Information and Support for Central Auditory Processing Disorder (CAPD)

When our ear hears a sound, the sound is taken into the inner ear and delivered to the brain and the brain translates what is being heard. When a person is deaf, the part of the ear that delivers the sound to the brain does not function.

When a person has central auditory processing disorder (CAPD) the part of the brain that translates what the ear delivers does not function properly. The person with CAPD can hear sounds, but how the brain translates those sound is disrupted, and the end result is a garbled message. Some call it "dyslexia of the ears."

People who have CAPD have normal hearing, so they are not considered hearing impaired. The neurological processing of the sounds they hear is impaired, which is why it's called a processing disorder.

Simulation of CAPD:
Reading of Ladle Rat Rotten Hut (Little Red Riding Hood)

The way the ear takes in sound is usually not an issue for people with CAPD. The outer ear, middle ear and cochlea (snail-shaped part) are all functioning properly. The brain also doesn't have an issue receiving the sound signal. The problem arises within the brain when the electrical signal from the cochlea is not processed accurately.

Imagine being in a country where you did not speak the language. You try to talk to people, and you can hear them perfectly fine, but you can't understand what they are saying. That is what CAPD is like.

The symptoms of CAPD vary greatly and often are different for each sub-type (see below). This list is not meant to diagnose, although a list similar this one was the light bulb that lit up for me that allowed me to figure out my son has CAPD.

• Difficulty hearing in the presence of ambient noise
• Difficulty following along or keeping up in conversations
• Poor auditory memory
• Difficulty following auditory instructions, especially multi-step instructions
• Speech delay from a young age
• Often misinterprets what is said, but doesn't realize it's been misinterpreted
• Missed subtle social cues
• May have difficulty with phonics and learning to read
• Exhibits attention issues
• May exhibit auditory distractibility
• Often says "huh?" or "what?"
• With younger kids, will appear to not listen or look at you blankly when asked to do something.

Central Auditory Processing Disorder is a general term used to describe a spectrum of various areas of auditory processing dysfunction. The subtypes describe more specific auditory dysfunction so that specific remedies can be implemented. A person could have one or more of these subtypes.

AUDITORY DECODING: Presents with auditory discrimination difficulties, especially in the presence of ambient sound. They have challenges analyzing differences between sounds. Challenged to hear rapid speech and often asks "huh?". Behaves as if there is a hearing loss when there is none. This is the classic type of CAPD.

INTEGRATION: This sub-type demonstrates difficulties in tasks that require both sides of the brain to work together. Presents with reading challenges, reading comprehension, note-taking difficulties as well as physical coordination issues. May also have poor visual-motor abilities.

ASSOCIATIVE: Presents with receptive language difficulties, especially with regards to the meaning of speech (semantics). Sometimes called a receptive language disorder. May have difficulty understanding common expressions that aren't literal (i.e. Aren't you just beat?).

OUTPUT-ORGANIZATION: Difficulty with organizing language and difficulty with expressive language. Presents difficulty with recalling information in a specific order and may have articulation issues.

PROSODIC: Presents as challenge with the prosodic elements of speech: tone, pitch, intonation. Listener cannot understand the underlying meaning behind the words that are said. May include poor pragmatic language skills and social challenges.

Visit website for Jeanne M. Ferre, PhD for a detailed explanation of CAPD Subtypes.

Our son has had nearly 2 dozen assessments from the age of 2-1/2 to 8-1/2 years old. He has been seen by:

• speech therapists
• school psychologists
• regular psychologists
• psychologist specializing in ADHD
• pediatrician
• neuropsychologist
• neurologist
• reading/language specialist
• behavioral specialist
• occupational therapists

as well as being in special education classes where he was overseen by teachers and aides who are experts in the field. Through all these assessments, NOT ONE SINGLE person brought up the subject of auditory processing disorder. Every single one of them missed it!

Throughout the process we repeatedly heard "your son is autistic-like, but he doesn't seem autistic". It is a fact that autism is on the rise in this country, and so it's the diagnosis that experts seem to gravitate towards.

