Auditory Processing Disorder (APD) feat. Dr. Angela Alexander

Blaise Delfino (00:06): You're tuned in to the Hearing Matters podcast, the show that discusses hearing technology, best practices, and a growing national epidemic: hearing loss. Before we kick this episode off, a special thank you to our partners. Weave - the all in one patient communication and engagement platform. Redux: faster, drier, smarter, verified. Fader Plugs: the world's first custom adjustable earplug. Welcome back to another Hearing Matters podcast episode. I'm your host, Blaise Delfino, and joining us today, this is a guest we have been so anxiously awaiting to have on the show. We have Dr. Angela Alexander all the way from Australia. Angela, welcome to the Hearing Matters podcast. 

Dr. Angela Alexander (00:58): Hello. Hello. It's wonderful to see you and hear you here today. 

Blaise Delfino (01:03): It is so awesome having you on the show. We have been following your success, but also your passion. Number one for Central Auditory Processing Disorder. This is your second love, your husband being number one, C A P D being number two. There's a lot of people out there today that say, I can hear you, but I can't quite understand you. So for those listening, can you explain what Central Auditory Processing Disorder is, the age detection and how you got started in the field of audiology? 

Dr. Angela Alexander (01:38): Fantastic. So, um, that's one triple barreled question right there. I love it., um,. So auditory processing just in general is what our brains do with what our ears hear. So once we receive sound, what does our brain do with it? So when there's a problem with auditory processing, we call it an auditory processing disorder. Now this is kind of crazy, but um, there was a study done in 1980. It's the Framingham cohort, and they found that one in five adults who report hearing loss actually have normal hearing test results. Hmm. So 20% of the population say, oh my goodness, I have so much hearing loss. And then they go to an audiologist, have a hearing test done, and find that their results are within normal limits, but that doesn't make sense and that doesn't match their life experience. Maybe they say, okay, I can't hear in background noise. 

(02:37): I can't remember what people say to me. These people are at risk for something we call auditory processing disorder or APD. But here's one thing that I think is really interesting. We used to think about auditory processing in terms of people who had no hearing loss whatsoever, but it is also possible to have hearing loss and processing problems. Hmm. I kind of wonder if people who have hearing aids but aren't getting the improvements they would like to see, I wonder how much of that is within the brain and how much we can change. So I'm really looking forward to our conversation today. To unpack all of that with you. I was really interested in audiology from a young age. My mom noticed that I wasn't really responding to sound as much as a baby. And so as a nurse she was concerned that I might have hearing loss. 

(03:31): Our next door neighbor was an audiologist and he did some tests and he thought that my hearing sensitivity was probably within normal limits. But he decided to track me and he was doing audiograms quite regularly for me through fourth or fifth grade. There were some interesting results from like Tympanometry. I had shallow tymps, but other than that everything was within normal limits. So when I was in college, I was at the University of Kansas and I was pursuing my audiology and speech language pathology degrees. And in undergraduate I was late to a class and because I was bowling, if I'm honest,  like it was a bowling class that I had right beforehand. So I walk into this classroom and I see that there's a speaker at the front who is not my my professor. I'm like, oh no. Oh no. I did not realize there was a guest today and there was only one seat left and it was at the front and center of this classroom. 

(04:30): So I, sheepishly walked in late, sat at the desk and proceeded to have my mind blown by Dr. Jack Katz. So Dr. Jack Katz is a well-known audiologist who has done a lot of work, not just in auditory processing, but he wrote the Handbook of Clinical Audiology, which is sometimes known as the audiology Bible. Yes. But I honestly believe that Jack Katz is a little bit of a Picasso, um, of audiology and the major work that will be attributed to him throughout the rest of time is what he has learned about how to assess auditory processing issues in people across the lifespan and across the Audiogram and also how we treat what we see. And I think that's the real richness that he will add to this world. For the rest of time. 

Blaise Delfino (05:24): Having been in private practice for a little over five years and working side by side with my father, who I, as I said is an audiologist as well, there would be so many times, and I'm not exaggerating when I say so many times, and we've seen so many patients who say, you know, Blaise, I can hear, I just can't understand. And I have been to two other hearing care providers, I have normal hearing sensitivity and they tell me I'm fine, but I'm still struggling. Then we have the conversation of going beyond the audiogram, going beyond peripheral hearing because central auditory processing happens in the brain. What can hearing healthcare professionals do today to raise awareness of CAPD and why is it so important that hearing care professionals add the CAPD test battery to their clinic menu, if you will? 

