make a difference. Diversification is key and I think Dr. Whitelaw talked about diversification. I think we all know when we talk about our financial portfolios, you want to diversify, you do not want to put all your eggs in one basket. So when you look at the times right now, if you are in a practice that you mainly only do hearing aids we have over the counter coming in and things, you know, you might not be sure what’s going on in the future for your practice. So diversifying, adding different services can help to have a profitable and a sustainable practice. And APD can be a profit center for your practice. So there are many different types of auditory processing practices or delivery models. So I wanted to discuss that with you next. You can determine and decide to just do diagnostic testing, and then refer out to your community, the therapy. And pretty much that’s what I did when I was Advanced Hearing Care. I had my main focus of the practice at that time was hearing aid dispensing adult or rehab. And I did some auditory processing testing, but I didn’t get involved with therapy at all. The next is providing diagnostic assessments and services and then delivering commercially based auditory training programs, that you train the individual on how it can be performed in the convenience of their home. And that is what is what I do at Lowcountry listening lab. You can have another model, doing diagnostic services, and then performing one on one auditory training with your patient inside your office. And then you as the Doctor of Audiology are doing those services, one on one. Lastly, you can provide the diagnostic services. And then you can hire a person to provide that auditory training in house. And this pretty much is what developmental optometrists do. They the Doctor of optometry does the diagnostic assessment. And then they hire somebody send them to some trainings. And they’re actually the one that does the therapy. So you’re not having it at the revenue producing Doctor of Audiology level, you’ve got a secondary level where you pay less for the therapist. So I wanted to go over pretty much how my practice works. So I wanted to start out with my scheduling process. So I think I told you at the beginning, I have a part time practice. So it’s me, myself and I another another audiologist last night asked me Well, do you have a front office person? And I was like, nope. Oh, yes, I do. It’s me. So I answer the phone. And I ask key questions, obviously to find out whoever’s on the other end. Are they really a candidate? How did they get to me? Were they referred by psychologist? Or did they just google me and find me on the internet? And they thought maybe their child needed an auditory processing evaluation. So I asked those key questions, and then determine Yes, I do believe you are a candidate for an assessment. So what I do is I schedule two appointments. Now I have many individuals will drive an hour up to four hours one way to see me. So I do a lot of telehealth visits. And then I do a one in person visit with with the individual with the patient. So when I tell them that we’re going to schedule two appointments, I do tell them that I expect half down for the evaluation when they schedule. So I want to know are they serious? And so when they start hemming and hawing and well, I need to talk to my husband about this or whatever. Usually, I don’t ever hear from them again. So I know they’re serious, they pay half down, and then we go ahead and make those appointments. So the first appointment is a case history, phone intake. What I do is I send all the APD paperwork, questionnaires, a lot of what Dr. Whitelaw talked about, via email to them, they complete it, they scan it, then they email it back to me. So I book this case history, phone intake for about 30 minutes. Usually it’s 20 to 30. And I print out all their information and then I take additional notes, I asked for clarification. When we’re done with that, then usually within a week, they come to see me in person. So the parent brings the child or if it’s an adult, they bring themselves that appointment last two hours. I do an initial basic hearing acuity test at that time wanting to make sure they don’t all of a sudden have an infection impacted wax all of that. And then I do my battery of central tests. Now, as Dr. Whitelaw said, there are numerous different models. There’s the Bellas firmware model, there’s the buffalo model, there’s the scan, I kind of do a hybrid, I don’t do the same test battery on every single patient, a lot of times it will depend upon the age of the patient, I do test down to age five, I find that I know that AAA talks about you know, age seven, age seven, and I do tell the parents that I can make a definitive diagnosis at age seven, I make a tentative diagnosis at ages five and six. I’m like, why wait two years, when you know, there’s issues going on, I can at least give you an idea. We can start with some therapy, and then go from there. Okay, so, um, I’ve totally lost my train of thought, now. We are.

