CAPD SubCategories

Kay Pittelkow provides details of the different variants of Central Auditory Processing Disorder, as part of her larger article "CAPD and the gifted child: The relevance of central auditory processing deficit to gifted education".

1. Auditory Decoding Deficit

This is the “classic” CAPD. These children are typically described as having a hearing problem even when no physical evidence exists. They process information in a way that is slow and inaccurate. This inefficiency in processing means that they are working harder to interpret what they hear.

Characteristics

• Tend to mis-hear words  eg: mouth for mouse, eighteen for eighty, park for bark. They have difficulty with differentiating and analysing the differences between speech sounds.
• Weak vocabulary, syntax (plurals, verb tenses) and semantics (multiple meaning words, understanding who, what, why, when and where questions).
• Difficulty in situations in which information is presented without sufficient contextual or visual cues.
• Difficulty understanding speech in noisy environments.
• Becomes overloaded in an auditory situation. Listening behaviour deteriorates over time.
• Performs better in subjects where phonic/phonological decoding is not requires – for example maths computations.
• Usually poor readers, spellers and note-takers. They can’t divide their time appropriately between listening and writing.

Diagnostic Identification

• Poor performance on monaural low-redundancy speech tests.
• Poor performance on speech in noise tests.
• Poor auditory closure abilities noted on other tests where the errors are similar to the target word.
• Poor performance on Phonemic synthesis test.

Classroom Strategies

• Change the physical environment to decrease noise level.
• Improve acoustic access by seating the child appropriately, by blocking out other noise with personal FM system or implementing a Soundfield amplified classroom.
• Repeat information only if you can say the information more clearly.
• Provide visual cues.
• Use attention-focusing devices.
• Pre-teach (using an aide or parent) new information, particularly vocabulary.
• Use clear, concise and explicit language. Provide a copy of instructions (for example) in writing as well as audibly (auditory). Use a buddy if necessary.
• Modify oral tests. (For example - always give spelling words in a sentence)
• Use assistive technologies (high quality tape recorders, computers, books on tape and note takers). Give children 2 sets of text so they have one at home.

Direct Intervention

• Speech/language therapies to improve auditory phonic and meta-phonological skills as well as listening and noise tolerance skills.
• Programs that are recommended: * Phonemic synthesis programme * Auditory discrimination in depth (Lindamood) * Fast for Word * Earobics * Hooked on Phonics * Rhyming, syllable and phoneme segmentation.
• Therapies to improve lip reading and non-auditory strategies (Such as using context or listening for meaning)

Compensation Strategies

• Teaching your child how to: * Listen (active versus passive listener) * Recognise adverse listening conditions and how to address them. * Methods of clarifying auditory instructions. * How to use visual cues to augment auditory information. * How to advocate on their own behalf.

2. Associative Deficit Tolerance Fading Memory

These children have difficulties applying the rules of language to sounds they hear. They often have intolerance for background noise and their understanding of speech declines markedly when noise is present. These children tend to perform less well with language demands in the classroom.

Characteristics

• Poor auditory memory.
• Poor receptive vocabulary.
• Poor vocabulary skills.
• Difficulty understanding complex sentences (Their language is very concrete - little syntax)
• May have language difficulties with: Categories and labels, Multiple meaning words, Negative wh-questions. Antonyms, synonyms and honyms.
• Difficulty following directions.
• Poor reading comprehension.
• Difficulty in making the necessary associations in order to understand verbal jokes, riddles, jargon.
• Usually asking for clarification.

Diagnostic Identification

• Diagnosis is usually not until 3rd or 4th grade when language requirements become more difficult.
• Good performance on temporal pattering.
• Good sound decoding and discrimination but word recognition may be poor.
• Bilateral deficits on dichotic listening talks.
• Poor performance on speech in noise discrimination tasks.

Classroom Strategies

• Change the physical environment (as above).
• Improve acoustic access to auditory (as above).
• Have the child in an educational environment that uses a structured, systematic, multi-sensory, rule-based approach to language and learning.
• Avoid or minimise classroom techniques that require self-monitoring of learning behaviour.
• Impose external organisation and structure.
• Pre-teach new vocabulary
• Use clear concise and explicit language
• Rephrase a message using simpler language instead of repeating it
• Obtain attention
• Use multiple choice tests
• Use assistive technologies
• Provide quiet study areas
• Use a tape recorder to record instructions and lectures
• Check comprehension by having child paraphrase or demonstrate what is expected

Direct Intervention

• Language therapy is a key component.
• Traditional receptive and expressive language techniques.
• Training in use and meaning of words that imply relationships such as tag words ( first, last next), casual words (because, since), adversative words (but however although).
• Strategies that aid in retention of complex messages such as chunking , verbal rehearsal, and paraphrasing.
• Metacognitive strategies.
• Methods to improve noise tolerance skills.
• Auditory memory enhancers.

