I Can Hear You Whisper (27 page)

No matter what language we're learning or when, it helps to pay attention. “When you focus on something specific, the brain produces a bigger response to it,” says Neville. Many changes in vision, audition, and language observed in neuroplasticity studies
depend in part on selective attention. (This was true of Merzenich's monkeys, by the way. The changes in cortical areas came only when they paid attention to the spinning disks they were being asked to touch.) I remembered that David Poeppel had said he could tell by glancing at an N1 whether the listener had been paying attention. In fact, the response can be
50 to 100 percent stronger, says Neville. Children's ability to pay attention matures just as their language does, but even at the age of three they are able to listen to one story over another, and when they do, there's a visible change in their brains.

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To show me how they test that in the lab, Eric Pakulak puts me in a soundproof booth where there are speakers to my left and right and a television screen in front of me. From the control room, he starts playing both audio and video. In my right ear, I hear the children's story of the Blue Kangaroo. In my left, another children's story, from the Harry the Dog series, is playing. I'm supposed to listen to the Blue Kangaroo story and ignore Harry. On the screen, pictures corresponding to the kangaroo story help me in my efforts to focus. When I zoom in on the story mentally—focusing the flashlight of my attention, as neuroscientists say—I find that I can do it. Harry fades to the background. But every so often, my attention wanders and Harry leaps back into my awareness. I have to work to keep him in his place.

In the actual test, the subjects would be wearing electrode caps for EEG recordings. Superimposed on both stories, there are extra beeps serving as auditory probes. What Pakulak, Neville, and their colleagues are really measuring is the neural response to those probes. They wanted to see if the response was larger when the subjects were paying attention. The answer was yes. In adults, it's about twice as large. Although the response is different in children of six, seven, and eight, there is still a clear enhancement when the children pay attention.

The real-life consequences of paying attention—or not—play out in the classroom. Those who are less focused learn less. It's that simple. Brain circuitry drives learning and it does a better job of it when the networks are working at optimal levels. I am not talking here about attention deficit disorder, which is a problem of a higher order, though obviously one on the same continuum. I'm just talking about the more routine ability to listen to the teacher or keep one's concentration on the page.

There is more than one kind of attention, it turns out, and the various forms also have different profiles in plasticity. Sustained selective attention, the kind that is particularly useful in a classroom, takes a very long time to develop. On the one hand, that explains why it's so hard for small children to stay focused. On the other hand, it means the window of opportunity to help them do it better stays open for longer. Neville has found that children of lower socioeconomic status have trouble with selective attention, particularly in tasks requiring the filtering of irrelevant information.

With so much work under her belt, Neville decided it was time to take what she knew about neuroplasticity and figure out how to use it to help children. “We've reached the point where we've learned an awful lot,” Pakulak tells me. “We're taking those results and having them inform our development of intervention and training programs.”

They started with attention for several reasons. It qualifies as a clear example of Neville's concern that what is enhanceable in the brain is also vulnerable—strengthened, attention helps; weakened, it's a major problem. The good news was that it seemed that attention might be trainable. “If you have a measure that's a predictor of being at risk for delays, that gives you a lot of information,” says Pakulak. Attention training might provide a lot of bang for the buck because its effects would be widely felt. It was also a necessary fundamental skill. “Having intact sensory and cognitive systems is really not worth that much if you do not have control of your emotions or have good social cognition,” says Neville. That point informs a wide range of current neuroeducational interventions, which most commonly home in on emotional regulation and executive function.

Pulling together the many pieces of the program took time, but now Neville's group has some intriguing results. One hundred forty-one three- to five-year-old children enrolled in the Head Start program were randomly assigned to three groups: One group simply continued to attend Head Start; a second got attention training during the school day for forty minutes a day, four times a week, with three sessions for parents over eight weeks; and the third section brought children and parents to the facility once a week for eight weeks for the children to receive some form of training and the adults to get proven strategies for parenting.

In addition to Dr. Distractor, the attention training included exercises like “Emotional Bingo,” in which kids took cards with the names of emotions printed on them, showed what those emotions look like and how they feel, and then learned techniques for calming down, like taking a big “bird breath” and saying, “Oh, well.” Children also worked on focusing attention by playing games that required them to start and stop listening, looking, or moving when teachers cried “Freeze.” In parenting sessions, “we assessed the way they used language with children, and we encouraged them to engage in more balanced turn taking,” says Pakulak.

Children in the attention classrooms—those who took a ride on the “brain train”—made the biggest gains across the board on standardized measures of language and nonverbal IQ, including working memory. Groups of children whose parents had also received the more extensive weekly training did the best of all. Problem behavior went down in the children and social skills increased.
Using EEG, the children all underwent the same study of auditory attention in the lab that I did and tried to focus on the Blue Kangaroo and ignore Harry the Dog. “There were changes in cognition,” says Pakulak. “We saw neural enhancement with focused attention within a tenth of a second, even with three- to five-year-olds. In the winning group, we saw greater gains in that measure. It made them look like higher socioeconomic status kids.”

