I found myself in a thoughtful disagreement this week with an Orientation and Mobility (O&M) specialist who questioned the relevance of auditory processing disorder (APD) and phonological awareness in blind children learning to read Braille.

She pointed out that the EY braille curriculum includes phonics instruction, which is true, and I respect the structure and purpose of these programs. But here is where our views diverge.

Phonics instruction only works when the brain can clearly access and process the sounds. That becomes difficult for children with APD, even if they are blind. If a child’s auditory input has been distorted because of repeated ear infections, neurological processing issues, or brain-based auditory differences, their ability to form accurate internal sound maps can be impaired. And that affects decoding and spelling, whether the child reads print or Braille.

Misophonia isn’t just “not liking sounds.” It is disgust. It is rage. It is panic.

That gut-deep reaction when someone chews too close, breathes your air, or invades your sensory space without realizing how violated your body feels. It is not a preference issue. It is a boundary issue, especially for autistic individuals or those with PDA, also known as Pathological Demand Avoidance. The reaction is not fear. It is a survival reflex.

It is also not psychological at first. It becomes psychological when the world refuses to accommodate it. When it is treated like bad behavior, defiance, or oversensitivity. That is when trauma takes root. That is when coping turns into meltdowns, shutdowns, or dissociation.

Autism, PDA, and misophonia often appear together as a kind of sensory and emotional Trinity. Each amplifies the other. Autism heightens sensory sensitivity, PDA intensifies the need for control and autonomy, and misophonia focuses the distress on specific auditory intrusions. Together, they create a perfect storm—one that is often misunderstood and mislabeled as defiance or emotional instability.

Why aren’t more audiologists fitting low-gain programmed hearing aids to children with APD?

Because it’s between fields.

Because there’s no prescriptive formula.

Because it requires listening differently,to data, to people, and to what doesn’t yet exist on paper.

And because it doesn’t fit the typical profile of who enters this profession.

But I never fit either.

So I made something that does.

As many of you know, UDL is a framework for building access upstream: Before kids fail, fall behind, or burn out. It’s built around three core principles:

1. Engagement (the why of learning): make it safe, relevant, motivating

2. Representation (the what): offer multiple ways to access content

3. Action & Expression (the how): give different ways to respond and show learning

It’s backed by decades of neuroscience and learning research. And it’s been widely embraced in special education, in theory.

But here’s the problem:

It’s almost never applied well, or at all, for Deaf, Hard of Hearing, or APD students.

D/HH kids are often supported through legal compliance (like captioning or interpreters), but not through flexible, integrated design.

APD kids are even more likely to be missed entirely—because they “pass” hearing tests and don’t qualify for structured supports.

And yet, these are the exact students who need flexible, predictable, multi-sensory access to language and meaning. They need systems that give them control, clarity, and ways to engage without fatigue or fear.

“If my child’s hearing loss is temporary, why don’t audiologists let us borrow hearing aids?”

A parent asked this in a group recently, and it stopped me in my tracks—not because it was outrageous, but because it was such a good question.

Their child had fluid in the ears. They went through the usual steps: waiting, nasal spray, eventually ear tubes. But even after the tubes were placed, the child still seemed to miss things. They pushed for more testing and discovered mild to moderate hearing loss. Once the child was finally fit with hearing aids, it was like a light came on. She was thriving. But it didn’t have to take that long.

Even when hearing loss is temporary or mild, the brain doesn’t wait. Language development is time-sensitive, and it depends on consistent, clear access to sound. When a child only hears parts of what’s said—because of fluid, ear asymmetry, or background noise—they’re not just missing language. Their entire nervous system is affected.

I want to be really clear. I am not, and have never been, saying that ASL isn’t the natural right of every Deaf child. It absolutely is. ASL is a full, rich, visual language, and Deaf children deserve access to it from the very beginning, regardless of whether their parents are Deaf or hearing.

