Understanding Auditory Difficulties and

Paying Attention  

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to Improve Auditory processing

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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: 

• 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?

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, 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."  

Info On Home Programs to Improve Auditory processing

ATTENTION & MEMORY ASPECTS OF CAPD

CAPD children may also have weaknesses in important processing systems that enhance audition.  For instance, problems in the critical abilities of attention and memory will directly interfere with auditory perception.  If a child cannot hold an auditory image in his/her initial echoic (perceptual) memory the child will not transfer the correct information to his/her short term (working) memory. Inability to transfer images into or out of short term memory will leave a child unable to organize memories of speech sounds or to develop sound equivalents to alphabet letters (certainly important for reading and writing skills).  During day to day discussions and school lessons the child with weakness in auditory short term memory will have enormous stress attempting to keep up with the ongoing stream of speech from teachers and 'specials'.  As a result the child may frequently miss key elements of assignments and/or have difficulty following two or three stage directions.   

Importantly, learning, in general, is more difficult for children with CAPD because they are unable to keep up with new information that streams by them as it is presented by the teacher . Thus, each day the material is new.   For the other children in the classroom, those without CAPD, the material has been 'heard' before, thus it is more familiar.

Attention is another immensely important aspect of CAPD.  Sound is an incredibly brief signal.  If I say, "hello," the word is immediately gone once I have said it.  If a child is not 'listening' when someone says hello the child does not 'hear' it.  On the contrary, look back two lines and read the word 'hello'.  You can do it because, unless erased, written images persist.  Tactile images persist.  We even enjoy, after dinner, lingering tastes of what we ate for dinner.  We can also recognize when someone has been smoking in a room we have entered because of the persistent smoke odor.  Sound, however, is gone as quickly as it occurs.  Hence, if a child is not 'attending' to a particular speaker at a specific moment he/she will most likely 'miss' part of what the speaker has said.  The result will be gaps and inconsistencies in the child's perception of what was said.  To really understand the impact of attention on audition one must understand that, like memory, there are multiple aspects (or types) of attention. 

Briefly, attention encompasses a variety of functions.  

1. There is initial 'focus' or 'recognition' attention.  It scans the environment and recognizes every possible auditory image.  

2. If a particular stimulus is more important or attractive to the listener 'selective attention' is brought into play. This is 'sustaining' attention or 'maintenance'.  This aspect of attention retains possession of the mind and keeps the subject's orientation toward the interesting stimulus.  

3. Another attention is that of 'vigilance'.  If a child is listening for the teacher to announce homework, amidst everything else the teacher is discussing the child is 'keying' on the word homework.  As the stream of spoken speech races  by, the child must be able to quickly recognize and attend to that portion which he/she has  been vigilant toward (or listening for).  Weak auditory vigilance causes a child to be less involved with the world because he/she is unable to grab that which has been deemed important out of the ongoing speech. 

4. Attention 'switching' is yet another form of attention.  It is the ability to divert one's attention from one item to another and then effectively jump back to that same point that was left. 

Some children do well attending to one stimulus or task, but have trouble switching back and forth from one task to another.  When they attempt this switching they become lost and have trouble picking up at the appropriate spot each time.  Another child may have difficulty with 'spare' attention.  This relates to load and capacity.  The child may perform well at one level of attention, but as task demands increase the child does not have enough attention 'reserve' (spare attention) to pull from in order to continue with effective maintenance.

These additional processing abilities (memory and attention) can greatly influence how a child's auditory system scans, focuses on, grasps and integrates auditory stimuli.  As an aside, this is partially why many people claim to have difficulty distinguishing between CAPD and ADD.  Children with impulsive-type ADD are inattentive to all sensory stimuli.  They have more opportunities to evaluate signals that are visual or tactile (as compared to brief auditory signals that are fleeting and transient), thus in these children we are more likely to observe weaknesses that are auditory based.   As a result, their weaknesses are frequently recognized as auditory - hence the confusion.  It is important to remember that CAPD is a disorder that relates to sound input and listening.  Whereas, children with ADD experience difficulties in many more sensory areas than do children who experience CAPD.

A positive, realistic attitude and healthy self-esteem in the CAPD child can work wonders. The sooner CAPD is diagnosed, the sooner the child can learn and benefit from his or her new listening skills.

