Central Auditory Processing Disorder
September 28, 2004, KidsHealth.org

Jennifer, 9, seems to pay attention when the teacher works with her one-on- one. But when there are group discussions, she spends most of her time looking out the window. The teacher is complaining she doesn't participate in class, and is giving Jennifer lower grades as a result.
Shawn, 12, was supposed to be home in time for his dentist's appointment at 3:30. But when he finally walked in the house at five o'clock, he was surprised to hear about the appointment and that his mother had reminded him about it that morning.

Normal kids? Or is something else going on?
Life is complicated these days, for children as much as adults. There is a lot to remember and a lot to do. But sometimes a child may seem to be more than simply distracted by a complex life. If you think there may be a problem with your child, answer these questions: [list][*]Is your child easily distracted or unusually bothered by loud or sudden noises? [*]Are noisy environments upsetting? [*]Does behavior and performance improve in quieter settings? [*]Does your child have difficulty following directions, whether simple or complicated ones? [*]Does your child have reading, spelling, writing or other speech-language difficulties? [*]Is abstract information difficult to comprehend? [*]Are verbal (word) math problems difficult? [*]Is your child disorganized and forgetful? [*]Are conversations hard for your child to follow?[/list:u]These, as well as other behaviors, may be signs of a central auditory processing disorder (CAPD), an often misunderstood problem. CAPD is misunderstood because many of the behaviors noted above may also appear in other conditions such as learning disability (LD), attention deficit hyperactivity disorder(ADHD), and even depression. Symptoms of CAPD can range from mild to severe, and can take many different forms. Trained professionals, such as speech-language pathologists and audiologists who specialize in CAPD, can determine if your child has a central auditory processing disorder.

What Is CAPD?
Central auditory processing disorder occurs when the ear and the brain do not coordinate fully. Assuming your child's hearing is good (and this should be verified by an audiologist), auditory information breaks down somewhere beyond the ear. The causes of CAPD are varied and can include head trauma, lead poisoning, possibly chronic ear infections - and unknown reasons. Because there are many different possibilities - even combinations of causes - each child has to be assessed on an individual basis.

Problem Areas
Here are the five main problem areas that can affect both home and school activities in children with CAPD.

1. Auditory Figure-Ground Problems: This is when the child cannot pay attention when there is noise in the background. Noisy, low-structured classrooms could be very frustrating to this child.
2. Auditory Memory Problems: This is when the child has difficulty remembering information such as directions, lists or study materials. It can exist on an immediate basis ("I can't remember it now") and/or a deferred basis ("I can't remember it when I need it for later").
3. Auditory Discrimination Problems: This is when the child has difficulty hearing the difference between sounds or words that are similar (COAT/BOAT or CH/SH). This problem can affect following directions, reading, spelling, and writing skills, among others.
4. Auditory Attention Problems: This is when the child cannot maintain focus for listening long enough to complete a task or requirement (listening to a lecture in school). Although health, motivation and attitude may also affect attention, among other factors, a child with CAPD cannot (not will not) maintain attention.
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 one through four above) are intact.

If your child has CAPD, there are strategies that can be used at home to alleviate some of the problem behaviors.

"Never Follows Directions"
Difficulty with following directions is possibly the single most common complaint. Reducing background noise, having your child look at you when you are speaking and using simple, expressive sentences usually help significantly. Speaking at a slightly slower rate and at a mildly increased volume may also help. Ask your child to repeat the directions back to you aloud and to keep repeating them aloud (or to herself) until the directions are completed. Make certain your child understands the directions and isn't just parroting your words. You can be more certain of this if your child is able to rephrase the directions. "Take the garbage to the side of the house," may be restated, "You want me to take the garbage, not to the front, but to the side of the house."

For directions that are to be completed at a later time, writing notes, wearing a watch, and maintaining a predicable routine in the household also help. General organization and scheduling appear beneficial to many children with CAPD.

It's important to teach your child to be responsible and actively involved in her own success. Your child can be encouraged to notice noisy environments, for example, and move to quieter places when listening is necessary.

Your child should realize that she has a responsibility to use the strategies taught in speech-language therapy, and to do so on a continuing basis. When she chooses to do so, success at home and in school is more likely.

Other home strategies are helpful. Providing your child with a quiet study place (not the kitchen table), maintaining a peaceful, organized lifestyle, encouraging good eating and sleeping habits, assigning regular and realistic chores, including keeping a neat room and desk, and building your child's self-esteem are all very important goals. Your model of these behaviors goes far toward encouraging them in your child.

As a parent, keep in regular contact with school personnel regarding your child's progress. Provide your child with whatever aids may help in class, such as an assignment pad or a tape recorder. Discuss seating plans with the classroom teacher (a child with CAPD should sit toward the front of the room with her back to the windows), as well as specific plans for problem academic areas.

One of the most important things that both a parent and teacher should do is to realize that CAPD is real. Symptoms and behaviors are not within the child's control. What is within the child's control is the recognition of these problems and the application of the strategies learned in therapy.

A positive, realistic attitude and healthy self-esteem in a child with CAPD can work wonders.