Distress Data Diary

Dear Diary,

Wait a minute, this is a migraine diary; useful and important, but not such a “dear” topic.

Dear Diary,

Today I had another migraine.  The symptoms included:

As mentioned, I’m putting together a diary of migraine details for an upcoming appointment with a specialist. The other week I had one so bad that my son had to take me to my GP for a Toradol injection, to be taken with a fresh dose of Imitrex — “fresh” in both meanings, because earlier I had taken my last and slightly-expired pill.  I’d planned on asking the pharmacist to order a refill, but of course, had been unable to go into work at the grocery!  (The irony.)
“Have you made an appointment with a neurologist?” asked my doc.
“Headache speshlist; don’ remember whom.”  I held my wallet in front of my nose and squinched one eye open a millimeter to pull out the correct business card.
“Oh good, that’s just the person I wanted you to see.  Takes forever to get an appointment, though.”
“In April,” I mumbled.
“Yeup; takes forever.  Okay, I’ll have the nurse come in with the injection, and I’m writing you a ‘script for some more Imitrex.”
” ‘Ank-you.”
When I do get to see this new specialist, I want to be armed with a good data set so we can maximise the efficacy of our first appointment.  But to do that, I had to figure out what kinds of data would be needed.  This in turn meant researching the various types of headaches, migraines, and symptoms.  I got to learn lots of great new words!
If the headache is bilateral (both sides of the head), then it’s a regular tension-type headache.  I’ve had some intractable ones that linger for a couple-three days, despite various medications.
Unilateral headaches (just one side of the head) are the migraine sort.
There are the icepick migraines that feel like someone just stabbed you in the head.  Although intense, they are mercifully brief — just a minute, though there can be several repeats throughout the day.
Migraines can be temporally divided into three stages:  the prodrome or early-warning symptoms, the migraine itself, and the postdromal after-effects.  If I wake up with a migraine, then I don’t have the benefit of prodromal symptoms to alert me to take some medication and stave off the worst effects.  However, one of the benefits to keeping data sheets is the ability to suss out what sorts of symptoms are prodromal, so I can have better self-awareness.
A persistent tension headache can turn into a migraine (ugh).  Eating much wheat also seems to be a trigger for me; a small cooky isn’t bad, but a couple slices of pizza will do me in later (not to mention digestive hoo-hahs as the gluten works through my kishkas).  Barometric pressure drops — especially those that bounce back up from a swiftly-passing storm — are notorious for making my ears and head hurt.
The cognitive and mood factors can be less obviously related to migraine prodrome: brain fog, depressive state, insomnia, or light sensitivity.  You might think these would be pretty obvious, but the problem with chronic pain (from hypermobility+osteoarthritis+TMJ, especially combined with 11-13 hour work days) is that one gets into those viscous circles of pain-sleep problems-depressive states.  Throw in everyday hyperacussis and UV-sensitivity, and sometimes it’s hard to sort out what is which.  “Ain’t we got fun.”
Once I started researching various migraine symptoms, I had a much better means of both identifying and describing the various symptoms I experience.
One thing that quickly became apparent was that like snowflakes, no two migraines were precisely the same.  This is interesting from an objective point of view, but it also means that I have to spend a bit of effort to verbally identify the symptoms I experience during each migraine, and then shortly thereafter note them.  Although a cognitive task that I cannot always perform throughout the entirety of the experience, it does afford me the opportunity to detach part of my consciousness to that objective state, which gives me one step of remove from the intensity of the experience.  (My research background is useful in so many ways.)
An Aura can include visual disturbances such as:
Scintillating scotoma the classic flickering/shimmering/sparkling arc, zig-zag or castle crenelation effect;
Drifting phosphenes phosphenes are “stars” you see if you stand up too quickly or sneeze; phosphenes can also refer to the geometric patterns that happen when you press on your closed eyes;
Diplopia just the fancy word for double vision;
Oscillopsia when objects appear to oscillate, vibrate or bounce;
Photophobia “the light, augh! too bright!”
Allodynia pain from nothing in particular, or something that wouldn’t normally cause pain, “augh the sheet’s touching my arm!”;
Osmophobia “the smells, augh! too overpowering!”
Olfactory hallucinations smelling things that aren’t really there;
Phonophobia when even the clattering of dust particles falling is too loud;
Hyperacussis I startle overmuch at sudden or sharp noises — well, even more so than usual;
Auditory hallucinations hearing things that aren’t there, nor are related to my tinnitus;
Synæsthesia Feeling sounds, and other odd cross-sensory effects;
Paresthesias tingling or numb feeling like “pins and needles”, or like someone is yanking on my kneecaps or tendons;
Vertigo, nausea, vomiting, chills or clamminess;
Ataxia a “lack of order” or bad muscle coordination;
Disarthria / aphasia disarthria is trouble speaking clearly, and aphasia is problems with speaking and understanding, or making sense of reading things.
Once all that is over, there is the postdrome, or “migraine hangover”. I’ve no idea how one compares to a drinking hangover — I’ve never drunk that much! But it is something like having the flu: weakness, generalized muscle aches, laterality confusion (right v left), fine-motor difficulties, exhaustion, lack of appetite, intense thirst, intermittent strabismus (wandering eye), temporary dyslexia / reading comprehension, auditory processing lags, concentration problems, or once in a while, feeling energetic — “wow, I’m no longer in pain!”
Then of course, the was the issue of creating a useful data sheet, one that was both complete and easily used — and this is where my dual backgrounds in behavioral research and typography+layout blend well.
As with any sort of biological data, it is important to note the frequency, intensity and duration.  In addition to those classic factors, there are also the sorts of factors that one more often considers in ecology: the type, season (if any – only a data set of more than a year can determine that), and the extent, in this case, the extent of the disability that results from migraines.
I’m sorted the pain and disablement into three levels:
1 annoying pain, workable
2 moderate pain, reduced work
3 severe pain, incapacitating.
With the diary, I can then sort out the frequency, intensity and duration of the issues. So far I’m relizing that it’s much more of a problem than I had realized. It’s not so much that one gets used to pain, but that one gets used to being in pain, to headaches as a way of life.
Damn, but April’s a long ways off.

