Why don’t most audiologists fit hearing aids for APD?

Why Aren’t More Audiologists Doing What I Do?

As an autistic clinician, I deeply believe that everything must be understood in context. That includes systems, people, decisions, and especially the question at the heart of this story:

Why don’t most audiologists fit hearing aids for APD?

This question matters,not just because of what it reveals about the profession, but because of what it says about how we train clinicians, define care, and support kids who fall between the cracks. To understand why this approach isn’t more widely offered, we have to look at three overlapping contexts: my personal background, the history and structure of audiology as a field, and the reasons speech-language pathologists and other professionals have tried to fill a gap that audiology left open.

The short answer? Because it doesn’t fit.

Not the training.

Not the system.

Not the culture.

Not the people the profession tends to attract.

And for a long time, I didn’t fit either.

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I started in audiology in 1999. I worked in clinical settings, private practice, corporate ENT, and large chains owned by hearing aid manufacturers. I’ve seen almost everything audiology has to offer,with the exception of hospital-based and educational audiology. And for a long time, I tried to make it work.

But the truth is, I wanted out of the tower.

In one corporate audiology setting, I was told I had to hit specific sales targets to qualify for my bonus. The base pay was low,everything else came from quarterly commissions. But if your return rate went above 10 or 12 percent, you lost your entire bonus for the quarter. That could be up to a fifth of your annual income,gone.

It didn’t matter why the devices were returned. I was told of situations where a patient passed away and their grieving family returned the hearing aids,and that return counted against the clinician’s commission. There was no grace, no room for the human element.

I also worked in practices where we were told to complete audiograms in 10 to 15 minutes, even if it meant skipping full speech testing. We were told to use monitored live voice (MLV) rather than recorded word lists, even though the research is clear: live voice is not valid or reliable for test-retest purposes.

The tower looked shiny from the outside. But the rooms were stifling. The furniture didn’t fit. And I couldn’t breathe.

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Even in school, I didn’t fit. At the University of Maryland, I was told that I was clearly very bright,but that I would do better in research, where I wouldn’t have to encounter clients. They didn’t see me as someone who could succeed in clinical work, and so I was not accepted into their graduate speech-language pathology program. Instead, I applied to the George Washington University audiology program.

During my clinical training at GW, I was once told I wouldn’t succeed in clinic because I had a hard day,an emotionally overloaded, neurodivergent day. I was dysregulated, tearful, and struggling to keep up with social expectations. A patient asked if I was okay, and I told a small white lie,that my cockatiel had passed away,so that we could connect over a shared love of pets. It helped me regulate. We finished the appointment just fine.

But that day defined me to my supervisor. Not my skills. Not my accuracy. Just that one moment of being visibly human.

I’m glad I did my clinical doctorate virtually. Because honestly, there’s nothing more painful than being bullied by your own department for being neurodivergent. And it happens more often than anyone talks about.

That’s one reason I now work virtually myself. To create space for families,and professionals,who don’t fit the mold. I also work virtually to give myself the accommodations I need: pacing, flexibility, and sensory regulation. And just as importantly, I can offer those same accommodations to the children and families I serve,breaking testing into multiple sessions, meeting kids where they’re most comfortable, and avoiding the artificial stress of a clinic environment. I do it to avoid judgmental colleagues, too. I’ve spent enough time being told I don’t belong.

Today, I’m lucky to work with a phenomenal team that I’ve built over the past four years,two dedicated professionals who both started as parents of kids with APD whom I treated. We share values, lived experience, and a commitment to this work that goes beyond credentials.

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After 15 years in the field,having exhausted nearly every option available in audiology except for hospital settings, which I knew I couldn’t tolerate due to sensory issues,I enrolled in the PhD program at Gallaudet University. I was in Hearing and Speech Sciences, a bridge between audiology and speech-language pathology. I had already completed so much coursework in my clinical doctorate that I ran out of classes within a year.

I proposed a dissertation on a topic I cared deeply about: how personality affects sound tolerance, particularly through the Acceptable Noise Level (ANL) test. It’s a clinical tool that measures how much background noise a person can tolerate while listening to speech. It’s also a known predictor of hearing aid satisfaction,because it reflects sensory regulation, not just hearing thresholds.

I wanted to explore how Myers-Briggs temperament,particularly introversion, emotional filtering, and sensory sensitivity,might relate to ANL scores. Could we predict which patients would struggle with amplification, not based on their hearing loss, but on how their brains handle noise and complexity?

To me, these were human questions. But to the department, it was “soft science.” Not grant-worthy. Not academic enough. And when the head of the department,who had made it clear he didn’t want me there,left abruptly after a personal confrontation, my committee and academic pathway unraveled.

I transferred into Gallaudet’s speech-language pathology program. The department head believed in me. I was accepted into one of the most competitive programs in the country. I did well academically. But socially, I struggled, as I always have in neurotypical spaces.

I requested accommodations,to type, to record, to mind map,and was told they were distracting. I used every tool I had to stay regulated and engaged, but I still stood out. And I learned that while I could do the work, I wasn’t built for it. Behavior management, lesson planning, multitasking,it overwhelmed me.

I could work with adults, but I didn’t want to spend my life in end-of-life care. And then something happened that solidified that decision. One of my clients, a seven-year-old child I was actively treating, was killed in a tragic accident while visiting a farm with his family for the weekend. It wasn’t during a session, but the impact was devastating. That loss broke something in me. I realized I couldn’t do this kind of work and survive emotionally.

So I returned to what had always drawn me: auditory processing.

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I started testing and treating APD in children who “hear fine” but still miss everything. Kids with normal audiograms but major listening fatigue. Kids with autism, ADHD, APD, misophonia, and sensory issues. Kids who were passed over because they didn’t fit the diagnostic criteria for help.

I began fitting low-gain hearing aids for these kids in 2013. The first time I did it, the results were stunning. I had flown in a family from out of state to try this approach with their daughter,a child who had been completely disengaged. After fitting her, she suddenly began interrupting conversations from the backseat of a moving car. For her, the noise of the road had always drowned everything out. With the hearing aids, she could finally hear.

I blurred boundaries. I followed function. And I was criticized relentlessly. I was told I had no right. That there was no research. That I was wrong.

But I knew what I had seen.

Now, ten years later, some audiologists are finally starting to try it. They see that it’s possible. That it helps. But there is still no official training program. No standard protocol. And most providers doing it are brand new. If you’re seeing someone just starting out, you are likely the guinea pig.

I’ve fit more than 3,000 children. I offer virtual fitting options as needed. I test for listening fatigue, not just thresholds. I customize fittings based on what works in real life, not just in the booth. And I build bridges across fields,because this work lives in the gray zone between audiology, speech, education, psychology, and sensory integration.

Why aren’t more audiologists doing this?

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.