Dr. Angela Alexander (06:22): I love it. I love it. Okay, so hearing healthcare providers listen in. I'm gonna give you the most fire tip I could possibly give in the next couple minutes. . All right. So for adults. These are people age 18 and older. I would suggest using something called the hearing handicap inventory for adults. This questionnaire has questions like, does a hearing problem cause you, um, to feel embarrassed when meeting new people? And a person answers these questions with yes sometimes or no. If they say yes, that gets four points, sometimes two points and no is zero points. You ask them 25 questions and ask them to go with their first thought. Like, don't overthink any questions. Just come up with your first response to each one of those questions. Um, let me try one with you. Does a hearing problem cause you difficulty when talking to members of your family? No. No. Good. So there are lots of people who may have a normal audiogram, but say yes to that question. We wanna look at the audiogram and then we wanna look at the H H I A and see how they match up. The H H I A has 25 questions. So if a person answers yes and gets four points to all 25 questions, you do the math for me. Blaise, how much would that be? 

Blaise Delfino (07:44): Oh, that's a hundred percent. 

Dr. Angela Alexander (07:46): A hundred percent right. So if a person gets a score of a hundred, it's awful. And a score of zero is awesome. All right. Got it. So we can almost think about this gradient with the same gradient as an audiogram. So where we have zero is awesome, a hundred is awful, we wanna look at these same scores in the same way. Does a person come to your clinic and they have an audiogram where on average their hearing sensitivity is around 15, which is either a slight loss or within normal limits, and then look at their H H I A score. Is that 50 there is a mismatch. So, we could almost put the H H I A score into the same thought process as the AUDIOMETRIC gradient. And so, a 50 is moderate, right? Moderate and slight. Those don't match up. Right. That is a red flag. (08:40): Refer that client on to a person near you who does auditory processing testing or become that provider yourself if you're an audiologist. So I think that honestly the H H I A is amazing. It looks at a person's social and emotional impacts of hearing problems. And I get worried because if we see an HHIA score that's close to a hundred with essentially normal hearing sensitivity, I get worried that those people are a red flag for mental wellbeing issues and potentially suicide. We talk a lot about suicide when it comes to tinnitus, but honestly we have really been underserving and under helping a, a group of individuals who really need our help. 

Blaise Delfino (09:27): I absolutely wholeheartedly agree with you, especially with the mental health aspect, Angela, not only with patients that have severe hearing loss, but you're absolutely right. Normal hearing thresholds, peripheral hearing, and struggling to understand speech in noisy situations. Really, we are in this loneliness epidemic and these individuals may start to withdraw. They have normal hearing and there are providers out there that can help them, but maybe they're not educated on what C A P D is or the hearing healthcare providers they visited don't know what C A P D is either. And that's what I love most about the work you're doing is you're using the gifts that you've been blessed with to spread awareness of central Auditory processing disorder and you've helped so many individuals. And I'd love to know more about the work that you've been doing with the Auditory Processing Institute. When did you found this organization? How does your training model look like for SLPs and audiologists? 

