Why your better half ignores you!

How a little known but surprisingly common condition could explain . . .

ASK 14-year-old Pippa Marchant to describe the machine that washes clothes and she might pause, then say: ‘The shaky-shaky thing.’

She knows what it is really called, but she can’t find the word. Because Pippa has a condition called auditory processing disorder, or APD.

APD is essentially a problem with how the brain interprets sound. It may explain why some people struggle to hear speech in a noisy restaurant and could even be the reason your spouse seems to ignore you.

People with APD find it hard to distinguish between very similar words or sounds. Unlike with typical hearing loss, in APD sounds reach the brain — people with the condition hear them, but find it difficult to process them. This means APD is hard to diagnose, as standard hearing tests rarely pick it up.

‘I’m sure there are thousands of children and adults in the UK who have not been correctly diagnosed,’ says Dr Ralph Holme, director of biomedical research at Action on Hearing Loss.

CHILDREN CAN BE MISDIAGNOSED

IN CASES where an adult has it but was never diagnosed, people might think them rude or unresponsive. Family members may complain about being ignored while the person with APD may become anxious or even depressed, say experts.

At nursery, while other children played together, Pippa chose to play alone. At first, her mother Jane, 46, whose son has autism, wondered if she had it too. But there was something else.

‘She never seemed to follow instructions,’ says Jane, who has two older children aged 19 and 15, and lives with her husband Bill, 44, in Hemel Hempstead. ‘She couldn’t seem to understand people and, although she could speak a little, her speech was muddled so people would ask her to repeat herself.’

When Pippa was four, Jane took her for a hearing test. The GP diagnosed glue ear and Pippa was given grommets — tubes to drain excess fluid.

But by the age of five, Pippa still wasn’t really talking, so doctors suggested speech therapy. Aged eight Pippa still muddled ‘st’ and ‘sl’ sounds, ‘spot’ would be ‘stot’ and ‘change clothes’ became ‘chase clothes.’

School proved difficult. ‘She couldn’t sit still during carpet time and again couldn’t follow instructions,’ Jane says.

This behaviour, according to experts, can lead to children being labelled ‘naughty’ or as having learning difficulties.

‘APD is not a learning difficulty, but it causes them,’ explains Alyson Mountjoy, co-founder of APDUK, a support group. ‘And it has lifelong implications, affecting education, relationships, work and self-esteem.’

Specialists have known about APD for over 40 years, however it is not well-understood. It can affect people in different ways, with some experiencing shortterm memory problems, while others may need longer to respond to verbal instructions. Some children, although not all, have delayed speech.

The biggest hurdle is that hearing tests do not pick it up.

‘Standard hearing tests assess whether patients can hear a pure tone at a range of pitches or not and what is the softest noise they can hear,’ explains Professor Doris-Eva Bamiou, a specialist in audiovestibular medicine and an honorary consultant at Great Ormond Street Hospital, which runs one of the few NHS APD clinics.

‘These are simple tests, so they’re not enough to identify sound processing in the brain.’

A NEW TEST ON THE HORIZON

PROFESSOR Bamiou says a few tests have been developed in recent years to try to detect APD, such as requiring the child to listen to a variety of sounds and to respond either verbally or by pushing a button. Electrodes attached to the head to record brain activity can also measure the auditory system’s response.

But there is still no ‘gold standard’ way of testing for APD, instead an assessment is made based on different measures, not just hearing tests.

And as a result, children are missing out on being diagnosed, adds Dr Holme. He hopes a new test being developed at University College London (UCL), funded by Action on Hearing Loss, will make diagnosis more straightforward.

As Stuart Rosen, a professor of speech and hearing science at UCL, who is leading the research, explains: ‘It involves listening to speech that is switched between the ears, with a distracting message played at the same time.

‘For some children who are suspected of having APD, we think it’s very likely the difficulty they have involves the ability to focus attention on one talker while ignoring the distracting speech from someone else.

‘For other children, it may be that a developmental language disorder is an important factor, or even the dominant one.’

PROGRESS IN LEAPS AND BOUNDS

AFTER pushing for help for years, Jane took Pippa, then 11, to see an NHS audiologist, who finally diagnosed APD.

Professor Bamiou says there are things that make it easier for children, such as minimising background noise, for example from the TV, sitting near the front of class, asking the teacher to back up verbal instructions with written ones.

Now at secondary school, Pippa still has trouble finding the right words, but she has come on leaps and bounds.

In her own eloquent way, Pippa describes her condition as like ‘fishing’ for words in a fishbowl. ‘The words are like fish and sometimes you catch the right word, sometimes you catch the wrong word and other times the word slips away,’ she explains.

Last year Pippa was diagnosed with autism and ADHD, too — disorders that, together with dyslexia, often run alongside APD. But it’s important APD is identified and symptoms are not attributed to other difficulties.