Central Auditory Processing Disorder (CAPD) What is CAPD? Central Auditory Processing Disorder (CAPD) - also known as Auditory Processing Disorder (APD) - is an umbrella term for a variety of disorders that result in a breakdown in the hearing process. In short, our brain cannot make sense of what our ears hear because the auditory signal is distorted in some way. As a result, one of the biggest problems experienced by individuals with CAPD is difficulty listening in background noise. For children, this generally means problems adequately understanding the teacher in the presence of competing classroom sounds. CAPD and Spatial Processing Disorder Spatial processing is the ability to use the cues that tell us where sounds are coming from. This ability allows us to focus on one sound while ignoring sounds coming from other directions and is one of the main skills we rely on when trying to listen in noise. Spatial Processing Disorder (SPD) is a type of CAPD that leads to a difficulty understanding speech in noisy situations. Australian Hearing’s CAPD program focuses on identifying SPD, but other areas of CAPD may also be assessed. Assessing for CAPD at Australian Hearing A number of central auditory processing tests can be used to assess CAPD. At Australian Hearing, we focus on identifying auditory deficits that are likely to lead to listening difficulties and poorer performance in the classroom. This includes how well your child hears in background noise. We aim to tailor our tests to suit the individual child and as such, what is included in each assessment may differ slightly between children. If we find that your child has a difficulty in an area of auditory processing we will then discuss management and auditory training options with you. If you decide to proceed with any of these management or training options, we will arrange further appointments to implement these options. Australian Hearing’s CAPD assessment and management service is provided on a fee-for-service basis. For more details on the fee structure, contact your Australian Hearing centre. Prior to your assessment appointment, a Pre-Appointment Questionnaire on the family, educational, behavioural, developmental and medical history of your child is sent. Please bring the completed form with you to your appointment. The assessment appointment is carried out by an audiologist to rule out peripheral hearing loss and to assess a range of auditory processing skills. The appointment takes about one hour and 15 minutes. At the appointment, your audiologist will go through the information supplied in the pre-appointment questionnaire and also conduct a range of tests. At the end of the appointment we will explain the test results and discuss a range of management options. A CAPD assessment includes: Hearing screening Your child’s hearing will be tested to establish whether it is within the normal range. Listening in Spatialized Noise – Sentences test (LiSN-S) The LiSN-S is a breakthrough in the acoustic assessment of children because it allows clinicians to measure how well a child uses the spatial information in sound to understand speech in noise. The inability to use spatial information has been found to be a leading cause of listening difficulty in noisy situations. LiSN-S was developed by Australian Hearing’s research division, the National Acoustics Laboratories (NAL) and further information on LiSN-S is available at http://capd.nal.gov.au Depending on the results of these tests we may also assess: Dichotic Digits Test (DDT) The DDT is used to assess the ability of your child to process different information being presented to each ear at the same time. The ability to integrate information is important for effective classroom listening. Number Memory Forward (NMF) The Number Memory Forward subtest of the Test of Auditory Processing Skills – Third Edition is designed to show how well a child can remember simple sequences of auditory information. This ability is commonly referred to as short term auditory memory. Deficits in short term memory have been found to be associated with poorer academic performance and increased reports of listening difficulty. Number Memory Reversed (NMR) The Number Memory Reversed subtest of the Test of Auditory Processing Skills – Third Edition is designed to show how well a child can remember and manipulate simple sequences of auditory information. This ability is commonly referred to as auditory working memory. Deficits in this area can affect a child’s performance in the classroom and lead to flow on effects such as listening fatigue. The assessment appointment Training and management options The management options recommended for your child will depend on the results of the assessment appointment. If your child is diagnosed with deficits on any of the above tests, your audiologist will discuss the most appropriate management or training option with you. For instance, a child with SPD can be supported through three different approaches:    Environmental modifications to improve access to auditory information. Remediation of deficient auditory abilities through auditory training. Teaching coping strategies to enhance auditory abilities. Deficits identified in other areas can be supported through:   Environmental modifications to improve access to auditory information. Teaching coping strategies to enhance auditory abilities. Environmental modification and classroom strategies These are selected, practical management suggestions which can be used in the classroom setting to improve the immediate listening environment. They may include:     Providing preferential seating Securing the child’s attention prior to being addressed Undertaking regular check on the comprehension of verbal instruction Use of an FM system which provides amplification of the teacher’s voice to the child, thereby giving the child better access to teacher instructions and directions. These strategies as well as other strategies will be discussed with you at the time of the appointment. Remediation Programs Auditory remediation (auditory training) activities aim to strengthen weak or deficient hearing abilities. To be most effective, auditory training activities should be practiced regularly and