WHAT IS A CENTRAL AUDITORY PROCESSING DISORDER?
Individuals with a central auditory processing disorder (CAPD) have difficulties processing auditory information. They may have difficulty in any situation in which the signal is degraded. They may also have difficulty with language based tasks like spelling and reading, as letters are graphic representations of sound. Difficulties are noted in the following situations: when there is background noise present, when the person is speaking at a distance (especially more than 6 feet away), when the person is not facing them, talks rapidly, has a foreign accent or does not speak clearly, and when lengthy verbal information is required (especially multiple complex directions).
* What we do with what we hear! It is what the brain does with the information after our ear hears it.
Characteristics of children with an auditory processing disorder:
- Reacts negatively to unexpected sounds or loud noises
- Holds hands over ears to block out certain sounds
- Misses some sounds or poorly discriminates sounds
- Seems confused about the direction of sound
- Makes loud noises or enjoys strange noises (difficulty modulating voice)
- Appears to not hear what you say
- Does not respond when his/her name is called, but hearing is fine
- Needs instructions repeated often
- Has difficulty remembering what is said
- Tends to repeat phrases used in videos or TV shows (echolalia)
- Voice quality is flat or monotone
- Reverses sounds or letters
- Has difficulty reading
- Delays in processing time
It is important to note that CAPD is not attributed to peripheral hearing loss or cognitive impairment. If we drop the word “central,” which implies the origin to be in the brain, and just say Auditory Processing Disorder, then the disorder can occur subsequent to auditory deprivation (due to long term hearing loss or chronic otitis media). It basically avoids the anatomic location.
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If an auditory processing disorder is suspected, it is important for the individual to be evaluated by a certified audiologist to determine the specific areas of weakness and recommend appropriate treatment. A comprehensive battery of tests should be performed in order to get an accurate picture of the individuals processing skills. The assessment should include the following: auditory closure (the ability to “fill in” missing gaps of information in order to comprehend the whole), auditory figure ground (the ability to distinguish foreground signals from background noise), dichotic listening (the ability to share auditory/linguistic information between the right and left hemispheres symmetrically), temporal processing (the ability for sequencing, timing and rhythm)and phonemic decoding skills (translating speech sounds into letter symbols and letter symbols into speech sounds).
Once an auditory processing disorder has been diagnosed, there are compensation and treatment strategies that should be individually incorporated. Most importantly, the auditory system should be trained to become more efficient and effective. We know this may be accomplished because of the brains plasticity. The research shows that frequent, intense, and challenging auditory training and stimulation will result in the greatest amount of improvement and progress. There are both formal and informal approaches to auditory training. Informal approaches to auditory training should be done at both the home and school environment whenever possible. The individual will generalize more if listening tasks are carried out in all environments. Individuals with auditory processing deficits tend to use their visual system to compensate. The goal in an auditory training program is to strengthen the auditory system for better auditory-visual integration. The American Speech and Hearing Association has documented that at least 2 times a week for 30 minutes is not enough to make a change. Most of the leaders in the field of auditory processing and training agree that individualized work should be done 30 minutes 5 days a week for 6-8 weeks in order to make changes. However, the treatment has to individualized based on the areas of weakness revealed from assessment.
Some ideas for auditory training in the home and school environment include the following:
reading out loud – also incorporating background noise
copying piano notes or tapping different rhythms (using a metronome)
selective listening games, such as listening for certain sounds, words, or themes (A book about a cow – every time they hear the word cow, they have to say moo)
describing a picture while drawing, left-sided motor response to a verbal command (Simon Says)
commercial games like Simon or Bop It
auditory thinking games like High-Low that works on pitch discrimination, Loud-Soft that works on intensity discrimination, and Sound Location that works on localization skills with sound makers
Integrated Listening Systems home auditory training programs
Books on tape – then asking simple comprehension questions
The formalized treatment of auditory processing disorders should be individually developed depending on what specific areas need to be addressed, which would be based on the results from a comprehensive evaluation. For instance, it is important to determine if it’s a language-based disorder, an auditory-based disorder, or a combination of both. Some of the treatments available are:
- Intensive Auditory/Sensory Training programs
- Individual auditory processing sessions.
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