The concept of a central auditory processing disorder (CAPD) is often difficult for educators and parents to understand. In a sense, a child with normal hearing and a central auditory processing disorder is comparable to a child with normal vision and a reading disorder. Vision acuity, or seeing, is good but the mind has a problem making use of the input from the eyes. For reasons not well understood, organizing the abstract symbols of letters and words is a problem for a child with a reading disorder. Children with CAPD have a similar problems comprehending speech. The sensory system (in this case the ear) that brings speech into the body is working properly, but the parts of the brain which analyze and interpret the sensory information are not. This problem becomes more apparent in poorer listening environments such as open classrooms and background noise. A child may not show the problem until he or she enters school.
The child can hear, but listening is the problem. Think of the problem you would have if suddenly you found yourself in England at the time of Shakespear. The speech is English but in a strange, accented style with different constructions and meanings. You might not comprehend enough of the common words to order a meal. Find this hard to believe? Just have someone rapidly read a section from Hamlet to you. It takes longer to comprehend than if it were written in modern structures and usage. Not all CAPD children have the same problems. Some have problems sequencing speech sounds, others have problems understanding speech in background noise, in some the timing appears off.
Nobody knows exactly why CAPD occurs or what is wrong. There is no evidence of brain damage. Birth and developmental histories are often unremarkable. Ear infections have been implicated as a factor in some children but not in others. Many children with CAPD do poorer on measures of neuromaturation of the auditory system. Some experts feel that CAPD may be a form of learning disability. Children may or may not have a speech disorder or language problem. A common presumption is that a child who has CAPD should have a language disorder. While this can occur, it is often not the case. What is most striking is a child of normal intelligence working far below their ability at school and having difficulty at home.
The lack of knowledge is frustrating for all who work with
CAPD children but
particularly parents and educators. It is hard to know if what is being done is
helping. Below are suggestions which target specific difficulties a
CAPD child may have.
These also work with children who have hearing loss. We have made great strides
in diagnosis and understanding
CAPD. More
research needs to be done. Research funding is never enough.
1. Background Noise at School, Home, and Other
Places
Environment: Noisy background. This does not need to be loud. Even mild noises such as the hum of a fan or the sounds of a quiet crowd may be enough to create a poor listening and learning environment for the child.
Behavior: failure to respond when spoken to, distractable, over active, confused, or shy.
Teachers:
A. Make every effort to eliminate extraneous noise. Open classrooms are a
very poor environment for CAPD children. Small
enclosed classrooms work best as long as they are in a quiet part of the
building away from traffic and other noises.
B. Move closer to the child (a better signal to noise ratio), obtain visual
attention by touching him or in some other manner. This is very important when
introducing a new idea, changing subjects, or giving directions. All
individuals respond better when attention is directed at the speaker. The
CAPD child needs
additional prompting in order to have attention focused properly.
Sound intensity drops quickly over a short distance. Moving closer is a great,
easy help.
C. Seat the child in the front of the class where he or she has good visual
reception of the area where most teaching is done. Avoid seating by open doors
or windows. Make sure the child can see the speaker's face. Avoid strong
shadows which hid the face. Standing in front of windows on a sunny day will
hide the face.
D. Earplugs or muffs may help the child during quiet study periods. The
earplugs will reduce extraneous noise and may allow the child to concentrate on
his work. If all the children in a class can use them then it will prevent one
child from being singled out as different.
E. Provide additional written or visual material. In some cases, outlines of
material to be presented verbally may help. Oral changes to instructions
printed on the board or handed out should be provided in writing to
CAPD children.
Parents:
Homes are increasing noisy places with TVS, radios, traffic noises, and the
like. We suggest a study time when no televisions or radios are being played in
the house. The same basic rules apply as for the classroom:
In other words if the child is not paying attention or asking for information to be repeated. Obtain visual attention before speaking. Don't try to carry on a conversation across large rooms, while the TV is playing, or if the child is in another room. This will only frustrate both of you. If you want to carry on a conversation, be in the same room with the same purpose - to talk with each other.
Away from home, be aware of the environment. In noisy places, such as a mall, the child may not hear your instructions on where to be at what time. It is better to minimize background noise by moving to a quiet place rather than yelling.
Your child may have problems at church and other places of gathering. Many church schools have hard, reflective walls resulting in reverberations. The normal auditory system will merge reverberations into a single auditory image. The CAPD child may not be able to do this. The suggestions given above for the classroom will apply to any meeting place.
Be aware that your child may not like to go to parities, meetings and other gatherings because they are difficult and frustrating. Avoid subjecting him or her too often to this type of situation.
For Everyone:
Help the child be responsible. This means encouraging the child to check that he "heard" all of the instructions. If a plan of action was discussed, then changed, check that the child is aware of the change. This is important for homework assignments, family plans, trips to the store, and other projects. Write information down. Speech is considered to be very redundant, but some parts of it have even less information for the child to rely on. Numbers, dates, addresses, and names are of this category. A person's phone number can be very hard to catch if spoken just once and rapidly. Encourage the child to ask that this type of information be written down by the speaker.
Summary: What this first part discusses is listening under poor conditions. The professionals would call this listening in a poor signal to noise ratios. The signal you want is hidden by background noise or the noise simply interferes. Try this at home. Turn on the TV as loud as possible. Sit as far from another person as possible and ask them to read a difficult passage from a book. Say Shakespear or Kant while speaking in a quiet conversational level. Can't understand it too well? Try the suggestions above: reduce the interference, move closer, watch the speaker, ask for visual aids or more explanation. This will work. Many - probably most children with CAPD have trouble in mild amounts of background noise. A lot of this is common sense. Most of us have some degree of problem hearing under poor listening conditions. The CAPD child has more of a problem.
This is also known as an auditory figure-ground problem. Sort of like the picture puzzles with hidden images but in this case the images are auditory and they are hidden in noise.
Environment: Any type.
Behavior: Unable to follow simple commands or directions in proper order. May complete only part of the sequence.
1. Be specific. Break down instructions into simple, concise, concrete actions. "Wash your hands" may be better than "Go clean up."
2. Be brief. Long sequences of commands may be too much. Rather than say, "Go in the house, put your coat away in the hall closet, pick up your toys in the living room, don't turn on the TV, and make your bed" tell him/her to do one or two things then return to you for more instructions.
3. Slow down rate of presentation.
4. Allow more time for processing and comprehension of the instructions. CAPD does better if they are allowed more time to process and organize the information.
5. Develop compensatory methods to check that instructions were understood. One method used by the hearing impaired is to repeat back to the speaker what was heard. When this is done, the speaker can identify errors and correct them. The speaker should not simply repeat the message in exactly the same way but modify it to provide additional information about the part not understood.
6. Confer with the child about new information or material. If it is not understood, review it again and introduce new elements to aid understanding. Use of gestures and visual aids is encouraged.
The webmaster wishes to acknowledge and thank the staff of the Audiology and Speech Pathology Clinic at Wilford Hall Medical Center, the United States Air Force hospital at Lackland Air Force Base, San Antonio, Texas for much of the material and organization for this handout.