A Comprehensive Guide to Central Auditory Processing Disorder (CAPD) in Children

Introduction

“My child doesn’t listen to me” is a statement that rings true to many parents. Often, it’s just because the child is focused on something else or developing their independence. However, it can sometimes indicate a deeper issue. One language problem that can cause this is central auditory processing disorder, also called CAPD, or auditory processing disorder (APD).

Central auditory processing disorder is a condition that affects a child’s ability to understand the sounds they hear. They can hear normally but cannot understand what they’re hearing. 

Catching it early and getting a diagnosis can help your child cope better in school, at home, and life. Additionally, early intervention leverages the brain’s ability to adapt, helping the child potentially “grow out” of the disorder [1].

This article explores CAPD, its symptoms, risks, diagnosis, and treatment options. We also review current research on CAPD and provide tips on how to help your child manage the condition at home and in school.

Key Take-Away Messages

What is Central Auditory Processing Disorder (CAPD) in Children?

CAPD is a condition where the child’s brain has difficulty interpreting the sounds they hear. This can cause them to have trouble in school and at home. A child with CAPD may:find it difficult to listen, especially in loud environmentsmishear what you sayfind it hard to follow conversationshave difficulties following verbal directions

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What is CAPD?

Central auditory processing disorder, or CAPD is a listening difficulty caused by problems in the central auditory nervous system (CANS), the part of the brain responsible for processing and interpreting the sounds you hear. 

CAPD is different from hearing loss. Unlike people with hearing loss, the ears of children with CAPD—the outer, middle, and inner ear, and the nerve sending signals from their inner ear to the brain— are normal and fully functional.

The condition is often misunderstood or undetected because it may present as behavioral problems in young children. Its symptoms also frequently overlap with behavioral conditions like autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD).

For example, both children with auditory processing disorder and ADHD may have trouble focusing and paying attention. However, children with ADHD display these difficulties in all settings, whereas children with APD primarily struggle in noisy environments. Meanwhile, experts believe that auditory processing disorder and autism may co-exist, particularly in minimally verbal and non-verbal ASD [2].

What are the Symptoms of CAPD?

Common symptoms seen in CAPD include [3]:

• problems finding the source of a sound
• difficulty understanding speech in noisy backgrounds or when words are spoken too fast
• longer response time
• frequent requests for repetitions
• saying “huh” and “what” frequently
• mishearing or misinterpreting words
• problems following long, spoken instructions
• difficulty following conversations
• academic challenges, particularly in reading, spelling, and learning
• distractibility and inattention
• poor musical ability and singing skills
• misunderstanding jokes and sarcasm

These difficulties may lead to problems in learning, preventing a child from joining activities and doing well in school. Communication difficulties may also hinder them from socializing with peers, leading to feelings of isolation and depression.

Causes and Risk Factors

CAPD happens due to a variety of reasons. Its cause is sometimes unknown but is often linked to a disorder or injury to the brain. Listed below are the most common in children:

• genetics
• ear infections (e.g., recurrent otitis media)
• exposure to heavy metals like lead [4]
• neurological damage like head trauma and brain infections (e.g., meningitis)
• brain tumor
• epilepsy
• developmental delay

While infants already have a fully developed auditory system by the time they are born, auditory pathways do not achieve complete myelination and maturation until they reach 10 to 12 years of age [5]. Because of this, any condition that deprives a child of auditory information can have a negative impact on the organization and maturation of their brain.

Conditions that happen in the womb or during the first 28 days of life (neonatal period) can also put a child at a higher risk of developing CAPD:

• prematurity [6,7]
• low levels (hypoxia) or lack of oxygen (anoxia) [8,9]
• hyperbilirubinemia [7]
• drug exposure, like cocaine [10]
• infections like cytomegalovirus [11]

Diagnosis of CAPD

Before a formal diagnosis, experts may perform a screening to identify children who may need a more comprehensive CAPD assessment. Screening may include questionnaires, checklists, tests, and batteries that check a child’s auditory behaviors related to their listening skills, communication, and academic achievement.