What I’ve been trying to draw attention to is the serious access gap. Families are often told to “use ASL,” but they aren’t given access to fluent models, Deaf mentors, immersive environments, or the kind of consistent support that helps them build a true language base at home. When kids don’t make progress, it’s not because ASL failed. It’s because we didn’t apply it with the structure, consistency, and community it deserves.

I wrote more about that here:
https://www.drraestout.com/blog/asl-didnt-failwe-failed-to-apply-it-with-the-commitment-it-deserves

Just to clarify, I also support cueing in some cases. But cueing is not a replacement for ASL. ASL is a complete language. Cueing is a tool for accessing spoken language, and for some children it can help, especially in developing phonemic precision. ASL and cueing serve different purposes, and access to ASL should never be considered optional. Families should not be forced to choose between them when both could be helpful.

This is going to be a long one, but I think it’s worth saying.

As both a professional and a person with lived experience, I believe that sensory processing plays a major role in shaping how we develop, how we think, and how we behave. What many people see as “behavior” is often just a reaction to invisible sensory input, too much noise, too little clarity, too many demands on a system already stretched thin.

Sometimes what we call attention problems or emotional dysregulation is really just a downstream effect of upstream sensory challenges. For example, I often explain how auditory processing disorder can develop from early auditory deprivation. If a child can’t consistently hear speech clearly, because of background noise, ear infections, or subtle processing delays, the brain has to work harder to make sense of the world. Over time, that leads to fatigue, missed information, frustration, and what looks like “behavior.”

But it’s not just behavior. It’s a nervous system trying to cope with inconsistent input.

That belief shapes how I see people and how I work. And it’s also shaped how I understand myself.

Hi there!

This story is based on something I wrote for grown-ups. But I turned it into a kid’s version—just for you.

Sometimes, kids feel big feelings.

Sometimes the world is loud, confusing, or too fast.

Sometimes grown-ups don’t stop to explain.

That can be really frustrating.

This story helps explain why—and what we can do about it.

I want to clarify a common issue I see in school-based hearing support. Children are often fitted with FM or DM microphone systems that allow the teacher’s voice to be sent directly to their hearing aids. While this can improve access to the teacher’s voice, it can also reduce the child’s autonomy and interfere with spatial hearing if it isn’t implemented thoughtfully.

The core issue is control. Many children are given microphone input from a teacher or support staff, but they have no ability to turn it off, adjust the volume, or blend it with environmental sounds. The microphone becomes dominant, and in many systems, raising the volume doesn’t just make things louder, it prioritizes the external microphone input and further suppresses the regular microphones on the hearing aids.

Those regular microphones—typically two on each device—are directional and designed to help children make sense of where sound is coming from. For children with mild hearing losses, these microphones often provide enough access on their own, and they may not need a remote microphone in many settings. But the greater the hearing loss, the more isolation is needed to make the teacher’s voice accessible. It becomes more like having the teacher on the phone, with their voice streamed directly to the child while the rest of the environment fades away.

This has a major impact on spatial hearing. When a child can’t hear where sounds are coming from, they lose orientation to their environment. They may hear the teacher, but not the classmate next to them. They may hear a voice in their head, but have no way to anchor that voice to a location in space.

Audiology is a deeply rule-bound, traditional profession. We are trained to rely on clear metrics: thresholds, decibels, tymps, reflexes, waveforms. In many ways, that precision is a strength. But auditory processing disorder (APD) doesn’t fit cleanly into that model.

It doesn’t give us the same yes/no answers that tone-based audiometry does. It lives in a gray zone where symptoms vary, patterns overlap, and no single test can definitively confirm or rule it out. That discomfort is part of why APD remains one of the most misunderstood and gatekept diagnoses in audiology today.

In some countries, the criteria for APD are tightly defined, requiring individuals to have hearing thresholds no worse than 20 dB HL across frequencies. That threshold exists because the research used it to control the study population. But it’s a mistake to treat it as a clinical truth. There are real problems with assuming “normal” is defined solely by the audiogram.