At the cognitive training center, I found myself nearly falling asleep while trying to keep up with the visual and auditory tasks that the kids and adults were doing, timed to the second. It was exhausting. The room was filled with motion, timers beeping, and the sharp clicks of multiple metronomes interacting in overlapping rhythms. There were no visual separations—just one large, open space echoing with layered sound. Voices, footsteps, and mechanical cues all competed for attention. Every surface reflected sound, and every corner demanded awareness. There was nowhere to rest your eyes, and no acoustic break to regroup.

The energy was intense. It was structured and purposeful, but unrelenting. And it made me realize just how much I’ve been compensating all these years. I struggle with memory, focus, and fatigue even in environments where I’m supposed to be the expert.

This mirrored the very challenges I see in my son and those I now recognize in myself. The desire for better focus. The fatigue after conversation. The inability to hold on to a thought while someone else is speaking. It helped me understand why I interrupt, why I lose the thread. When memory is fragile, it’s hard to wait your turn. You speak not to dominate, but because the idea might vanish if you don’t.

These aren’t just patient struggles. They are ours too. And seeing that in myself reminded me how essential it is to stay humble, stay curious, and look at our blind spots with compassion.

We are not lacking research because the tools do not work. We are lacking research because the system is not built to study interventions that must be personalized. That is why so many of us rely on clinical observation and interdisciplinary input. That is why parent reports and school feedback are often more telling than standardized scores. And that is why we continue to do this work, even when the literature is behind us rather than ahead of us.

What we are doing is not easy to measure. But it is not anecdotal. It is functional. It is repeatable. It is observable. And it is deeply rooted in the real-world needs of children who are struggling to access the world of sound, speech, and connection.

Don’t be afraid to ask.

I think it’s really important to be in continuous contact with your audiologist during a low-gain programmed hearing aid (LGHA) trial.

There is no universally accepted methodology of fitting these devices, and for that reason the implementation can vary enormously from clinician to clinician, as can the success rate. Many audiologists predominantly work with more traditional patients, and APD hearing aid fitting - that is fittings of hearing aids at low levels of amplification for individuals with normal hearing thresholds - are the exception rather than the norm.

We are all learning. It’s a constant learning process of how to do these kinds of fittings because there are no trainings nor accepted prescriptive targets. It is challenging to get enough power to make soft sounds audible and clear, medium sounds comfortable, and loud sounds non-disturbing and safe.

It is to be expected that the initial settings may not be ideal. They are just a rough draft. Just like in creating a sculpture, we have to chip away or add material until it is just right.

I recently visited the LearningRx center in Chattanooga, Tennessee, a top-rated franchise of their 47 centers. I could have easily gone locally (the closest center is within 23 miles of my home), but it seemed worth the trip, just to meet this particular owner and see what she was doing.

I went not just out of curiosity, but because the owner reached out to me after reading some of my posts about low-gain hearing aids. She wondered whether what I do might help make some of their training more accessible to clients who struggle with auditory processing.

But it wasn’t just the question that drew me in. It was her depth of knowledge, her passion, and the fact that she made sure to introduce me to the research audiologist who helps guide the company’s direction. After speaking with both of them, I realized I couldn’t not go. I might live in the Washington DC area, but I took a plane to Tennessee. I needed to see what they were describing for myself. I needed to know if it was real.

We all know that EDS affects connective tissue throughout the body, but what many do not realize is that this includes the tiny, delicate structures of the ear. When these structures become unstable or inconsistent, the result can be what looks like a language delay, auditory processing disorder, or even sensory overwhelm. But these issues may not stem from how the brain processes sound. Instead, they may begin with unreliable input from the ears themselves.

I recently worked with a young girl I will call Lily, whose family has a strong history of EDS. She herself shows clear signs of the condition, including joint hyperflexibility and bowel issues. Despite having “normal” hearing on a basic audiogram, she showed marked language delays, particularly in following directions, articulation, and expressive language.