An audiologist and a speech-language therapist (SLP) typically work together to diagnose CAPD based on the child’s symptoms and assessment results. Audiologists focus on evaluating issues with the reception and delivery of auditory input to the central auditory nervous system (CANS), while SLPs assess the linguistic processing of these signals.

Auditory processing disorder tests are divided into two:

• Behavioral tests: These tests include monaural redundancy speech tests, which assess the brain’s ability to recognize degraded speech, and binaural interaction tests, which assess the brain’s ability to combine information from both ears to locate a sound.
• Electrophysiological tests: These tests may be preferable for young children and infants or if specialists suspect a neurological disorder. They can also confirm the results of behavioral tests or be used when behavioral tests are inconclusive. Examples include auditory brainstem evoked responses (ABR) and middle latency response (MLR) tests.

A comprehensive evaluation gives professionals a complete picture of a child’s skills and difficulties. This aids in providing children with specific intervention strategies that could best help them communicate effectively.

CAPD Treatment Options

Auditory processing disorder therapies are highly individualized based on a child’s needs. It is generally divided into three treatment approaches:

1. Direct Skills Remediation

Direct skills remediation involves the use of targeted auditory skills training, focusing on specific auditory processing difficulties the child may have. Training may target skills like auditory discrimination, auditory pattern recognition, sound localization, and binaural separation and integration.

Direct skills remediation may also come in the form of computer-based training programs.

2. Environmental Modifications

These modifications aim to improve the child’s access to sounds by enhancing the signal to make them clear and audible or modifying the environment. One way to enhance the signal is using assistive listening devices like frequency modulation/digital modulation (FM/DM). 

Some ways the environment could be enhanced include:

–       eliminating noise sources

–       decrease reverberations by covering reflective surfaces

–       placing acoustic dividers

3. Compensatory Strategies

Specialists may teach children strategies to utilize their attention, memory, and language skills to improve their listening, social, and communication abilities and learning outcomes. For example, they might use context clues to understand what was said or practice active listening to reduce the chances of missing details in a conversation.

Managing CAPD at Home and School

Aside from receiving treatments, parents and teachers can also help their children manage their condition. For instance, you can teach the child to look into the faces of the people they’re listening to and read their mouths.

Below are some other helpful strategies you can do at home:

• Reduce background noise.
• Provide short, simple verbal instructions.
• Speak with a clear voice and a slower pace.
• Create a to-do list and a visual schedule.
• Follow a routine.
• Teach children to advocate for themselves by asking adults if they need help. 

In addition to the tips above, here are some strategies teachers can use in school:

• Utilize visual aids and notes
• Record lessons that children can review
• Use computer-assisted programs
• Place the child in a spot with less noise, such as in front or near the teacher.

Latest Research and Advances

At present, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not recognize CAPD as a condition. However, the Individuals with Disabilities Education Improvement Act (IDEA) recognizes it to fall within the scope of illnesses covered by “other health impairment.”

A recent cross-sectional study involving 134 U.S. audiologists showed that these experts believe that APD is a unique disorder, based on literature and their clinical experience [12]. However, they also agree that the presence of co-existing disorders complicates it and tends to be overdiagnosed. Meanwhile, a 2023 study using diffusor MRI on 58 children with APD found alterations in particular brain regions in those with APD, leading to their listening difficulties [13].

Currently, although the social media presence of Central Auditory Processing Disorder (CAPD) is increasing, many individuals with CAPD and their families remain unaware of the condition. This lack of awareness makes it difficult for them to access support and resources. Additionally, there is no standardized way to screen for CAPD, which hinders early identification. Developing a standardized screening method could lead to earlier diagnosis, improved access to care, and better outcomes for those affected.

Personal Stories and Testimonials

Children with CAPD and their parents often face more emotional difficulties. They also have poorer social and emotional skills compared to their typically-developing peers. [14] 

In an online forum thread that talks about auditory processing disorder in adults, one user shared that his struggles in school began in kindergarten, but getting a formal diagnosis for his issues was not possible because he was considered too young. He described his communication skills as so poor that only his mother could understand him.

