Smart or Dumb

One of the many facets of my job is to see children for Central Auditory Processing evaluations, typically these are children or adults that struggle with staying on task, focus or task completion. These are individuals who often find language based learning challenging, that misunderstand and misinterpret. One of the first comments I make to these individuals is that these differences in learning style have nothing to do with how smart you are. Unfortunately those that do not fit into the normative learning model often question their intellectual ability, in reality these individuals can often be the brightest and the best but they, themselves, do not know it.  I wrote an article earlier on attention deficit disorder with this very theme. It is one thing to make this bold statement regarding intellect but it is another to get one to buy into their own giftedness. Here is a story  that I love to tell regarding a spectacular example of the gifted child that was made to feel stupid.

I saw this child many years ago as a  ten year old. This little girl was adopted early in life. In those days the parents that were adopting had little to no access to family history  so these parents knew very little about the special needs that might arise for their daughter.  At ten this little girl could not read at all, not even a little. This child was unable to do any of the required work for her age and grade. The situation was so dire that the school was moving towards putting her in a "life skills" class. This type of a class is for those deemed of low intellectual ability. The idea is to equip a child through  the classroom to be able to deal with the basics of function in society. As we talked about our testing process and why we were looking at the Auditory Processing Ability our conversation finally came to the point where the Mom finally blurted out "but she is not dumb". This was really the crux of the matter. the message being conveyed through the school and the professionals that this girl was dealing with was that she was intellectually, significantly limited.

When Mom had made her assertion I asked her to tell me more and what I heard next blew me away. Mom revealed to me that she could take this little girl shopping with her and she could fill up her cart and this ten year old could calculate in her head what her groceries would cost her with tax. I could have fallen off my chair at this point. I agreed that indeed there was potentially much more to this girl than she was showing at school. After a long conversation with Mom we set out to find out what was going on. Upon further investigation it was found that this girl was off the charts brilliant when it came to mathematical thinking and off the charts in the opposite direction when it came to language based learning. So the question became what to do with this child? Was this girl a genius or was she "dumb" so to speak. My commentary is that she was obviously very bright. The problem at school was that even math had become language based at that age. This girl was given what she needed at school and began to flourish. When this child got to high school she was the annual winner of a province wide math competition each year that she entered and was taking University math while in high school and yet she was always a lousy reader.

This brilliant young woman had sadly spent her early years in life thinking that she was less intelligent than her peers and had started to give up her willingness to learn. In the end this child was far superior to the rest of her peers  but didn't know it. The point is that we are all individuals with strengths and weaknesses but we are all taught the exact same way. Some traditional learners can thrive in this environment but others that potentially are the brightest and the best sometimes never have the opportunity to feel intelligent.

Overwhelmed By Personality

As an audiologist, I have opportunity to meet folks from young to old, from all walks of life with disorders and differences. Really, it could be anyone that walks in my door. What I know as a strength and what is rewarding is reaching the otherwise unreachable connecting with people that might be difficult to connect with, having relationships with those that seem to be impossible to relate to. It is not because I feel I have something to offer them but it is because I know they have something to offer me.

The other day I was tasked with testing a 14 year old girl with cerebral palsy.  This girl was sent to me to do audiometric brain stem response evaluation (this is an objective neurologically evoked response that allows hearing threshold testing in infants and the difficult to test). The reason for the referral from another clinic was that they could not get results with traditional evaluation. This young woman was accompanied by her mother at the time of evaluation. From the moment this young lady arrived in my office, it was obvious that her ability to communicate with language was quite impaired, most of her vocalizations were sounds without apparent distinguishable content. Even with the absence of understandable vocalization, it was soon realized that we could communicate. I ended up having a conversation with this child that we both understood. As we started to understand each other, I understood with certainty that I could indeed do subjective testing and that this girl knew exactly what I required of her in order to accomplish this task. We ended up getting results that others had failed to get in her 14 years of life because we were able to communicate and understand each other because we had developed a relationship. There is a very strong clinical implication in this story as to the importance of connecting with and understanding each patient that walks in my door but there is a much stronger implication that I would like to share.

During our visit together I was profoundly impacted by the strength of this child's personality and how she made me feel. I am not talking about how it made me feel dealing with the sadness of a handicapped child but I am talking about the nonverbal communication of joy and happiness. Sometimes we see what we want to see in life and transfer feelings from within but this was different. This young woman had such a beautiful, magnetic personality with strenght and joy that could not be misunderstood. While her body limited her ability to communicate physically, she had learned to communicate with subtleties that were now very powerful. I went in to my office overcome with emotion having come to conclude that I was the one who had gained much from this encounter, that I was the one that had been given a gift that day.

