AO/Beck: Hi, Karen. Its a pleasure to meet you. I read your new book and now I feel like I know your whole family! Foli: Hi, Doug. Its great to meet you too. Ive heard about Audiology Online, and Ive seen the website too. Its nice to spend some time with the folks who make that happen. AO/Beck: Thanks - I can assure you its a total team effort! Karen, let me get the readers up to speed a little. The book is brand new. Its a 2002 publication through Pocket Books, a division of Simon and Schuster. The exact title is Like Sound Through Water: A Mothers Journey Through Auditory Processing Disorder (ISBN: 0743421981). In essence, the book is about you and your son Ben, and how you discovered his diagnosis, treatment options, and ultimately, some of the clinical and management strategies related to Auditory Processing Disorders. Foli: Yes, in a nutshell that describes the main plot, if you will, very nicely. Theres also an important second component to my book and that deals with the family dynamics that happen when a child is struggling. How other siblings are affected, how a marriage can be tested. And finally, how important hope is. AO/Beck: Karen, before we get into the issues of APD and the book, can we find out a little about your professional history? I think your professional training probably had a great deal to do with your decisions and the decision making process. Foli: Yes, to a certain extent. Im one of those people with 9 lives regarding their careers. I started with an associates degree in nursing, became a registered nurse, and worked in the operating room for a time. Then I finished my bachelors degree and worked in a variety of areas, including rehabilitation, extended care, and psychiatric nursing. AO/Beck: Where did you earn your nursing degrees? Foli: Indiana State University at Terre Haute, Indiana. AO/Beck: And then you also earned a masters degree and a doctorate too? Foli: Yes, after about five years in nursing, I went back to school in 1983 and received my masters in nursing science in 1985 from Indiana University, which focused on administration. Finally in 1987, I went back for my doctorate. At that time I was living in proximity to the University of Illinois at Urbana-Champaign, so I attended there, and it was a wonderful school. My Ph.D. was through the Institute of Communication Research, and it was just an outstanding place. In all of my educational history, the experience of earning my doctorate from the U of I was clearly the highlight. The focus of my program was thinking outside of the box and as you can imagine, that led to my dissertation, which discussed Metaphors in Nurse-Physician Communication. AO/Beck: And when were you awarded your doctorate? Foli: In 1990 the day I turned in my final paperwork was the day I met John, who became my husband. AO/Beck: And John is a physician, and he completed his residency in psychiatry? Foli: Yes, he completed a general residency in psychiatry and completed an additional two-year fellowship in child and adolescent psychiatry. He is now working primarily with an adult population in an acute hospital setting. AO/Beck: And then you guys had two children of your own, and years later you adopted a third child? Foli: Yes, thats right. AO/Beck: There is something else interesting about your career history. After Ben was born, you began to explore the craft of writing, which Im sure was also influential in getting this book published. Foli: Very much so. The years I spent learning how to express myself through the written word were critical. But Im impressed. You really did read the book. AO/Beck: Well, of course. I have two kids and I can only imagine how tough it would be if one needed special services, to spend so much time with one of them, while not spending the same time with the second one. I have to juggle that too, and neither of my kids has APD. It mustve been extremely difficult for you. Foli: Yes, it is very hard. I know lots of moms and dads feel guilty about that, and they worry about neglect issues for the child who gets less attention. Those are very real issues and emotions and they are difficult to manage. The book was hard to write because, of course, I had to be as honest as possible in order to be authentic. AO/Beck: Bens first APD manifestation was a rather significant language delay. Can you tell me a little more about that? Foli: We knew something was wrong early on, but we didnt know what it was. Ben was a healthy and happy baby, always ahead of the height and weight charts. Nice personality, very agreeable little boy. I was a little older than the other moms, I had Ben when I was 31 or so, and I really didnt have much background in pediatrics or growth and development. John and I were totally enamored with this little boy, and he did great, right up until it was time for Ben to speak. But his language skills just didnt develop. We went from the university clinic to the community-based hospital, office to-office, pre-school-to-pre-school, looking for someone or something that could help us understand what was going on. We didnt understand his receptive deficit when he seemed so bright to us. Finally, when Ben was six after three long years we heard the words auditory processing disorders, and thats when things started to click. Of course I know, and the readers need to know, that all children with the same signs and symptoms that Ben had are not going to be APD kids. Some will have more things going on, some will have less. Some will do better with therapy; some will not do as well. I make it clear in the final chapter of the book, Hindsight and Help, that this journey of ours is not meant to be a template for others to follow, but perhaps it can give a parent fresh ideas or a new road to explore for their child. AO/Beck: Yes, thats very important. I think many people tend to self-diagnose, and of course that is very dangerous too. The other big error is treating the problem before the diagnosis has been made by a qualified and competent professional. We hear about this all the timediagnosis first, treatment second. AO/Beck: What