We Mutants

“Now remember — you’re special, just like everyone else!”
It seems that classic punch line (for all the jokes on useless self-esteem boosters) was never truer.  At the ever-entertaining NeuroLogica Blog, Steven Novella explains recent findings that everyone is a mutant.
Given my numerous neurological quirks, I had long assumed my mutant status to be true, and when finally diagnosed with prosopagnosia (which can result from a single point mutation), I then took it to be a given.
As Novella, points out, not all mutations give one super-powers; in fact, most of mutations are neither beneficial nor detrimental.  There’s certainly nothing exciting about hyperacussis, as I’d previously described in Can you sue your Fairy Godmother for malpractice? Some things like the are just annoying; were I graceful, the hypermobility might have enabled me to be a dancer or gymnast.  Instead, I’m just arthritic and bruised, for all it’s handy to always be able to reach that itchy spot.
100 – 200 mutations per person may be trivial in the genomic sense, but is far from trivial when considering human diversity.  Mutation is normal.  It’s ubiquitous.  Not only are there no “perfectly average” people, but we’re all mutants.  Now, can we finally lay disablism, transphobia, and the rest of the xenophobic rot to rest?
Now ‘scuse me while I go for a soak in the tub; maybe I can distract meself from this silly jingle that’s gotten stuck in my head:

I’m a mutant, you’re a mutant, xe’s a mutant, too.

We’re all alike in our differences, so whatcha gonna do?

