Does your child’s teacher complain that he/she just doesn’t pay attention or insist your child has ADD, but you know they’re wrong? Trust your instincts! Many children who have been diagnosed with Attention Deficit Disorder may actually have a Central Auditory Processing Disorder, and mood-altering drugs will not affect their ability to perform well in school.

For the longest time, I thought my daughter was “slow” or brain damaged. When the cashier at the grocery told her she looked pretty, Hannah would reply, “Fine, thank you.” When the announcer called for clean-up on aisle five, Hannah would shout, “Where’s the fire?” And when her tumbling coach asked her to demonstrate a cartwheel for the other children, she looked at him like he was speaking Martian.

I knew there was a problem, but what the heck was it?

What is CAPD?

Central Auditory Processing Disorder is a condition in which the sensory organ (the ear) functions properly, but the signals don’t make it through the processing organ (the brain) properly. No one knows exactly what causes the problem, but many audiologists believe it is due to the improper building of neurological pathways in the brain during infancy and early childhood. Neurological pathways are built through the repetition of information or actions (like memorizing the multiplication tables). If a child does not hear sounds and words correctly or in the same way each time, these pathways will not be built properly. There can be many reasons why a child may not hear sounds correctly, such as head trauma or lead poisoning, but the most common factor is chronic ear infections in infancy and early childhood. Because the ear is filled with fluid for such a long time, the child hears muffled or distorted sounds, and the brain is unable to make the proper neural pathways.

Signs and Symptoms

If your child displays the following symptoms, he/she should be evaluated for CAPD:

• Easily distracted or unusually bothered by loud noises,
• Marked improvement in ability to focus when placed in a quiet environment; for example, a good attention span at home, but poor attention at school,
• Difficulty following multi-step instructions,
• Difficulty with word problems in math,
• Unwillingness to go first during games and contests,
• Difficulty comprehending verbal or abstract information,
• Inappropriate responses to questions,
• Doesn’t know the names of children in his/her classroom,
• Inability to carry on long telephone conversations.

Diagnosis

I knew for a long time that Hannah had a problem, but her kindergarten teacher insisted she was fine, just a little “immature.” When Hannah finally said, “Mom, I like kindergarten, but I just don’t know what she’s talking about,” I knew we had a serious problem. I immediately sat down and made a list of all the things that I thought were strange, and I took Hannah and the list to the pediatrician the next day.

Fortunately, we got the good pediatrician. He took my concerns seriously and made an appointment for Hannah to see a pediatric neurologist. After some basic tests to rule out a tumor, the neurologist sent us to a pediatric audiologist. She performed a long battery of tests, including tests of hearing comprehension in both quiet and noisy environments. Hannah was able to comprehend almost 100 percent of the information in the quiet environment, but only 30 percent in the noisy environment (sound like a kindergarten classroom?).

Although I was distressed to discover that my perfect child had a learning disability, I was relieved to find out she was not mentally challenged.

Treatment

Unfortunately, there are no medications or surgeries that will fix CAPD. The most common treatment is actually just learning to cope with the situation. The audiologist referred us to a speech-language pathologist, and Hannah spent two years in intensive therapy (many insurance plans will cover this). During this time, she learned many techniques to address the most common problems:

• auditory memory, or the ability to remember long lists, directions, or instructions,
• auditory discrimination, or the ability to distinguish the difference between sounds or words that are similar (goat/boat and hat/bat are two examples),
• auditory attention, or the ability to focus long enough to complete a specific task, and
• auditory cohesion skills, or the ability to draw inferences from conversations, understanding riddles, and working word problems.

The auditory cohesion skills have been the most difficult for Hannah to master. Even after two years of therapy and countless of hours of practice at home, she still doesn’t “get” jokes or riddles. She usually just laughs when everyone else does, then asks me later what was so funny. After I explain exactly why the fact that “Orange you glad I didn’t say banana” is so funny, she’ll think for a little while, then finally say, “Oh, I GET it!”

Most audiologists have found, and I agree, that the best way to treat CAPD is through the use of multiple coping strategies.

Coping Strategies

These strategies consist of environmental controls, teacher support, electronic listening devices, and most of all, love and emotional support.

Controlling the environment at home isn’t too hard. Turn off the television, make sure only one person speaks at a time, and make sure you have your child’s full attention before giving instructions. Controlling the classroom environment can be much more difficult. We have found that having Hannah sit as far as possible from the heating/air conditioning unit has helped, and we have been able to request teachers that are known for maintaining tight control in their classrooms.

Teacher support consists of having the classroom teacher seat your child as far away from the talkative children as possible, standing next to your child when giving instructions, and seating your child near the front of the classroom so that he/she will be able to maintain good visual attention. Teachers should also break instructions down into single components, rather than giving a long string of complicated directions.

Electronic listening devices (or FM trainers) are devices in which the teacher wears a special microphone and the student wears special headphones which are tuned into the microphone. Everything the teacher says is amplified for the child. Unfortunately, many teachers forget to turn the microphone off before speaking privately to other students or teachers, and some CAPD students know everyone’s secrets. These can be very beneficial to some children, but my daughter refused to wear one because she didn’t want to look “different.” I decided that her self-image was in bad enough shape, so I didn’t argue about the trainer.

Finally, love and emotional support are absolutely the most important strategy for helping your child. It is very difficult to function when you don’t know what other people are talking about, and feeling “stupid” is a terrible blow to anyone’s self-esteem. By explaining CAPD to your child, working on coping strategies with him/her, and educating your child’s friends and teachers about CAPD, you can set your child up for a lifetime of success.