Listen, it's a complicated matter

2nd November 2012 at 00:00
For Jennifer Tingle, school presented a huge challenge and she didn't know why. That was until she was diagnosed with a little-known developmental problem called auditory processing disorder

Jennifer Tingle, 18, always knew there was something different about her, but could never work out what it was. "Other kids seemed to be getting something I wasn't. They'd talk to each other and understand stuff. They'd speak about people and things I had never heard of.

"I was out of the loop socially. I never understood sarcasm. I'd get the wrong end of the stick in conversation. If someone said, `I've had a bad day - don't ask', I wouldn't ask. I would just leave them."

The audience of professionals and parents at the University of Stirling conference laughs. Jennifer and her mum Evelyn have agreed to be a case study today, to illustrate little-known developmental problems, how they impact on young people's lives and learning, and how both can be transformed with the right therapies.

"If there was background noise, I could hear sounds but not words," Jenny continues. "It was like they were talking gibberish. I have acute hearing, so I didn't understand. I didn't know anything, apart from being deaf, could go wrong with your hearing.

"School went downhill when I went to secondary. I worked hard but was very slow. I was quiet and well behaved though, so I didn't get into trouble. I was under the radar."

Organised by the Movement and Learning Centre in Bo'ness, whose director Ian McGowan is a former principal teacher, today's Enhancing Learning conference features experts in developmental difficulties that can cause underachievement in many areas, including reading and spelling, coordination, manual dexterity, handwriting, listening skills, concentration and memory.

With no access to other people's perceptions, a child with any of these outer manifestations has no way of knowing how their inner world differs from the norm.

"I assumed everyone had the same problems but were coping better," says Jenny. "I thought they were smarter or I was a wimp. I didn't know that what I felt was unusual. I didn't know how to describe it.

"I wondered if I was autistic. I even asked my mum if she had dropped me on my head as a baby."

As an Alexander Technique teacher, Evelyn Tingle has considerable experience of the interacting effects of bodies and brains. But her daughter's problems were unlike anything she had encountered. "As a mother I wanted so much to help but didn't know what the problem was."

There had been no real difficulties at Jenny's birth, she says. "She was small for dates and there wasn't a lot of fluid around her in the womb. They induced her a week early. In her cot she thrashed around. She took hours to get to sleep and would waken through the night. She walked with a head-down, cautious gait. But she was walking at nine months, so there didn't seem to be anything wrong physically.

"At primary she was quiet and sensitive. She got lots of colds and tired easily. But her father and I are like that, so I thought it might be a double dose of genes. When she got further up she struggled more, and by Standard grades she was very unwell."

"I was always tired," Jenny says. "Homework piled up. If I couldn't do a problem in maths, I'd stare at it for ages. I knew if I asked the teacher, nothing would go in. I could stare at a page for an hour then have to take that work home too. I could be up till 2am doing homework and it still wasn't right. It was demoralising."

School was difficult, homework hard, but night-times were the worst, Jenny says. "I was getting bullied at school and was an incredibly paranoid little kid. I'd get a wee torch and hide under the duvet, hearing all these sounds. My dad snoring sounded like growling in the dark. I was convinced something was coming to get me. I had horrible nightmares.

"You're supposed to wake up before you die, but I didn't. I'd get my headset on fire, eaten alive by big dogs or chased and chopped up by people with knives. I'd be exhausted when I went to school in the morning."

The past picture of a troubled child could hardly differ more from the present reality of the articulate young woman painting it. Few mature adults could hold the attention of a professional audience with such confidence and charm. It might come easily now, says speech and language therapist Camilla Leslie, but it wasn't always so. "It's been a long, hard journey for Jenny."

The journey began when her mum realised listening might be the problem rather than hearing. "We had a long session with Camilla and at the end of it she told us it was very serious," says Mrs Tingle. "Jenny said `I'm so glad, Mum - it's felt serious."

That first session showed that Jenny had auditory processing difficulties, as distinct from hearing impairment, says Ms Leslie (see below). "The ears work, but there are problems in the neurological pathways between ear and brain. Something good happens when you explain this to people."