The long and short of it

It’s going to be a long day; I can tell already.
Last night I finally got eight hours of sleep, aside from several prolonged coughing fits.  The previous three nights I’d only gotten four hours of sleep.  You’d think the extra rest would make me feel better, but I’m still running short on good sleep because I have this bronchitis or whatever (we’re waiting on the lab results from the nasal swab to see if I have Pertussis, holy shit).
At least I only have to work one job today.  But I’m teaching an evening class and I suspect that by then some of my cognitive functions will be running on Reserve Power.  At least it’s a subject I’ve done several times before, so I can get by with using a lot of verbal scripts.
It’s going to be a long day; I can tell already.  That’s because I’m already running into “System Overload: Error Messages”.
P.S.  I’m going to have a bowl of Mint-Chip ice cream and see if that doesn’t do anything for me, since the efficacy of Häagen Dazs Vanilla Swiss Almond ice cream isn’t up to par. Thanks, Bev!
[now clink on this link for System Overload: Error Messages where post continues]

That joist isn't funny

squeeee-squeeey-squeeeeee

The bathroom to the master bedroom is above the kitchen, and when someone is (dressing? brushing their teeth? pacing?) at a particular spot, the floor squeaks abominably, like two pieces of Styrofoam [polystyrene] being scraped together.  (Were this a ground level floor, we could go to the basement to hammer in some splints in the joists.  But of course there’s a ceiling in the way, so we’re stuck and I just have to cope.)

squeeee-squeeey-skwor-skwork-squeeey

There are some noises that make me flinch, jump out of my seat, and/or send me packing from the room.  Not just the typical squeaky things, like the proverbial (and literal) fingernails-on-the-blackboard, but also fire alarms, theatre movies, teakettle whistles, the shattering of dropped water glasses, chainsaws and leaf-blowers and string-trimmers and hedge clippers and table saws and wood chippers and …  Okay, lots of people dislike those noises, but during the quarterly fire drills only another staff member and I are plugging our ears in distress as we herd the students outside.
Then there are the more mundane noises that no one expects anyone to mind: the sour whine of computer hard drives going bad, the strident jangling of class bells echoing down tiled hallways, the cavernous reverberation and intense whirring of elevators,  “merely” stacking pots and pans and shutting the stove drawer where they’re kept, the clanking when stacking ceramic casseroles in the cabinet, or the grating squeal of the pressure-hinge when opening and shutting an aluminum storm door.  (WD-40 is my friend, and periodically I go around the house and spray every room and cabinet door hinge before I “come unhinged”.)
Even my apartment neighbors thought me overly “picky” because I asked them if they could be quieter when washing dishes or taking a shower or walking about in boots or high heels.  Even everyday noises like vacuuming or their sputtering coffeemaker and beeping microwaves or their tinny radio and yakkity telly programs would drive me ’round the twist.
Sometimes it’s neither the suddenness nor the loudness nor the high pitch of the noise, but the combined effects of all the daily noises, the “life in surround-sound” as described in “Bridge Load Limit”.  As I’ve described before, hyperacussis is a “super-power” that truly, truly sucks, even when you don’t have a profoundly debilitating case.

I’m with Karl !

LOLcat Karl makes an anguished face as another cat asks, "They say itz a sound only we can hear. IDK. I don't hear anything Karl. Do u?"

Requesting your thoughts, please

Howdy folks,
This morning I’m again in pain and rather stiff.  I know that many of you have rather specialised knowledge, and would appreciate your thoughts on getting diagnostics.
I have a number of conditions, both common and uncommon, including Raynaud’s, migraines, cough-variant asthma, tinnitus & hyperacussis and Auditory Processing Disorder, motor tics, and assorted neurological glitches including prosopagnosia (face-blindness) and ADHD. Getting these things diagnosed over the past decade has been wonderfully helpful for those that can be medicated, figuring out how to make accommodations for those that can’t, and being able to prove to others that I have documented reasons for difficulties, and that I’m not being lazy or stupid.
However, the crux of this post is that I also have Continue reading Requesting your thoughts, please

