Central Auditory Processing Disorder in Children

Auditory processing disorder (APD), also known as central auditory processing disorder (CAPD), is a hearing problem that affects about 5% of school-aged children.

Kids with this condition can’t process what they hear in the same way other kids do because their ears and brain don’t fully coordinate. Something interferes with the way the brain recognizes and interprets sounds, especially speech.

With the right therapy, kids with APD can be successful in school and life. Early diagnosis is important, because when the condition isn’t caught and treated early, a child can have speech and language delays or problems learning in school

CAUSES OF CAPD:

Exactly what causes auditory processing disorder isn’t fully understood. Sometimes a possible underlying factor is identified, but not always.

In children, the condition may occur after a persistent hearing problem at a young age, such as glue ear, which has since passed but has had a permanent effect on how the brain processes sound. It may also be caused by a genetic defect, as some cases seem to run in families.

In adults and children, the condition may be associated with damage to the brain from a head injury, stroke, brain tumour or meningitis.

Some cases in adults have also been linked to age-related changes in the ability of the brain to process sounds and progressive conditions affecting the nervous system, such as multiple sclerosis.

SYMPTOMS OF CAPD:

There are several kinds of auditory processing issues. The symptoms can range from mild to severe. Children with APD can have weaknesses in one, some or all of these areas:

• Auditory discrimination: The ability to notice, compare and distinguish between distinct and separate sounds. The words seventy and seventeen may sound alike, for instance.
• Auditory figure-ground discrimination: The ability to focus on the important sounds in a noisy setting. It would be like sitting at a party and not being able to hear the person next to you because there’s so much background chatter.
• Auditory memory: The ability to recall what you’ve heard, either immediately or when you need it later.
• Auditory sequencing: The ability to understand and recall the order of sounds and words. A child might say or write “ephelant” instead of “elephant,” or hear the number 357 but write 735.

Children with APD usually have at least some of the following symptoms:

• Find it hard to follow spoken directions, especially multi-step instructions
• Ask speakers to repeat what they’ve said, or saying, “huh?” or “what?”
• Be easily distracted, especially by background noise or loud and sudden noises
• Have trouble with reading and spelling, which require the ability to process and interpret sounds
• Struggle with oral (word) math problems
• Find it hard to follow conversations
• Have poor musical ability
• Find it hard to learn songs or nursery rhymes
• Have trouble remembering details of what was read or heard

It’s difficult to diagnose children with APD before age 7 or 8. Some of these auditory skills don’t develop until then. Getting a diagnosis requires finding a trained audiologist who can run electrophysiological tests. These tests record how the brain responds to sounds

DIAGNOSIS:

If you think your child is having trouble hearing or understanding when people talk, have an audiologist (hearing specialist) exam your child. Only audiologists can diagnose auditory processing disorder.

Audiologists look for five main problem areas in kids with APD:

1. Auditory figure-ground problems: This is when a child can’t pay attention if there’s noise in the background. Noisy, loosely structured classrooms could be very frustrating.
2. Auditory memory problems: This is when a child has difficulty remembering information such as directions, lists, or study materials. It can be immediate (“I can’t remember it now”) and/or delayed (“I can’t remember it when I need it for later”).
3. Auditory discrimination problems: This is when a child has difficulty hearing the difference between words or sounds that are similar (COAT/BOAT or CH/SH). This can affect following directions and reading, spelling, and writing skills, among others.
4. Auditory attention problems: This is when a child can’t stay focused on listening long enough to complete a task or requirement (such as listening to a lecture in school). Kids with CAPD often have trouble maintaining attention, although health, motivation, and attitude also can play a role.
5. Auditory cohesion problems: This is when higher-level listening tasks are difficult. Auditory cohesion skills — drawing inferences from conversations, understanding riddles, or comprehending verbal math problems — require heightened auditory processing and language levels. They develop best when all the other skills (levels 1 through 4 above) are intact.

Since most of the tests done to check for APD require a child to be at least 7 or 8 years old, many kids aren’t diagnosed until then or later.

HELPING YOUR CHILD:

A child’s auditory system isn’t fully developed until age 15. So, many kids diagnosed with APD can develop better skills over time as their auditory system matures. While there is no known cure, speech language therapy and assistive listening devices can help kids make sense of sounds and develop good communication skills.

A frequency modulation (FM) system is a type of assistive listening device that reduces background noise and makes a speaker’s voice louder so a child can understand it. The speaker wears a tiny microphone and a transmitter, which sends an electrical signal to a wireless receiver that the child wears either on the ear or elsewhere on the body. It’s portable and can be helpful in classroom settings.

A crucial part of making the FM system effective is ongoing therapy with a speech-language pathologist, who will help the child develop speaking and hearing skills. The speech-language pathologist or audiologist also may recommend tutoring programs.

Several computer-assisted programs are geared toward children with APD. They mainly help the brain do a better job of processing sounds in a noisy environment. Some schools offer these programs, so if your child has APD, be sure to ask school officials about what may be available.

At Home:

Strategies applied at home and school can ease some of the problem behaviors associated with APD.

Kids with APD often have trouble following directions, so these suggestions may help:

• Reduce background noise whenever possible at home and at school.
• Have your child look at you when you’re speaking.
• Use simple, expressive sentences.
• Speak at a slightly slower rate and at a mildly increased volume.
• Ask your child to repeat the directions back to you and to keep repeating them aloud (to you or to himself or herself) until the directions are completed.
• For directions that are to be completed later, writing notes, wearing a watch, or maintaining a household routine can help. So can general organization and scheduling.
• It can be frustrating for kids with APD when they’re in a noisy setting and they need to listen. Teach your child to notice noisy environments and move to quieter places when listening is necessary.

Other tips that might help:

• Provide your child with a quiet study place (not the kitchen table).
• Maintain a peaceful, organized lifestyle.
• Encourage good eating and sleeping habits.
• Assign regular and realistic chores, including keeping a neat room and desk.
• Build your child’s self-esteem.

At School:

It’s important for the people caring for your child to know about APD. Be sure to tell teachers and other school officials about the APD and how it may affect learning. Kids with APD aren’t typically put in special education programs, but you may find that your child is eligible for a 504 plan through the school district that would outline any special needs for the classroom.

Some things that may help:

• changing seating plans so your child can sit in the front of the classroom or with his or her back to the window
• study aids, like a tape recorder or notes that can be viewed online
• computer-assisted programs designed for kids with APD

Keep in regular contact with school officials about your child’s progress. One of the most important things that both parents and teachers can do is to acknowledge that APD is real. Its symptoms and behaviors are not something that a child can control. What the child can control is recognizing the problems associated with APD and using the strategies recommended both at home and school.

A positive, realistic attitude and healthy self-esteem in a child with APD can work wonders. And kids with APD can go on to be just as successful as other classmates. Coping strategies and techniques learned in speech therapy can help them go far.

REFERENCES:

1. “Clinical practice guidelines – diagnosis, treatment, and management of children and adults with central auditory processing” (pdf). American Academy of Audiology.
2. Musiek, Frank; Gail, Chermak (2007). Handbook of central auditory processing disorder [auditory neuroscience and diagnosis]. Plural Publishing. p. 448. ISBN1-59756-056-1
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