"Finding out I had a learning difficulty was great for my confidence," Jenny agrees. "It means I'm not stupid. I'm doing my best."

A programme of therapy using the Johansen method, in which special music stimulates neural pathways, was devised for Jenny, who made good progress initially. "I could make out words where I'd never heard them before," she says. "I discovered it wasn't `Harold be thy name' in the Lord's Prayer."

Then came a setback. "With a lot of interventions you go back before going forward again, because everything is being reorganised," says Ms Leslie. "Jenny was at the extreme end of that and we had to look at something else before continuing."

She referred Jenny to the Movement and Learning Centre, where Ian McGowan carried out another series of tests (see below). These showed that besides auditory processing, Jenny also had difficulties with movement and balance caused by retained reflexes, he says. "These are involuntary movements in response to specific stimuli - like closing the fingers around anything touching the palm - that a baby comes into the world with. They help it survive.

"These primitive reflexes should be inhibited during the first year of life. If they persist, they interfere with normal development and cause movement, balance, behaviour and cognitive problems in children at school."

Jenny couldn't stand up with her eyes closed, she explains. "When I was walking, I could never tell where my feet were so I had to walk like this," she demonstrates, head down, moving cautiously. "When I was going downstairs, I had to hold on to the wall."

It's a pattern typical of the retention of the Moro reflex, Mr McGowan explains. This is the infant fight or flight response, whose persistence can be highly disruptive to development. Tests showed that Jenny had this and four other retained neonatal reflexes, says Mr McGowan.

He devised a programme of daily exercises, designed to put these infant reflexes to sleep and allow the higher brain to function without interference. Over 18 months, Jenny worked at these, as well as returning when ready to the auditory processing therapy.

The outcome of all this has been the transformation of a troubled child into a confident young woman, who plans to study horticulture at university, as well as sign language and jewellery-making in her spare time.

"I can't tell you how good it feels to see Jenny like this," says Mrs Tingle. "We were so worried. I didn't know how well she'd be able to talk today. She is a private person. But she told me she wanted schools to know all about these problems. I've never seen her so articulate. Wouldn't it be lovely if all those kids out there could be spared what Jenny went through?"

"There must be lots of kids struggling the way I was," Jenny agrees. "I want them to get the same chance I did. This has changed my life."

Behind the condition

Auditory processing disorder (APD) is an area of active scientific research that "results from impaired neural function and is characterised by poor recognition, discrimination, separation, grouping, localisation, or ordering of speech sounds", according to the British Society of Audiology.

Individuals with APD usually have normal structure and function of the middle and inner ears, but difficulty in interpreting signals from them to the brain. With a range of possible causes which can be developmental or acquired, the disorder can also produce a variety of symptoms.

"There may be a diagnosis of dyslexia, dyspraxia, attention deficit, specific language impairment or autistic spectrum disorder," says Camilla Leslie. "Co-morbidity - the presence of two or more disorders - is very common in children with learning difficulties."

Individual intervention for APD takes the form of structured listening to synthetic sounds which improves function over time, by stimulating the neural pathways. Effective school programmes have been devised, says Ms Leslie. "They are now being used with groups of schoolchildren in England and around Europe," she says.


A feel for retained reflexes

Originally the Scottish branch of a Chester-based organisation set up in 1975 and known as INPP, Ian McGowan's Movement and Learning Centre uses diagnostic methods and interventions developed by them.

Retained reflexes are not part of mainstream neuroscience, he says. "But there is a wealth of clinical evidence for the effectiveness of the interventions, as well as a scientific study published in The Lancet."

The main cause of retained reflexes proposed by practitioners is trauma between conception and the early months of life, particularly birth trauma. There may also be a genetic predisposition, they say.

The incidence of retained reflexes in the school population is not known, says Mr McGowan, but when one mainstream school let him use his diagnostic methods on 21 children with learning difficulties, all tested positive.

"Every single one," he stresses. "There is a great deal of overlap among learning difficulties. A lot of hyperactivity and inattention in school is caused by retained reflexes."

Programmes of 10-minute exercises have been developed for the classroom.

"The nice thing is that they benefit the children with these problems in particular, while being part of normal PE for the rest of the class," says Mr McGowan.


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