Will those gains last? To answer that, Neville's group has been following the children longitudinally, bringing them into the lab and visiting them in school every year. The data from the first eighteen months suggested that the kids were maintaining their gains, but only time will tell.

“Attention is a force multiplier,” says Neville. “It's key to everything. If you want to learn soccer, if you want to learn to play the cello, if you want to learn to use your cochlear implant, it doesn't matter. . . . If you don't have the ability to focus and suppress distracting information, you can't do anything. And if you do have control of it, you can do anything.”

Straightforward though it was, I thought this might be one of the most useful pieces of information I'd learned yet.

M
OMMY! MOMMY! MOMMY! MOMMY!” the voice was screaming. It was early morning and we were at our farm in central New York State. When I'd gone out a few minutes earlier to walk the dog and enjoy the bright and chilly December day, the boys had all been asleep. Usually, they'd have stayed that way for at least another hour. From the hill behind the house, I turned and looked back. A small figure was standing in the doorway on the front porch, yelling and waving. It looked like Alex.

I turned and ran.

“I can't talk! I can't talk!” he cried, panic-stricken, when I reached him. His face was bright red and tears were streaming down his cheeks. It took me a few minutes to realize what was happening. He could no longer hear himself talk.

After Alex lost the hearing in his right ear completely, we expected he would probably lose the remaining hearing in the left ear, too. Every time he smacked into a table or came too close to a flying toy, my heart skipped a beat. We would frantically do our listening checks, but everything stayed marvelously the same. Eventually, our anxiety level lessened. Two and a half years had passed and he was now five.

But the night before, he had had a bad fall. He was climbing a ladder to the sleeping loft in our cabin when he slipped and fell several feet to the floor, smack on his face. I had been very worried, but all evening there had been no change except the spectacular bruise developing across the bridge of his nose. Now he was hysterical.

There had probably been internal swelling in the night, and the rest of his hearing was finally gone. I thought I'd been prepared for that, but his reaction threw me. Until that point, when Alex took off his processor—the external part of his cochlear implant—and his hearing aid to go to bed or get in the bathtub, we had still been able to communicate in a limited way. I had to get close and yell into his left ear. But he could hear me. Once he had cracked the code of language with the help of the implant, it had gotten easier. Probably by combining speechreading and what he knew of language, he managed well enough for me to help him with his bath.

I had assumed that when he lost the remaining hearing, it would be this limited conversation we would miss. He hadn't told me and I hadn't realized—presumably he hadn't realized either—that for him, hearing his own voice was the all-important distinction between his profoundly deaf right ear and his hard-of-hearing left ear. The hearing in his left ear hadn't been enough to kick the spoken language motor into gear on its own, and he couldn't possibly have heard himself very well, but something was not at all the same as nothing.

I ran for my purse. The night before, after the fall, we'd all gone out to dinner. Perhaps shaken up by the accident, or just worn out from playing all day at the farm, Alex had become sleepy early and crawled into my lap at the restaurant. He handed me his processor and hearing aid and I put them in my bag. They were still there in the morning when he woke up. I pulled them out and put his processor on. He could hear me again. He could hear himself again. I rocked him in my lap and tried to soothe him. He began to calm down, but we were both shaken. Mark was up in the fields doing the early-morning farm chores; to get him, I would have had to leave Alex, and I wasn't going to do that. Besides, I knew there was nothing he could do. Jake and Matthew, who'd been awoken by Alex's screams, were hovering in the background, unsure what was going on. “What's the matter, Mommy? What's the matter?” they asked anxiously. I tried to explain. They crowded onto my lap and added to our hug.

It was December 30. We were more than two hundred miles from New York City, and several feet of snow lay on the ground. It was only seven in the morning. Dr. Parisier's office wasn't open yet. With three anxious children to keep calm, I pulled out the Dog Bingo game they loved and we played a few rounds. I felt surreally as if I were at the eye of the hurricane, waiting for the wind and rain to whip up again.

When Mark came near enough—to the closest corral to feed the goats—I ran out to explain what had happened.

At nine, I called Dr. Parisier's office.

“How long will it take you to get here?” his receptionist, Eva, asked.

“About four and a half hours. It depends on traffic.”

She put me on hold briefly, then returned to the line.

“He was supposed to leave at twelve for the holiday, but he'll wait. Come as fast as you can.”

I had Alex dressed and in the car in minutes. We'd decided that I would take him into the city alone and the others would stay at the farm. It seemed quicker and more efficient.

Everyone stood waving in the driveway.

“Hey, buddy,” I said as I pulled into the road. “It's not every day we get to go somewhere just you and me. And, wow, you get to pick the movie you want to watch! No arguing with your brothers.” Like comfort food, he picked
Elmo Visits the Firehouse
, which the bigger boys thought was entirely beneath them by that point.

The sun was glaring off the snow, and I had to keep reminding myself to slow down on the slippery, winding roads.