Yes, test battery. Thank you so much. So, um, after I finished the testing, I don’t give the test results immediately. I do a phone conference, generally about a week later. So that gives me time to really go through all the test results looking for patterns of performance. I don’t just diagnose an auditory processing disorder. I diagnose, confirm or rule out. And then I determine what the specific deficits are in auditory processing. And that’s how you know what type of therapy to recommend. That’s, that’s the important part. So I usually call them up, that appointment lasts about an hour. And after I’m done, telling them about the diagnosis, I tell them that I’m going to be sending them multiple emails, I educate a lot. So I’ll be sending eight to 10 emails to them filled with information on auditory processing and accommodations. On the specific therapy programs that I’m recommending. My Reports are generally 10 to 12 pages, my recommendations are a three prong approach. I go over environmental modifications and teacher suggestions. Or if it’s an adult, I go over work suggestions, I go over the remediation or auditory training therapy programs that I’m recommending the same challenges. So after I’m done with that one hour, I call it an APD phone conference discussing the results, I then email everything to them. Some individuals are ready right then and there while they’re on the phone to go ahead and move forward with therapy. Others, they want to see everything in writing, they want to discuss it with family. So if that is the case, then I scheduled another appointment usually a week later. And that usually lasts about 30 minutes. And I answer any more questions over the report that I’ve sent them, or about the therapy program information. If they decide they want to pursue therapy, then they get the subscriptions through me. And I then send them training emails. And I scheduled another appointment for training. So sometimes there might be three different appointments for training on each program that I’m recommending. And those appointments can last anywhere from 15 to 45 minutes. So once we get them on board, they’re working with the therapy programs I can remote in I can see how they’re doing with the programs. Sometimes they’ll email me questions, or I’ll be like, Nope, I need to call you. This is what you need to do. When they’re done, then I get them back in for retesting. And we see what happens. What are the benefits of the therapy that I have just, you know, asked you to pay money for out of pocket. And every single patient that I’ve done, we see improvements and may not be as much as I wanted on some of them. But the majority of them, the parents are seeing differences. The teachers are seeing differences that child, the child if it’s a child patient. They’re seeing differences. I have a couple little testimonials from 11 and 13 and 14 year olds, and they really didn’t want to do this therapy. And afterwards I look at them and say what do you think? Have you noticed any improvement? Yes. I’m like, Well, what are the improvements? I can understand my teacher better. I’m like, very good. I even had one child say I feel like I have more friends. Because when you have an auditory processing disorder, it’s hard. What a friends do they’re in groups. They’re this they’re that you’ve conversations over on top of one another and they just kind of shrink back back a little bit, and they’re anxious, so really can make a difference. I want to share an APD case study. This is a patient I saw about a year and a half ago. His name is Robert. And he’s 13, 7th grader at a private school in Charleston. He was referred by a local psychologist who diagnosed him with specific learning disabilities in reading, written expression in math. And then I think he was previously diagnosed a few years earlier with ADHD. He’s on medication successfully. So he came in, I did my assessment, normal hearing acuity, I did diagnose an auditory processing disorder. The deficits were in binaural, integration, auditory decoding, closure, and tolerance, faking memory. So over the next six months, he spent working on two different auditory training therapy programs. He was actually a child that was at this private school. He had a study hall, and there was a learning specialist. So I trained the learning specialist to give the programs during school, this this child was involved in a couple of different sports activities. And I think the parents were struggling, how are we going to have time, and this fit the bill perfectly. This was a private school parents paid for everything. And then the Learning Specialist was the one that administer Good question. All right, so what were his therapy games, pre and post therapy APD, clinical test results improved significantly. All the tests, I gave him improved within the norms. He did not have an auditory processing disorder anymore. What I do is I give a questionnaire that I actually received from somebody else, and it’s on a scale of one to five, and I give it to the parents, and then they email it back. And this is before I do my post therapy testing. And he scored fours and fives and on this particular questionnaire, and so showed improved hearing and listening abilities, improvement and following directions. A decrease in asking for repetition. He didn’t misunderstand in conversations. The teachers reported that he was more alert. And it seemed like his working memory was improved. He was able he was raising his hand a lot more and answering questions. And academic performance grades greatly improved. So demographics, what’s the typical profile of an auditory processing patient? As you saw, and Dr. Whitelaw’s, slide presentation, the really is not a typical patient. I think a lot of people when I go to different audiology conferences, and they asked me, What do I do? I’ll say auditory processing practice, oh, you see a lot of kids, you’re a pediatric practice. And I’m like, Well, I do see a lot of kids, but I also see adults. So here are three other profiles of patients that I have seen in the past. One was a woman involved in a motor vehicle accident, sustained a concussion, and ever since cannot hear background noise. Another one was an individual a man, he was in his 40s came in, really struggled with multi step direction following, he was disorganized. He had a track record of being fired from jobs, because they said he was a poor employee never did what he was supposed to do. I saw a College of Charleston, senior I think, I think she was a senior GPA of 3.7. Smart girl. This was her third time trying to pass a foreign language. At the College of Charleston, you have to have a foreign language and you have to pass it in order to graduate. But if you are found to have an auditory processing disorder, you can get an exemption and take like a multicultural course history course or something like that. So all three of these adults, what they had in common, they all had normal hearing acuity. They all were diagnosed with an auditory processing disorder. So I’m sure there. Many of you may have seen one of those three types of adults and maybe didn’t refer on to have an auditory processing evaluation. So where did my referrals come from? Psychologist, speech language pathologist, occupational therapist, other audiologist ENTs Pediatricians, dyslexia tutors, developmental optometrists, concussion specialists. So in marketing your APD services is I think over the decades, I’ve found, there’s two main things that you need to get across. Number one is, this is our scope of practice, we are the only professional that can diagnose an auditory processing disorder. Thank goodness, because as you know, with a lot of other services we provide, there are other professionals that can do the exact same thing we, we do, they don’t do it as well, but that, but they can do it. So there will be. And I’ve had it in communities where I’ve worked, where psychologists diagnose an APD, or speech language pathologist diagnosis and APD. And it’s not in their scope of practice. So the more we get out, we educate that it’s us, you know, refer to us not the psychologist or not the not the SLP, then more people will know about it.

