Read an Excerpt
The Many Faces of APD
Jeff was seventeen years old, over six feet tall, and outweighed me by at least a hundred pounds. He was a big kid. Tough, too. He was one of the starring offensive linemen on his high school football team. Word had it that he could cut through the other team's defense like a knife through butter, scattering smaller players in all directions.
Yet, despite all of his toughness, he had a gentle, polite manner and a heart of gold. When Jeff and his mother arrived at the clinic, he greeted me with a shy smile. He was extremely cooperative during testing and apologized whenever he made a mistake or missed an item. He even called me "ma'am." I'm not too fond of that generally, but, coming from him, I found it quite endearing. Which is probably why I felt as if my heart were breaking when, halfway through my explanation of his test results, he dropped his head onto his folded hands and began to cry.
My voice stuttered to a stop. I laid my hand lightly on Jeff's shoulder, and he grasped it in his large, meaty palm and squeezed.
In a choked voice, he whispered, "I thought I was just stupid."
"What do you mean?"
He lifted his head and met my gaze. There was relief in his eyes, but also anger, embarrassment, and just a little defiance.
"You know, dumb jock. I just always figured I was stupid. That's why I couldn't get it. I was just a big, dumb jock. A joke."
These were astounding words coming from a boy who had just been elected "most popular" in his junior class and was a sure bet for prom king in his senior year.
Jeff had experienced academic difficulties ever since he had begun school. He had had problems learning to spell and read and still struggled with those subjects in his junior year in high school. He liked the idea of losing himself in a book, of journeying to far-off lands or reading about historical people, but he rarely opened a book unless forced to. Jeff had a difficult time sounding out the words, so his reading was slow and laborious. As he described it, by the time he figured out what the words were, he had lost the thread of the story.
But Jeff loved to spin tales. He would make up stories about princes and dragons, life in the circus and travels to outer space, and tell them to his younger brother, who would sit spellbound in wonder as the stories unfolded. Creative as he was, Jeff never wrote his stories down. As with his reading, spelling was a struggle, so much so that even if he focused on telling the story and just coming close enough to the spelling of the words so that he could return and correct them later, he was unable to understand his own writing when it came time to polish what he had set to paper. As a result, his English composition and creative writing papers were short, poorly organized, and contained only simple language and elementary vocabulary. They exhibited no hint whatsoever of the imaginative mind of the boy who held the pen.
Jeff came from a rural school district, and special education services were scarce. Nevertheless, during his elementary school years, he did qualify for reading remediation and tutoring under the classification of learning disability. Since junior high school, however, he had not received any services, primarily because he consistently earned A's and B's in all of his classes. Therefore, the school-based special education team had decided that his reading problems were no longer affecting him academically.
The reason for Jeff's apparent educational success was, unfortunately, all too common. As a student who excelled at football in a town where football was all-important, he had been passed through every class since he was in the ninth grade. No academic probation or C's for our boy, no, sir. In fact, his good academic record, combined with his amazing sports ability, had already resulted in offers of full-ride sports scholarships from several major universities before he had even begun his senior year in high school.
Any other kid in his shoes would have been turning cartwheels.
But Jeff was different. He was acutely aware that he hadn't earned the grades he had been given. In fact, despite putting several hours into his studies every night after football practice, he knew that he should, by rights, barely be passing subjects such as social studies, history, and English composition.
His mother had initiated Jeff's referral to me for central auditory processing evaluation. Because she saw Jeff still struggling so hard with reading, she had arranged for independent, private testing by a specialist in learning disabilities. This testing had confirmed that Jeff exhibited low average to borderline abilities in reading decoding (e.g., sounding out words, or word-attack skills), general fund of knowledge, and auditory discrimination abilities. Other symptoms leading to the suspicion of auditory processing deficit were his difficulty following information presented in lectures and, particularly illuminating, his inability to hear the quarterback of his football team call plays during the huddle. "I can't ever hear him," he told me. "But I don't let on. I just keep my eye on where the ball is. I know what I'm supposed to do, so I just go out there and do it." In this manner, Jeff had succeeded in football without anyone being aware of what he had secretly come to call his "hearing problem."
In social situations, he frequently smiled his shy smile and nodded rather than jumping into the conversation, furthering others' perception of him as the sweet, strong, silent type. And when he was unable to answer questions posed directly to him or answered as if he hadn't been paying attention, he took the ribbing of his friends still with the same, shy smile.
But inside Jeff was hurting.
"You're not stupid, Jeff," I told him. "You never were. You have what we call an auditory processing disorder. Basically, what this means is that your hearing itself is fine, but what gets into the ear somehow gets jumbled by the time it gets to the brain. Because of this, different letters may sound the same to you, making it hard to tell the difference between different speech sounds. Or you might hear what someone is saying, but it's distorted or muffled, like the person is mumbling, especially if there's a lot of noise around. If you can't hear the speech sounds clearly, it's hard to learn how to sound out words when you're reading or to spell them when you're writing. That's why you have to work so hard." With that, Jeff released my hand, nodded once, and listened while I explained the rest of the test results and what I thought we should do to help him overcome his disorder. A disorder that had a name for the first time. One that could be addressed, confronted, and although maybe not completely fixed, one for which he could at least learn ways of compensating.