By the time he was a freshman in high school, his academic struggles became too challenging to handle. He wrote, “I couldn’t understand what the teachers were trying to tell me, background noise held me back from socializing with friends. My brain was processing words I heard in a dyslexic manner. My grades plummeted like they never had before (The school I am going to demands more academically, and because of that, it required more of my hearing and processing abilities, which were poorly developed.) Instead of struggling, I was suffering.”

One user shared on a forum that their child was recently diagnosed with CAPD at age 7. Another user responded to help the parent understand the condition better, sharing his own experience with CAPD. He mentioned,

“I have APD, and the biggest struggle I had in school and college was not being able to take notes well. Wish I could have had someone take notes for me. By the time I heard something and processed it, I didn’t have time to write it. I would just forget it since everything would get piled up and out the window together. If you decide to keep your son in normal classes, this could be something he may have help with somehow. Although he is only 7, I had more trouble with this in, say 5th or 6th grade, when lecturey type classes were more common.”

Meanwhile, another chimed in about how their parents and teachers have helped them manage the condition:

“One thing that made a world of difference to me was my parents and the teachers and aids in my life helping me feel empowered in managing this. We worked through strategies that would mitigate the impacts and help me feel like I had some control over what help I got and the ability to advocate for myself.”

Resources and Support

Several national organizations offer valuable resources about the condition. They may also help you look for specialists who can help diagnose and treat your child:

• American Academy of Audiology
• American Speech-Language-Hearing Association
• The National Coalition on Auditory Processing Disorders

There are also specialized centers like the Able Kids Foundation that specialize in diagnosing and treating CAPD. Parents and individuals looking for support groups can look on Facebook for groups created for parents and individuals with CAPD, including Auditory Processing Disorder – APD Support and  (Central) Auditory Processing Disorder (C)APD.There is also a community on Reddit called r/AudiProcDisorder for people with the condition. 

In addition to therapy and auditory training, some programs may help children with CAPD by stimulating their auditory system and tapping the brain’s ability to adapt (neuroplasticity). 

For instance, a brain training device called Forbrain® uses a patented dynamic filter to enhance the child’s voice before sending it back to them as feedback to improve their auditory processing. Meanwhile, Soundsory® is a 40-day multisensory program done at home, which aims to retrain the ear and the brain to process multisensory information more quickly and accurately through a combination of rhythmic music and movement exercises.

Summary

Central Auditory Processing Disorder (CAPD) affects children’s ability to process sounds despite normal hearing. Without an accurate diagnosis and treatment, children with CAPD can stay undiagnosed and continue to struggle with their difficulties. Specialists can help diagnose and manage CAPD through different strategies.

You may also consider looking for support groups or seeking assistance and resources from organizations or your child’s school to equip you to help your child in this journey. In addition to conventional treatments, you can explore programs like Soundsory® or Forbrain® to support your child’s auditory development and improve their listening skills.

FAQs 

Is CAPD a form of autism?

No, CAPD (Central Auditory Processing Disorder) and autism are generally considered separate conditions. However, many experts believe they are related, though the exact nature of this relationship remains unclear. Studies show many children with autism have auditory processing difficulties and may also have CAPD [15]. However, the exact percentage is unknown.

Is CAPD a form of ADHD?

No, CAPD and ADHD are two distinct conditions that have overlapping symptoms. Experts are still unsure of the link between the two but see relationships between them. The two conditions may also co-occur in an individual.

Is CAPD a learning disability?

No, CAPD in and of itself is not a learning disability. However, because CAPD affects how a person perceives and understands sounds, it may lead to learning problems. It also co-occurs with learning disabilities like dyslexia [1]. 

Does CAPD affect speech?

Yes. Processing speech is a complex process involving the brain processing the signals received by the ears, using phonemic skills to discriminate the features of this signal, and linguistic processing, where meaning is attached to the signal. In CAPD, one or more of these can be affected, leading to problems in speech and language development.

Is CAPD hereditary?

Yes, some studies show that certain genetic variants may be associated with CAPD [16].