How much more of a responsibility do those of us have to make others feel with our words and our actions. We that are fortunate enough to have been born without handicap have an even greater set of tools with which to engage those around us. It is so difficult to put into words the effect of that particular encounter on my life  but it is definitely indelible and unforgettable and undeniable. I could not help but be drawn in by this child, it was she who connected with me not the other way around.

The Power of Sincerity

In life, there are often anecdotal experiences that lead one to the knowledge of inherent truths, sometimes validated by research and other times validated through common sense consideration. There is much I have learned from my patients over the years. I learned very early in my career that my patients required an authenticity to my approach. This group of people wanted me to be sincere and honest, with the reward being loyalty , trust and friendship. I have known in my heart that sincerity is a very powerful human characteristic, recently one of my patients validated this viewpoint through a wonderful personal experience.

The story that is told is one that took place many years ago. This woman with adult children had been seeing a particular ears nose and throat specialist for some time and had developed a familiar but professional patient doctor relationship. The woman was a smoker and the physician had been advising her to quit for some time. It came to the point that at every appointment this topic of conversation would inevitably arise. The patient would listen and return home unfazed and with no motivation or intention to stop smoking. While the advice was politely received it really did go in one ear and out the other. One day the patient arrived at the doctor's office for an appointment and found that the physician was somewhat distracted and disturbed. It turned out that this doctor's sister in-law had only the day before been diagnosed with terminal lung cancer. True to form, at this visit the doctor again brought up the topic of smoking and the health concerns that he had for the patient. On this occasion it was a heartfelt and personal plea that was rendered to the patient to stop smoking. The woman went home like any other day not giving a great deal of thought to the possibility of quiting smoking. The very next day without a great deal of thought she left her cigarettes at home and never smoked again. When I questioned her about it she really did not have a rational explanation for what came over her other than the power of the sincere plea brought on by personal tragedy.

As I thought about this message delivered to me through a personal experience I couldn't help but relate that experience to my own professional life. One has to be true to their beliefs speaking truth from the heart in order to really be heard. If we, as professionals, are not convicted of the message we deliver, our patients will not reward us with trust and loyalty. At this point in her story I turned to my patient and suggested to her that I sincerely hoped she would go to the mall and buy me a wonderful Christmas present. I suppose my request was not all that sincere since she did not really feel compelled to do so.

The art of conversation.....lost, or just changed?

lol....ttyl..... bff....g2g...nvm....is this how we converse today? Indeed in vast portions of society this is the language of choice. The question becomes what does this do to our ability to really understand one another and effectively communicate? I do not dispense of  this form of communication as irrelevant, it is obvious that is is here to stay and evolve as a communication mode.

In the professional context as an Audiologist I have reason to be concerned with the way in which we communicate specifically with the hearing impaired. The generation caught in the middle of this clipped short formed communication style as opposed to the more elongated, developed, elegant conversation of an era fading away are the Baby Boomers.  The Baby Boomers do communicate on the information highway  but also value social conversation that develops over time. These folks still take part in group social activity that revolves around communication and conversation.

The hearing impaired individual requires multiple cues to really understand speech. There is a necessary need for redundancy and reiteration of subject and content to enable optimal understanding for the hearing impaired individual. In addition to auditory redundancy is a need for further redundancy linked to visual cuing as well. We find communication optimized when we can both hear and see the individual with whom we are conversing.

No matter what our generational style of communication it is probably true that taking the time to have a slow conversation that develops over time on a face to face basis can be a rewarding and relaxing process. Sitting down and having a coffee with a friend or colleague can lead one to have a clearer understanding of that person. It is far more likely that we will misunderstand a quick comment or assertion than one that is introduced, developed, and completed as a thought.  Should it not be our intent to make every effort to be clearly understood?  

Misson Impossible

Years ago when I was in graduate school I was fortunate enough to have access to what was cutting edge technology.  The school had a partnership with research facilities second to none and as a result we were able to see technology long before it went to market.  At one point a well known research facility came to the school and placed in the middle of the table a literal black box, perhaps 12”x 10”.  The scientists were rather excited to tell us this was a prototype of a digital sound processor.  These scientists were very hopeful that one day they could miniaturize this prototype to fit as a pack on one’s waist with a wire that would go to the ear attached to a mold to hear with.  This was eons ago in the world of technology.

A few weeks ago I was at an innovation summit for another unveiling of a digital sound processor.  The processor was so tiny it could fit into one’s ear canal with very little visibility.  More impressively this miniature processor, designed for hearing loss, was able to receive a wireless signal from one’s television or other audio device with no other wires, cables or other attachments. These hearing devices are now miniature wireless custom ear phones.  More impressively they have an iPod like remote - soon to be released with a touch screen - that allows one to connect via blue tooth to the telephone but also allows the other party to hear you through the custom devise in your ear, all hands free and hidden away,  primarily invisible to the casual observer.  This technology, that at one time seemed only imaginable in fiction, now exists in reality.