That was when Jeff shared his dreams for the future with me. It wasn't enough for him to be popular, to be a football star, and to have a college education virtually handed to him on a platter. It wasn't enough that there was already talk of his possibly not needing to finish college, of being picked up by a farm team or even a pro team before he even reached his senior year at whatever university he chose.
Jeff had bigger plans. "I'm happy about the whole scholarship thing, sure," he admitted. "I mean, that'll get me there, pay for everything. And I like football. It's fun." He shrugged. "But I really want to do well in college. I want to learn. I don't want to be a football player for real, not after college. I mean, that's not what I want to do with my life."
"What do you want to do with your life?" I inquired gently.
He dropped his head just a little, almost apologetically, and color rushed to his cheeks. "I want to be a lawyer," he said, very, very quietly.
"Like my dad."
And at that, his mother began to cry, too.
Jeff was facing a unique set of difficulties. On the one hand, he was virtually assured a college education. On the other hand, for him to reach his goal, he would have to actually perform in college. Football might get him through with a general liberal arts degree, but to be a lawyer he would have to go beyond that. He wouldn't be able to hide behind the misguided, albeit well-meaning, protection of his coaches or teachers. He would have to meet high academic expectations just to get into law school, then perform at an even more advanced level to succeed once he was accepted. He wouldn't be able to rely on his good looks and charming personality.
Jeff was aware of all of these things. Just as he was excruciatingly aware that his problems with reading and writing his 'hearing problem" would pose substantial barriers to his ever being able to meet those expectations.
But at least now the disorder had a name. He could take comfort in the fact that he wasn't stupid as he had always feared. Instead "his difficulties had a very real physiologic cause. And we had agreed on an intensive plan of attack, including therapy techniques, environmental modification suggestions, and ways for him to compensate for his difficulties. When he left my office, he was once again smiling. This time it was a smile full of hope.
After intensive computer-based therapy, Jeff's reading decoding and auditory discrimination skills improved significantly. Acknowledging his disorder and giving it a name helped him to gain confidence in himself and his abilities. So, too, did teaching him to become an active listener and providing him with strategies to compensate for his disorder. Right now, Jeff is a sophomore in college, majoring in political science and playing football on a full-ride scholarship. He receives some special accommodations related to his disorder through the university's office of disabilities services, and he is earning solid A's and B's.
It wouldn't surprise me at all if Jeff did, indeed, finally make it to law school.
Jeff's story is somewhat typical of the children I see with APD. Many of them complain of difficulty with spelling and reading, inability to understand what is being said especially with noise in the background, and inner feelings of inadequacy and ignorance. Children with APD gradually become aware that something is wrong because they find themselves having to work so much harder at certain tasks than their friends do. Many children with APD, like Jeff, perform near enough to the normal range in school to disqualify them for special services. However, even those children who achieve some academic success usually come home from school at the end of every day exhausted from having to spend so much effort just listening. Then they are faced with several more grueling hours of effort to finish homework that might take their friends less than half that time to complete. Over time, they may learn to compensate to some degree for the disorder. But many children with APD continue to have problems into adulthood, especially if the disorder goes undiagnosed and untreated.
Also like Jeff, many children with APD become masters at hiding their disorder. In their early years, they may try to participate in conversations or classroom discussions; however, because their input is frequently off-topic or shows a lack of comprehension of the topic, they may be ridiculed, laughed at, or even worse simply ignored. After years of this, some children simply withdraw from communication altogether. Some become sullen and sit in their chairs with arms folded and hands fisted, belligerent scowls on their faces, daring anyone and everyone to attempt a connection. But this is merely a mask that allows them to protect their vulnerable, hidden inner selves and to retain some semblance of power over the daily situations in which they feel powerless. Although this frequently leads to social isolation, it is a self-imposed isolation and appears far more preferable and less humiliating to the child than the inevitable overt exclusion by others that they have experienced throughout their lives.
Others, like Jeff, continue to participate in life, to accumulate friends and join in extracurricular activities. This is particularly true for those children who exhibit some special talent in other areas such as sports, music, art, or theater. This special talent gives them an outlet for their need to connect with others while, at the same time, providing them with at least one environment in which they feel safe and can succeed. But even these children must deal with the frequent, and often unintentionally cruel, barbs from friends and teachers, the perception of them as somewhat "slow," the teasing that accompanies their frequent social and communicative faux pas "Jeez, what are you, stupid or something?" So they, too, wear a mask of smiling tolerance and become the "good buddy" who'll put up with anything. And they frequently withdraw in their own way, becoming quiet followers in the parade of life, seemingly happy, sometimes even popular, but, all the while, bleeding inside.
Copyright (c) 2002 Teri James Bellis, Ph.D.