Central Auditory Processing Disorder: An Overview

By Donna Geffner, Ph.D, and Eve Kessler, Esq.

AT A GLANCE

CAPD occurs when there are problems processing aural information • Assessment for the disorder should be done by an audiologist that specializes in CAPD • The negative impacts of CAPD can often be addressed through implementation of evidence-based interventions


1.1.8-CAPDThe American Speech and Hearing Association defines Central Auditory Processing as the efficiency and effectiveness with which the central nervous system uses auditory information. In other words, it’s what the brain does with what the ears hear.

A Central Auditory Processing Disorder (CAPD, also referred to as Auditory Processing Disorder or APD) occurs when the central nervous system has problems processing information that comes through listening.

The Basics

People with CAPD have difficulty processing auditory input, especially in unfavorable listening environments. They also have problems using auditory information to communicate and learn.

CAPD manifests itself in a number of ways, some of which look like other learning difficulties. Examples include poor performance in listening tasks, understanding speech, developing language, and learning in general, all of which could be symptomatic of other learning disabilities as well. (See below for a list of signs and symptoms.)

Auditory processing difficulties can have a tremendous impact on learning, from the ability to absorb content presented verbally to utilizing phonics strategies when reading and spelling.

Research suggests that 3% to 20% of children have CAPD and that a significant number of those children also have attention issues, such as ADHD 

Diagnosis

The assessment for CAPD includes a complete audiological battery, a CAPD battery, a Listening Inventory, and electrophysiological measures, such as a functional MRI.

Parents should discuss with a professional audiologist the types of tests needed. Most assessments must be conducted by an audiologist specifically trained in CAPD and should take place in an environment that includes a soundproof booth.

Treatment

Children spend up to 60% of their day focused on listening, much of that time in school. Classrooms often are noisy places, and children have a harder time than adults hearing speech in noisy environments. For children with high-risk listening conditions such as CAPD the problem becomes even more acute.

Appropriate treatment and modifications can help improve attention skills, speech perception, eye contact, and reduce listening difficulties and listening fatigue. Following are some evidence-based strategies that have proved effective for kids with auditory processing issues.

Classroom Modifications. These aim to eliminate noise and distractions in learning environments while enhancing important sounds and signals.

  • The most widely recommended modification is a sound field FM amplification system, which provides uniform amplification throughout the classroom, regardless of the position of the teacher or students. It consists of a microphone and transmitter worn by the teacher, which amplifies her voice and improves the sound-to-noise ratio of the listening environment.
  • Personal FM systems, with a student wearing an earpiece and the teacher wearing a headpiece microphone, are even more effective in improving the sound-to-noise ratio and making it easier for a student not to miss anything.
  • Other changes in the school environment and in teachers’ behaviors can have a beneficial impact as well. These include putting rubber tips or tennis balls on chair legs, keeping doors closed, using carpeting or rugs on floors and curtains or drapes on windows, and installing acoustic tiles to soundproof ceilings and walls.
  • It also helps for students to be given preferential seating, have access to a quiet study area free from distractions, and for teachers to speak slowly, use visual models, and get a child’s attention by touching his shoulder or saying his name.

Home Modifications. It is also important for noise levels and distractions to be reduced at home.

  • Lack of proper insulation can make for a poor study area with increased distractions. Carpets and rugs can help reduce the overall noise level at home.
  • Children should work in an area without a telephone, siblings, or other distractions. Some children may need to wear earplugs; others may need tutoring or “coaching.”

Coping Strategies. Children with CAPD should be taught self-advocacy skills.

  • If children cannot hear properly, they must become comfortable asking parents or teachers for help.
  • Some kids benefit from pre-teaching vocabulary words so they’ll know the words and concepts when they hear them used in upcoming lessons.
  • Other helpful strategies include getting notes from an organized buddy, using a tape recorder with reduced-speed playback, and learning to visualize auditory information through a particular reading or spelling program (such as Lindamood Bell Visualizing and Verbalizing® or Cast-A-Spell).

Auditory Discrimination Rehabilitation. There are numerous trainings that focus on specific deficits experienced by children with CAPD.

  • Those with auditory closure challenges have trouble filling in what they do not hear. Their training consists of vocabulary building, using silly sentences or wrong words and learning to recognize degraded words in context.
  • Other kids must be taught to interpret, organize and integrate information, discriminate differences in frequency, follow directions, sequence properly, and detect gaps in sentences. They learn by replicating rhythms, reading aloud, and playing electronic games that encourage fast responses.
  • Binaural separation rehabilitation trains children to pay attention to what each or both ears are hearing by listening to words, digits, and messages in the presence of background noise and distractions.
  • Figure-ground activities train kids to recognize words and differentiate them from background noise. Activities may include noise-desensitization training to obliterate background noise interference, and listening to directives in a background of increasing noise.
  • Some children must also be taught to distinguish sound sources by identifying the source of the sound while a clinician moves around the area.
  • Another form of rehabilitation trains the brain to integrate auditory information across brain hemispheres by carrying out directives that arrive at the brain from both ears. For example, children will learn to verbally identify tones, sounds, or phonemes through tactile cues of objects in the left hand while describing or drawing a picture with the right hand.
  • Children might also need training in the following deficit areas: auditory attention (maintaining focus over a period of time for an intended purpose); auditory cohesion (interpreting, organizing, and synthesizing auditory information on a higher-order level of functioning, such as listening comprehension, categorization or discerning the main idea); and auditory latency (responding without delay to auditory input; for example, being able to process an entire sentence without missing the beginning or the end and being able to understand rapid speech).

Technological Help. There are computer programs or apps available to address CAPD deficits at home. Because the field is changing so rapidly, it’s best to get recommendations from an audiologist or your school Assistive Technology specialist. In general, options include the following:

  • Multi-sensory, interactive games that focus on auditory skills, blending, sensory integration, and phonological awareness.
  • Software designed to help kids learn faster, improve memory and become better thinkers.
  • Programs that build auditory attention and help children become better listeners and readers.
Signs & Symptoms of CAPD
  • Poor listening skills and auditory attention
  • Reduced comfort levels for listening in general
  • Difficulty learning auditorily
  • Problems in the presence of background noise: poor speech recognition, difficulty understanding, and tendency to be distracted
  • Reduced tolerance for loud noises; hypersensitivity to noise in general
  • Difficulty understanding speech when it is muffled, distorted, or rapid
  • Slow or delayed responses to verbal stimuli
  • Frequent requests for information to be repeated
  • Auditory integration deficits for sound blending and auditory closure (filling in what is not heard), phonological awareness, and phonics skills
  • Misunderstanding or “mishearing” what is said; often will say “huh?” or “what?”
  • Poor receptive language skills: understanding double and non-literal meanings, puns, and abstractions; understanding salient points in order to take notes efficiently; taking notes and listening at the same time; following auditory directions and recalling what has been heard, especially commands and instructions
  • Poor expressive language skills: getting to the point, finding words, expressing feelings, sequencing events, and organizing thoughts
  • Poor pragmatic language skills: reading the situation and knowing what to say and how to say it; taking turns in communication; beginning or ending a conversation; entering a group play situation; asking questions, making inquiries, and asking for assistance
  • Problems with reading, spelling, and academics in general

Donna Geffner is the Director of the Speech and Hearing Center at St. John’s University, Queens, NY. Eve Kessler, a criminal appellate attorney with The Legal Aid Society, NYC, is co-founder and President of SPED*NET, Wilton, CT., and a Contributing Editor of Smart Kids.