The symptoms of CAPD look very similar to autism include:

• Not responding when spoken to
• Answering with an unrelated topic.
• Inappropriate social responses
• Inability to comprehend what is happening with those around them (i.e. mixing up game rules).
• Speech delay (big one!)
• Unintelligable speech
• Difficulty staying focused
• Difficulty following instructions

It is true that ADHD and CAPD can co-exist in the same individual, but often CAPD is the only condition, and it is misdiagnosed as ADHD. Both challenges present with very similar symptoms. The symptoms are often so similar a child with CAPD will test positive for ADHD on assessment tools.

As you can see from my list of specialists above, most learning disability assessors miss CAPD. But they want to give you a firm diagnosis, so they will give you what it looks like. It's really not their fault. Many are unfamiliar with CAPD, and when a child's hearing tests are fine, they assume there is no problem with the entire hearing system.

What signs show the difference between CAPD and ADHD?
From my experience the best way to determine the difference is environment. Our son is less distracted and understands more when he is in a quiet environment. In a noisy classroom, he looks like a kid with ADHD. Indeed, the way I figured out it was CAPD was when he was first mainstreamed into a typical classroom. While he was praised for attention in special ed classes, he was labeled a "problem" child in his 22+ child kindergarten class which was adjacent to the school's main playground. Lots of background noise = huge distractibility.

Unfortunately nobody really knows what causes auditory processing disorder. There are theories, but it is a little-known disorder and not enough research has been done to confirm the theories.

Hereditary CAPD is a mis-wiring of the brain. The brain is actually hardwired so that the auditory system cannot correctly process auditory information. Hereditary CAPD does not seem to gain help from therapies. A person's best strategy is to learn how to accommodate their challenges.

I have met adults with CAPD that have tried many different therapies and nothing has made any difference. In their case they have had multiple members of their family with CAPD. Obviously there is some sort of genetic link.

Acquired CAPD is the result of some insult or trauma to the brain. This could include a minor head injury from a fall, excessive ear infections or high fever. In all these cases, the brain was effected and auditory development was hampered and/or delayed. With under-stimulation, the auditory system did not mature properly, and therefore presents CAPD. Acquired CAPD can respond very well to therapies that improve brain function, but there are no guarantees. It's a trial and error process to figure out which therapies will help.

In our son's case the audiologist theorized that excessive ear infections as a toddler, and subsequent conductive hearing loss, caused an under stimulation of the auditory system. She believed he would grow out of his auditory processing disorder if he is auditory system received the right stimulation. I happen to agree with her because our son has seen tremendous progress with the therapies we have tried. AIT (auditory integration training) was the first therapy we tried, and it actually remedied his conductive hearing loss and suddenly he was able to understand us a bit better (when it was quiet). We have since discovered that he also has mild traumatic brain injury from a couple bad falls as a toddler. 55% of individuals with brain injury have CAPD, so we believe this is the major cause of his CAPD.

How do you know if it's hereditary or acquired?
There really is not way to know for sure. Clearly if nobody else has CAPD, and your child has a history of ear infections, the probability is that it is acquired. On the other hand, if several people in your family have CAPD, there is a strong probability it is hereditary. Then again, the family may also have a history of ear infections and everybody got a mild acquired CAPD.

You don't know which type it is until you try some therapies. If the therapies help, then it is acquired. If they do little or nothing, then chances are it is hereditary. That does not mean you give up on therapies. Keep trying! New therapies are coming to light all the time, and you never know when something will help.

Auditory Processing Disorder is a term used to describe any issues related to the auditory system. This could include outer, middle and inner problems, as well as neurologic issues related to getting the message into the brain or translation of the message once it reaches the brain.

Central Auditory Processing Disorder was initially the term used to describe the auditory processing disorders that occur in the central nervous system, i.e. the brain. Over time the term has been shortened to Auditory Processing Disorders, and these days CAPD and APD are essentially interchangeable.

CAPD can effect a child's ability to remember what is said. Because the listening process requires intense focus by the child, the child's brain does not have the resources to store in short-term memory what has been said. If a child with CAPD has to listen to long-winded instructions, the child may exhibit signs of fatigue, inattention or frustration because of the extra effort required to attune to the auditory information.

People with CAPD have a lot of difficult following multi-step instructions because of the resource memory issue. It is best to use visual cues or only provide instructions 1 or 2 steps at a time.

People with CAPD also have issues with rapid speech. They cannot process the information that is coming at them quickly because they do not have the brain resources to store the information. Slowing down a bit really helps this processing challenge.

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