Central Auditory Processing

behind the ear

Central Auditory Processing Disorder (CAPD) Testing

When we usually discuss hearing loss and hearing issues we talk about the outer and middle ear causing problems (conductive hearing loss) or the inner ear (sensorineural hearing loss). However there is actually an area beyond the inner ear that can cause issues and this is called a Central Auditory Processing Disorder (CAPD). It occurs in the area of the brain that processes auditory information. What is tricky about this type of issue is that the anatomy and physiology of the ear are intact and so the audiogram will indicate that the person’s hearing is normal, even though that’s not entirely the case.

Why doesn’t it show up on an audiogram?

The simplest answer to this is that an audiogram is testing for conductive and/or sensorineural hearing loss. It is not meant to tell us what is happening in terms of the brain processing information.

So how do you know if Normal isn’t actually normal?

There are usually behavioral indicators that help identify when something in the central auditory processing system isn’t working correctly. However, they can range from mild to severe and present differently depending on the person. The following list provides some indicators that may be present in individuals with CAPD.

  • Difficulty following or remembering verbalinstructions
  • Repeating back words and phrases without comprehension (Echolalia)
  • Difficulty with memorizing names and places.
  • Difficulty repeating words or numbers in sequence
  • Frequently replying with "huh" or "what"
  • Needs instructions to be repeated multiple times
  • Difficulty discriminating between sounds
  • Difficulty understanding when there is background noise or more than one person speaking
  • Highly distractible/active
  • Difficulty learning in large noisy environments (classrooms and homes)
  • Speech or language delays
  • Poor receptive and expressive language skills
  • Insecure, anxious, angry, or aggressive in situations with a lot of auditory stimuli
  • Higher stress levels and difficulty in social situations
  • Difficulty identifying where a sound is coming from
  • Mishearing words or speech with background noise or loud environments

If you can’t identify this issue with an audiogram how is CAPD diagnosed?

A hearing healthcare professional will administer a series of assessments designed to put stress on the auditory system in order to see the response. These assessments may include a hearing test (audiogram), listening activities such as repeating words in background noise, repeating two words presented at the same time, number or pitch recognition tests, as well as other tests. These tests will help to determine the areas of issue and what supports may be helpful to the individual.

Who is the CAPD test appropriate for?

The CAPD tests and methods are suitable for children age 7 and up. Children under the age of 7 are still undergoing brain development and so testing results may not be accurate for this age group.

As CAPD testing requires a reliable response to auditory stimuli it may not be suitable for individuals that are non-verbal, have learning or behavioural disabilities that will prevent them from accurately following directions. It may also not be suitable for individuals with a conductive or sensorineural hearing loss or individuals using their second language for assessment.

What should I expect when getting a CAPD test?

Prior to testing, an assessment may be requested from the parents, the child’s teacher, or their speech language pathologist. This report will be looking for behavioural indicators that may narrow down areas where the child is struggling and identify areas that supports may need to be put in place.

The test itself will begin with a hearing test (if one hasn’t already been done, or hasn’t been done recently) followed by specific central auditory tests that narrow down the areas of difficulty for the individual. For individuals who are sensitive to auditory stimuli or children with short attention spans the test may be split into more than one appointment.

After the appointment, the hearing healthcare practitioner will score the test to determine whether a CAP Disorder may be present and create a report to send to the family doctor, school, speech language pathologist, or any other party who plays a role in supporting the individual.

Is there anything that can be done to treat CAPD?

This is very dependent on the test results and needs of the individual.

Some recommendations may include:

  • Hearing Aids
  • FM System
  • Seating changes in classroom environment
  • Working with a Speech Language Pathologist
  • Adapting the acoustic environment
  • Individual Education Plan
  • CAP Therapy

Call us to book an appointment for CAPD Assessment


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