Dr. Angela Alexander (10:32): Oh my goodness. Okay. One other thing I wanna fly in and just say, what do we say not to do with tinnitus clients? We say don't, don't tell a tinnitus client a person who has ringing in the ears. We should never say to them that it doesn't exist, that it doesn't bother them that it can't be treated. But what do we continuously say to these people with normal audiograms that it doesn't exist mm-hmm. , that it shouldn't bother them and that it can't be treated. Which I'm gonna go ahead and say right now. Auditory processing difficulties are absolutely treatable. Back in 2017, I was massively pregnant with my daughter. I mean like gigantic . Um, you know, I, I was really excited to be pregnant. I was really, I really wanted to be a mom. I mean, lots of people thought I was having triplets. (11:19): I was not. I was having one child with lots of room. I was kind of embarrassed when she was born slightly, you know, like lower than average weight cuz I had been blaming it on a chunky baby this whole time. When I was marinating that kiddo , um, in my innards, I started realizing that the clients that I was doing auditory training with where I was doing ear exercises to improve their auditory processing, we're suddenly not gonna have a clinician walking them through auditory processing treatment. Um, because we usually do 12 to 14 weeks, one hour sessions of doing actual ear workouts to help a person understand what they're hearing, to understand speech sounds, hear in background noise, remember what they hear, organize what they hear. And it's not just telling a person you need to try harder. It's like actually doing kind of like physical therapy for the ears and the brain, more importantly the brain. (12:10): But I thought, okay, what am I gonna do if like, once I give birth to help these clients continue to move forward? So I made a series of videos where a client could take themselves through the therapy and I released that online and I'm like, yeah, this is gonna be like the biggest thing ever. It's gonna be so awesome. It's gonna be so sick. And then, you know, a few weeks later I'm like, yeah, that's the worst thing I'm, I've ever done . It's terrible, it's horrific. I should just erase it. And then I had a client who came in and she had the testing done, found out he, she had auditory processing disorder, went and did the video exercises and came back and her retest results looked like what it looked like when I was doing the work with her. I was like, okay, maybe there's something to this. 

(12:55): But there wasn't really necessarily a big market out there cuz not a lot of people knew about auditory processing. But there were clinicians who said to me, Hey, could I learn how to do this treatment for clients? And so I started out on that journey in 2017 and I thought, okay, here we go. I will teach audiologists and speech language pathologists how to do the treatment. And then I got a, an email, I got messages from Dr. Tom Goin and Dr. Megan Thomas on the same day within 24 hours. And it said, Hey you. And they're just Facebook messages , um, hey, you teach people how to treat auditory processing, will you train us or how to evaluate it? And I was really overwhelmed by this because there's a lot of things I don't know, there's a lot of things I don't necessarily understand. But I also am glad that I went ahead and said I will try because I have learned more in the last two years than I had previously clinically and together as a group, I'm now trained 170 audiologists and speech language pathologists how to do central testing and treatment for people who are, the youngest I really test is three and a half. Mm-hmm . And you know, I had a client who was 99 who signed up for therapy. Um, but then she decided to do it the next year and I didn't hear from her since that was like seven years ago. So I can only assume that she's matured out of auditory processing disorder.

Blaise Delfino (14:26): 170. Wow. Yeah, for lack of a better term, that has to fill your cup. 

Dr. Angela Alexander (14:33): It does because, 

Blaise Delfino (14:34): Because you're paying it forward. 

Dr. Angela Alexander (14:35): I mean, well okay. But these people have added as much to my life as I have added to theirs. Back in 2008, I realized that it was really hard for clients with auditory processing to find clinicians in their area who were doing this work. And so, I created an online searchable map where people could go on and find someone close to them. I'll go ahead and plug that here. It's apdsupport.com/apd map. Um, once again a p d like auditory processing disorder support.com/apd map on this map you can enter your location and find the clinician nearest to you, um, who's doing this. And when I first started the map in 2008, there were 250 providers worldwide. So then I did an update of the map in 2018. I was like, okay, here we go. Let's see how many people are there. Like some people had retired, some people had added their practice. 

(15:30): Guess how many people there were, Blaise? 250 still. Hadn't changed. Wo, some lost some, but the net difference was nothing. So, it was my goal to double that number in the next four years. So as many as 300 million people worldwide who have auditory processing issues, we say one out of every thousand children is born with permanent childhood hearing loss. And we say that between five to 6% of the child population may have auditory processing issues. So that's 50 to 60 times the rate of permanent childhood hearing loss. And there's only 200, well now there's 400 of us worldwide doing auditory processing services. But the great thing is that more people are testing younger. They're not just testing at seven years of age. There was this terrible bit of information which got misconstrued a long time ago and then taken for fact that we couldn't test before seven years of age. It's total BS. It's not true. Most of the clinicians are testing earlier than seven. They're testing and treating and a majority of them are doing work over telepractice as well. So a hundred percent of my, my work is over telepractice. And let me tell you, March of 2020 was a total game changer. I went from seeing almost all children with normal hearing sensitivity to seeing mostly adults with severe hearing loss. So here we go. 