And you also need to let them know that we don’t just diagnose, give the same type of recommendations, preferential seating FM system, there are auditory training therapy programs to remediate those auditory processing challenges. So what I wanted to end on is a testimonial. And I have since moved I’m no longer in Charleston This past summer, I moved to Spartanburg, which is in the upstate of South Carolina, to be closer children and grandchildren. And I asked a specific psychologist, would you write a testimonial for me and my services so that I can go around in the Upstate and share it with other professionals and she said, not a problem. I will tell you, I was blown away by this testimonial, and it’s not necessarily on me, but it’s on what audiology can do with auditory processing, so I’m just going to read it. As a school psychologist in private practice, I strongly recommend Dr. Mary anne Larkin and her services. She has been an invaluable asset to my clients. I refer students with deficits and pragmatic language, auditory working memory, receptive language skills and phonological processing. After she makes a differential diagnosis and impaired auditory pathways, she prescribes interventions that target specific weak neural pathways. And this is the most powerful statement I think. I often see students making approximately two years academic gains during her treatment programs. Parents notice market improvements and social interactions, and decrease in anxiety as their child better understands conversational speech. Of the plethora of recommendations I make. I routinely recommend that Dr. Larkins auditory processing evaluation, and interventions be their first and primary intervention. So obviously, John, so who was with me? APD services can be an integral part of the future of audiology practices. There’s a definite need. It’s rewarding work. Individuals with auditory processing challenges will pay for care out of pocket. So take a deep dive and see if adding APD services is right for you. Thank you. Okay, I am switching hats. And believe it or not, my name is Matt. Dr. Barker. Okay. Dr. Barker has a case of laryngitis. And he went to his son’s football game. And Did Did he win? Yeah. All right. He one. So yeah, he said he’s not infectious or anything like that. So this morning, I find out that he wants me to read. I haven’t really seen this, I’m going to do the best I can. So he first wanted to say hello. And how many of you have done any APD work? Raise your hand. All right, good. And for those that didn’t raise your hand, are there major reasons on why you would be hesitant to start?

audience 49:28
So the last time I did anything with APD was as a student in a master’s program in the early 90s. And what it seemed like to me was, it didn’t matter what the results were all we were going to do was recommend a you know, an FM system so why even do the test? I mean, what it didn’t matter.

Mary Anne Larkin 49:51
Okay, perfect. You’re feeding into this script beautifully.

audience 49:57
I hadn’t added it because it was mysterious. So I’ve graduated 25 years ago, I don’t even remember ever having this course. And I in my AuD program, I still don’t remember having it. So it was a mysterious thing and kids and I work with adults. So, but now I see there’s some future here. So I’m excited about that.

Mary Anne Larkin 50:18
Yeah, it’s it’s not so scary. I know it’s Halloween, but it is not scary. Well,

audience 50:23
and I need a training. I’m not in school anymore. So now where do I go to get a comprehensive soup to nuts? Training?

