If a child appears distractible, inattentive and has trouble following instructions, we think about ADHD. If they are easily overwhelmed, socially withdrawn or have poor language skills, we think about autism. If they struggle to read, write and spell, we think about dyslexia. If they fall behind at school and struggle to keep up in lessons, we think about IQ and processing speeds.
We almost never stop to ask whether the way a child hears may be affecting them, and yet this can create all the symptoms above. The British Society of Audiology points out that these difficulties usually go unidentified until after the age of seven, and that people who have them are generally poorly supported.
Start with a hearing test. But a clear result does not settle it. The test only checks whether sound is getting in. It does not check what the brain does with it next. Your child may hear a sound perfectly well and still struggle to make sense of it.
It is rather like the difference between a phone call that runs smoothly and one on a poor connection. The call still comes through. You can tell it is speech. But when the audio keeps breaking up, when some words arrive clipped, and others drop out altogether, you spend the whole conversation working to reassemble the sentence, with nothing left over for what it actually means. You come away drained despite your best efforts, and not entirely sure you got it right.
So what steps can make processing language easier?
Start with the basics. Change the listening environment. Get his attention before you start talking, rather than speaking to the back of his head. Face him, so he has your mouth to work with. Slow down. One instruction at a time, and ask him to say it back. Turn the radio off when it matters.
Schools will usually help if you ask. Move him to the front, away from the door, the corridor and the fan. Carpets, curtains, felt pads on chair legs, a few absorbent screens. Classrooms are echo chambers, and schools here have to meet acoustic standards anyway. If more is needed, there are remote microphones: the teacher wears a small transmitter that sends her voice straight to a receiver he wears. It cuts through background noise in a way that trying harder never will, and costs a fraction of what it used to.
If your child is still struggling, ask your GP about a referral to audiology for a more in-depth assessment.
There are also auditory training programmes that set out to retrain how the ear and brain handle sound. This is an area we have pioneered at The Key Clinic over the past decade, building on the work of ENT doctors such as Alfred Tomatis and Guy Berard. We worked with Audiology Professor Joshua Reiss at Queen Mary University, London, to create BrightBeatz, a 10-day, at-home, modulated auditory therapy program designed to stimulate the muscles and reflexes of the middle ear, with the aim of improving listening skills and helping reduce hypersensitivity to sounds. We have used this approach for years, with parents reporting great results, though it is still experimental and research is still catching up.
None of this needs a label. It needs somebody to have noticed. If your child hears everything and listens to nothing, consider that he may not be ignoring you at all. He may be working harder than anyone realises just to hear you.
Sarah Warley is the author of The Thriving Brain and works with children and families at The Key Clinic.
