18 July 2023

Understanding Central Auditory Processing Disorder

By Anna Tyranes, Head of Department: Speech-Language Pathology and Audiology at Bellavista School

When the brain hears differently...but what exactly does this mean?

1. Terminology

Central Auditory Processing (CAP) can be best described as “What the brain does with what the ears hear” (Bellis, T.J. 2001). It is the job of the brain to correctly decode the information that the ears obtain from the external world. A Central Auditory Processing Disorder (CAPD) or Auditory Processing Disorder (APD) makes reference to how the Central Nervous System makes use of the presented auditory information. This isn’t due to a low cognitive functioning or hearing loss but rather when the coordination of auditory stimuli between the brain and the ears isn't fully functional.

1. Ages and Stages

Firstly, it is important to note that individuals of all ages can have or be diagnosed as having CAPD/APD. It commonly occurs in childhood, yet it is becoming more notable later in life. Other important aspects to note such as the fact more males than females are likely to have APD and that it can potentially lead to language learning delays.

1. Four main auditory skills that people with CAPD/APD may have difficulty with:

• Auditory discrimination - the ability to differentiate, compare and notice subtle differences between separate sounds (e.g. to hear the difference between pat and bat, to hear the difference between forty and fourteen).
• Auditory figure ground - the ability to focus on the relevant and important sounds within a noisy environment (e.g. focusing on a teacher’s voice in a classroom or focusing on a colleague’s voice in a meeting).
• Auditory memory - recalling information that has been heard, either straight away or later in the future.
• Auditory sequencing - understanding and recalling the specific order of sounds and words.

1. The most commonly noted signs of CAPD/APD

• Difficulty understanding speech, mostly within noisy environments (such as a classroom) or when there is more than one speaker.
• Frequent asking for repetition of information and commonly using the responses “what” or “sorry”.
• Misunderstanding presented information.
• Requiring longer response times when partaking in conversations.
• Difficulty localising sounds.
• Difficulty distinguishing between similar sounds.
• Difficulty paying attention or concentrating and recalling information.

1. The CAPD/APD diagnosis

The initial step in diagnosing CAPD/APD is to ensure that there is indeed no hearing  loss. Visiting an audiologist will not only help to rule out a hearing loss but also allow for further specific and advanced listening tests which are used for CAPD/APD diagnosis. Further testing, if required, can be conducted by a Speech-Language Therapist.

An important aspect is that should a parent want his/her child to be tested is that the recommended age is seven years and older, as auditory skills are still developing prior to that. It should further be noted that ADHD, working memory issues and receptive language disorders should be ruled out, as similar challenges can be noted within these areas. Adults can be tested and identified at any age.   

1. Help

• The main treatment for CAPD/APD is speech-language therapy and the sooner treatment starts, the better.
• Class teachers or work-spaces could help manage these challenges by including the following during the day:
  • Using simple, one-step directions
  • Being patient and providing repetition when needed.
  • Speaking at a slower rate or an appropriately higher volume.
  • Providing a quiet spot for doing work.
• Being diagnosed with CAPD/APD can provide challenges within the home, school and work environment but with the correct intervention and support, people who have it can thrive.

For more information, visit www.bellavista.org.za

About Bellavista SHARE

Bellavista S.H.A.R.E. is the Education Resource Centre of Bellavista School, an independent school in Johannesburg that is widely regarded as a centre of excellence in the field of remedial education. With the Bellavista S.H.A.R.E initiative, the school harnesses the collective capacity it holds within its own staff to improve the quality of educational delivery in Southern Africa by sharing its wealth of professional knowledge, experience, and collective expertise with the community of educators and health professionals working with children in the region. 

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