OU Medicine News

Keys Speech and Hearing Center Helps Student Overcome Challenges

     Oklahoma City -- Chandler Hill of Altus, Oklahoma, has overcome more challenges in his 13 years than many will confront in a lifetime. His story is a demonstration of exceptional determination to navigate hurdles and confront learning differences that might have held him back.

     Ginger Hill, Chandler’s mother, is especially grateful for the resources available through the John W. Keys Speech and Hearing Center at the University of Oklahoma College of Allied Health. Here, she found professional expertise with a passion to see children learn, thrive and succeed. “Often, it felt as if we faced a new obstacle at every turn and our struggle was uphill all the way. Having a strong advocate on your side makes all the difference.”

      As early as nine months into his life, Chandler began to experience setbacks, including multiple hospitalizations for pneumonia, respiratory syncytial virus (RSV) and rotavirus. Only a year old, he developed severe allergic reactions to food. As a result of daily vomiting and diarrhea, Chandler lost a third of his body weight and was hospitalized for failure to thrive. During one week-long hospital stay, he underwent many diagnostic tests, which seemed to confirm celiac disease. A strict gluten-free diet became the norm until he was 4. At that time, genetic testing was recommended, followed by biopsies that ultimately reversed the celiac disease diagnosis. As gluten was reintroduced to his diet, the severe food allergies Chandler experienced as an infant didn’t return.

       His battles with illness included chronic ear infections, which led to Chandler having not one, but two sets of tubes in his ears. Long-term occlusion of the ear canal was a factor as Chandler began to fall behind in speech-language development. He began speech-language therapy, which continued through kindergarten, then was re-established in the third grade to present. But, the cumulative effects began to disrupt Chandler’s ability to adapt to classroom learning.

       He struggled to memorize the alphabet, recognize sight words and learning to read and write independently. Well-meaning people tried to reassure Hill, offering what seemed like reasonable answers. She often heard, “He’ll be fine; boys are always slower to develop in these areas,” or, “He’s capable - maybe he needs to apply himself more.” In the void of other plausible reasons or causes, Hill admits there were times when she seriously considered these responses, even disciplining her son for not accomplishing tasks. “But deep down, I know my son. He was making the effort, as much as he knew how. I saw clearly how on one day he would process new information and make great progress. The next day, we took three steps back and started again. There was clearly more going on than resistance or unwillingness to do the work.” 

     Hill began to research different disorders that affect the ability to process language and information. Chandler saw specialists from Oklahoma City, Tulsa and Kansas City for testing to determine the best course of action. Through these encounters, he was found to have dyslexia, dysgraphia, convergence insufficiency and auditory processing disorder (APD). 

     APD is a condition that interferes with how the brain recognizes and interprets sound, especially speech and its causes are unknown. Children with APD seem to hear normally when sounds are delivered distinctly and in a quiet environment. They often don’t recognize subtle differences in words, even when those sounds are clear enough to be heard. When speech or conversational sounds are layered with background noise that occurs naturally with social and sporting events, on playgrounds, in school cafeterias and even classrooms, the challenge to understand what is being said is significant.  

     In 2016, Hearts for Hearing confirmed the APD diagnosis and prescribed a wireless hearing system to help improve Chandler’s classroom experience. The microphone, which directs the teacher’s voice directly to Chandler’s ears, paired with the hearing aid to filter noise, improved the situation considerably. Chandler does not have hearing loss but the reduction in background noise helps his ability to focus and process information.

     John W. Keys Speech and Hearing Center began working with Chandler in 2019. Mona Ryan, M.S., CCC-SLP, ASHA Fellow, clinical associate professor and speech-language pathology clinical coordinator for the Keys Center, described the assessment for APD. “The team assessment is quite comprehensive and includes audiologists and speech-language pathologists. Audiologists use various tests to determine hearing acuity and ability to hear speech frequency. Listening tests follow. These measure ability to listen with or without noise, delayed response times and effects of distortions on speech understanding.” The speech-language portion of the assessment includes receptive and expressive language, phonological awareness, auditory memory, listening comprehension, problem solving, and other tests specific to the client. Christi Barbee, AuD, CCC-A, F-AAA, leads the audiology portion of the team.

     Barbee explained that reliable diagnosis of APD is related to brain maturity and development as well. “Speech-language pathologists can look at language from birth, but it is only around the age of 7 or 8 that audiologists can detect the transfer of information from one side of the brain to the other. That’s a significant element in auditory processing, a development of early childhood, not infancy, and some of the testing isn’t conclusive if performed at earlier ages.”

     Professional and public awareness of APD has surged in recent years, however, Ryan said misconceptions and misunderstanding have flourished as well. “Management and treatment depend on accurate diagnosis, and the APD label is often used to describe a wide variety of related, but quite distinct disorders.”

