CAPD – Learning how to live and learn with Central Auditory Processing Disorder

Back in the middle of the last century when I was in grade school, there was no label for what was “wrong” with me (other than “troubled”). But in 1948, Samuel J. Kopetzky described the presenting symptoms. Unfortunately, it wasn’t until 1996 that there was finally an official paper written about the subject, and an update to that information was published in 2005 by ASHA, American Speech-Language-Hearing Association.

The following is a recent partial list from The University of Akron Auditory & Speech Center of some of the common characteristics I exhibited as a child and into adulthood:

• Difficulty following multistep directives  
• Trouble understanding in noisy listening environments  
• Poor listening skills  
• Academic performance does not match ability  
• Struggles to pay attention  
• May exhibit auditory memory issues 
• Needs more time to process auditory information  
• Difficulty with reading, spelling, math word problems, and vocabulary
• Disorganized and forgetful  
• Tires easily when engaged in listening tasks for extended periods  
• May have problems with receptive language or comprehending abstract information  
• Often looks for visual cues to help “fill in” gaps they miss through oral information
• Becomes frustrated and may exhibit behavior problems

Back in my school days, no one was keyed into the cluster of symptoms I had. The problem is that many times in children, CAPD can be mistaken for dyslexia, ADHD, or ASD because there are some similarities. So when a child (or an adult) presents with similar symptoms as listed above and has a normal or almost-normal audiogram, it is crucial to take the next step. If you are a parent of a child presenting with these symptoms, consider CAPD and request a full evaluation of the central auditory nervous system. Today there are therapies available to help.

Most of these symptoms and behaviors do carry into adulthood. Many who have CAPD but were never diagnosed have developed their own coping strategies and systems and can lead extremely productive lives. Thankfully, I was one of those children.

It is important to understand what an Auditory Processing Disorder is and what it is not.

What it is:

Auditory processing disorder (APD), rarely known as King-Kopetzky syndrome or auditory disability with normal hearing (ADN), is an umbrella term for a variety of disorders that affect the way the brain processes auditory information. Individuals with APD usually have normal structure and function of the outer, middle, and inner ear (peripheral hearing).

Central auditory processing (CAP)—also seen in the literature as auditory processing—is the perceptual processing of auditory information in the central auditory nervous system (CANS) and the neurobiological activity that underlies that processing and gives rise to electrophysiologic auditory potentials (American Speech-Language-Hearing Association [ASHA], 2005).

ASHA uses the term Central Auditory Processing Disorder (CAPD) to refer to deficits in the neural processing of auditory information in the CANS not due to higher order language or cognition, as demonstrated by poor performance in one or more of the skills listed below* (ASHA, 2005). 

What it is not:

• A hearing deficit
• Socio-economic behavioural problems
• A psychiatric problem
• Something “they’ll grow out of”
• Curable 

• An intellectual disability 
• Autism spectrum disorder*  
• Attention deficit hyperactivity disorder (ADHD)*

*ASD and ADHD may also be present however, CAPD is not caused by either. (ASHA)

In 2005 I moved to Israel where I enrolled in an Ulpan, a school for teaching adult immigrants Hebrew. Unfortunately, at the time I didn’t know I had an actual learning challenge and thought I was simply experiencing age-related deficits. I didn’t realize that this experience was directly related to the problems I had been having since kindergarten. 

The following is part of the response I received from a specialist in audiology in 2015, regarding Auditory Processing Disorder, addressing my inquiry about my struggles and frustration in learning Hebrew in ulpan (intensive Hebrew-learning class):

“The best advice I can give ”, wrote the audiologist, “is awareness of how APD can impact learning….especially a new language.

A person with APD takes longer to process information, has poorer short-term memory, and is easily distracted.

So, therefore, a person with APD typically needs (in an educational situation):

• a louder signal 
• a very quiet environment 
• a slower presentation of new information
• frequent pauses in the presentation 
• the use of visual tools to reinforce what is being taught verbally
• and more practice to learn the material.

Likely the person with APD will learn much better in a one-on-one personal tutoring situation (rather than in a class) in a quiet environment, with a very patient instructor who is comfortable with a slow and repetitive presentation of new information.

The learning likely will take a longer time than expected. It’s important to be patient (stress will complicate learning), take frequent breaks, learn in smaller chunks of information…..and practice, practice, practice.”

Unfortunately, I was not privileged to have that type of learning experience in this particular ulpan. Even after attempting to discuss it with the teacher, she did not get it. The next time she called on me in class, I was formulating my answer but was too slow to respond. She stood over me at my seat and started ridiculing me and snapping her fingers in my face! I was humiliated in front of my fellow students (something a teacher should never do). I left the room in tears. And I did not return. 

What life was like growing up with CAPD  

Knowing that I was different, I instinctively started doing things differently. I admitted to my Mom that I struggled doing certain math problems. She sat with me until we figured out what worked best. 

I excelled in English by studying the dictionary. I took it (the physical book) with me into the bathroom so I could study in a quiet space.

I took copious notes during lectures hoping to fill in gaps when I got home.

I sang in all the school choirs but could not learn the music or lyrics just from hearing a song. 

I struggled immensely in all my classes. My emotional reactions turned into real physical problems. I frequently stayed home “sick” with stomach aches many more days than was normal. I did not understand why life was so difficult when seemingly everyone else was happy. 

I somehow managed to graduate high school but had very few friends – ever the wallflower, a loner, and painfully shy. Never quite fitting into anyone’s clique. Because I couldn’t manage a lot of noise or more than one conversation at a time, it was easier to avoid those situations.