Please Don't Knock Auditory or Cognitive Training

I wrote to several colleagues about my change of heart about cognitive and auditory training (particularly auditory training - as it's their passion) recently, but unfortunately, my letter never reached the people I most wanted to hear it. I have a bit of a disruptor reputation of pioneering the low-gain programmed hearing aids with remote/FM mics and trialing them in nearly every imaginable scenario. This does not always go over well in audiology.

I really did try to apologize. It was heartfelt and overly-long (a bad habit of mine) - and, unsurprisingly, my message was mainly suppressed in transit.

So I want to say it here.
I’m sorry.
I was wrong.

For a long time, I acted as if low-gain programmed hearing aids with remote microphones were the only real option for auditory processing disorder. They are not.

I still believe in them strongly, and I have seen them make a huge difference, especially right away. You do not have to wait months to see improvement. Children and adults can experience clearer sound, less fatigue, and more confidence within days or weeks. Are they a "bandaid" or a "crutch"? Yes. But they help you heal.

I also believe that the hearing aids themselves are a form of auditory training you can take everywhere with you. They are like wearing an arch support in a shoe, which can prevent fatigue, improve balance, and over time, help you gain strength.

The initial jump in skills can feel almost magical, but that quick climb slows, then rises more gradually, and eventually it plateaus. When you reach that plateau, you have to ask, “How far am I from my goal?” If you are still too far away, you will need to add something else.

This is exactly why I value our group expert, Canadian APD audiologist Lalsa Perepa. She is one of the most knowledgeable auditory training experts in the world, both a researcher and a clinician, and her results reflect her ability to adapt and individualize.

She turned to me to understand my tool, low-gain programmed hearing aids with remote microphones, and I turned to her to understand hers. This is collaboration. We do not need to live in silos, and we do not need to scare off our allies. Her work proves that when auditory training is done with skill and flexibility, it can take people far beyond what devices alone can achieve.

She also stays in our space, despite being continually told that the people here do not particularly like the concept of auditory training. This is a club for low-gain programming, for devices and technology, not therapy. She is the definition of resiliant. She patiently states and restates what she has seen.

She, too, uses low-gain aids, but in the opposite order of what I typically do. Rather than starting with a trial, she starts with auditory training, then goes to LGHA if her training is not fully successful. These are different but both hybrid approaches.

Either method could work. I b elieve using the aids is slightly upstream of auditory training. First fix the signal. Then, it may process better. But aids may not always be the best option.

What if a child cannot tolerate the feeling or look of the aids?

What if the immediate cost (after the trial's low financial risk) is too high?

What if the school won't allow the use of devices?

Still, I often choose the trial first, because of the lack of initial financial risk to the families. They KNOW the aids are working, before they commit to the cost. That and the immediate benefits. Lalsa Perepa charges in time spent, like any therapy. She likely considers auditory training as the least invasive beginning. No stigma from devices, nothing to get used to using on a daily basis. It's like physical therapy vs an ankle brace and regular use.

I understand there are people who would start with auditory training alone and say you are wasting money on hearing aids. I tend to disagree. I know that Lalsa might disagree with me on this, and there are certainly others who do, including the people who did not allow my letter to be read.

Many of these professionals strongly believe the use of hearing aids for APD is a waste of money, that individuals should instead only do auditory training. I understand where they are coming from, but I disagree. Sometimes, it's not ok to wait for results.

I must say, however, there is a level of confidence that comes when someone can function at a higher level right away, without waiting for long-term training to take effect. I think that is priceless. It often leads to other benefits that ripple into learning, participation, and self-esteem.

That is not to say training does not have significant value. It absolutely does, and I have seen what it can achieve when done well.

This is when auditory training can be transformative. Done well, it is not just running through a program, it is a skilled, adaptive process that changes how the brain processes sound.

The most effective training blends one-on-one clinician work, where strategies are adjusted in real time, with computerized adaptive practice that responds to the listener’s performance, along with real-world integration activities that bridge the gap from clinic to life.

Real listening is messy and unpredictable. That is why auditory training should include sudden, variable noise distractors to build split-attention skills and the ability to recover quickly after interruptions.

Dichotic listening tasks are equally important because daily life often demands processing different sounds in each ear, especially in group conversations. Music training strengthens timing, pitch, rhythm, and auditory memory. Spatial listening practice improves localization, safety, and reduces listening effort.

We also have to ask the bigger questions. Should we first address upstream factors like focus, attention, working memory, sleep hygiene, and nutrition?

How much attention should go to downstream fallout, such as speech clarity and articulation work that speech-language pathologists address, versus tackling upstream listening and processing so those issues may resolve naturally? The right answer depends on the person, their history, and a collaborative team willing to look at the whole child or adult.

I also respect the work of Michelle Hecker Davis at LearningRx in Chattanooga, Tennessee, who offers both in-person and virtual cognitive training. I am helping from the audiology perspective as best I can, as one of her clients.

I am working with her directly to strengthen my own auditory memory and resilience to distraction, challenges I face because of autism and ADHD. I am also putting my poor 12-year-old son through it. He went through the testing with them today, and I could see how frustrated he was with the level of concentration required.

When I visited the center back in July, I nearly fell asleep just watching the kids train. The work is that intense. It is deliberately more difficult than life itself, designed to quickly build skills in focus, split attention, and visual memory.

All of the things Michelle targets can strengthen language competence, auditory closure, and access to auditory and visual memory, as well as resilience against distraction. These improvements can, even indirectly, support better auditory processing.

Her work is not as much of a scalpel like Lalsa’s training, but it is a powerful bolster that builds the mental stamina and flexibility needed to make the most of other interventions.

The brain can change at any age, but it changes best under skilled guidance. Just as you would never expect to play a piano well simply by buying it, you cannot expect a device or a program to transform listening without a knowledgeable teacher and ongoing practice.

Low-gain programmed hearing aids with remote microphones can open the door. Auditory training, in whatever form is most appropriate, helps people walk through that door and keep going toward their fullest communication and participation.

Not everyone needs to start with the same thing.
This may be the largest collection of people in the world who support low-gain programmed hearing aids with remote microphones, and often the combination of the two, but that does not mean it should be a clubhouse with a sign on the door.

It should say: “Welcome in. We will consider your ideas as a possibility. We will stay open minded. Everyone is welcome here.”

We move further when we bring in people who can add their expertise, their perspective, and their strengths. If we do not consider the strength of the people around us, we will never progress as far as we might otherwise. There is always a limit to any one type of treatment, and collaboration is the best way to build a bridge to optimal function.