News & Views - November,
2001 Issue #87
Central Auditory Processing Disorders (CAPD)
One Cause of Attention Deficits,
Defiance and School Failures
By Michael G. Conner, Psy.D
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[Dr. Conner, Director and Researcher at Mentor Research Institute,
is a clinical, medical and family psychologist who completed a research and training fellowship in graduate medical education and
health education. He is Board Certified in Traumatic Stress, Emergency Crisis Intervention and Emergency School Response.]
Does your child:
∑ have a short attention span?
∑ become stressed or nervous when required to listen?
∑ become easily distracted?
∑ become restless or bored in classrooms and group discussions?
∑ have difficulty following directions?
∑ become defensive or argumentative for no apparent reason?
∑ say, ĒYou donít understandĒ, even when you do?
∑ have a history of a delay or problem in language development?
Counselors, mental health professionals and schools most frequently attribute these behaviors to depression, anxiety, attention deficits
or an oppositional and defiant disorder. Thatís all fine, but the problem may not stop there and the solution may be far from clear.
A diagnosis can tell you what type of problem your child may have, but it can tell you very little about the cause or what to do about
There are many possible reasons, but one reason that some children act this way is due to a central auditory processing disorder (CAPD),
which is an inability or limited ability to: pay attention, recognize, tell the difference, remember or comprehend auditory information.
A person with CAPD can have normal intelligence and hearing.
Children with normal auditory processing skills are able to understand speech in a wide variety of listening conditions.
Symptoms of CAPD include but are not limited to:
∑ an inability to tune out background noise
∑ problems understanding words when there are poor acoustics
∑ an inability to adapt to a wide variety of speaking styles
∑ difficulty understanding incomplete sentences.
How Does CAPD Affect Children?
We live in a world where there are various expectations concerning our childrenís behavior that we want them to fulfill. We hope that
our children will participate and contribute productively in family life. We expect them to attend school, complete their homework
and become involved in community and school activities. All this becomes difficult for children with CAPD.
Children with CAPD donít recognize they have a problem with auditory processing. They do not understand what is being said as well
as they should. They donít learn as well as other kids Ė especially in large noisy classrooms and homes. They may understand only
portions of what is said. They act like they understand but they really become lost when more than one person is talking or when there
is background noise and people are speaking rapidly with incomplete sentences. Fear and anger during a conversation can make understanding
even more difficult.
Nearly all these kids lose confidence and end up feeling insecure. Rather than get real help, they repeatedly encounter moments of
despair. They feel incapable and unable to change for the better. Some may become isolated, withdrawn and depressed. Others become
bored and restless. They can look like they arenít paying attention or they donít follow instructions. Rather than feel incompetent
and bored, many will become disruptive, risk takers or thrill seekers. A large number will become cynical, argumentative and even
aggressive when challenged.
How Common is CAPD?
What disturbs me the most about these disorders is how often CADP is not identified. Drug companies are quick to encourage parents
to treat symptoms, such as anger, depression, anxiety, attention deficits, with drugs. They ignore dealing with the cause. Family
counseling and parent education can help, but it takes time. Very few counselors and teachers have even heard of CAPD.
Researchers cannot agree on the number of children affected by this disorder. Many teachers, special education professionals and school
psychologists have never heard of it. But the disorder may be as common as reading disorders Ė referred to as dyslexia. In my practice
I have identified 3 out of 20 troubled adolescents with undiagnosed CAPD. Another couldnít hear well enough to avoid misunderstandings.
Partial deafness and auditory processing problems may be more common than we think.
What Causes CAPD?
CAPD is a neurological problem that may be inherited or caused by a birth defect. There appears to be a link between CAPD and ear
infections during infancy. But that link is not entirely clear. We know that ear infections donít cause CAPD in all children. There
may be other contributing factors involved that we donít understand yet.
Does My Child Have CAPD?
The diagnosis of CAPD normally involves consultation with a psychologist, an audiologist and a specialist in learning disabilities.
A cooperative team approach is best. Screening for CAPD with young children is more complicated and difficult than the evaluation
of adolescents and adults. In all cases, a thorough hearing examination is necessary. Standard hearing screenings conducted by public
schools are not adequate for a diagnosis of CAPD. I have encountered adolescents who passed a school hearing exam but were later found
to be partially deaf. Keep in mind that school based hearing exams are very important. They are screenings and a very important part
of your childís education. A screening for CAPD is a specialized activity over and above what schools should be doing. Evaluations
of CAPD can be reliably conducted on children who are 8 years and older.
Is There Treatment or Cure?
You may encounter resistance or difficulty trying to get an evaluation for CAPD. Very few professionals understand the disorder, the
impact, evaluation procedures and treatment. It is uncommon to find people are qualified to diagnose and treat CAPD. Many
professionals mistakenly believe that nothing can be done. There is no cure for CAPD, but there are skills, exercises and structures for
the home or a school that can minimize the impact and help tremendously in a childís education and socialization. What
to look for when searching for a school that could handle this condition depends on the child and the form of CAPD; it is not an easy
formula to express in general terms.
However, I have found that children with CAPD benefit a great deal when they realize that they are not ďstupidĒ and that there are
techniques that will help them to feel more confident and successful. Learning to live with CAPD effectively is better than allowing
a child to become anxious, depressed and oppositional or blaming the world and giving up.