Mission impossible has now become possible.  What the next ‘black box’ prototype will be capable of one can only imagine.

Finding Your Happily Ever After

We will inevitably find ourselves in challenging listening situations; parties, dinners, church services, concerts etc.  Perhaps it is at times like these, that we wonder why a loved one seems to avoid the very gatherings they previously enjoyed.

Are you perplexed by this unexplained change?  While there are many potential explanations for this change there is one that is readily understood and has the potential for a happy ending, so to speak.

Given that this article is dealing with hearing and issues related to hearing I am obviously suggesting that hearing loss can lead to social withdrawal, I talk to people every day that have come to this understanding.  It stands to reason to say that we avoid situations that are difficult or challenging.  Why go to that party if the background noise is so loud that you can’t follow the conversations?  Why be in a listening situation that makes you feel like you are less than competent?  The resulting avoidance and ultimate withdrawal may not be sudden but perhaps a slow and insidious process which, nonetheless, will take root over time to such a degree that those around will start to take notice of this change in social interaction.

If one is inherently a social being and find themselves withdrawing from social settings the end result may be to miss those interactions to the point of depression.  I have heard patients rationalize this withdrawal suggesting that this is the way they prefer life. Typically, it is the family member that disagrees in this regard.

It is one of the more amazing experiences to watch a patient re-engage with the world as their hearing is brought back through the use of prescribed amplification.  I have story after story related to me of the life altering changes that occur when one can communicate effectively.  To be able to connect with each other in social and other settings can be one of life’s great joys and when that is taken away, through the loss of hearing, the results can certainly be life altering, even devastating.

Perhaps it is time to find that happy ending.

Simon says "Wiggle your toes".

Hearing is integral to communication. How we hear things as well as how we interpret what we hear can have a significant effect on our response and where the conversation goes from there.

Perhaps 11 years ago, I was doing some work on our house and had borrowed a neighbour's jigsaw and after I was finished with the jigsaw, I put it and all the attachments back in the case in which it came. My boys had been "helping" me with this project and wanted to continue to be helpful. I asked the two older boys to take the box across the street, deliver it to the neighbour and thank him for its use. My oldest son was five and his brother four at the time. Ours was a quiet neighbourhood and a dead end street but still as a responsible and concerned parent I sat in my living room at my piano and began to play while I had the chance while keeping an eye on the boys crossing the street. . A few moments later I heard a blood curdling scream and saw the younger of my two boys running across the street with a horrified look on his face with tears streaming. My heart may have skipped several beats as I jumped up and ran outside to see what had happened.

In haste, my oldest son, Sammy had run across the road spilling the contents of the jigsaw case while tripping and falling down. When Sammy tried to stand back up he snagged a blade in the bottom of his foot causing the blade to go through the bottom of his foot vertically.

In the emergency room the physician examined the bottom of the foot  while Sammy lay on his stomach. The concern was that the blade may have interfered with a nerve or significant blood vessel. The doctor asked Sammy, my five year old son, "Do you think you can wiggle your toe?"  Sammy, after giving the question careful consideration replied "I don't think so". The physician looked a little worried. After checking the foot out thoroughly, he decided to wait a little before removing the blade. Some time later the doctor returned, checked the foot and asked again about the ability to wiggle the toe, and again the answer was "I don't think so". The doctor was somewhat concerned but decided to remove the blade carefully. With the area in question locally anesthetized, he excised the blade without consequence upon which he cleaned and bandaged the wound.

With the concern for the ability to move his big toe still primary Sammy was moved onto his back with his foot propped up. The question was whether the ability to wiggle that toe had yet returned. Once the anesthetic was thought to have worn off the doctor returned and asked Sammy again "Ok, now do you think you can wiggle your toe?" Sammy replied "I...........I will try."   At this point this five year old proceeded to sit up and while getting a hold of his big toe between his thumb and fore finger began to "wiggle" his toe back and forth. Indeed he could "wiggle his toe". The very serious doctor couldn't hide a mild chuckle and the very relieved father couldn't help but understand his child's literal interpretation of the request in question.

This story is a wonderful lesson in the art of communication. The person initiating conversation asking questions may think that their question is well understood while in reality the person interpreting the question may have come to a completely different understanding. The hearing impaired individual experiences added complexity in communication given that their hearing loss causes the speech signal to be inherently compromised.

I recently had one of my staff call a patient to book their annual hearing test, my patient responded by saying they would be happy to come in for their annual urine test. Hmmmmm.........   Choose your words carefully.