ME: Tell me about why you decided to be evaluated.
ADULT CLIENT: I think I might have HDHD and dahlexia.
ME (unsure): You think you might have ADHD and dyslexia?
ADULT CLIENT (embarrassed): Right, ADHD…but I think I have dahlexia, too.
Auditory processing problems are among the hardest problems to explain. If you were to give parents a simple, technically correct definition of auditory processing (e.g., the ability to perceive patterns in sound), you are likely to be misunderstood. Parents know that “auditory” has something to do with hearing and are likely to think that their child has a hearing problem or has difficulty understanding speech. Auditory processing is the ability that I spend the most time explaining so that I do not cause confusion. If a child has auditory processing problems, I say something like this to the parents:
Auditory processing is not the ability to hear. Your daughter can hear just fine. The problem that she has is difficult to explain so I am going to start by comparing her problem to vision problems (She does not have a vision problem, either. I am just comparing the two problems.). Near-sighted people are not blind. Up close, they see well. Things that are far away, however, are blurry. Making lights brighter does not help; near-sighted people need glasses. In the same way that someone who is near-sighted is not blind, your daughter is not deaf; she is not even hard of hearing. However, for her, speech sounds are a little blurry for her. It is as if she needs glasses for her ears, to make sounds clearer. Unfortunately, no such thing exists. A hearing aid would not help because it is not the volume of the sound that is the problem.
The problem is that the sounds in words are hard for her to distinguish. I’ll explain what I mean. Words are made of different sounds blended together. We usually think of the word cat as one big blob of sound – /cat/. However, whenever we need to, we can break cat into three separate sounds – /c/ /a/ /t/. With a word like cat, this is easy to do and even your daughter does not have much trouble with it. However, when she hears a long word or a word with a lot of consonants bunched together, it is hard for her to break the word into individual sounds. For example, the word strength has only one syllable but it has six sounds – /s/ /t/ /r/ /e/ /ŋ/ /θ/. With cat there are three letters, one for each sound. With strength it gets complicated because the n and the g form a single sound /ŋ/ and the t and the h make the sound /θ/. If I pronounce both the n and the g separately – /stren/ /g/ /θ/ – it sounds strange. With a word like strength, your daughter can hear the first sound and the last sound but gets lost in the middle and starts leaving sounds out or guessing wrong sounds.
Now, if you say the word strength out loud, she can hear it and she understands it. She is not confused. She can even pronounce the word correctly. Why? I’ll make another comparison to vision. When you are driving and you see a road sign from far away, you might not be able to see every letter on the sign distinctly. However, you might be able to make out the shape of the word and because you know what different signs are likely to say, you can tell someone what the word on the sign is. This is sort of like what you daughter can do. She hears the word and can say what it is based on the overall features of the word. However, she has difficulty hearing each of the sounds as distinct from each other.
If the only thing that were wrong was that she could not split words into different sounds, there would be no cause for concern. However, it turns out that this ability to hear the sounds in words as distinct rather than as big blobs of sound is really important to learn to read. If you can hear the different sounds in words, you can hear why the words are spelled as they are (if they are words with regular spelling). If you are reading and you come across a new word, you can sound it out like they do on Sesame Street.
Children who have difficulty hearing speech sounds distinctly, often have trouble learning to spell and to read. Most children learn their letters and the sounds they make and then can figure out how to read and spell most words (at least the ones with regular spelling). Without the ability to sound out a word, learning to read and spell depends mostly on memorizing each word one-by-one. New words have to be taught explicitly to the child. Some children with this problem figure out how to work around it; some have help. When children with this problem fall behind in their ability to read, we call the problem dyslexia.
I want to be clear what dyslexia is and what it is not. You may have heard that dyslexia is when children see words backwards. This is not true. I have been doing this for a long time and I have seen many children with dyslexia. Not one of those children saw anything backwards. However, many of them jumble their letters and, like younger children, sometimes they write their letters backwards. This is not due to seeing things backwards. Instead, these mistakes are due to ordinary memory errors. If you give me a long list of groceries to buy, I might remember most of the items on the list but I might not remember them in the right order. When children with dyslexia learn a new word, they might remember which letters were in the word but might forget their order. They will probably remember the first and last letters but might mix up the middle letters. If they could sound out the words, they would be able to see that the order was wrong but that does not happen as often as it otherwise would.
The reason that young children often write letters backward is that letters are very unusual. Most things have the same name no matter what angle we view them from [I demonstrate with a pen, rotating it and turning it]. This pen is called a pen no matter what I do with it. Letters are not like that. The letter b changes its name, depending on how it is rotated or flipped. It can be a d, a p, or even a q. A backwards j does not even have a name. This is weird for children and it takes a while for them to get the hang of it. Children with dyslexia have a bit of a problem remembering which sounds go with which letters and thus continue making these sorts of errors longer than do most children. The problem is blurry sounds, not backwards vision.
Of course, I would probably not say all this in one long speech but try to make the discussion more interactive.
This post is an excerpt from:
Schneider, W. J. (2013). Principles of assessment of aptitude and achievement. In D. Saklofske, C. Reynolds, & V. Schwean (Eds.), Oxford handbook of psychological assessment of children and adolescents (pp. 286–330). New York: Oxford.