Backwards Symphonies

“It’s been a long week — I bet you’re ready to decompose.”
I stared at my husband, blinking through the mental fog of too-many-jobs-not-enough-sleep.
“I’m not ready for the compost pile yet,” I replied, trying to figure out what his latest malapropism was meant to be.
“Or whatever the term is,” he added.
My brain finally catches up. “Decompress,” I answered.
What an incredibly long week.  I can’t remember the last time I had one like this, and in my over-busy world that’s saying something.
Wednesday last week I had a pneumonia vaccination, which left my arm so sore I couldn’t take off my jogbra without assistance, nor even get my hand up to head level until the weekend.  Moreover, Continue reading Backwards Symphonies

Buzz Off!

No, “buzz off” does not mean that I am being grumpy and telling everyone to Go Away. There are apparently a lot of other people out there who are grumpy about Mosquitos, but not the insect kind. The story (like most) gets complex very fast.
So. There are some young people who hang out in front of shops or public areas and are annoying, even to the point of committing misdemeanors. This is hardly a new problem of urban settings; doubtless ancient Greek and Roman shopkeepers complained about much the same thing. In addition to the primary problems of what the yobbos / chavs / hooligans (pick your fave term) may engage in, there’s the secondary problem of their presence intimidating customers and driving away trade.
Of course, not all young people act like this. In fact, very, very few do. And young people, like people of other age groups, like to get together with their pals and socialise. Of course, when you’re young you don’t have your own place, and not everyone wants to hang around the living room where dad’s watching Top Gear or yet another history programme about some war or another. So kids hang around in parks, on sidewalks, in malls, and other public areas. And then people complain because shockingly, there are kids hanging around. Well, duh; few can afford to spend lots of cash at movie theatres or pool halls or video game parlors, and if you’re not spending, they don’t want you there.
Back in 2005, Howard Stapleton realised that he could use teens’ better hearing against them. In theory, young people can hear up to 20 kHz (20,000 Hertz), but as people age they lose this ability due to presbycusis. Although most older adults can pass a basic hearing exam with flying colors, such exams only test up to 8,000 Hz, because audiologists are concerned with how well people perceive common speech and environmental sounds. (This concept also assumes that those targeted have not had any hearing loss due to listening to loud music in vehicles, headphones, and / or concerts.) Thus, the Mosquito device was born.
According to a distributor’s description, these speakers broadcast a 17.5-18.5 kHz tone at 75 decibels. Although not damaging, the whine becomes very annoying after a couple of minutes, and those who can hear it usually leave after a few minutes, although the unit runs for 20 minutes before shutting off. It can be heard 15 meters / 50 feet away, with stronger models audible as far as 90 meters / 300 feet away.
The Mosquito device proved popular with a number of shopkeepers and other business owners; some 3500 units have been installed around the UK, to prevent young people from congregating outside of stores, rail stations, car parks, industrial areas, city parks, and even school grounds (used after hours). Now it’s being sold in the U.S. and Canada as well.
Naturally, there were protests about the use of the devices. The prototype was banned in its place of inception, Newport, South Wales. Although legal elsewhere, other groups have taken up complaint, and not just young people:

Scotland’s Commissioner for Children and Young People, Children in Scotland, and the Scottish Youth Parliament fully support the campaign launched today in England against the use of the Mosquito device.

So too is Liberty, the National Youth Agency, the Children’s Commissioner for England, which is spearheading the Buzz Off campaign.
Frankly, I find the whole idea of using sonic deterrents as weapons (attack devices) against young people to be abhorrent. These things target and punish all young people present for the actions of a few. You get what you give, so how is being deliberately obnoxious supposed to encourage better social behavior in others? We don’t like it when people go around playing their music too loud, so why is it okay to broadcast high-pitched whines that are meant to get on people’s nerves?
Furthermore, the manufacturers and users assume that only young people can hear these sounds, and that simply isn’t true. I’m 47 and I can hear such frequencies (despite the tinnitus), and a 75 kHz noise is also pretty damn loud, even if it’s not technically at the damaging threshold. If I came across a shop that was using this sonic attack, the shopkeeper would certainly get an earful from me! There’s too much noise as it is, without adding gratuitous noise.
It’s not that I don’t sympathise with business owners and other citizens who are dealing with the effects of antisocial or criminal behavior. But this kind of antisocial retaliation hurts everyone, and is blatant discrimination.