did you hope to accomplish by writing this book? Foli: First, I wanted to increase the general awareness of APD so that parents, when they seek out testing, can begin to trust that the diagnostician will have heard of Auditory Processing Disorders. Second, I wanted to convey a general sense of hope many children need special tools, but with the right ones, they can really make great strides. Third, I wanted the book to be a bit of a consumers brochure on some of the common management strategies that are offered for APD. Four, I have been told by several clinicians that the book has raised their awareness of how they come across to parents in conference situations. These clinicians are very kind people, and they just didnt realize how parents hear various messages. Those four reasons are nestled into the personal story about Ben. Although Ben is a very mature child, funny, kind, and hardworking, he still has some expressive difficulties. But he has come a very long way and, I believe, he has a bright future ahead of him. AO/Beck: I noticed the definition you used in the book for auditory processing disorders. Can you review that here? Foli: The definition I use for APD comes from Dr. Jack Katz. Basically he boils it down to What we do with what we hear. AO/Beck: I think thats a great definition because it describes APD beyond hearing. That is, we know that hearing is extremely important for language development and other psychological processes, but there is more to it than sound awareness, and indeed, one can have significant APD despite absolutely normal hearing. Foli: Yes, and thats a concept that will be new for many, many people. I think the image that comes to mind when you mention APD is usually a hearing test, and of course thats an important component, but its not the whole issue. After I forwarded some information about learning and the auditory environment in a typical classroom, a friend of mineactually the principal of a schoolwanted to see what kids go through during the day and so she went to the back of the classroom and just listened. She was surprised and dismayed. For example, she realized that the students who were speaking to the teacher couldnt be heard by other students, and so on. AO/Beck: I agree. I cannot imagine how kids in the back half of the classroom get by. I know for sure that I couldnt do it. There are only two solutions I can think of that really work in that situation, FM and SoundField amplification are the two that come to mind. AO/Beck: So, not to let the cat out of the bag, do you think the multiple-modality program you used was the key to Bens success, or do you think Ben was at the right time in his life to progress? In other words, was it his personal maturation issues or was it the management strategies that you used? Foli: I am firmly convinced that the multiple-modality program was the key to Bens success. If we had waited for maturity to occur, it wouldve taken much longer. Its important to emphasize that the computer technology we used wasnt enough, and Bens progress wasnt complete after these programs. But it was the right start at the right time, and its what helped Ben at that juncture, particularly in the receptive areas. The multi-sensory language programs were the next needed step. I think we were very fortunate. But its much more than good fortune. It takes an amazing amount of work and diligence to get the kids through these programs, but they can and do get through them. AO/Beck: What about other kids in Bens class? Foli: I think a lot of the APD, ADD and ADHD kids are generally sold short. In my county, at least they were willing to listen and we worked through the issues. But we all hear horror stories about children who need services, and the financial constraints, or the apparent financial constraints that preclude solutions. We need to educate the school boards and the principals and the teachers. It takes lots of energy to fight every day! I know one mother now who is trying to make this decision should she keep fighting or invest in helping her child herself. AO/Beck: So Karen, now that youve been through all of this, what is the primary thing that alerts you to the fact that a particular child may have an APD? Foli: Thats a tough one. There are so many presentations of APD, that it really would be a mistake to characterize the top one or two. However, I suggest some general red flags in my book. For example, if the parent hears their child say what? and huh? frequently, that behavior should be checked out. Additionally, if the parent thinks there might be something wrong get your child to the audiologist and get them tested. Trust yourself. Dont be afraid to ask about the diagnosticians background and if they have specialized training in APD testing and interventions. Dont be afraid to ask questions such as: What behaviors or symptoms does my child have that led you to this diagnosis? And just as importantly, What behaviors or symptoms do NOT fit this diagnosis? Time is really critical. The younger the child, the more benefit theyll receive from the intervention. But I think there are many junior and high school kids who would really benefit from testing and aggressive interventions as well. I cant say, dont worry about the labels and dont worry about the costs, because those are real issues for parents. But in the final analysis, you have to decide that the quality of life of your child is at stake in many ways. And finding a good diagnostician will be well worth the effort and cost. The sooner the diagnosis is made, the sooner treatment can start, and the results can be dramatic. AO/Beck: And what is the final, take-home message for the moms and dads out there? Foli: Never give up. AO/Beck: Karen do you have a website for people interested in corresponding with you and learning about how to acquire the book? Foli: Sure Doug, the website is www.karenfoli.com. AO/Beck: Thank you Dr. Foli. It has been a pleasure to spend time with you. I wish you and Ben a glorious future and all the best to the rest of the family, too! Foli: Thanks Dr. Beck, its been fun.