References 

1. Aristidou, I & Hohman, M. (2023). Central Auditory Processing Disorder. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing
2. Schwartz, S., Wang, L., Shinn-Cunningham, B. G., & Tager-Flusberg, H. (2020). Atypical Perception of Sounds in Minimally and Low Verbal Children and Adolescents With Autism as Revealed by Behavioral and Neural Measures. Autism research : official journal of the International Society for Autism Research, 13(10), 1718–1729. https://doi.org/10.1002/aur.2363
3. Weill Cornell Medicine. Central Auditory Processing Disorder. (n.d.). https://ent.weill.cornell.edu/patients/clinical-specialties/conditions/central-auditory-processing-disorder-capd
4. Dietrich, K. N., Succop, P. A., Berger, O. G., & Keith, R. W. (1992). Lead exposure and the central auditory processing abilities and cognitive development of urban children: the Cincinnati Lead Study cohort at age 5 years. Neurotoxicology and teratology, 14(1), 51–56. https://doi.org/10.1016/0892-0362(92)90028-9
5. Bamiou, D. E., Musiek, F. E., & Luxon, L. M. (2001). Aetiology and clinical presentations of auditory processing disorders–a review. Archives of disease in childhood, 85(5), 361–365. https://doi.org/10.1136/adc.85.5.361
6. Boboshko, M. Y., Savenko, I. V., Garbaruk, E. S., Knyazeva, V. M., & Vasilyeva, M. J. (2023). Impact of Prematurity on Auditory Processing in Children. Pathophysiology : the official journal of the International Society for Pathophysiology, 30(4), 505–521. https://doi.org/10.3390/pathophysiology30040038
7. Amin, S. B., Orlando, M., Monczynski, C., & Tillery, K. (2015). Central auditory processing disorder profile in premature and term infants. American journal of perinatology, 32(4), 399–404. https://doi.org/10.1055/s-0034-1387928
8. Sonbay Yılmaz, N. D., Saka, C., Oktay Arslan, B., Aygener Yeşilyurt, N., Saka, D., Ardıç, S., & Akın, İ. (2019). The effect of hypoxia on hearing function. Turkish journal of medical sciences, 49(5), 1450–1454. https://doi.org/10.3906/sag-1902-210
9. Gross, R., Kolevzon, A., & Reichenberg, A. (2007). Auditory system damage and Anoxic Birth—Reply. Archives of Pediatrics & Adolescent Medicine, 161(11), 1106. https://doi.org/10.1001/archpedi.161.11.1106-b
10. Mactutus, C. F., Harrod, S. B., Hord, L. L., Moran, L. M., & Booze, R. M. (2011). Prenatal IV cocaine: Alterations in auditory information processing. Frontiers in Psychiatry, 2. https://doi.org/10.3389/fpsyt.2011.00038
11. Vikhnina, S. M., Boboshko, M. Y., & Garbaruk, E. S. (2019). Congenital cytomegalovirus infection as a risk factor of central auditory processing disorders. Rossijskaâ Otorinolaringologiâ, 99(2), 16–24. https://doi.org/10.18692/1810-4800-2019-2-16-24
12. Ismen, K., & Emanuel, D. C. (2023). Auditory Processing Disorder: Protocols and controversy. American Journal of Audiology, 32(3), 614–639. https://doi.org/10.1044/2023_aja-23-00035
13. Alvand, A., Kuruvilla-Mathew, A., Roberts, R. P., Pedersen, M., Kirk, I. J., & Purdy, S. C. (2023). Altered structural connectome of children with auditory processing disorder: a diffusion MRI study. Cerebral Cortex, 33(12), 7727–7740. https://doi.org/10.1093/cercor/bhad075
14. Gonçalves, L. F., Paiva, K. M., Patatt, F. S. A., Stolz, J. V., & Haas, P. (2021). Association between autism spectrum disorder and changes in the central auditory processing in children. Revista da Associacao Medica Brasileira (1992), 67(1), 156–162. https://doi.org/10.1590/1806-9282.67.01.20200588
15. Brewer, C. C., Zalewski, C. K., King, K. A., Zobay, O., Riley, A., Ferguson, M. A., Bird, J. E., McCabe, M. M., Hood, L. J., Drayna, D., Griffith, A. J., Morell, R. J., Friedman, T. B., & Moore, D. R. (2016). Heritability of non-speech auditory processing skills. European journal of human genetics : EJHG, 24(8), 1137–1144. https://doi.org/10.1038/ejhg.2015.277