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ADHD, Central Auditory Processing Disorder, and Learning Disabilities
Author: Dr. David Rabiner    
Source: Attention Research Update
Date: August 1999    
     

ADHD, Central Auditory Processing Disorder, and Learning Disabilities

In recent years, several researchers have suggested that there is considerable overlap between ADHD and central auditory processing disorder (CAPD). In fact, some have questioned whether CAPD and ADHD are actually distinct disorders, and have suggested that children diagnosed with ADHD often have CAPD instead. A study published in the Journal of Learning Disabilities takes a careful look at this issue (Vol. 32, 1999).

Since many people are unfamiliar with CAPD, I'll begin with a brief overview of the condition. CAPD is defined as a deficiency in one or more of the following processes:
sound localization (ability to determine where sounds are coming from), auditory discrimination (ability to detect differences between sounds), auditory pattern recognition (ability to correctly identify patterns of sounds), temporal aspects of audition (ability to identify the ordering of different sounds), and auditory performance decrements in the presence of competing sounds (ability to screen out extraneous auditory stimuli to correctly identify important sounds).

Deficits in one or more of these areas are believed to adversely affect an individual's speech and language functioning. Thus, someone with CAPD may have unusual difficulties in accurately processing spoken language, particularly in the presence of background noise, and thus have a difficult time comprehending what is being said. One can certainly see how such a problem would make it difficult for a child sitting in a crowded and noisy classroom, and how this child might display symptoms of inattention and hyperactivity as a result. This is why some professional speech and language specialists, among others, suggest that CAPD may often be misdiagnosed as ADHD. (Note that speech and language problems are more common in children with ADHD.) Prior studies have shown that children with ADHD tend to perform poorly on central auditory processing tasks and that as many as 50% of children diagnosed with CAPD also have ADHD.

The authors of this study were interested in examining what might account for the considerable overlap between ADHD and CAPD, and hypothesized that the common link may be learning disabilities (LD). Children with ADHD and children with CAPD both have significantly higher rates of LD than is found in the general population. Although learning disabilities are defined in several different ways, a commonly used procedure for identifying a child as LD is to determine the discrepancy between the child's IQ and achievement test scores using standardized tests. When a child’s achievement level is significantly below what they should be capable of based on their intellectual level, the child is considered to have a learning disability. Learning disabilities can occur in a number of areas including basic reading skills, reading comprehension, math, and written language. A child may have a learning disability in one area but not others, or may have multiple learning disabilities.

In the study, the authors began with 3 groups of 15 school-age children. One group was comprised of children with ADHD alone, a second group included children with ADHD and a learning disability in reading, and the third group was made up of children without either diagnosis. The ratio of boys to girls in each group was about 3:1. (Note: It would have been preferable if they included a fourth group comprised of children diagnosed with CAPD but not ADHD, and a final group of children with both CAPD and LD as this would have allowed for a more complete set of comparisons.)
Each child was given several different tests of central auditory processing ability. These tests included: completing words that were presented with portions missing, an auditory discrimination task in which participants were asked to repeat words that were presented with background noise, dichotic listening tasks in which different words were presented in each ear, and participants have to repeat both words in a specified order, and an auditory conceptualization task in which children had to discriminate different speech sounds (the sound of /p/ from the sound of /b/), and to perceive and compare the number and order of sounds within a pattern. All of these tasks are elements of determining whether an individual child has CAPD. All testing was done individually, and care was taken to ensure that children with ADHD had not received any medication for at least 48 hours prior to testing.

The results were quite clear. Based on a composite score derived from the different auditory processing tests, children with ADHD alone did not differ from the control group. Children with both ADHD and LD, however, scored significantly lower than both control children, and children with ADHD. This clearly suggests that problems in central auditory processing ability are associated with LD and not ADHD. It is also provides strong evidence that ADHD and CAPD are truly different disorders, rather than being slightly different expressions of the same basic disorder.

Now, even though these results suggest that ADHD and CAPD are distinct conditions, it is still quite possible that some children with CAPD are misdiagnosed as having ADHD.  If this were to occur, it seems unlikely that proper treatment would be instituted, although there is some data to indicate that stimulant medication is helpful to children with CAPD. These results also suggest that children with ADHD who are also learning disabled in reading may be especially likely to have CAPD. For such children, a careful evaluation of this possibility may prove to be quite helpful in developing the most effective treatment plan.  

Incredible Horizons strives to offer cutting edge technologies to provide healthy options for improving the life of individuals with attentional, memory, and cognitive difficulties. Please look at the Auditory programs and home services that we provide.  

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