Blaise Delfino (17:04): The statistics are alarming to say the least. You had said that that would equate to about 300 million individuals who present with central auditory processing disorder. So, there's about, what is it, like 315 million individuals in the United States. That's almost everyone in this country in the United States like presents with C A P D. That is insane. And we're not saying disclaimer, it's not all 300 million in the United States that present with CAPD. 

Dr. Angela Alexander (17:36): There's, there's 15 mil, there's only 15 million like normal people wandering the streets, understanding what they hear. All the rest of 'em are just a what? 

Blaise Delfino (17:46): Huh? When I was in graduate school, one of my first clients presented with C A P D and I used some of Jack Katzs' tools. Thankful that my father had those cuz they really did help me cuz I'm, you know, mid-twenties. I'm like CAPD, I've heard about this during dinner conversations, but I don't know how to like treat this. And you know, I'll shout out Dr. Susan Dillmuth-Miller, she's the audiologist at East Stroudsburg University. She is so passionate not only about audiology, but also C A P D. And she taught us so much about it, but to have the Katz tools really did help with this client. And it was so amazing to see the improvement throughout the semester. Angela, you have quite the voice in the hearing healthcare industry and the space in and of itself. And I've been following you on social media for a few years now, and I saw that you recently met with Matt Hay, Nina Kraus, Judy Huch, and a few other thought leaders in the hearing healthcare space. And whenever thought leaders like yourselves get together, some amazing industry breakthroughs are often the result. What can you share with us about this retreat slash get together? Or is that confidential? 

Dr. Angela Alexander (19:10): Let me just tell you, there's going to be more to come, however, let me give you a tasty little nugget, a little tidbit of information. Um, so first of all, Matt Hay, um, who you've had on your podcast, loved that episode. I listened to it in an airport once. It was quite good. So Matt Hay is a phenomenal person. He was in college and had a hard time hearing on the phone. Went and found out that his hearing was asymmetrical. And as a result of that hearing test, he went and had an MRI done, which just made him discover that he has neurofibromatosis type two. Um, he gets these benign tumors on any nerve of his body. And unfortunately, those, those tumors often like the auditory nerve. So, he had acoustic neuromas and he found out that okay, he was going to lose his hearing. 

(20:02): It was kind of a slow process. So he taught himself, he actually, he didn't realize that he was creating the tools to help himself in the future, but he took 67 of his favorite songs and he played them on repeat to himself his little soundtrack of silence and kept listening to these songs over and over because he said if in the future he heard nothing, he wanted these songs stuck in his head. One day he lost his hearing and they said we could do an auditory brainstem implant. So they opened up his brainstem and implanted 12 electrodes where basically anytime sound is in his environment, it shocks his brainstem, which is perceived in his brain as sound. Now they didn't expect that he was really going to understand what he was hearing. They said, you're, you just will know that life noises exist. And he said that when you're used to not hearing anything, even hearing an oven timer sounds like a choir of angels. (21:07): So basically we didn't expect him to understand what he heard, but he started listening to that music, that soundtrack of silence over and over again and pairing what he was hearing with what his brain remembered. And he was able to, over 16 years, get up to 60% correct on hearing in noise sentences. These were in quiet though at a comfortable level. So that is mind blowing. First of all, we do not expect someone with an auditory brainstem implant to have that good of word recognition. And at the point where he was implanted, there were only 200 in the world. That is just mind blowing. 

Blaise Delfino (21:46): That's incredible. 

Dr. Angela Alexander (21:47): Isn't it cool? 

Blaise Delfino (21:48): Matt Hay is Matt Hay 

Dr. Angela Alexander (21:49): Is amazing. He is a legend. And that is the reason why Channing Tatum reached out to Matt and bought his life story to make a movie with Paramount Pictures about Matt Hay's story. He's, he's just absolutely incredible. So then last year he reached out to me on LinkedIn and he was like, "Hey Angela, I see you're an audiologist in Australia. You want a Redux?", wink wink. And, and, and I'm like, you know, "Hi Matt, my name is Angela and yeah, uh, I'm not really into that but that's because I'm not dispensing hearing aids in my practice. I'm doing a hundred percent auditory processing and a hundred percent on Telepractice." And he was like, "Well, could we still get together? I have an auditory brainstem implant." And I'm like, Bing, let's do this. I would love to hear you. So I met with him and I said, can I do some of these tests that I would do on a child with normal hearing sensitivity? 

