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.

Misophonia. Hyperacusis. Noxacusis. These aren’t just quirks of perception. They are sensory intrusions. They are real, painful, overwhelming. They don’t stem from obsession. They stem from a nervous system that has learned to protect itself from something harmful. When we treat them like OCD, we risk retraumatizing the person we’re trying to help.

Exposure therapy, in this case, can make things worse. Not because the person is unwilling, but because their system is already flooded. They are stuck in high-alert mode, scanning their surroundings for the next strike.

Imagine I followed you around with a thumbtack. Not constantly. Just often enough to keep you guessing. Sometimes I prick you. Sometimes I hide. But you know I’m out there. You’d flinch. You’d tense up. You might stop trusting people altogether. You’d wonder who was going to prick you next.

Now imagine I bring you into a clinic. I sit across from you, holding the same thumbtack, and I say, “Don’t worry. I’m going to keep pricking you until you get used to it.”

Could you relax?

Imagine your child is falling backward, like in a trust fall. But instead of one person catching them, there’s a net. That net is made up of professionals—an audiologist, a speech-language pathologist, a psychologist, an occupational therapist, a teacher, a reading specialist, and you.

Each person holds a different strand. Each one sees a part of your child. One sees speech. One sees behavior. One sees sensory overload. One sees listening. One sees academics. The idea is that together, they’ll catch what matters. But even when everyone is doing their job, sometimes the child still falls through.

That’s because the net isn’t broken. It’s just full of holes.

And those holes are not an accident. They’re built in.

For many families, an auditory processing disorder diagnosis doesn’t bring clarity or comfort. It brings confusion. Or silence. Or blame.

Some parents are told their child just needs to focus more, try harder, or stop being sensitive. Others are told the struggles are emotional or behavioral. Teachers and speech-language pathologists sometimes question whether APD is even real. Audiologists may explain the scores but offer no plan. Parents are left with unfamiliar terms and percentile rankings, but no one connects those results to daily life, school, or relationships.

Families are told to talk to the school, but the school doesn’t always recognize APD. Even when a diagnosis is made, there may be no services, no follow-up, and no clear next step. Parents are often left to figure it out alone, while their child continues to fall behind or shut down.

Background and Context: Navigating the APD Controversy

Earlier this month, The Informed SLP published "Do You Hear What I Hear? Navigating Controversies in Auditory Processing." The piece raised several critiques of auditory processing disorder (APD), including variability in testing, diagnostic overlap with ADHD and language disorders, and questions about the long-term effectiveness of interventions, particularly auditory training.

As an audiologist with more than 25 years of experience, including seven years focused almost entirely on auditory processing, I felt it was important to respond. I work virtually and moderate a support group of nearly 13,000 members—including parents, professionals, and adults living with APD, hyperacusis, misophonia, tinnitus, and other related auditory challenges. Many members are international and neurodivergent, as am I. I am autistic, and I intentionally chose this population because I understand how often their needs are dismissed or misinterpreted by systems not built for them.

This article is intended for clinicians, educators, and researchers who are actively navigating the complexity of listening challenges and diagnostic uncertainty. It contributes to an ongoing professional conversation about how to move forward—ethically, effectively, and collaboratively.

The fluid started early.

By six months, something was off. I cried more than other babies—especially at night, especially after lying down.
Sometimes there were fevers. Sometimes just congestion. Sometimes I’d wake up screaming, always tugging at my ears, especially the left one.

The pediatrician said it was normal. Said it was teething, or a cold, or allergies.
“You’ve just put him in daycare,” they said. “This is what happens.”

So they treated it like childhood.
Round after round of antibiotics.
Each time, the crying eased.
Then it came back.

Then came the plane ride.

I screamed during descent. Clawed at my ears. Afterward, my left ear stayed jammed. It didn’t pop for a week.

My mom brought me back in. The pediatrician said, “Let’s try one more round. It’ll clear up on its own.”

It didn’t.

It took months to see a specialist.
The ENT checked the pressure: negative in one ear, fluid in the other.
“He needs tubes,” they said. “He needed them a while ago.”

I was two.

Introduction

Meet Liam, age 7. He passed his hearing screening at school but struggles to follow conversations in noisy classrooms. He bumps into desks, gets overwhelmed at recess, and says his ears feel "off" even though nothing hurts. For kids like Liam, the problem isn't what traditional tests pick up. It's what they miss.

If your child has ever had chronic ear infections, asymmetric hearing, or a diagnosis of auditory processing disorder (APD), even if their hearing appears "normal" on testing, you need to know this. They may still be navigating the world with broken or inconsistent input.

Fluctuating or uneven hearing during early development doesn't just affect speech perception. It disrupts how the brain builds its internal map of space, motion, and orientation. And even after the ears clear up, the downstream effects often remain.

Chronic Fluid and Hearing Instability

One of the most common contributors is chronic middle ear fluid. Not just a passing infection or a week of congestion, but fluid that lingers, returns often, or causes hearing to fluctuate. This muffles sound, distorts clarity, and confuses spatial cues. A child may appear to hear, but the input is blurred or incomplete.

Asymmetry and Brain Miswiring

When fluid affects one ear more than the other, the brain gets unequal input. That disrupts how it learns to time, localize, and balance sound. Even short bouts of asymmetry can rewire the system in lasting ways. The brain needs balanced input to build proper auditory maps.

If you're considering an auditory processing disorder (APD) evaluation for your child, it’s normal to feel unsure about what to expect—not just during testing, but also when it comes to funding and follow-up care. Many families worry they’ll be on their own financially. While coverage is not guaranteed, there are several real pathways that can make both the testing and recommended interventions more affordable and accessible.

Paying for APD Testing

Because I am a licensed audiologist, families are typically able to use Health Savings Account (HSA) or Flexible Spending Account (FSA) funds to pay for APD testing directly.

I will provide detailed receipts and documentation as needed.

Many private insurance plans also reimburse for diagnostic audiology services, including APD testing, especially if your plan includes out-of-network coverage.

I do not bill insurance directly, but I provide a superbill that includes:

• Procedure codes
• My license and NPI information
• All necessary documentation for submitting a claim

The criticism of APD diagnostics isn’t wrong. There is a real problem.

And it’s not that auditory processing disorder isn’t real. It’s that the way we test and diagnose it is deeply flawed.

Here’s what the research actually says:

“Using different diagnostic criteria, the percentage of children identified as having APD ranged from 7.3 percent to 96 percent.”
— Wilson and Arnott, 2013

That’s from a study where the same group of referred children showed diagnosis rates that varied dramatically, just based on which test battery was used. That’s not scientific precision. That’s chaos.

Other researchers have noted that some of the most commonly used tests may miss large numbers of struggling children. For example:

“The sensitivity of the SCAN and SCAN-3 in identifying children with APD was only 50 percent and 33 percent, respectively.”
— Elsisy, 2013

In other words, children who are clearly struggling to process language in real life may still pass the most commonly used auditory tests. These false negatives can delay support, deny access to services, and undermine confidence in the diagnosis itself.

Dr. David DeBonis directly addressed this concern when he wrote:

“It is possible that the use of these protocols underestimates the presence of the disorder in children who do not meet the diagnostic criteria but are, in fact, experiencing functional difficulties.”
— DeBonis, 2015