Information and Support for Central Auditory Processing Disorder (CAPD)
All about Central Auditory Processing Disorder (CAPD)
I am a mom of a boy with central auditory processing disorder. I went through an arduous process getting him diagnosed, and through that ordeal realized there was a need for more organized information on the subject to help parents figure it out.
This lens gives information and resources about Central Auditory Processing Disorder (CAPD). CAPD is not as rare as once thought, and current trends suggest that many children are being diagnosed with ADHD, PDD or Autism when in fact they have CAPD.
Hearing through a CAPD disability can make it challenging for a child to learn to speak and socialize, and school becomes a frustrating and confusing experience. The information provided here includes resources and information on how to help and cope with central auditory processing disorder.
What is Central Auditory Processing Disorder (CAPD)?
Some call it "dyslexia of the ears".
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."
What does CAPD sound like?
This example shows how a person with auditory processing disorder perceives what is being said.
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.
What are the symptoms of CAPD?
The symptoms of CAPD can often mimic other learning challenges.
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.
Sub-types of CAPD
There are 5 sub-types of CAPD, each with its own symptoms and challenges.
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.
Autistic-Like, but Not Autistic
We heard this phrase so much during the diagnosis process...
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
- reading/language specialist
- behavioral specialist
- occupational therapists
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
Best book to figure out the puzzle!
Is it ADHD or CAPD?
Another diagnosis often foisted on our son, ADHD...
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.
What causes Auditory Processing Disorder?
Experts do not have a specific answer to this question.
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.
A mother's story of getting a diagnosis...
Why does CAPD cause memory problems?
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.
A Reading Solution for Kids With CAPD
Learning to read is a fundamental skill for school success, but kids with APD are at a disadvantage.
APD affects a person's ability to distinguish between the individual sounds that make up words, or phonemes. As a result, speech is heard as "blending all together" or somewhat muddied. Because of this difficulty, when a child with APD begins reading, they have significant difficulty learning phonics. As a result, they are unable to learn how to sound out, or decode, words properly.
Children with APD will often compensate for this by learning to sight read the words. This means they memorize the words as whole pictures, but are unable to sound out the individual phonemes that make up words. This strategy words in Kindergarten and 1st grade, but by the time they reach 3rd grade the volume of words they must memorize begins to become overwhelming. In addition, because they have memorized the words as pictures rather than letter patterns, their spelling is atrocious. As a result, any reading skill they have gained halts and may even backslide.
Many other children with APD are unable to manage a sight-reading approach, and these children never make progress in reading, despite a lot of effort by the school and parents. This was the case with my son. He started 3rd grade reading at a Kindergarten level. The school was out of ideas, and I sought out a solution.
How my son learned to read
My son with CAPD is a very visual learner, so I searched for a visual reading program for him. I thought it might be possible that we could use his strength to help his weakness. What I found was the Easyread System. They have several programs that use the child's visual strength to teach phonetic reading.
They use an approach called Guided Phonetic Reading which uses cartoon characters to represent the phonemes, and the child then uses these characters to learn how to decode words. Through repetition, the reading because fluent and effortless for the child. In addition, they have identified 8 causes of reading difficulties, and we found our son had 2 of them, so we were able to work on resolving them.
My son took to the Easyread System like a fish to water. Six weeks into the program he was reading at a 2nd grade level, and 7 months into it he had caught up to reading at grade level! It was the best decision we ever made for him.
When we found our younger son had an auditory weakeness and difficulty with reading, we put him on Easyread Accelerator, and he also learned how to read in a matter of months.
Is it called CAPD or APD?
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.
Video that Explains CAPD
These videos discuss auditory processing disorder in children. They talk about the signs, diagnosis and accommodations that may help for CAPD.
Blogs and Lenses by people who live with CAPD
I have found some very interesting accounts of people who live with CAPD. They share the challenges they face in work and relationships, and things they have done to assist in working with their CAPD.
- Andrea's Buzzing About: Living with Central Auditory Processing Disorder
Auditory Processing Disorder is an invisible disability, a developmental condition that interferes with the processing of speech. Although my hearing is perfect, I yet have intermittent problems with perceiving and decoding what people are saying. It
- Living with APD - A Teen's Point of View
A Day in the life of a teenager with Auditory Processing Disorder. Great blog sharing perspective, struggles and solutions.
- APD - Three Simple Letters...One Hard Explanation
I'm a 16 year old girl going through school and life living with Auditory Processing Disorder and trying to help people understand me and other people out with a APD and any Learning Disability.
- Holly's Story: Coping and Learning About this Disorder
Written by a mom, she tracks her young daughter's journey with APD. Great for other parents trying to understand APD or find ways to help their child.
- My Child with Auditory Processing Disorder
Hello! This blog is about my daughter Hailey (currently 11 years old) and her experiences living with auditory processing disorder. Most of the posts will be written by me, her mother, but I've promised to post some that she wants to write herself.
Young People Raising Awareness of CAPD
These kids and their parents are working to raise awareness of CAPD. Follow them and leave them comments and show them that you support their efforts to make a difference!
- Madison Ray for APD
Madison Ray is 9 years old and has Auditory Processing Disorder (APD). She also has Dyspraxia, which is a developmental coordination disorder, and ADD. She is currently in the 2nd grade and is in the Special Ed class full time at her school. To help
- Mack Hanisco - Junior Golfer for APD
Mack Hanisco is an 8-year-old junior golfer that has a significant language disability called APD - (Central) Auditory Processing Disorder. Mack began playing golf when he was 6 and he is the only golfer in the family... although mom and dad and litt
- Megan with APD
A beautiful teenager, Megan is a beauty pageant contestant who has entered the Miss Teen Minnesota pageant. She has made APD her platform for the pageant as a way to spread awareness about this disorder.
Resources to help with CAPD
The following websites have information, resources or online communities for CAPD.
CAPDsupport is a place where individuals, parents and family members can gain understanding and support while living with Central Auditory Processing Disorder (CAPD).
APDUK is trying to promote an increased understanding of APD in the UK by both the professional establishment, especially in the fields of education and employment, and the general public.
- Auditory Processing Network
At Auditory Processing Network we provide evaluation and treatment of Auditory Processing Disorder for both children and adults.
- CAPD Facebook Group
This very active group has over 800 members who regularly talk. It is a mixture of parents looking for ideas to help their kids and adults who live with CAPD.
- Teens with APD
A place for teenagers to come together and get support and find strategies for managing APD.
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