I find that I’m just overwhelmed with the test and not knowing which ones to choose or how to set up the actual clinical protocol. And then owning a business. It’s the billing side of it and knowing how you can be profitable doing that as well.

Mary Anne Larkin 50:52
All right, very good. Well, again, remember I am I am not Maryann or Dr. Larkin, I am Matt, Dr. Barker. I was this really geeky kid in grad school. That would take as many APD evals as possible, I went to Texas Tech and my classmates would trade me out. My ABRs or hearing aid evolves so that I could get their APD cases. I just found them fascinating to be a little detective to try and figure out what their strengths and weaknesses were, and match it to their case history to put the results in the larger context of what they were struggling with. One day, my supervisor had a family emergency and asked me if I would be okay to do the APD eval on my own. I was confident enough with my testing, and that I could explain the results to the parents. Usually any follow up questions were answered by the supervisor, but I felt I could handle these. Okay. And then the parents asked me a question that hadn’t really done me before. They said, Okay, we understand the test you went through and what our son is struggling with. But how do we fix it? Dunt Dunt Dunt dah. So, after I fumbled through and basically said we would send out a report with any recommendations, I finished up grad school headed down to a little country in the south pacific known as New Zealand. I worked for large private practice that focused on adult amplification. But I also taught psycho acoustics and auditory processing at the University of Canterbury. While I was there and getting to know the audiology community, I was noticing that almost nobody was doing APD work. So I started to ask questions about why it wasn’t more commonly done. There were a lot of answers from I don’t like it. I don’t know enough about it. But the three most commonly reported were, I don’t have the time it takes to administer a two or three hour battery with analysis. Afterward, I don’t want to spend the energy and time to write the report. And the kicker was, why would I do all the effort to test somebody find out their areas of weakness, and then list the same exact recommendations, like pre teach vocabulary, preferential seating, reduce the noise, etc, etc, etc, regardless of what areas were deficient. So exactly what you said. So there weren’t any deficit specific interventions. So why measure the deficit? I really felt that those were really good points. So driving down the road, one day, hyped up on way too much delicious New Zealand coffee. God put an idea in my head, he said, Why don’t you build an APD test battery into a video game, and then make some other video games to make important deficits better. And from there, acoustic pioneer was born. One of the points I would like to emphasize for this talk would be to mention that you can get started without feeling like you are the expert of the world. There are a number of ways you can get started with incorporating APD into your practice that are very simple and easy. In addition to that, you can perform entire batteries including automated reporting, within 30 minutes, there is a lot of flexibility of how and where you could administer an APD eval it can be in a sound booth or it can be in a quiet office. There are even ways of tele testing and allowing patients to be tested at home via their caregiver or parent. Also, I find it very helpful to put auditory processing in the context of the larger picture of our patients after and how it affects other issues. If you really back out and you look at things, you will see that at the base or bottom of a lot of higher functioning skills is audition or our auditory processing. Without that we cannot develop language. Well, just think of how limited people were that were born with severe to profound hearing loss before amplification and cochlear implants. With limited auditory processing abilities, the Individual will struggle to learn language well, and and further will have difficulty with reading. Reading is nothing more than language that has been written down. If you struggle with language, you will struggle with reading. They are both processed in the same neural centers. One gets there by the ears, the other gets there by the eyes, but they end up at the same point. Now that advancements in the field have been happening, we are no longer in the era of having to do testing and give the same old recommendations regardless of the test results, we now can address the deficits and make them better. And by making them better, we can see real world improvements and other areas. For details on this. Come see me. I mean, come see Dr. Barker tomorrow morning for all the details. Okay, so as an example of some of the real world impacts we can see, I recall the first patient to go through a dichotic listening therapy program for me. She was a 32 year old female with some cognitive limitations based on her presentation, and communication ability. She worked in an office as a receptionist. Her test results showed significant weakness in her dichotic listening abilities. So I told her about this experimental therapy I wanted to try, she agreed to participate. And she did the therapy twice a week for almost 10 months. After it was over. She came in for follow up testing. Her dichotic listening was completely normal, compared to her peers. But curiously, I asked her, have you noticed any changes any changes or benefits since doing the therapy? She said, I don’t have to tell you what I feel. Because my boss even noticed he asked me what’s changed, I noticed you don’t need to have instructions repeated anymore. Now if I were looking into delving into another area of practice, I would want to know what the potential for clientele would be. Well, I have some really strong data on the school age population. All of the following will likely benefit from an auditory intervention or therapy. Anybody that has a reading delay, anyone with a language delay, and anyone with a classroom learning difficulty, because remember, reading is built on language, and language is built on intact auditory processing, and input. To review these studies in more detail, don’t forget to come to see me. I mean, Matt, Dr. Barker tomorrow morning. That is just over 10% of the school age population. So if you take a small city, like Amarillo, Texas, for example, there are about 16,000 kids between kindergarten and fifth grade. That means 1600 of them could benefit from your help. Let me show you a nice pretherapy posttherapy cased example to show a nice observable change we can make to our patients. This 11 year old male was present pre tested with a test battery and had weaknesses indicated in both auditory patterning as well as dichotic. Listening. The top four tests are the auditory patterning. And these two areas are the dichotic listening. First, he went through a dichotic listening therapy program. Check out the follow up test.