It was close to two in the afternoon when we reached Dr. Parisier's office, but he was waiting. The hearing test showed a nearly flat line at the bottom of the chart. Alex couldn't hear anything softer than ninety decibels—a train whistle or a jackhammer. The audiogram of his left ear now looked like his right. “Profound hearing loss in both ears,” wrote the audiologist.

The vestibular aqueduct that sat above Alex's inner ear had ruptured. Because he had hit his face rather than the side of his head, it had taken longer for the swelling to do its damage, but the damage was done.

Dr. Parisier prescribed an intense course of steroids, which, if taken quickly enough after the trauma, might stop the inflammation before too much harm had been done. We'd been warned that this was the course of action we'd have to take. That was why I'd driven pell-mell through the frozen countryside to get back to the city.

“How often does it work?” I asked.

Parisier hesitated. “I've seen it work,” he replied.

Our chances are not good, I thought.

Back home in Brooklyn, Alex and I went from one pharmacy to another in search of the prescribed steroid. It was dark, getting toward closing time, and no one seemed to have it.

“What's it for?” asked one pharmacist. “Allergies?”

How to answer that?

“My son hit his head. If he doesn't get this medicine today, he could lose what remains of his hearing.” I tried to quiet the panic I could hear in my voice. Alex was holding tight to my hand.

“Sorry. I could get it by Monday, after the holiday.”

Up the street, the same answer.

“What's it for? Croup?”

After a few minutes of looking on the shelves, no luck. Sensing the desperation on my side of the counter, the pharmacist dug out the phone book so I could call other pharmacies. I called four. No luck. I was beginning to be unable to speak a coherent sentence.

There was a metal chair pushed up against a rack of Ace bandages in the far aisle, where customers sat while waiting for prescriptions to be filled. I collapsed into it and began sobbing. The people in the store were glancing toward me and then looking uncomfortably away. I was embarrassed and horrified that I was so completely losing it in front of Alex.

And he was equally horrified. “Mommy, don't cry. Mommy, don't cry. We'll find it.” He clambered onto my lap and put his arms around my neck. He started crying, too. I knew better, oh so much better. I am utterly and completely blowing it, I thought. There we sat in the pharmacy's dinky metal chair, mother and son, clinging to each other and weeping.

A voice interrupted. “I found it.”

I looked up. The pharmacist, a young Hispanic woman with long dark hair, was holding up a box triumphantly. “It was hidden away.”

I didn't know what to say. “You have it? You have it!”

Alex exclaimed through his tears, “She has it!”

It had been hidden on a back shelf. We had it. We blew our noses, wiped our eyes, paid for the steroids, and walked back through the dark streets—it was now night—to the empty house.

Alex and I had never spent the night in the house alone. I promised him he could sleep in my room. But first, he had to take the medicine.

It tasted awful. I tried to make him just gulp it down. I made it into a milk shake but diluted it too much, so now he had to drink an enormous glass of bitter shake. He took tiny sips. I bribed. I cajoled. I begged. I threatened. I held his nose. I added syrup and anything else I could think of. I lost it again.

“I'm sorry I fell, Mommy,” Alex said in a small voice.

Oh god. We sat on the floor and hugged.

“I wish Dr. Parisier could just make it better,” he said.

“I do, too.”

Again, I was blowing it. I remembered the mantra of Deaf culture: “There's nothing wrong with Alex.” Clearly, I was not sending that message. As far down the path toward profound deafness as we already were, I was surprised by how desperately I was clinging to what hearing remained. I really, really wanted him to take the medicine. Although I'd given the cochlear implant most of the credit for his transformative progress, I understood by now how much help he was getting from his left ear and how useful it would be for learning to read, which he had yet to do. I had also been rattled by Alex's hysteria. I wished he was old enough to tell me more about how he was experiencing the world.

Four hours later, he had downed three-quarters of it. Enough.

When we went to bed, Alex insisted on keeping his processor on his head (and still does).

The next day, New Year's Eve, we drove back to the farm in a blizzard. It took us nearly eight hours to get back. It was four below zero, but Mark was waiting in the driveway.

For the next ten days, Alex did battle with the milk shakes. I let Mark take over making the concoctions. He bribed, cajoled, threatened, and did vaudeville acts. Alex took the medicine.

And it worked.

On the ninth day, back in Brooklyn, we were putting the boys to bed. Mark was doing an unscientific hearing test, one that traditionally made the boys laugh. Standing behind Alex's left ear, with no cochlear implant on the other side, Mark said loudly, “Scooby-Dooby-Doo.” And Alex said, “Scooby-Dooby-Doo.” Then he turned around and looked at Mark in surprise.

“Daddy, I heard you.”

“You heard me?!”

“I heard you!”

“Hamburger.”

“Hamburger.”

“Banana, banana, banana.”

“Banana, banana, banana.”

“He heard him!” we all shouted. Mark threw Alex up on his shoulders and we all did a victory dance. But quickly, we lifted him down. Gently.