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Central Auditory Processing Deficit (CAPD)
Q: In the public school system, is a Central Auditory Processing Disorder (CAPD) a choice? Our son has CAPD due to severe Otitis Media early in childhood. I worry that a lot of children are labeled LD that are not receiving specific strategies for CAPD because it is a new discovery. Not so much new -- just being recognized.
A: You're right about CAPD being missed by schools. Kids who have difficulty following directions are often accused of not paying attention, and some are misdiagnosed as having attention deficit hyperactivity disorder (ADHD). In reality, a lot of students who seem to be confused by spoken language have a specific type of learning disability known as a central auditory processing deficit. This problem can make learning especially difficult if a teacher or parent (or other kids) speak too rapidly or if their language is too complex. Some students with CAPD have a terrible time following a lecture, or processing language in a place where a lot is going on. This is not a problem with hearing; the ears work just fine. This problem occurs when the brain can't make sense out of what the ears hear.
At home, parents are often aware that something is "different" about their child with CAPD. They see that he or she is often confused or doesn't seem to respond. They may worry that the child has a hearing loss, or they may just think that their child is willfully not paying attention -- being difficult or stubborn. In a school system, it is usually a teacher who notices that a child does not seem to understand what's going on or that he or she has trouble paying attention. The teacher who is not familiar with CAPD may focus on the behaviors (not paying attention, etc.) that are associated with this condition. The speech and language pathologist is the professional in the school who knows the most about CAPD. The speech and language pathologist is responsible for assessing the child's perception of speech and his/her receptive (understanding) and expressive (production) language use. Special education teachers and psychologists who keep up to date may also be able to spot this condition, which is sometimes shows up in very subtle ways. If the child is seen at a hospital-based clinic, an audiologist will probably join forces with a speech and language pathologist to evaluate a child's hearing and identify possible processing problems. They can recommend ways to set up the classroom and how to use activities that help the child process language better. They also give suggestions to teachers and parents about how to communicate effectively with a child with this type of learning disability.
One method of helping students with CAPD involves the training of specific skills that are weak or inefficient. This might include teaching children how to tell the difference between two words that sound the same (thigh and sigh), or how to pick out important sounds in a noisy place, such as a school cafeteria. Since it's not always easy for a child to apply the new listening skills to everyday life in school, many speech-language therapists now work in the classroom helping kids work on vocabulary, grammar, and conversations. These specialists also help the classroom teacher learn better ways to work with the child. By demonstrating techniques such as how to repeat requests or questions in a way that won't make the child with CAPD feel like he's singled out, they help create a learning environment that focuses on a child's strengths and not his weaknesses.
Since your son had otitis media (inflammation of the middle ear which affects hearing) when he was a baby, the sounds going to his brain may have been distorted. As a result, his brain didn't have the chance to learn how to listen well. As a result, your son may have the kind of difficulties with language described above. Talk to the speech-language pathologist who works in your school district, or seek an evaluation at a local speech and hearing clinic. Early intervention by a trained team of professionals can help your son develop better processing skills, but the longer this problem goes unrecognized and untreated, the greater the chance that learning and social relationships may suffer.
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Jerome (Jerry) Schultz is the founding clinical director of the Learning Lab @ Lesley University, a program that provides assessment, tutoring, and case management services for children with learning challenges. Schultz holds a Ph.D. from Boston College, and has completed postdoctoral fellowships in both clinical psychology and pediatric neuropsychology.