And then he went through an auditory patterning training program. And now look at the final result. Not bad, right?

Have a look at the raw scores for the dichotic listening pre and post. As you can see, we can make a real change. All right, have a look at his very detailed study from a bird’s eye view. Let’s say we have two identical groups of kids, all of them have a language disorder diagnosis and all of them are struggling to read. Group one is getting reading intervention. And and so is group two. Group one is getting language therapy. And so is group two. Group one received a placebo auditory processing therapy. Group two got a deficit specific therapy that was indicated by APD testing. Guess what? group to develop their reading age at twice the pace of group one. Yep, so it says Join me tomorrow morning for some why and how

audience 1:00:07
Thank you so much. So my first question is about something a topic that you brought up in regards to treating pediatric, where you said that you can do a definitive diagnosis. Hmm. But a tentative diagnosis at age five, I was curious how that affects things like IEP or, you know, disability statements. If they’ll accept a tentative diagnosis in that place, you have to act really just for the family’s benefit, so that they have a little bit of like, advanced knowledge, and then they’ll be able to walk ahead.

Mary Anne Larkin 1:00:39
All right, insofar as an IEP, I know for our state in South Carolina, and auditory processing disorder is not considered a learning disability. So they do not get IEP services, unfortunately. So they are able to get a section five of for being diagnosed with a tentative diagnosis that age five or six has not made any difference with them being able to get that section 504, they are still able to get it. Okay.

Gail Whitelaw 1:01:09
Okay, and what Mary Anne just said with that, too, we find that in Ohio, it really ranges from no diagnosis of APD to some school districts looking at it on the continuum of hearing loss. And I’m always pushing for that, because I believe everything that Mary Anne said about, Gosh, this is our wheelhouse, and we have to be the ones in charge of it, and making the diagnosis. But I will tell you that for a lot of kids in school districts where we do see them that are younger, I think it sets them up for success, because in many cases, it gives them speech and language services. It gives them auditory training services that we can provide. And so, you know, looking at it from a broader perspective, I think sometimes that’s really, really helpful. And it does give the child more access to school based services. When we identify them earlier.

audience 1:02:07
In the state of New Jersey, we actually can get an IEP for auditory processing. One thing I just want to state though, that on the clinical side, because I do educational audiology as well, we have to be very mindful of the terminology and verbiage that we put in our report as well. Because if you say well consider, that’s their loophole. Or I considered it doesn’t mean I have to do it, and you didn’t recommend it. Alright, where we’ve had cases where if we say, okay, we recommend this, at the younger ages, they are allowed to get access to the Headstart programs. Now I was

Dawn Heiman 1:02:46
taught, I worked it, I do auditory processing, and I started in my CFY. Year, a long time ago. 99, not 83. But I was taught when I covered someone’s maternity leave at Bucks County Intermediate Unit, and it was in Bucks County in Pennsylvania. And we were taught to say that to consider this because if you’d make a strong statement, then the schools have to do it. And that becomes a legal battle. So different ways to look at it. I also had a parent recently, just this week, say Oh, cool. If you’re recommending Logan gain hearing aids, the school district will listen to me and allow it to be in her IEP and will actually allow mandate that these hearing aids are used, we get our hearing aids because we’ve had an FM system for two years, and the teachers won’t use it. And they don’t have to require it. Like oh… this is complicated. This is i Illinois.

