Central Auditory Processing Disorder: Symptoms And Diagnosis

Central Auditory Processing Disorders are hard to understand, to the point that some people, including some doctors, claim they don't exist at all. "Hard to understand" also describes a good bit of the difficulties encountered by individuals with CAPDs, because a lot of the things people tell them may simply not make any sense.

What does that mean in real terms? Imagine living in a world where you can't understand what people tell you, because you're hearing something really quite different to what they're actually saying. Imagine encountering even more difficulties in the presence of any type of background noise and having to spend all your energy correctly decoding what is being said. Not only will you still not understand everything correctly, you'll also be unable to recall information afterwards because your working memory was spent trying to comprehend the message.

While this is obviously incredibly frustrating, other people may not have any idea what's going on and could label you as inattentive, rude, or simply not very intelligent. 

What Is Central Auditory Processing Disorder?

What causes CAPDs, then? Are we talking about a hearing impairment? No. Deaf people can't hear sounds because they never get to the brain. Most individuals affected by Central Auditory Processing disorders do not suffer from any kind of hearing loss, so testing will reveal normal hearing. Auditory stimuli do reach the brain, but they get "scrambled" — are improperly processed — once they get there. 

Rather, CAPD is an umbrella term that refers to a group of disorders that affect auditory processing in different ways, which is why you'll see the term pluralized quite often. Since auditory processing is a complex process, quite a lot can go wrong between the physical input of a sound and the brain's interpretation of it. CAPD comes in several sub-types that describe exactly where the impairment lies. Individuals with CAPD may have one or more of these issues. 

Auditory Decoding Weakness

Auditory decoding weakness represents the classic profile of CAPD. Patients display auditory discrimination difficulties, meaning they have trouble telling different sounds apart, particularly in the presence of background noise. They'll often ask what you just said, and are unlikely to be able to repeat what you said back to you. In addition, they may substitute a similar-sounding word for the one they had intended to say, and may encounter problems with decoding letters (learning to read) as well. 

Prosodic Weakness

Individuals with a prosodic weakness find coping with the patterns and rhythm of speech a challenge; their speech may sound monotonic and cognitive tests reveal verbal skills are more advanced than non-verbal skills. Those with this CAPD profile may misunderstand the underlying meaning of words, and also often have poor social skills. 

Integration Weakness

Individuals with an integration weakness will have difficulty following (complex, multi-step) verbal directions. They will also typically struggle with note-taking, physical coordination, following lengthy conversations, and functioning in the presence of background noise. Components of speech may be missing and spelling and reading may be hard. 

Output-Organization Weakness

This CAPD profile pertains to articulation, expressive language, eloquence and recalling information — particularly in a certain order. These individuals may have poor organizational skills in general and they may demonstrate an inability to function in noisy environments.

See Also: Brain Scans Show Ages Two To Four As "Critical Window" For Language Development

Associative Weakness

Receptive language difficulties are characteristic to those with associative weaknesses. The meaning of speech is often unclear to these individuals, who also have a tendency to take expressions very literally. Expressive difficulties go along with comprehension challenges. Grammar and words with multiple meanings will be tricky. 

CAPD Symptoms And Diagnosis

CAPD Symptoms By Age

Central Auditory Processing Disorders can affected adults and children alike. In children, the apparent inability to pay attention frequently leads to a misdiagnosis of ADHD or ADD. Indeed, these attention-deficit disorders have been shown to coexist with CAPD quite often, making the correct diagnosis even more difficult. Another major problem is the fact that testing will usually reveal the child has normal hearing, though sounds are not processed correctly. So, what are the symptoms of CAPD in childhood?

During early childhood kids with CAPD are likely to have delayed speech, will not comprehend verbal communication easily, have trouble differentiating meaningful sounds and background noises, and demonstrate an unusual sensitivity to sounds. They will not focus on a person's voice like most other kids, and confuse similar-sounding words. 

Once a child with CAPD reaches school age, people around them may notice an inability to understand verbal directions, remembering names, understanding people who speak quickly, and understanding speech in noisy environments. They may appear to ignore those who address they when focused on something (they can't hear what's being said), and have trouble learning new words or finding the right words to use in everyday speech.

Teens and adults with CAPD may speak much louder than average, can't remember lists or memorize long blocks of text, ask for speech to be repeated, and takes words very literally. Like their younger counterparts, functioning in noisy environments is a problem for teens and adults with CAPD. They may seek out quiet working environments and use adaptive strategies to cope with lengthy oral presentations. 

Diagnosing CAPD

Testing that will eventually lead to a CAPD diagnosis may be be pursued in children for the following reasons:

• The child doesn't appear to be hearing properly
• The child has difficulty with reading, spelling, or speech
• The child can't tell the difference between similar sounds
• The child doesn't seem to be able to focus or follow directions

All of these symptoms can indicate any number of disorders, so a multi-disciplinary diagnostic team is essential if the correct diagnosis is to be obtained. A developmental psychologist and speech-language pathologist may both be useful during the process, but an audiologist should make the final diagnosis.  

The audiologist administers a number of tests in a specialized, sound-treated space. During these tests, the child will be asked to respond to a variety of auditory stimuli in a variety of different ways. Physiological reactions to sounds may also be noted. Once CAPD is diagnosed, the audiologist will look at the sub-types or profiles — the areas with which the child is struggling. 

See Also: Does Easy Distraction Mean ADHD?

Diagnosis enables children — and their parents and caregivers — to make accomodations and develop strategies to cope with the problem areas. The environment may be adjusted, in the form of a quieter space or sitting closer to the teacher in a classroom. The individual's reaction to challenges may also be adapted. Recording verbal presentations can allow someone to listen to the same information again, for instance, and asking others to rephrase statements may also aid comprehension.

Treatment activities that seek to remedy CAPD itself do exist and are still being developed. The treatment plan should always be highly individualized and specifically address the challenges the person is facing. With time, diagnosis and treatment can improve both the impact of CAPD and the way in which a person deals with it.