A man I’ll call Thomas had been assaulted. As part of a victims of crime process, two different practitioners assessed him — and produced two remarkably different reports.

The first concluded that Thomas had experienced minimal impact from the assault and raised concerns that he might be fabricating his distress. The examiner noted long pauses before answers, a flat emotional tone, and responses that seemed carefully constructed rather than genuine.

The second report told a completely different story. This practitioner found Thomas to be experiencing real and significant distress, which he described with genuine feeling and appropriate emotion.

The difference wasn’t Thomas. It was the questions.

Why the questions mattered

Thomas had mild hearing loss and auditory processing difficulties which is common enough, affecting roughly one in five of us. The first practitioner had used a standard mental state examination: a structured sequence of direct questions covering set topics. The second began differently, simply asking Thomas to describe what had happened in his own words, following up with questions that arose naturally from his account.

When Thomas told his own story, he was in familiar territory. The listening demands were low. He knew what he wanted to say, and he said it with feeling. But when faced with a rapid series of disconnected questions, each one a fresh topic, arriving without context, something different happened. He struggled to process each question clearly. The cognitive effort of decoding what was being asked left little room for emotional expression. His responses slowed. His effect flattened. To an observer, he looked evasive. Possibly deceptive.

This is what decontextualised questioning does to people with listening difficulties. A survey or structured examination moves rapidly between unrelated topics. Each question arrives without the scaffolding of a shared narrative. There’s no thread to follow; no story already in motion to help you anticipate what’s coming. For someone whose auditory processing is already working overtime, this kind of interaction is genuinely exhausting, and the signs of that exhaustion can look, to the untrained eye, like evasion, low intelligence, or emotional detachment.

The second practitioner noticed the discrepancy and asked himself why the same man was presenting so differently in different parts of the same session. That question saved Thomas from a deeply unjust outcome.

When assessments don’t tell the full story

If you have listening difficulties, you may recognise something from Thomas’s experience. Formal assessments and structured questionnaires place demands on people who find listening hard and the results can be badly misleading for everyone involved.

There are some practical things worth asking for when you face this kind of appointment:

• Ask to see the questions in writing beforehand, so you can read them rather than process them on the spot.
• Let the practitioner know upfront that you find structured questioning difficult and ask to tell your story first in your own words.
• Ask for questions to be given one at a time, with a pause between them.
• Ask for questions to be rephrased or written down if they don’t land clearly.
• Ask for a quieter space if background noise is an issue.