Compensation Strategies

• These children should be encourages to "talk themselves through" homework (example: draw diagrams, highlight, makes notes in the margin in effort to provide a framework to understand the message).
• Use of organisation aids such as: * Calendars * Tape recorders * Checklists * Assignment notebooks * Dictionaries * Computers
• Develop problem solving skills

3. Integration Deficit

These children demonstrate difficult across modalities with any task that requires efficient inter-hemispheric communication. They have trouble tying together auditory and visual information. They frequently exhibit long delays in responding.

Characteristics

• Difficulty with multi-modality tasks.
• Difficulty with sound-symbol relationships.
• Reading and spelling difficulties related to difficulty recognising and using the patterns of 'wholes" necessary for word recognition and spelling.
• Motor skills that require bimanual or bipedal co-ordination may be affected.
• Difficulty determining how to do a task, may need a lot of extra time and practice to complete, tasks, or may have a great deal of difficulty getting started on tasks.

Diagnostic Identification

• Left ear deficits on dichotic speech tasks.
• Bilateral deficits on tests of temporal patterning in the linguistic labelling condition.
• Scores within normal range for monaural low-redundancy speech tests.

Classroom Strategies

• Reduce or avoid multi-modality cues - present information via one modality at a time.
• Provide note takers.
• Pre teach new information.
• Tape record classes. R
• eader for tests and/or a scribe.
• Texts on tape.
• Word processors with audio spell-check.
• Never rephrase (this is confusing) rather repeat and emphasise key points.
• Test should not be timed.

Direct Intervention

• OP/PT therapy which focuses on multi-sensory integration and non auditory inter-hemispheric activities to improve corpus callosum function.
• Speech and language therapy which focuses on speech and auditory inter-hemispheric activities.

Compensation Strategies

• Avoidance of division of attention.
• Focus attention on the task they are presently doing.

4. Prosadic Deficit

These children talk or read without intonation, stress or rhythm. They often have difficulty with pragmatic communication skills, sequencing, social judgement, gestalt patterning and spatial abilities, They have difficulty in perceiving the prosodic cues that underlies humour, sarcasm, question forms that rely heavily on intonational cues to gauge intent.

Characteristics

• Poor music skills.
• Speaks and reads in a monotone.
• Difficulty in social communication situations.
• Difficulty or inability to perceive prosodic cues such as rhythm, stress and intonation.

Diagnostic Identification

• Normal performance on monaural low redundancy speech test.
• Left ear deficits on dichotic speech tests (usually slight).
• Bilateral deficits on tests of temporal patterning in both the linguistic labelling and humming conditions.

Classroom Strategies

• Placement with "animated" teacher.
• Additional visual cues.
• Pre teaching new information with emphasis on prosodic cues.

Direct Intervention

• Speech and language therapy: * Prosody training * Key work extraction * Pragmatics

Compensation Strategies

• Reading aloud with exaggerated prosodic features.
• Encourage music and/or dance.

5. Output-Organisational Deficit

These children have trouble organising, sequencing, recalling and/or expressing an answer. They have listened to, analysed, correctly connected and pulled together the information but still have difficulty responding correct. In general these children have difficulty on tasks where success is dependent on motor and or planning skills.

Characteristics

• Difficulty following directions, particularly if they are long.
• Difficulty in starting assignments, remembering homework, taking notes, or organising their papers or work.
• Difficulty with sound blending.
• Receptive auditory skills are good, however they have difficulty acting upon incoming information (such as memory based skills such as work retrieval abilities).
• Weaknesses often in expressive language skills and or speech articulation.

Diagnostic Identification

• Good performance on monaural low redundancy speech talks.
• Poor performance on tests that require a response that has multiple elements such as the frequency and duration pattern tests, or dichotic speech tests, or phonemic synthesis test.
• Poor performance on tests with background noise.
• Other indicators are omitting words on tests, using words that were given on a previous test item and difficulty with sequencing words in a response.

Classroom Strategies

• Repetition or rephrasing is useful but only if the information in broken down into small units.
• Use of tag words when giving instructions and information.
• Use of organisational tools such as consistent routines, outlines, calendars, checklists, and assignment notebooks.
• Pre teach new information.
• Avoid situations requiring self monitoring.

Direct Intervention

• Speech and language therapy for expressive language difficulties as well as the use of visualisation and visual imager.
• Training metacognitive techniques to strengthen memory based skills which in turn help item recall.

Compensation Strategies

• Use of computer technology and organisational aids.
• Learning good study skills.

From the Conference Notes "From Central Auditory Processing Skills to Language and Literacy" held by Speech Pathology Australia, National Conference in Adelaide on May 8-12, 2000. Presenters: Martha C Cummings and Dorsey Heithaus (Based on work by Bellis (1996), Ferre (1997), Master, Stecker, Katz (1997))

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