Leaks

Last ngiht I had an absolutely BRILL idea for a blog post. Even came up with a catchy title. Thought it would be a good way to remember it. Didn’t write it down, owing to having finally warmed up my spot on the bed and it being past midnight, so I didn’t want to climb out of bed and grope around in the cold and dark for writing materials.
And, then of course the next morning I couldn’t remember it. Still by evening I can’t remember it. The idea seems to have leaked out my ears during the night. So it goes. Maybe it’ll come back to me — this time, I’ve a pencil and paper at bedside.
Meanwhile, here’s a lovely little Minuscule vid that I’d not seen before. It’s part of an animation series done in France, short little stories with natural scenery and computer-modeled invertebrates (insects, spiders and snails). The funny stories have no dialog, just some light background music and humorous sound effects. (No captions needed.) The physics are just spot-on, too, with only slight exaggerations for effect.
This one has a fuzzy black house spider that has taken up residence in the kitchen of a country house. Alas, the sink drips, drips, drips. The sound clips we get from the spider’s perspective sound horribly loud … maybe it has hyperacussis.
Anyway, enjoy the story as our protagonist seeks to create some “Silence”:

[youtube=http://www.youtube.com/watch?v=KAhbGvjid8c]

Fishing With the Wrong bAIT

The other day (er, week) I promised to post some thoughts on AIT, so here they are.
There are plenty of treatments offered to cure or improve Auditory Processing Disorder (APD). Auditory processing is not just about hearing. Hearing is the sensory business that the ears do, and the auditory processing is what the brain then does with the signals from the auditory nerves. The ears also have the semicircular canals, which provide us with information about balance — that sense of balance, along with the proprioception of our joints, ligaments, muscles, tendons and bones, give us the sensory information we need for coördination. In auditory processing disorder, the sensory part of hearing often works just fine; it is not a hearing problem, it is an understanding problem. The ears are getting the information and are sending suitable signals; but there are some “tangles” or “speed-bumps” in the interpretation of the signal.
One treatment popularly lauded on Web advertisements is Auditory Integration Training (AIT), which is supposed to also help problems related to tinnitus, hyperacussis (oversensitivity to high-pitched and/or sudden noises, or sound in general), autism, ADD or ADHD. Depending upon the practitioner, AIT may also be sold as effective treatment for dyslexia, stuttering, depression, speech delay, and even head-banging or echolalia. That’s quite a list of highly diverse issues, which immediately sends off mental warning bells.
AIT was developed by Dr Guy Berard, who is also the author of the (out-of-print) book, Hearing Equals Behavior,

“Everything happens as if human behavior were largely conditioned by the manner in which one hears.”

(Hmn, I bet a lot of Deaf people would beg to differ with Dr Berard’s assertion!)
So how is this method supposed to work? Continue reading Fishing With the Wrong bAIT