(22:41): And based on the results of that test, I said to Matt, "Yo, I think there are some things we could do to optimize what you've got going on." And he was like, all right, I guess. So, we met once a week for 12 weeks. We did auditory training and after that his word recognition score went up to 87 and 92% correct in quiet. So he said over 16 years he taught himself how to get 60% of the way. And then in three months we worked together in kind of a coach, coach-like way in an auditory training format and got him another 30%. Wow. Now that's in quiet and we all know noises everywhere, so that's more important. But Matt reached out to Nina Kraus, who is a world-famous researcher at University of Northwestern. And he said, Hey, I know you love music. I love music. (23:34): I taught myself how to understand with music. And as Nina Kraus and Carol Flexer say, we don't hear with our ears, we hear with our brains. So Nina said, Matt, you don't hear with your ears at all. You only hear with your brain. She didn't actually say that cuz that would be like hear explaining. But she was like, I wanna understand, I wanna study your brain and I wanna see how your brain is understanding what you hear. And he was like, yo, Nina, I'd love to come to your lab but I'm gonna bring my friend Angela. Is that okay? . And so I got looped into this conversation and on on my birthday morning I woke up to a conversation between Matt Hay and Nina Kraus over online like, and I started ugly crying like I have never ugly cried before. Like my like tears were spraying out of my eyes cuz Nina was like, you know what, what you and Matt have done together is gonna change the course of the hearing care industry.  

Blaise Delfino (24:36): Wow. that gives me goosebumps. Angela. 

Dr. Angela Alexander (24:39): Exciting. I know. 

Blaise Delfino (24:40): Yo. Oh my gosh. 

Dr. Angela Alexander (24:41): I'm not gonna spray my eye water at you. My, my husband was pretty sure my mom had passed away. 

Blaise Delfino (24:47): I was 

Dr. Angela Alexander (24:48): Like, gosh. 

Blaise Delfino (24:48): That's incredible. So, all right, I'm excited. 

Dr. Angela Alexander (24:51): So, then we went to Chicago. Yeah. So, we went to Chicago, and we met up and we studied Matt's brain.  

Blaise Delfino (24:57): And to be continued 

Dr. Angela Alexander (24:59): To be continued. 

Blaise Delfino (24:59): Oh, I'm so excited to hear, no pun intended about what the results of that trip are going to be. Matt Hay, incredible human being puts family and friends, number one, and then to link up with you for you to use your gifts, help him and then Nina Kraus and the rest of the team. This is like the audiology all stars. If there were to be a dodge ball game, y'all would be a team. So, we need to get these jerseys made. 

Dr. Angela Alexander (25:29): It can be roller derby cuz I'm awful at any game with balls. That's right. Yeah. 

Blaise Delfino (25:33): Yeah. It can be roller derby and you'll most likely win. Absolutely. Um, we should probably talk a little bit more about C A P D, right? Yeah. 

Dr. Angela Alexander (25:41): that's no, I mean this is pro and I think this is the issue is that a lot of people think that APD is only this one little thing. Yes. But auditory processing is huge. Let's say a person has hearing aids, hearing aids are like a bike, right? They're like a bike. But if you don't know how to ride a bike, you're not gonna do very well auditory processing is like the ability to ride a bike. Do you think that a person who gets like a performance bike is gonna do better than a person who gets a Walmart bike if the person with a Walmart bike actually has like an Olympic level trainer helping them with their Walmart bike. 

Blaise Delfino (26:20): Exactly. Ring 

Dr. Angela Alexander (26:21): Ring. Little bells and whistles. 

Blaise Delfino (26:22): I'm with you there, Angela. Parents looking for answers. What does treatment look like? My child was just diagnosed with C A P D, now what? I want an FM system in their classroom. The school doesn't wanna do that. So, what does remediation and treatment look like for those with C A P D? 