     She explained that APD broadly refers to how the central nervous system uses auditory information. But because the central nervous system is vast and also controls functions including memory, attention and language, determining the causes of certain disorders is a complex process. Symptoms span a broad range from mild to severe and take different forms. Some of the same symptoms may be seen with other conditions, such as learning disabilities and attention deficit hyperactivity disorder. Audiologists have the expertise to look at specific problem areas when making a diagnosis. APD may be considered if a child:

  • Is unusually bothered by loud or sudden noises
  • Becomes upset in noisy environments
  • Has performance issues or behaviors that improve in quiet settings
  • Has trouble following directions, whether simple or complicated
  • Is challenged by reading, spelling, writing and other speech-language functions
  • Struggles to follow verbal math problems
  • Is disorganized and forgetful
  • Struggles to follow conversations

     Because the Hill family lives in Altus, Chandler’s therapy occurs primarily through virtual platforms, which became essential in other programs as the COVID-19 pandemic erupted. Teletherapy created a different dynamic for services offered at the Keys Center. One-on-one sessions are tailored to the specific needs of the student. A typical schedule is a 30-minute session twice weekly, but is variable to accommodate parents’ work schedules and the child’s school hours. Insurance coverage varies and may be limited to rehabilitative services, for example, if the condition is the result of a head injury and not related to developmental delays or unknown etiologies. Ryan said the Oklahoma Health Care Authority is a good resource to help facilitate client access to services.

     Using teletherapy to provide services, Emma Menard, one of Chandler’s clinicians, realized how much she has relied on physical expressions of encouragement, such as a simple high five. “Patients like Chandler thrive on positive feedback,” she said. “It’s just not the same over a computer screen, so I had to get creative.”

     Ordinarily, off-topic ramblings aren’t encouraged, but Menard found ways to use Chandler’s “gift of gab” therapeutically. She learned that Chandler is a fan of professional basketball, which sparked her use of different aids. “He helped me understand that focusing on his interests was an effective way to motivate and encourage. This simple lesson has changed how I plan teletherapy sessions.” Chandler gave this strategy high marks. “I like all the games and activities. They call it therapy, but I always have fun.”

     Working with Chandler also brought a new educational element to staff at the Keys Center, especially for graduate students. “Conversations with Chandler have taught them about a more rural/agricultural lifestyle - raising goats, cows and 4-H projects,” Ryan said. “He’s a great young man with tons of personality. He gives 110% all the time.”

     Distraction may be a problem for some patients doing teletherapy in their homes, but for Chandler, it is an ideal situation. “I love being at home where I can just relax and be comfortable. Being in my own room with my stuff helps me focus better during sessions, and it’s also fun to meet new therapists at each session.”

     Menard and Ryan emphasized the critical importance of parental involvement, which directs where the work done via teletherapy is applied to every-day life skills. However, the parental check-in, which would occur naturally during an in-person visit, requires a more intentional effort using virtual platforms. “I had to reserve a few minutes at the end of sessions to check with Mrs. Hill to gain those valuable insights, not only about difficulties, but also about the victories where Chandler has used his new speech skills at home or school on his own,” Menard said. Because each patient is unique, Menard said successful therapy depends in part on discovering what works best in each individual case, for each patient and family. “These quick conversations help me apply therapy to equip Chandler with speech, language and social skills that will best prepare him for the stage of life he is in.”

     As a second-year graduate student, Menard’s experience with rural school systems is somewhat limited, however, teletherapy has broadened her perspectives. “We make every effort to create a sense of partnership with school administrators and teachers.” Teachers are asked to complete a checklist about classroom dynamics. Based on this information, therapists make practical suggestions. “For example, if a child seems unable to follow oral instructions, we might recommend writing instructions on the board or on paper,” said Menard. “Children with APD often struggle to understand and remember verbal instructions. Written instructions are often more effective, and simply highlighting in color or underlining important points can be helpful aids. We address skills and solutions consistently.”

    Ryan said speech-language therapy seeks to cultivate global language skills, including reasoning and memory, an area where Chandler has struggled. Often, the information also is social and cultural, and when it isn’t precise it can be difficult to make the leap from the implied to the concrete. “For example, you may tell me you want a Big Mac for lunch, and I know we’re probably going to McDonald’s. There’s an auditory processing component at work in that understanding.” In terms of social language skills, Chandler has learned helpful cues. “He’s quite the talker,” Ryan said, “and sometimes, conversation was more like a monologue. Now he recognizes when he may have lost a listener, and understands the ebb and flow of a two-way conversation.”

     Much of the session time is focused on grammar to ensure spoken and written forms match. While the virtual format isn’t ideal for reviewing written work, clinicians like Menard make it work. “How many students say, ‘Let’s do more grammar!’ Chandler is all in for whatever the session holds in store.”

     She said her work with clients who live in rural areas has taught her the importance of communication between the teacher and clinician. “Having a window into each child’s performance in the classroom and understanding teachers’ main concerns helps us align speech therapy goals with clients’ grade level goals,” Menard explained. “It’s not enough to see our clients succeed in our therapy rooms. Our goal is success in the classroom and beyond.”

     Hill acknowledged the difficulty of the journey, from educating herself, then navigating unfamiliar landscapes, not only in healthcare, but also in the educational realm. “Chandler is an intelligent, amazing young man with a great heart, who perseveres to overcome his challenges. It takes an intense degree of parental advocacy, as well as the help of specialized clinicians and teachers with grace and a knowledge of accommodations and available tools. These will help Chandler be successful in his endeavors,” she said. “My hope is to make sure he has every opportunity to learn and become the man God intended him to be. We are grateful for the support and knowledge found at John Keys. I hope our experience will encourage other parents. The best things you do for your child are usually not easy. You won’t regret an investment that ensures your child’s best possible future.”

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