ALDs in the Classroom

On my page about Auditory Processing Disorder, someone had enquired if using ALDs (Assistive Listening Devices) in the classroom would be helpful. Her daughter, like many students, did not want to be singled out by using them and perceived by her peers as being “weird”. I thought I would expand upon the response to include more information. Please note that these suggestions are slated more toward APD and general educational design suggestions, rather than toward ALD equipment for students with severe hearing loss.
Although ALDs do work to an extent, they may not be the best choice for some situations. We should also note that although schools focus on the deficiencies of the student’s hearing, listening comprehension, or attention, quite frequently some of the deficiencies are really in the design of the school classrooms. These make it more difficult for students with APD, ADHD, or hyperacussis, and they also make it more tiring for the instructors who must spend all day trying to talk over noisy environments, and for the other students. (More on this aspect in the latter part of this post.)
One type of ALD is an FM or infrared system that involves a microphone (for the teacher) and receiver headphones (for the student). Naturally this is highly visible, so not everyone wants to be singled out in this manner.
The microphone must be positioned correctly, so the speaker’s voice does not fade in and out of range (you may have experienced this yourself when sitting in presentations or conferences). Of course, both pieces of the equipment needs to have fresh batteries and be in good repair, or it’s useless.
Sometimes microphones with speakers are recommended for teachers so they can broadcast better to the students in the back of the room. Usually the speakers are not high quality, and such systems just add to the amount of noise, rather than improving the clarity of communication!
Because the microphone is used by the primary speaker, it presents problems if anyone else in the classroom speaks. Either the mike is passed around when there are group discussions or questions, or the listener does not get comments and queries by the other students in the room. The latter not only removes a layer of information, but can also lead to reduce social inclusiveness because the person with the headphones loses the small commentaries that may not be part of the formal instruction, but are part of the socialisation and informal culture of the classroom. Even if the microphone does get passed around, the other students’ lack of familiarity with holding the mike where it can pick up their voices and the considerable junk-noise of passing the microphone do not improve the listening experience.
I will say that there are special situations when an ALD such as this would be especially good, such as when the teacher is doing instruction during a bus ride, in noisy places like zoos, factory tours, science museums and so on. It should also be made clear (and probably reminded) to the teacher that PA announcements are often unintelligible to people with APD (or hearing loss) — this means that messages will need to be passed on, and the teacher should not rely on the student being able to follow those announcements, except where they are simply following the herd of students. (I’ve had my family page me at airports and other places, and I not only couldn’t understand the page, I couldn’t even tell that I was the one being paged!)
There are alternatives to using an ALD, which should be considered and probably tried before deciding to use the ALD.
Students with APD should get “preferential seating”, which is often used for ADHD students as well. This means sitting near the teacher and/or instruction board or instruction area. The point is to reduce the amount of space and distractions between the student and the source of information. This is especially helpful if the student does some lip-reading (not everyone with APD is even aware they do this).
The teacher should be careful to not address the students when writing on the board. (Unfortunately, most teachers start out very conscientious, and then after a few days revert back to their old habits.) The student will have to get in the habit of asking, “What was that?” or “Can you repeat that?” or may have to advocate after the fact. Meaning, when everyone has started on the work, raising her hand, and then when the teacher comes by to talk with her, point out that the teacher was talking to the board (again) and she couldn’t understand everything. She could also have a special hand-signal to make when the teacher turns back around from the board, to alert the teacher of the missed communication.
Have the instructor turn on captions to broadcast media — these are good for the ESL students, and they help the other students catch the terms and spelling of details they need from the program. It’s best for the teacher to not point out that they are turning on the captions for your daughter specifically — just turn them on, and if anyone asks, simply explain that they are on so everyone can more easily understand the dialog. That’s the truth; there’s no one need for one person to be singled out.
As I referred to earlier, the classroom design can aggravate APD and ADHD difficulties. Not all of the problem should be set at the feet of the student!
