2. INTRODUCTION
• Auditory processing disorder (APD), also known as central
auditory processing disorder (CAPD) is an umbrella term for
central auditory deficits that affect the way the brain
processes auditory information.
• Individuals with CAPD usually have normal structure and
function of the peripheral hearing systems. However, due to
dysfunction in the central auditory nervous system, they
cannot process the information they hear in and structures
with consequential auditory processing deficits (Moore, 2007;
Whitton & Polley, 2012)
• Ellis (2002a, 2002b) aptly describes CAPD as a hearing
problem in which “the brain can’t hear.”
• APD is more likely to occur with other conditions than in
isolation. Common comorbidities include dyslexia, attention
deficit hyperactivity disorder (ADHD), autism spectrum
disorder (ASD), and specific language impairment and
reading disorder (Sharma et al., 2009)
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3. • CAPD can manifest in children as problems for them to
determine the direction of sounds, difficulty perceiving differences
between speech sounds, and the sequencing of these sounds
into meaningful words, confusing similar soundssuch as “hat” with
“bat”
• CAPD can be genetic in origin or can be caused by disease
processes, neurological conditions, traumatic brain injury,
developmental abnormalities including delayed maturation of the
central auditory nervous system, and metabolic disorders
(Bamiou, Musiek, & Luxon, 2001).
• Those suffering from CAPD may have problems relating what has
been said with its meaning.
• Auditory processing deficits are also a key underlying factor in
dyslexia (Burns, 2013)
• CAPD particularly affects temporal processing of auditory
information which in turn affects the recognition and discrimination
of phonemes. (Corriveau, Goswami, & Thomson, 2010)
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4. Patients often report that speech seems fast,
fragmented and confusing , jumble the order of
sounds, and they may miss pitch or intonation
cues that affect the meaning of spoken
language. They also report difficulty in localizing
sounds.
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5. CHILDREN WITH CAPD ARE KNOWN TO EXHIBIT ONE OR MORE OF A
WIDE RANGE OF BEHAVIORS AS THEY EXPERIENCE LANGUAGE AND
LEARNING PROBLEMS (KEITH, 2000A):
• Inconsistent responses to auditory stimuli;
• Inability to follow auditory instructions;
• Difficulty with auditory localization;
• Inability to differentiate soft and loud sounds;
• Unexplainable fear of loud noises, or being
overwhelmed by the auditory environment;
• Difficulties in learning, discriminating, and remembering
phonemes and manipulating them in tasks such as
reading, spelling, and phonics.
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6. • Poor perception of pitch, intonation, and other suprasegmental
features of speech that affect meaning;
• Difficulty understanding speech in noisy backgrounds or against
any competing sounds;
• Impaired ability to recall and repeat simple musical patterns of
high- and low-pitch notes o
• Difficulty with auditory memory, either span or sequence;
• Poor listening skills with decreased attention, increased
distractibility, and restlessness;
• Frequent requests to repeat information;
• Low academic performance, significant reading problems, poor
spelling;
• Behavioral problems; and • withdrawal tendencies, shyness with
poor self-concept resulting from multiple failures temporal (rhythm)
patterns.
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7. A NUMBER OF SCREENING TESTS TO IDENTIFY
CHILDREN WHO MIGHT HAVE CAPD HAVE BEEN
DEVELOPED.
• Although a number of questionnaires have been used to screen for CAPD, they
generally have poor specificity, tend to under- or overrefer, and have not been
completely validated.
• Groups that warrant almost automatic referral for central auditory evaluation
include children with dyslexia and children with reading disorders .
• The screening tests can be used to determine whether the full diagnostic
battery is required.
• A number of CAPD screening tests are currently in use including the ;
• Children’s Auditory Performance Scale (CHAPS), a 25-item scale that utilizes
a scaling continuum related to the child’s auditory behaviors (Smoski, Brunt,
& Tannah)
• The Children’s Home Inventory for Listening Difficulties (CHILD), for use with
children between the ages of 3 and 12 which is completed by a parent
(Anderson & Smaldino, 2000)
The Listening Inventory (TLI) developed by Geffner and Ross-Swain (2006)
• The Screening Instrument for Targeting Educational Risk (SIFTER) from
Anderson and Matkin (1989)
• Listening Inventory for Education (LIFE) (Anderson & Smaldino, 1998).
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8. Presentation title 8
Screening checklist for auditory processing (SCAP)
(Indian test) Yathiraj and Maggu (2013) .
SCAN-3 for Children consists of three groups of tests.
The screening tests include the gap detection test,
auditory figure ground testing at 8 dB signal-to-noise
(S/N) ratio, and competing words free recall
9. Presentation title 9
Most tests of CAPD are based on some form of
challenging auditory signal for the auditory nervous
system to identify as in speech-in-noise or distorted
speech tests.
These tests, known as sensitized speech tests, use
various means of distorting speech to reduce the
intelligibility of the message.
Another approach is to reduce the intensity level of
speech above a simultaneously presented background
noise (auditory figure ground testing)(Figure Ground is the
ability to identify a primary signal or message in the presence of competing
sounds)
10. Presentation title 10
Persons with normal hearing and normal auditory
pathways can understand distorted speech
messages; however, when a central auditory
processing disorder is present, speech
intelligibility under difficult circumstances .
The construct of sensitized speech testing is
extremely powerful and forms the basis of all
behavioral speech tests of central auditory
function (Keith, 1999a).
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The screening tests can be used to determine
whether the full diagnostic battery is required.
The full diagnostic battery should also be
administered when the child’s referral source or
history indicate
12. CONSIDERATIONS :
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• The audiologist must be certain that no conductive or sensorineural
hearing loss is present in either ear of the child.
• Pediatric audiologists should consider the language, cognitive, and other
nonauditory demands of the auditory tasks in selecting and administering
a central auditory diagnostic test battery
• The AAA Guidelines (2010) recommend using the term at risk for CAPD
for diagnoses below age 7, but stress that intervention should not be
delayed.
• The central auditory evaluation should include:
(a) a carefully documented patient history;
(b) observation of auditory behaviors;
(c) assessment of peripheral hearing;
(d) tests of central auditory function including temporal processing skills,
localization and lateralization, low redundancy monaural speech, dichotic
stimuli, binaural interaction procedures, and electrophysiological tests as
appropriate; and
(e) cognitive and language evaluation. Comprehensive assessment for CAPD
is ideally carried out by a multidisciplinary team including the audiologist,