intensely and be sufficiently challenging. At Australian Hearing we offer the LiSN & Learn auditory training software for children who are diagnosed with SPD. The LiSN & Learn was developed by Dr Sharon Cameron and Dr Harvey Dillon at the National Acoustic Laboratories. LiSN & Learn is designed to train children who experience listening difficulties in the classroom due to SPD, to attend to target speech while suppressing spatially-separated background noise. It is recommended that children train with the software for 15 to 20 minutes per day, five days per week, for 10 weeks. Additional information on the LiSN & Learn auditory training software is available at http://capd.nal.gov.au We also offer memory booster software as a remediation program. Memory Booster software is used to train children to use memory strategies and practice these skills. This helps children develop good memory strategies, organise information efficiently and practice the skills necessary for effective learning and recall of information. It is recommended that children train with the memory booster software for 20 minutes per day, three days per week for an eight week period. Compensatory strategies These aim to teach the child skills so they can operate more effectively in listening and learning situations. These skills aim to help the child to identify difficult listening situations and to apply strategies that will help their learning and comprehension. They also aim to help the child become confident so that they can make a difference in their own listening and learning.  Whole-body listening approach. Have the child to sit up straight in an alert mode, incline the upper body and head to the speaker, maintain eye contact and keep attention on the speaker.  Self-regulation and problem solving. Alert the child to his/her listening strengths and weaknesses, identify potential situations where listening may be difficult (e.g. in the canteen) and encourage the child to think of possible solutions to improve his/her listening (e.g. move to a quieter corner) and then evaluate its effectiveness in the circumstances.  Verbal rehearsal. Encourage the child to repeat information to him or herself to remember it better. Auditory processing disorders can co-exist with a number of other disorders (for example cognitive, language or attention disorders). Therefore your audiologist may recommend other assessments depending on the child’s history and presenting difficulties. For example: Assessment by a speech pathologist: A qualified speech pathologist assesses the child’s receptive and expressive language abilities. Speech Pathology Australia www.speechpathologyaustralia.org.au Assessment by an education psychologist: A qualified psychologist tests the child’s cognitive skills and mental abilities. Australian Psychological Society www.psychology.org.au These assessments can further identify the individual’s strengths and help explain how a child’s difficulties are affecting his or her learning and communicative skills. Other assessments that may be of benefit About Australian Hearing Australian Hearing has 65 years’ experience in providing the community with the best hearing care. We are the largest provider of hearing services for children, young adults, veterans, pensioners and Indigenous people in Australia. The National Acoustic Laboratories (NAL) is the research division of Australian Hearing. Since 1947, NAL’s research into hearing has opened new ways in which people with hearing loss can be helped. References American Speech and Hearing Association (1996): Central auditory processing consensus development, Journal of the American Academy of Audiology, 5, 41-54. Bellis, T. J. (2002): When the brain can’t hear. Unravelling the mystery of Auditory Processing Disorder, New York, NY: Pocket Books Bellis TJ. (2003) Assessment and management of central auditory processing disorders in the educational setting. From Science to practice. New York, NY: Delmar Learning. Cameron, S., & Dillon, H. (2011). Development and Evaluation of the LiSN & Learn Auditory Training Software for Deficit-Specific Remediation of Binaural Processing Deficits in Children: Preliminary Findings. Journal of the American Academy of Audiology, 22(10), 678-696. Cameron, S., & Dillon, H. (2010). LISN & Learn Auditory Training Software [Computer software]. Sydney, NSW: National Acoustic Laboratories. Cameron S, Dillon H. (2009) Listening in Spatialized Noise – Sentences test (LISN-S) [Computer software]. Murten, Switzerland: Phonak Communications AG. Cameron, S. & Dillon, H. (2008). The Listening in Spatialized Noise – Sentences Test: Comparison to prototype LISN test and results from children with either a suspected (central) auditory processing disorder of a confirmed language disorder. Journal of the American Academy of Audiology, 19(5), 377-391. Cameron, S. & Dillon, H. (2008). Spatial hearing deficits as a major cause of auditory processing disorders: Diagnosis with the LISN-S and management options. In R. Seewald & J. Bamford, eds. A Sound Foundation Through Early Amplification 2007. Proceedings of the Fourth International Conference. Phonak AG, Switzerland, 235-241. Cameron, S., Glyde, H., & Dillon, H. (2011). Listening in Spatialized Noise- Sentences Test (LiSN-S): Normative and retest reliability data for adolescents and adults up to 60 years of age. Journal of the American Academy of Audiology, 22(10), 697-709. Katz, J, Stecker, N. A. & Henderson, D. (1992): Central auditory processing, a trans-disciplinary view, St Louis: Mosby Year Book. Kelly, D. A. (1995): Central auditory processing disorder: Strategies for use with children and adolescents. San Antonio, Tx: Communication Skill Builders Martin, M. & Brownwell, R. (2005): Test of Auditory Processing Skills – Third Edition (Manual). California: Academic Therapy Publications. Moore, B.C.J. (1997): An introduction to the psychology of hearing. San Diego: Academic Press. Wilson, R.H. & Strouse, A. (1998). Tonal & speech materials for auditory perceptual assessment disc 2.0. [CD]. New Hampshire: VA Medical Centres. Australian Hearing Head Office: 126 Greville Street Chatswood NSW 2067 Tel: (02) 9412 6800 TTY: (02) 9412 6802 Fax: (02) 9413 3362 www.hearing.com.au