“Noise” is composed of a number of factors. Most people just think of the volume (measured in decibels). But there is also the complexity factor — it’s hard to focus on one sound source when there are other sound sources going on at the same time. There is also the noise-to-signal-ratio factor where clarity is important, and clarity can be lost from not just background noise, but also echoes, unclear speech, and poor transmission equipment (fuzzy speakers, tinny receivers and so on).
ALDs are often recommended because the student (or employee) is having trouble hearing or understanding because the room is atmospherically noisy. This is in large part due to bad environmental design — too many hard surfaces, noisy HVAC (air conditioners, radiators, fans), various kinds of equipment, lots of voices at once and so on. Please note that “noisy equipment” does not mean it has to be loud by OSHA standards — students who are distractible and/or have APD problems and/or hyperacussis will find the noise levels in an average classroom to be more of a problem than many of their peers. (This also applies to many students with autism.)
Things like area rugs, draperies and acoustic tiles (or new, much more effective acoustic tiles) will help muffle a lot of the echo and reverberation. Turning off equipment when it’s not being used helps more than people realise, and is also important to save energy. If there are times when multiple instruction is going on (for example, an aide helping a few students) then setting up an area with a couple of those portable, upholstered cubicle-type dividers will help not only your student, but also be more effective for the aide and the other students. It’s always easier to “sell” an idea when the benefits to numbers of people are described.
I don’t believe that students with ADHD or APD should not even be in settings with the “open classroom” design that was in vogue some decades ago, as having several different classes and multiple instructions and larger numbers of students milling around is just too much to deal with effectively. Schools that have tried to retrofit open classroom areas into individual classrooms often end up with inadequate materials (due to budgetary issues). Unfortunately, merely pulling a folding divider wall between two rooms does not adequately damp all the noise that seeps through. A suspended (common) ceiling that is sometimes added along with the partitions does not effectively mute sound, but rather serves to transmit the sounds from one room to the next.
Likewise, rows of file cabinets are also poor excuses for walls between “rooms” in libraries or other resource rooms. It’s hard for adults to work in such environments, so I don’t know why we expect that children should find it easy. Furthermore, pretending that experiencing classes in such poorly-divided greatrooms is good practice for working in “cubicle farms” is nothing more than piss-poor rationalisation, what Alfie Kohn refers to as “getting hit on the head lessons” (justifying bad educational practices as preparation for more of the same).
Sadly, there are a great many districts that are suffering from insufficient classroom space. Teachers and students end up in a variety of locations that were never meant to be classrooms, and have had only minimal modifications, usually hanging up a whiteboard and cramming in some desks and chairs. In addition to features like thin, hollow “temporary” walls that have been there for years, odd room shapes or cramped conditions (including putting the board on a free wall rather than one that works with the traffic flow or desk orientation), and ventilation quirks we often find that these ad hoc classrooms are poorly placed with respect to other functions of the school.
Usually school architects try to create noise-buffer zones between the classrooms and the other functional areas of the school, such as the gymnasium, lunch room, kitchen, power plant, or specialty classrooms such as shop (wood/metal/engine working) or band instruction. These desperation classrooms are stuck in all sorts of bad locations, even in part of the custodian’s storage area. I remember having my Government class in a tiny room set in the back hallway by the gymnasium (it was probably once the coaches’ office), and the students reached the room by virtue of going through the boys’ or girls’ locker room. We spent the entire time assaulted by the locker room and pool chlorine smells, and the instructor had to talk over the noise from the adjoining gymnasium and natatorium.
Many older school buildings were designed in eras when passive lighting and ventilation were more commonplace. These frequently have high ceilings hung with banks of fluorescent lights and tall windows that are usually shaded by metal blinds. Those high ceilings and the hard surfaces combine to accentuate the noise echo and reverberation, and the banks of fluorescent lights are often noisy in their own regard. Because the fans are beneath the windows, the air flow will create ripples and rattles in the blinds, even when teachers try to pin down the bottoms of the blinds with stacks of extra textbooks. These are the sorts of rooms where general amplification speakers are especially un-helpful.
In summary, Assistive Listening Devices are helpful for reducing some of the noise-to-signal ratio.  However, they cannot substitute for effective interpersonal communication skills, and can only mediate some kinds of environmental noise problems.  They are not an easy fix to the problems faced by a student with APD.  As I have mentioned before, our various assistive devices do not remove our cure our problems, but rather, are part of the system of coping methods.