Understanding central auditory processing disorder (CAPD)
Usually the easiest and most-time efficient way to communicate with someone is to simply say something. However, if the listener has central auditory processing disorder (CAPD), your comment or question might be received with some words drowned out by other noises, with some words sounding like different words or maybe even as a string of meaningless verbal noise. You might begin to suspect something is wrong if they look like they didn’t register much understanding, if they provide an answer to a question you didn’t ask or if they request additional information for clarification.
Most people aren’t very knowledgeable about the specifics of CAPD and are more likely to wonder if the listener just isn’t very intelligent or doesn’t really care about what you’re saying. However, children and adults with CAPD do care about what you’re saying. In fact, they’re probably working twice as hard to capture the meaning of your communication but are neuropsychologically incapable of processing the detail properly.
Living with CAPD
Sue is a vibrant six-year-old with CAPD. She, and many children like her, typically has normal hearing and intelligence. However, she has trouble paying attention to and remembering information presented orally and problems carrying out multi-step directions. She confuses syllable sequences, has problems developing vocabulary, difficulty with reading, comprehension and spelling and has overall poor listening skills, all resulting in low academic performance. @BC2:Life is complicated for children like Sue. There are a lot of new social and scholastic demands bombarding them with a multitude of information. The seemingly simple problems with learning to read and write, following directions and hearing in noisy environments are often not all that alarming to parents and school teachers because they would appear quite understandable. However, sometimes parents like Sue’s do become concerned because their child may seem to be more than simply distracted by the complexity of his/her life. Uncertain of what to do because the child’s hearing has been deemed healthy, they often feel they are left without a resolution to their fears and concerns regarding their child’s development.
Although a child’s hearing ability may be diagnosed as average or normal, he/she can still be suffering from CAPD. This is because a child with CAPD can hear in the sense that there is no damage to the ear’s ability to receive and perceive sounds. The problem is the child can’t fully process the information they hear because their ears and brain are not communicating with each other properly, which produces many of their learning and communication difficulties. Human beings hear when energy we recognise as sound travels through the ear and is changed into electrical information that can be interpreted by the brain. CAPD indicates something is adversely affecting the processing or interpretation of the sounds received by the brain. Children with CAPD typically have normal hearing and intelligence and their difficulties do not lie in developmental intelligence. At a fundamental level, their language and communication problems can be linked to an underdeveloped ear.
Living What causes CAPD?
CAPD goes by many other names: auditory processing disorder, auditory perception problem, auditory comprehension deficit, central auditory dysfunction, central deafness and so-called “word deafness”. Although it’s a physical hearing impairment, it’s not one that shows up as a hearing loss on routine screenings or an audiogram. Instead, CAPD affects the neurological system beyond the ear, which identifies and separates meaningful messages from non-essential background noise and sends that information to the intellectual centres of the brain.
A constant interference in the processing of information (CAPD) can be hereditary in families or the result of a difficult birth, or the disorder can be acquired from a head injury or severe illness during the child’s first years. Frequently, the exact cause is unable to be identified.
Symptoms of CAPD
The following symptoms of CAPD can range from mild to severe and can take many different forms. If you think there may be a problem with how your child processes information or what they are able to hear and pick up, consider the following questions. Ultimately, however, you will need to have your child diagnosed by a qualified professional.
- Is your child easily distracted or unusually bothered by loud or sudden noises?
- Do noisy environments upset him/her?
- Does your child have difficulty following directions, whether simple or complicated?
- Does your child have reading, spelling, writing or other speech/language difficulties?
- Is abstract information difficult for your child to comprehend?
- Does your child have difficulty following conversations?
These, as well as other behaviours, may be signs of CAPD. However, CAPD is often misunderstood or misdiagnosed because many of these symptoms may be indicative of other conditions such as learning disabilities, attention-deficit/hyperactivity disorder (ADHD) and other related developmental difficulties.
Diagnosis and therapy
If you suspect your child meets many of the criteria for CAPD, what is the next step?
An audiologist can determine if your child has CAPD by performing a central auditory processing test to determine whether there is a problem. Nonetheless, many of the skills a child needs to be fully and correctly evaluated for CAPD do not naturally develop until they are eight or nine years old. So when many children are tested for CAPD during their early primary school years, the auditory centre of the brain has not fully developed and would naturally face some difficulty in receiving and processing a lot of information because the brain has not yet fully matured. Therefore, many children diagnosed with CAPD can improve many skills with time.
Once diagnosed, children with CAPD most often work with a speech therapist. For example, there are exercises to improve language-building skills, which can increase the ability to learn new words and develop a child’s language base. Also, auditory memory enhancement tasks are effective in reducing detailed information into more basic chunks of information. Another exercise is informal auditory training techniques, which can be used by teachers and therapists to address specific difficulties, or auditory integration training, which retrains the auditory system and decreases hearing distortion. Yet another popular strategy is environmental modification, such as to classroom acoustics or the location of the child’s desk or to seating in social group situations. There’s a variety of commercially available strategies to help children with auditory processing difficulties. Some of these methods have been well researched while others may not have been. Consequently, any therapy selected should be used under the guidance of a team of professionals, and the effectiveness of the method needs to be evaluated on a regular basis. One common approach to treating CAPD is with the use of an auditory trainer, which is an electronic device that allows the child to focus their attention on the speaker and reduce the interference of background noise. They are often used in classrooms with the teacher wearing a microphone to transmit speech sounds while the child wears a headset to receive them.
