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Signs & Symptoms
Even though children with CAPD may have normal hearing, they exhibit unusual difficulty in processing auditory stimuli presented in unfavourable acoustic conditions.
Some possible symptoms likely to be seen in the general population of children with CAPD are:
- Respond inconsistently to auditory stimuli. i.e. seems to follow auditory instructions inconsistently
- Have trouble listening in the presence of noise
- Have trouble with auditory localization — determining where a sound is coming from
- Show sensitiveness to loud noises or certain frequencies
- Have generally poor listening skills and decreased attention for auditory information
- Easily distractible and restless in listening situations
- Have difficulty understanding rapid speech or unclear speech
- Have difficulty understanding speech in the presence of background noise (e.g. speech in noisy environment or crowds) or in a reverberant room (e.g. when acoustics are poor and where sounds echo).
- Frequently ask that information be repeated. Says “huh?” or “what?” repeatedly
- Have significant difficulties with reading, writing, and spelling
- Have trouble associating speech sounds to their symbols (letters)
- Perform better in small groups and one-to-one setting
- Give inappropriate responses to questions
- Insensitive to speaker’s tone of voice
- Suffer from poor self-esteem or frustration
- Have delays in speech and language development
- Have trouble discriminating one sound from another (especially speech sounds)
- Have trouble remembering information that has been presented in the auditory mode.
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What causes it
Accordingto the American Society Hearing Association (ASHA), CAPD can result from a "dysfunction of processes dedicated to audition," while other factors include a general dysfunction that affects performance across modalities (e.g., attention deficit disorder).
Delayed maturation of the central auditory system, certain neurological disorders and developmental abnormalities are some probable causes of CAPD.
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About the condition
Central Auditory Processing Disorder (CAPD) or Auditory Processing Disorder (APD) is a term used to describe individuals with normal hearing, but with auditory-based receptive communication or language learning problems.
Children and adults with CAPD have trouble understanding language despite having normal hearing. In simple terms, the ear is fine but the brain has difficulty processing or interpreting the information it receives.
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Diagnosis and Treatment Options
Diagnosis
Behavioural auditory processing evaluation can be done for people with:
- Normal or near-normal peripheral hearing
- Sufficient receptive and expressive language skills to understand and respond to the tasks
- Sufficient cognitive function
- Seven years of age is usually considered the lower age limit for CAPD testing. Adults can also be candidates for CAPD evaluation.
Assessment of CAPD
A comprehensive multidisciplinary approach led by an audiologist is important to identify CAPD and it may comprise of the following:
Audiological assessment
An Audiologist will first carry out tests to rule out peripheral hearing loss and middle ear pathologies. A background of the family, educational, social emotional concerns, behavioural and medical history is helpful in the assessment battery.
A number of tonal and speech tests are then carried out to assess auditory memory, discrimination and other auditory processes which include the following:
Auditory closure
A process that helps us to fill in missing parts of a word even when we do not hear all parts of the word. It helps us to hear well in a situation where there is a lot of background noise and where the speaker is not speaking clearly.
Binaural integration
Helps us to process different words heard by each ear simultaneously. It helps our ears to work simultaneously without confusing each other.
Binaural separation
Helps us to process words heard by one ear while ignoring different words heard concurrently by the other ear. It helps our ears to work simultaneously without confusing each other.
Temporal Patterning
Helps us to recognise changes in the rhythm and timing of sounds. It helps us to detect changes in voice intonation and stresses on importance of extracting key words and judging the intent of communication.
Temporal processing
Helps us to detect that one sound has ended and another has begun. It helps us to tell the difference between different sounds in speech.
Binaural interaction
Helps us to combine different sounds presented to both ears simultaneously. It helps our ears to work together to overcome background noises and locate where the sound comes from.
Speech and Language Assessment
Some of the symptoms of CAPD are similar to that of other learning disorders such as language delay, attention deficit disorders, cognitive delay and dyslexia.
As a result, the audiologist may recommend a referral to other professionals to determine whether another disorder is the root cause of the child's difficulties and/or whether the child has CAPD. These professionals may include speech-language pathologists, educational psychologists, pediatricians and occupational therapists.
Management Options
Management plans are tailored jointly between the audiologist and speech-language therapist to suit individual auditory processing deficit profile.
These may include some or all of the following:
Direct Intervention
Speech-language therapists provide therapy activities that directly target the auditory processes that the child has difficulty in, and at an appropriate level of difficulty. At least one family member is encouraged to attend therapy with the patient because successful remediation requires consistent practice. Where appropriate, computer-based programs may be recommended.
Compensatory Strategies
Some of these include development of listening strategies to avoid auditory fatigue and improving language skills to improve understanding of degraded auditory signals.
Environmental modifications
Some modifications in the classroom may be sufficient to help some children listen and process better. Preferential seating in the classroom to allow for additional visual cues may help a child with CAPD. Cutting down on background noises by closing the door or using a classroom with friendlier acoustics may also be recommended. The child may also benefit from an assistive listening device that allows the child to hear the teacher directly whilst cutting out background noise.
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