Dr. Angela Alexander (26:43): Yep. Okay. So, there are both technical and non-technical options and I will be very honest with you that I have a bias toward using low gain hearing aids for adults more than kids. So, let's say in particular you have a client who comes to your office, and they have a high HHIA, but their audiogram is normal. You can try hearing aids with them and look at the Roup et al 2018 study to get the um, the settings for the hearing aids. But it's basically mm-hmm 10 DB of gain from one to four for soft and medium inputs and nothing for loud sounds. Just throwing that out there. If you put these hearing aids on them, have them come back in a week's time and check their HHIA again, has it dropped? Let's say, like I said before, the patient has an audiogram that's 15 across the board and an HHIA of 50, there's a mismatch, which is a red flag. They need more help. So, let's say you fit low gain hearing aids on them, boom, it's like up to 20 or something like that where it's a lot closer together, then you've done your job and that's good enough. If not, have them come back the next week, try a better level product, like a higher-level product or maybe add like a remote mic. 

Blaise Delfino (28:04): Yes. 

Dr. Angela Alexander (28:05): Then have them come back into the clinic again. Check again. Has their HHIA dropped? If it hasn't, you need to refer them on for APD testing, you need to refer them on for treatment. I would like for every single person in the world who has a p d to have auditory training given by an individual audiologist. I know that is not realistic, especially with only 500 audiologists (eventually) online doing this work. However, I think we have to start measuring what the impacts are of our interventions. Have we done enough? And I don't think we've been doing that. 

Blaise Delfino (28:42): We've had adults come into the practice and they've only had pure tones, bone conduction, but no otoacoustic emissions, no tympanometry and no speech in noise testing. And to your point, patients can have normal hearing and then if you test their speech in noise, it's severe speech in noise scores. So, something's definitely not matching up. Let's change gears to children specifically. Parent is not sure what C A P D is. Their child was just diagnosed with C A P D. This news to a parent, number one is scary. What is, what's going on with my child? So, I know this is sort of a loaded question. How would you, with the 10,000-foot view, counsel these parents assist these children to ensure that they're better able to comprehend the world around them? 

Dr. Angela Alexander (29:37): Ooh, I love it. Okay, first of all, auditory processing disorder is a hopeful diagnosis because there's so much we can do about it as long as you work with the right people. I'm not seeing clients myself other than case studies right now. So, on that map, you can find people to help you with your child, but auditory processing can co-occur with dyslexia, A D H D, autism, brain injury. Like there are a lot of different reasons why a person might have auditory processing and it can also co-occur with all these other things. But unlike those other things, auditory processing is easier to change, it's easier to improve. So for me, I almost feel like everyone who gets a diagnosis of A D H D should also have an auditory processing test just to see how much of this is sensory and what can we improve from a sensory side that will also help with a behavior. 

(30:35): And you know, on, on that side of things. Number one, if you realize that your child might have auditory processing disorder, go get an auditory processing evaluation done. Find a clinician who also does therapy because those clinicians have a really clear understanding of what things can change and what the potential for improvement might be. I also am a big fan of not putting a glass ceiling on top of children. I have worked with children who have congenital brain anomalies, children with severe speech, children who are non-verbal. And the results that we have from auditory training, training, just really basic understanding of speech sounds can have huge, huge improvements throughout everything in the child's life. It's amazing. I sound like a crazy person talking like that. 

Blaise Delfino (31:26): No, I love it. It's passion. 

Dr. Angela Alexander (31:27): it really is actually kind of miraculous. For me, if it's my kid, I would rather look into auditory training than devices. But if you don't have the luxury of someone, having someone near you who can do the auditory training or who is knowledgeable about this, then looking into devices can also be helpful. And there is some good research behind that as well. 

Blaise Delfino (31:52): I love it, Angela. I love the passion. I so appreciate on behalf of the entire hearing healthcare industry. Thank you for all that you're doing. I'm nothing man. No, no, this is, we love the hearing matters podcast because all of the guests that we have on, it's like we've established such great professional relationships with and we're raising awareness of these best practices. That's number one. Because you go on Google and it's like whoa, there's a lot of misinformation out there. And when you were saying to team up with an audiologist who treats C A P D, my hope one day is that the majority of hearing healthcare clinics, because hearing healthcare is more than just a hearing aid. Just, you know, throwing that out there, that there is an SLP, speech language pathologist on staff who, who can assist with some of these services that are being administered. 

Dr. Angela Alexander (32:49): Which by the way, audiologists can do that too. Auditory training and stuff. Just throwing that out there, throwing that out there. 

Blaise Delfino (32:55): AuDs can do that. And we encourage all of our audiologists learn C A P D treatment.  