An effective form of treatment among parents, to support the work the child does with a speech therapist, is the Tomatis Method listening program. Founded by French ear, nose and throat specialist Dr Alfred A Tomatis (1920-2001), the Tomatis Method uses sound via an electronic device to exercise the whole ear through bone and air conduction. It strengthens language, learning and the processing of sounds according to the essential principle “the voice can only reproduce what the ear hears”. Overall, the Tomatis Method strengthens the effects of the middle ear, the inner ear, the auditory system as a whole and the central nervous system, and helps in rewiring the connections needed for the brain to process auditory information.
Sue, who was mentioned at the beginning of the article, is an exemplary case of how the application of the Tomatis Method enabled a child to mature and overcome the limitations of CAPD.
In May 2004, Sue’s mother took her for a Tomatis Method listening assessment and consultation to address her auditory processing difficulties. Sue immediately began her first Tomatis listening therapy program, which comprised a total of 30 hours (two hours a day for five days over a period of three weeks). Sue’s mother also underwent the same program as her daughter to experience what the child was going through. Despite suffering from various ear infections during the program, which resulted in a ruptured eardrum and the need for antibiotics, Sue’s stages of progress were noted both at home and school by the end of June 2004, a mere four weeks after starting the program.
Sue’s teacher commented that she had started to distinguish between sounds much better and was able to reproduce those sounds better than before. In general, her speech improved in clarity, with less hesitation, and even her concentration improved. Consequently, she was less cranky and frustrated in class and at home as was able to keep up with what everyone else was doing. Additionally, Sue’s writing improved and she began to finish tasks she started, a totally new behaviour for her. In class she was putting her hand up to answer questions, which was very unlike her. Her teacher was pleased and her mother relieved and full of hope for what Sue might be able to achieve.
Sue came back at the end of July 2004 for a second program of eight days. Her mother commented that even after the first program ended, Sue had continued to evolve positively. The program seemed to still be affecting Sue’s development beneficially even though she had finished it about a month before. Sue continued to be less fidgety and more in control of herself as the weeks went by.
When Sue came back to start her third program, her mother reported that the speech therapist was also impressed and had commented that she had not seen such a huge improvement in a child after four weeks break! Sue’s mother also noticed a tremendous change in Sue’s behaviour in that she was much more cooperative.
CAPD in adulthood
Children with CAPD do not simply “grow out of” the disorder. If CAPD is not identified and treated in childhood, the sufferer will continue to experience the symptoms and difficulties into adulthood. Those people whose auditory problems have not been recognised and dealt with in childhood are forced to invent their own solutions to cope with the demands of adulthood. Their subsequent behaviours often mask the real problem and provoke difficulties in their tertiary studies, the workplace and their close personal relationships.
Phillip is a 29-year-old man working for an international shipping company in its customer service call centre. How could his customers on the other end of the phone or his supervisor and co-workers possibly know that his all-too-frequent mistakes were not a result of what might have been perceived as lack of interest or stupidity? No one had diagnosed Phillip’s auditory processing problems during childhood because he grew up at a time when CAPD wasn’t as widely recognised and his “deafness” and “confusion” had been passed off by calling him a “late bloomer”. Phillip never “bloomed”.
He initially sought the Tomatis Method to help improve his concentration and possibly reduce his stress at work, caused by his inability to follow directions and keep up with his departmental team. When Phillip had a listening assessment and initial consultation, it was clear much more was going on than his inability to concentrate. Rather, he was not capable of fully processing the sounds he received. It was suggested he may be suffering from CAPD, as he displayed many of the signs and symptoms. It was also suggested that he obtain an official diagnosis from an audiologist and that the Tomatis listening program would alleviate many of his communication and concentration difficulties.
Phillip never did get an official diagnosis but he did follow a 30-hour Tomatis listening program at a rate of two hours a day for 15 days. He was amazed at the few but very significant changes in his ability to process information and direction correctly at work. Overall, he was making fewer errors, which reduced his stress level. Phillip subsequently followed two more 16-hour Tomatis listening programs within a four-month period. Consequently, not only did he have his own accounts at work to show the programs had helped his communication and concentration skills, but he also had a biannual performance review from his employer to compare with his previous ones, demonstrating his professional improvement.
The internet is a great resource for educating yourself about CAPD and accessing assistance and support. A regional site for chat discussions about CAPD is http://groups.msn.com/CentralAuditoryProcessingDisorderDownUnder, or visit the Australian Tomatis Method at www.tomatis.com.au to learn more about CAPD and the Tomatis listening program.
Clients’ names have been changed to protect their privacy.
Kara Mac Donald teaches ESL (English as a second language) pronunciation at The University of Sydney’s Centre for Continuing Education and works with ESL clients at the Australian Tomatis EARobic Centre<\#153> run by Francoise Nicoloff, President of the International Association of Registered Certified Tomatis Consultants. W: www.tomatis.com.au.