Unknown Speaker 1:03:47
Hi, hey, hey. So

audience 1:03:51
I’m just gonna throw a brief kind of where my journey has been for those of you that have not taken any leap into APD and maybe I can get some feedback from this. So in COVID world, the beginning of COVID world I went all in on learning APD I was like this is I was so felt so passionate about it. And I learned about I got a demo account on acoustic pioneer and and I joined Angela Alexander’s program. And I just went all in and I built all my materials. I started marketing I like I was like, I believe in this hardcore that knew nothing like started from zero, okay, I don’t feel like my program really educated us very well on APD. Then my practice opened back up, and I was fully booked with my hearing patients, my tinnitus, my sound sensitivity, and all of that learning that I put into APD was like, I can’t keep learning. Like I go, I’m going back to like, I’m a solo practitioner office right now. So I had to put it on the backburner. But I keep coming back, I’m sitting and like I like I’m drawn to it. But the same point, and some of your brains may work this way, I don’t like to go into something until I understand it in total, I really have to work maybe with my husband, who’s a mental health counselor, on accepting the fact that this is a field that seems to be a portion of our field. That is, I don’t think we’re ever going to fully understand it. I think we just have to take the data and go, well, that works. And I’m like, Angela, why does that work? Why is that train, like what’s happening neurologically? And it’s like, I don’t know, you know, like, I don’t think we’re ever gonna grasp it. But I’m like, I need to understand why, you know, that’s an issue of mine. But so I’ve partnered with, I have a, I have a very, very well known school for dyslexia, less like a mile from my office, people literally move across the country to go to the school. And I’ve met with them, I’ve, we’ve talked about it, and it’s like, such like, it just feels like duh like, you know, but for some reason I one person, right. And I know a lot of us were one person where maybe the owner. And so I think just the logistics, I am just sharing this to say I am bogged down with the logistics, not my passion, not my understanding of what we can do. A little bit of there are a lot of tests, how will I learn them all? And you know, figure out what to do for who, right? triaging, but just logistics of like, yes. Like, how do you make sure that they’re you’re covering your time, like Kayla said, Right? And how much to bill for and even if you know your hourly rate, it’s like, well, if they need that additional phone call Mary Anne, are you charging them additionally for that phone call? Or did you make it a bundled package assuming that they might need up? I’m truly saying like, those are logistics that bogged me down. And if anybody else feels like those things are preventing them from taking action. I just want you to feel heard and seen and please help.

Dawn Heiman 1:07:12
If you’ve seen one person with APD, you’ve seen one person. So when we’re all talking to each other, and collaborating and all that, and this is always evolving, but just because you’re like, I made it perfect. I’m ready now. There’s always going to be an exception. Nothing’s perfect. But when you’re ready, if you’re ready, then try go ahead. Well for sharing them. Yeah.

audience 1:07:35
Um, first, I want to say thank you Dr. Whitelaw for for giving us all the freedom to step into this not being experts. And because that is a huge hurdle, hurdle to get past this. And then I wanted to make a comment about what you said, when I started working with tinnitus patients, I felt the same way. And Dr. Natan, Bauman put together a program to the tinnitus practitioners association that put nuts and bolts to it, that gave me a structure. I still didn’t feel that great about it when I first started it, but then I started it. And then I started getting better and better at it. And I got more confident. And I feel like that’s what we as audiologists that we need this, because coming to this is great. I know I want to do it with all the cognitive decline, movement that’s working, I work with adults, I don’t work with children. One of the things I butted up against when I started trying to do this is a lot of it’s just pediatric information. And that’s not what I’m doing. I need to apply it to adults. And I need the structure. I didn’t understand some of these testing protocols. And then I didn’t really know how to follow through. And then there’s the other major question of what if you’re putting hearing aids on a person who has normal hearing, normal peripheral hearing? How are you justifying that? So these are the things that I found and that I would like to move past I’m not saying hey, I want to dump this in somebody else’s lap. Please give me the the roadmap, but you guys move forward on it. I would like to, I would agree with