I want to start with a sincere apology. A post came up for moderation, and I accidentally removed it. My hand slipped. I can’t recover it, but I want to make sure the family and the situation still receive the care and attention they deserve:

It was an anonymous post about an 8½-year-old boy who had been fitted with low-gain programmed hearing aids but is refusing to wear them due to embarrassment. He reportedly knows they help, but continues to avoid using them. Growing his hair out hasn’t helped, and the emotional barrier seems to be the central issue.

I want to raise a question…

When a child says they know something helps, sometimes that’s because they’ve been told it helps, not necessarily because they can feel the difference for themselves. Especially for neurodivergent kids, internal motivation and lived experience often matter more than adult logic or reassurance.

For years, audiologists have turned to structured auditory training programs to support children with challenges like auditory processing disorder (APD), hearing-in-noise difficulties, and left-right ear imbalances. Tools like DIID, Aria, Zookeeper Skyscraper, SoundStorm, and CAPDOTS were developed with care and intention—often by clinicians who saw a need for more targeted, accessible support. These programs offer clear, measurable benefits, and for many children, they’ve been a lifeline.

But if you’ve ever tried to get a child to complete these programs day after day, you’ll know what we’ve also seen in practice: they can be expensive, repetitive, and hard to stick with. That doesn’t mean they’re ineffective. It just means they’re limited by the same thing that limits many interventions—motivation, attention, and generalization.

Most of these programs isolate one auditory skill at a time (like frequency discrimination or dichotic listening), which makes them great for foundational training, but they often struggle to replicate the complexity of real-world listening: the unpredictability, the layers of sound, the need to coordinate what you hear with what you do.

So here's the question: What if the most immersive auditory training tools weren’t in a clinic at all—but already in your living room?

I’ve always known I was autistic. Even when I didn’t have the word for it, I could feel the difference. The world just came in too loud. Too bright. Too much.

At first, I tried to block it out. I wore earplugs. Then noise-canceling headphones. It was like building myself a quiet little room in my head where I could only hear my own breath and footsteps. It was peaceful, but lonely.

I started using earplugs when I was little, after an occupational therapist said it might help me stay calm in loud places. And it did, for a while. But I think I went too far with it. I stayed in that quiet room too long.

Eventually, I started falling behind in school. I missed conversations. I couldn’t follow group lessons. I just sat there, watching the shadows on the wall like in that story. You know, the one where people live in a cave and only see the outlines of things, not the real world.

That was me.

I felt safer, sure, but I was cut off. I didn’t know what was going on around me. I was lonely. Isolated.

And it got worse.

You know that Heinlein quote?

“A human being should be able to change a diaper, plan an invasion… cook a tasty meal, fight efficiently, die gallantly. Specialization is for insects.”

That line has stuck with me because it describes exactly why I don’t fully trust “experts,” at least not the kind that get stuck in their one little tunnel and forget the rest of the child.

In medicine and education, everyone has their lane: the audiologist won’t touch reading, the reading specialist won’t talk about sound access, the speech pathologist won’t talk about cognition, and the psychologist won’t talk about hearing. Each person is polished in their niche, but they often don’t see the child… they see a checklist or a label.

I’ve been working through the drills on LipReading.org, and they’re impressively designed. The videos are clean and focused. The lighting is ideal. The speaker looks directly at the camera, and each word is presented in isolation. There is no background noise, no distractions, and no overlapping speech. These are the most supportive conditions possible for lipreading.

The site includes more than just vowels. You can practice consonants, numbers, minimal pairs, and closed set tasks, where you choose from a limited list of possible answers. That structure makes it easier. Your brain has fewer options to sort through, and the format helps guide your choice. But in everyday life, we don’t get a word bank. We don’t know what’s coming next. We don’t get to pause or guess with help.

This is where lipreading often falls short.

When you have sounds that look identical on the lips, like “mat,” “pat,” and “bat,” there is no reliable way to tell them apart using lipreading alone. The lips move in almost exactly the same way. Without sound or some kind of visual clarification, it becomes a guessing game. For children who already have strong language skills, they might be able to fill in the blanks using memory or context. But children with limited language often cannot.