Dr. Angela Alexander (33:03): Sorry, I threw you off the track. Go ahead, go ahead. 

Blaise Delfino (33:05): No, I love it. Um, the last question that we have for you, this is a big question. Share with us the experience that you had with TEDx, because your TEDx video is absolutely incredible. 13 steps and one click. You are an inspiration to so many. So thank you for your strength and sharing your story and being vulnerable. 

Dr. Angela Alexander (33:31): Thank you. Oh my goodness. TEDx. So I've been on the TEDx journey for a very long time. I, um, you, you get nominated or you are a total wanker and you nominate yourself, which is what I did. Um, I nominated myself many years ago and I started down a journey and interviewed with one TEDx group and they said, everyone in the world needs to hear this. I'm like, I know. And then they ghosted me. . Oh no. Um, because let's be honest, I wasn't ready. I was not ready. Everything I was sending to them, they're like, no, this is crap. Any TEDx journey if you're doing it right is like just completely full of rejection. So I I was rejected heaps and applied to other TEDxes in the area. Ted TED talks are like, they're like the unicorn, like Bill Gates and Oprah and whatnot. And Brene Brown get those. TEDx are independently organized with, with much lower quality, thank God. (34:31): So, I went for another TEDx and I applied to them two years ago. And literally last year I wrote down in the next three to five years, I wanna do a Tedx like in my goal setting. And four hours later I got an email asking if I would be interested in doing a TEDx, that was in May. Would I be ready to go in July? Wow. So I interviewed with them, I threw it out there. They did not ghost me. I was not rejected that time. Very surprising. I actually, I went into that interview, I'm like, you are not, you are not rejecting me. I refuse. I 

Blaise Delfino (35:08): Am. You are gonna give you this opportunity now 

Dr. Angela Alexander (35:10): And it's gonna go, it's gonna be at least okay. But like my goal was to get between four and 5,000 views over the lifetime of that talk. Like, I was watching talks that were, that had about those numbers. So, I don't know if you were we connected when my TEDx finally went up because I was like, it was almost like I was in labor. 

Blaise Delfino (35:32): It was, it was climbing. Well it was climbing. 

Dr. Angela Alexander (35:36): The crazy thing was I was like, like okay, I know it's gonna hit YouTube soon. It's going to hit YouTube soon. I wanna get, you know, like it would be cool to get a couple hundred views on the first day that would be sick. And then, um, I got an email and it was, someone's like, it's up and it had been up for 17 minutes and it had 1,700 views already and I almost fell on my chair. And then now it's at like a little over a million. 

Blaise Delfino (35:58): Yeah, over a million. 

Dr. Angela Alexander (35:59): I mean a million people know my daddy issues 

Blaise Delfino (36:01): 2 million ears. 

Dr. Angela Alexander (36:03): That's wild. 

Blaise Delfino (36:04):  2,000,000 ears. 

Dr. Angela Alexander (36:06): Oh! This just in! 2 million ears and at least one auditory brainstem implant cuz Matt Hay also helped me write that speech. 

Blaise Delfino (36:15): Reading the comments. And I love, I love the fact that you submitted a comment from the speaker and so many people connected with you. Thank you. This is one of the best, uh, talks that I've heard. She speaks so clear and precise. I'm like, yes. That's Dr. Angela Alexander, mic Drop. 

Dr. Angela Alexander (36:33): Thank you so much my friend. 

Blaise Delfino (36:35): Dr. Angela, thank you so much for joining us on the Hearing Matters podcast. For our listeners tuned in, where can they connect with you and please share the APD institute website with us again. We're also gonna put that information in the show notes. 

Dr. Angela Alexander (36:52): Fantastic. So, audiologists and speech language pathologists can be trained to do evaluation if you're an AuD or um, treatment if you're an AuD or SLP, um, auditory processing institute.com. Um, and then apd support.com is where you can find the APD map if you are a parent of an individual or if you are an individual themselves who has auditory processing issues with or without hearing loss. Let's see what we can do to get your processing better. 

Blaise Delfino (37:20): You're tuned in to the Hearing Matters podcast. Today we had Dr. Angela Alexander join us talking all things central auditory processing disorder. And until next time, Hear Life's Story.