Mary Anne Larkin 1:09:20
ya. I would like to respond to that. So I know I was a part of TPA, that Neil Bellman, I went to some of his courses. And that really helped me figure out how to work with the tinnitus patient. If you all have the app, right, the app app. And so I don’t know if you looked at the handouts that we have for this session. I wrote them up. But if you look at the APD educational resources, I will say one of the things I’m constantly learning, Dr. Tarvin with auditory processing, you know, I thought I knew what I was doing in my Advanced Hearing Care Practice. And then when I went to low country listening lab, I was like, Ooh, There’s so much more I have to learn. So I am a part of I gaps. It’s IG APS international guild of auditory processing specialists. So the web, their website is www. I gaps.org. And I think I think that’s in the handout. And it is a room, we have an annual convention or conference once a year. It’s usually in Kansas City. And it’s in Kansas City, because Dr. Jack Katz, who’s like the father of APD, he lives there. He’s 80. I think 86-87 Still doing some testing and therapy. He’s 82. Oh, I thought he was older. Okay. I thought somebody told me he was older, not that he doesn’t look older at all, he looks in his 70s. It looks amazing. So it is filled anywhere, usually, I’d say 30 to 40 to 50. professionals come and they’re like minded auditory processing. So you’re going to be in with audiologists speech language pathologists and OTs come. And it’s a great group. So I got there. And as I’m talking, I’m like, Oh, my gosh, my eye, I need to add to my battery. I’m not testing for this. I’m not doing that. How do you handle this, and you’re talking to colleagues that the majority of what they do is auditory processing. So it’s very exciting. It can give better structure for you. I put on here. Well, they also just started doing ssw workshops. And so I went to one in Atlanta, it’s three days, pretty detailed. I think they’re doing one in Virginia, maybe in February or March. I’m not sure where they’re next one will be. Dr. Tarvin talked about Angela Alexander. And she is probably the biggest driving force in the world for auditory processing, getting recognized, and getting professionals trying to, you know, make do assessments and work with individuals that have auditory processing challenges. And so she has a company, it’s APD support. And so she does two different training modules. One is on the diagnostic side, one is on the therapy side. So if you decide you only want to do diagnostics, then you spend the money for that module. And it’s a lot of it’s more remote learning. And then I think you get together with video chats, and she’ll make clarifications and stuff like that. So that is something good also. And that’s all based off of the buffalo model. And then there are books in my library that were really, really helpful. Terry Bellus has a couple of books. A new one came out a year and a half ago, the Geffner Swain, auditory processing book, Gail Chermak. Frank Musiek has a book, The AAA clinical practice guidelines, that’s something that you really need to look through, that’ll give you some more information as to Okay, what do I need to do? How do I need to set this up? So that I’m doing the right thing and you know, doing evidence based clinical practice?

audience 1:13:14
So I have a real practical question. And Gail and Don both know how much I love. I love auditory processing, I took extra placements in grad school, I am a nerd of the brain. I am passionate about all this stuff. I can’t afford it. I take Medicaid in Ohio. And so because I do that I have stabbed myself. By doing that. I looked at my reimbursement. And I am a 2 practitioner. But we have one testing booth and we’re busy. But we take all the we take all the stuff that nobody else wants to take. So as a private practitioner, I’m already in pain. But putting somebody for two hours in my booth, which we do great work. And then spending a lot of heart writing a really detailed report. Even the private insurances are only paying me for two units of nine to six to one. They cap it at that. I looked at it my hourly with APD. I’m making less than $65 an hour, how I don’t know how to and it makes me want to cry. Because I know that I need to help these people, but I can’t kill my practice to do it. I’m sorry.

Dawn Heiman 1:14:30
Like she said, make a new one. You’re going to create another entity and you’re not going to take insurance for that and you’re just going to do APD. You can do this. Yeah.

audience 1:14:40
It’s Honey, please do not cry. Because I do not because I will start just as Don said, you have to think strategy. There are grants out there. Do a different entity, do a nonprofit, get your board and get the money and you can provide the services, get a lawyer get I’m not giving you any type of legal or business advice. But it can be done. I have the heart and I’m okay

Dawn Heiman 1:15:18
I, you know, when I was in Pennsylvania, I had school vouchers, and the schools would give the kids a voucher and they would bring it and I would get paid.

Mary Anne Larkin 1:15:26
I have a question, are you going to the talk tomorrow because I’m, I don’t have as much knowledge. This is for Dr. Barker’s he has a, a test battery called feather squadron. And it can be completed within 30 minutes, you can send your patient with an iPad is that correct? They can go to a quiet room, you’re not using the booth. And they can get that completed that way. Um, that might be a potential to where you’re still your other audiologist is in the booth, they’re generating the revenue, and you’re still able to to do your APD services. So you may want to link up when he has a voice. And figure if that that delivery model can work for you.

