The message on my answering machine was intriguing-a young woman needed an auditory processing evaluation to qualify for accommodations in taking the Medical College Admissions Test (MCAT). When I returned her call, Lynnie introduced herself to me as a research technician on staff at the university. She had graduated from an Ivy League school two years earlier and was applying to medical school. She felt she had an auditory processing disorder and needed documentation to take the standardized tests in a separate room.
In person, Lynnie was articulate, focused, direct, and confident. She quickly outlined her history: she had been born with mild microtia of the right pinna. Her mother has high-frequency sensorineural hearing loss. Lynnie had frequent ear infections as a child and occasionally still gets one. Although her hearing acuity had been documented as normal in the past, an audiological evaluation done six years ago had suggested "auditory discrimination problems in the presence of background noise."
Lynnie attended private schools through high school, with small classes and individualized attention. She first started to notice difficulty concentrating in background noise, especially during tests, her last year or two of high school. In college, a psychoeducational evaluation found her general intelligence to be in the "very superior" range. However, she showed some difficulty with auditory memory and a sound blending test. The diagnosis was mild attention deficit disorder with sensitivity to auditory distraction. Recommendations included being allowed to complete testing in a low-distraction, separate testing room, and preferential seating in the classroom, allowing a good view of the lecturer and to optimize the signal-to-noise ratio.
We headed into the sound suite, where hearing acuity was found to be excellent in both ears, as was word recognition in quiet. Speech reception thresholds were slightly worse than the pure-tone averages. Middle-ear function was entirely normal bilaterally.
Tests of auditory closure and auditory figure-ground yielded scores well below the normal range. Lynnie required more time than usual to respond, and her tone of voice showed her lack of confidence in her answers. Her scores on dichotic tests of binaural separation and binaural integration were also below normal. Temporal processing was normal. We discussed the results and the report was written, and a week later, Lynnie told me she received permission for the accommodation in taking the MCAT.
Lynnie describes her experience of listening in noise as like being "in a tin can or a canyon, where you just hear a lot of echoes all the time. I think my main issue is an inability to subconsciously decide if a particular sound is 'important' or not. I can't seem to turn certain sounds 'off.' In a testing situation, especially in a room with a lot of people in it, I get very distracted by background sounds, such as the sound of pencils writing on paper, even my own pencil." Her hardest classes were the largest ones. "I tried to sit in the front row so most of the noise would be behind me. That helped a lot." Once the psychoeducational evaluation documented the needed accommodations, she had no difficulty approaching her professors and explaining her needs.
Lynnie requires no accommodations in her present job other than sitting in front at seminars or presentations. "Parties are tough," she states.
Although Lynnie's situation is very different from that of most of the school-aged children I see for auditory processing evaluations, several factors seem to have mitigated the impact of her auditory processing disorder. Most obvious, perhaps, is her superior intellectual functioning. Being an only child, living in a quiet organized household, and having a mother who was able to provide support and skills to optimize her study habits were probably beneficial, as were schools with smaller classes and more individual attention.
Through these experiences and her innate abilities, she has been able to discover what works best for her and to advocate for herself. I foresee a successful outcome for her in whatever area she chooses to pursue.
Lynnie Rudner attended Dartmouth College in Hanover, NH, graduating in 2002 with a degree in genetics, cell and developmental biology. She now works at the University of Vermont College of Medicine as a research technician in a laboratory that studies HIV.