Central Auditory Processing Disorders (CAPD)

Central auditory processing disorder is also know as a central auditory dysfunction, auditory processing disorder, central auditory disorder, and auditory perceptual problem.

The individual with a central auditory processing disorder (CAPD) has difficulty listening to or comprehending auditory information despite having normal peripheral hearing sensitivity. CAPD may be defined as a reduced or impaired ability to discriminate, recognize, or comprehend auditory information. This problem will be most pronounced when the auditory signals are compromised by distortion, competition, poor acoustic environment, or other reduction in signal clarity, strength, or information content. In other words, the CAPD individual will experience greater problems when the acoustic environment is less than ideal such as in an open classroom or when the signal is poor due to interference, intensity, or content.

Individuals who have a central auditory processing problem are as heterogeneous as their behavioral manifestations. One point of view is to consider CAPD a subset of language and learning disorders. Central auditory disorders can occur in individuals with peripheral hearing loss or of limited cognitive ability. A CAPD can occur as a result of injury to or disease process in the central nervous system. It may be due to neuromaturational factors. The wide range of behaviors and factor make diagnosis of CAPD a challenge to the clinical audiologist and others.

Consider testing if a child is doing poorly in school due to difficulties in learning through the auditory modality, poor listening skills, or difficulty understanding in the presence of background noise.

Behavior of children considered "at risk" include:

  1. Frequently misunderstands oral instructions or questions
  2. Delays in responding to oral instructions or questions
  3. Says "Huh" or "What" frequently
  4. Frequently needs repetition of directions or information
  5. Frequently needs requests repetition
  6. Has problems understanding in background noise
  7. Is easily distracted by background noise
  8. May have problems with phonics or discriminating speech sounds
  9. May have poor expressive or receptive language
  10. May have spelling, reading, and other academic problems
  11. May have behavioral problems

Normal children will often display one or more of these behaviors during maturation. Not all children are attentive and responsive all the time. Parents and educators should be concerned when there is a consistent pattern of behavior, difficulty in school, and failure to fulfill potential. Parents should keep in mind that these same behaviors may be due to something other than a CAPD. An underlying receptive language problem will cause many of the behaviors. If there is a middle ear problem, such as otitis media (fluid in the middle ear), many of the behaviors described will be present.

CAPD type behaviors may be one aspect of a larger problem. The true cause of the behaviors may lie elsewhere. Many parents cannot accept the idea that the child has an attention deficit disorder or a learning disorder. The child may not have the intellectual ability to fulfill parental dreams of academic success. In some cases, the behaviors may signal that the family is dysfunctional. Parents may seek the least painful explanation because the alternative is emotionally or intellectually unacceptable. Parents have been known to hid the fact that earlier testing suggested a different diagnosis. Parents must be careful not to bias or hinder evaluations by withholding information. Testing for a CAPD problem cannot be done in isolation. Finding solutions to a child's academic problems cannot be done if parents do not cooperate fully and openly.

CAPD testing requires a team approach. The child's doctor should be involved to rule out diseases as well as provide a statement as to the child's growth and development. Educators are needed to provide input about how the child does in school, significant behaviors, and impressions of academic ability. A speech and language pathologist should evaluate the child for speech and language problems. A psychologist is needed to provide information about cognitive and other mental strengths and weaknesses. And, an audiologist is needed to provide the in depth testing for CAPD.

The Audiologist's Role
The audiologist is a critical element. Although the child may have passed a school screening program, only an audiologist can rule out all degrees of peripheral hearing loss as well as begin to check the integrity of the auditory system from the external ear to the auditory cortex. Psychologists, speech pathologists, and medical doctors have tests which may indicate the presence of CAPD or other audio logical disorders, but only the audiologist has the equipment and training to provide a detailed information about the auditory system.

Readings:

Central Auditory Processing Disorders
An Overview of Assessment and Management Practices by Mignon M. Schminky and Jane A. Baran

Living and Working with a Central Auditory Processing Disorder (CAPD)
By Judith W. Paton, M. A., Audiologist - San Mateo, CA

Links:

National Coalition on Auditory Processing Disorders, Inc. Website: http://www.ncapd.org
The mission of the National Coalition on Auditory Processing Disorders, Inc. is to assist families and individuals affected by auditory processing disorders through education, support, and public awareness as well as promoting auditory access of information for those affected by auditory processing disorders.

Kids Health for Parents Website: http://www.kidshealth.org/parent/medical/ears/central_auditory.html
Information for parents.