Dawn Heiman 1:16:19
I can attest to that. Like I would suggest, if I may you do the regular comprehensive on one day, free up that booth. They come back, let’s say you did the buffalo model, you just do SSW do words in noise and you do phonemic synthesis, then you have them go to a different room. And they’re going to do the feather squadron with the cos 22. You are 10 headphones on an iPad in a different room and just have someone kind of monitor them in case they’re like distractible, but they always love it. I tell them, if you there’s the carrot, if you really good, you get to play the Angry Birds game on my iPad. And they love that and then you know, so you can break this up and it becomes then you can also do always on a different day and maybe get reimbursed better and all that good stuff.

Gail Whitelaw 1:17:07
Can I Can I just address the question that was before that Mary Anne was talking about. But I want to say I love you, Sarah Curtis, and the fact that you know that we are now passionate about these kinds of things. And we want to serve the people that are out there. People talk about how learning how to do this. And Dawn and I have been in a group that I wish we were more active in. But I think we can think about learning communities. The person who asked the question about working with adults, I would be so happy to share every protocol that we use with you. We’ve got lots of evidence I work in a university. And that’s one of the reasons why. And I want people to go out and do this stuff. So you know, Don and I and Meghan Mapes. And we have some other pals who get together and we sit around and talk about this, and there’s no charge to do it. And we educate each other. And every time I walk out of one of those virtual sessions, I think, man did I learn a lot tonight. So maybe one of the things we need to think about is how do we bring like minded what Mary Anne said, Bring like minded people together to talk about some of this. In addition, the other night, Angela, Alexandra and I are working together on a patient who was in a plane crash on an adult. It’s amazing. He’s not my patient, I was brought in asked if I would help consult and what we’re doing what she’s doing with him from a auditory training perspective, in two sessions. Oh my gosh, you guys, it is unbelievable. His word recognition under headphones after his playing private plane crash was like 0%. And what has happened is just amazing. And I have learned so much from that. So I think that I would encourage all of us, certainly a go to matts talk tomorrow. But also how do we have the opportunity to connect with each other and talk about these things and learn from each other because I think there’s a great amount of information. And for the person who said, I’m not always comfortable. I’ve been doing this for 40 years, and at least a couple of times a year, I have somebody who comes in and I say to myself, Wow, I’m not even sure where to start or what to do. But we all have that skill. And we can all learn through that. Most of these patients don’t expect us to be perfect. And to be, you know, the knower of all information in APD. They just want to be validated what the person said before about doing all the work and being heard. I think a lot of our patients want to be heard and don’t want to be told, Oh, your audiogram is normal. You’re just perfectly fine. And so starting at that point, is really, really great place to start. Alright, I’m shutting up now.

Dawn Heiman 1:19:56
Awesome. We’re gonna take one more question.

audience 1:19:59
So this It’s just a comment, I was able to attend ARIA training. A couple of weekends ago, that’s with Dr. Debbie Moncrief at the University of Tennessee in Memphis, she spent her life long, you know, we’re we’re looking at ear weaknesses or ear advantages. And so she’s developed this program to remediate that. And that’s just one of the dichotic therapies that’s available, you know, such as Matt’s program or cat dot, that when hearing aids came up, and FM systems, she said that we really have to be careful with that, because we can actually make that asymmetry worse. And so I had to kind of rethink my strategy because I’ve put logain hearing aids on several adolescents and adults and they’ve been successful, and I think is audiologist that’s our first go to hearing loss, hearing aids noise reduction. But um, I just kind of wanted to throw that out that we may need to work on the system a little bit more, and maybe it’ll let that be the last resort. You know, if they’re still struggling.

Gail Whitelaw 1:21:09
I’d like to hear her her research on that, because I’m involved in a project right now. And that’s absolutely not what we’re seeing. But I would love to hear what her research is. If it’s not anecdotal, and I don’t know that it is or it’s not. Yeah,

Dawn Heiman 1:21:25
I think and you could also say, you know, differential diagnosis is very important listening to the patient. We you have a lot of resources here. And Gail, would you agree? Well, we’ll I’ll reach out to Meghan Mapes today and say, can we make this happen more often and invite a lot of good people to just hop knob, people coming from all different aspects. Someone from University of Minnesota was like, Look, I’ve never done this guy’s helped me and then went from Penn State, another one from someone from New Jersey. And we’re just like, or some of us that are the old dogs out there that have been doing it for a while and we have our comfort tests, but we’re interested in learning new stuff. You know, if we work together as a profession, we will rise to the occasion and help each other out.