Differentiating
Central Auditory Processing Disorder (CAPD)
and
Language Processing Disorders
Among a lot of the speech and language disorders difficult to diagnose, CAPD and language processeing disorders is high up there among the rest of them. However, The Source from Linguisystems breaks down the differences between the two very simply, as I will do here. The diagnosis of each includes differential diagnosis (a breaking down of skills). Therefore each needs to first be defined and separated. The confusing element is that with CAPD there can be a few co-existing disorders that also may have a resemblence to CAPD and therefore may get misdiagnosed or just missed. These disorders are ADHD, language disorders, cognitive disorders, and Learning Disorders. Diagnosis of CAPD generally requires performance deficits on the order of at least two standard deviations below the mean on two or more tests in the battery (Chermak & Musiek, 1997). The audiologist and SLP should be alert, however, to inconsistencies across tests that would signal the presence of a nonauditory confound rather than a CAPD even when an individual meets this criterion
Central Auditory Processing Disorder or CAPD is as in its name an Auditory Deficit, therefore must have an auditory component involved. CAPD is defined as In the simplest of terms, as a listening disorder (involving the ears). However, in these cases, the ear hears fine but the brain does not process the information it receives accurately or quickly enough. The brain just needs more time to process the information, or a different way to process. It depends on the diagnosis and situation.
Some of the following signs may be indicative of someone with an APD: ASHA describes it as auditory mechanisms (must include difficulty with some aspect of hearing) that underlie the following abilities or skills: 1. sound localization and lateralization; 2. auditory discrimination; 3. auditory pattern recognition; 4. temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; 5. auditory performance in competing acoustic signals (including dichotic listening - essentially doing two things at once while listening to something or someone); 6. and auditory performance with degraded acoustic signals (ASHA, 1996; Bellis, 2003; Chermak & Musiek, 1997). Numbers 1 - 6 are the parameters that define what CAPD are, however there are as I said earlier behaivors and/or language behaviors that differentiate the difference between CAPD and Language Disorders defined by The Source of Linguisystems. As always when diagnosing anyone with anything you must consider individuality and factors such as chronological and developmental age; language age and experience; cognitive abilities, including attention and memory; education; linguistic, cultural, and social background; medications; motivation; decision processes; visual acuity; motor skills; and other variables can influence how a given person performs on behavioral tests.
The five primary components of
Central Auditory Processing Disorders are:
1. RETENTION AND ORGANIZATION: This component involves the ability to listen to something, remember it, and repeat it in the original order. Difficulties in
this area limit a person’s ability to follow directions, to remember information, and to retell or describe events. People with deficient retention and organization skills often have trouble completing tasks at home, in school, or at work.
2. AUDITORY DISCRIMINATION: This component enables the listener to differentiate among auditory signals. On an advanced level, auditory discrimination
helps a person hear differences among speech patterns in conversation as well as in pitch changes. Poor discrimination is apparent when a person misunderstands what he hears, confuses one word for another, misarticulates various sounds in his own speech, or experiences difficulty in learning to read.
3. SEQUENCING: This component is directly related to the ability to follow directions. Since most of us, especially students, spend a great deal of our day
following directions in school or at work, disturbances in this area are usually fairly obvious. Inattentiveness, incomplete paperwork, and learning difficulties may be
directly related to poor sequencing skills.
4. CONCEPTUALIZATION: Conceptualizing auditory messages enables the listenerto give meaning to what he hears. Effective conceptualization is crucial to abstract concepts such as time, direction, and space. Disturbances in this area can create the impression that a student is disorganized and unable to adapt to new situations. Such a student is apt to be considered inflexible, concrete, and confused.
5. SYNTHESIS OF INFORMATION: This auditory processing component is fundamental for pulling together all the language skills that are necessary to
communicate effectively. These skills include the ability to learn to read, to anticipate spoken messages, to grasp the main idea of a conversation or story, and to
fill in missing information in a conversation.
• Behaves as if there is a hearing loss despite normal hearing abilities • Is easily distracted by background noise • Has difficulty following both simple and complex directions • Displays poor reading and spelling skills • Requires several repetitions or says “huh?” or “what?” often. • Does not seem to understand what is required of him/her – does not “get it”. • May have difficulty understanding abstract information, sarcasm or humor. • May display some sensitivity to loud sounds (hyperacusis)
Central Auditory Processing Disorder or CAPD is as in its name an Auditory Deficit, therefore must have an auditory component involved. CAPD is defined as In the simplest of terms, as a listening disorder (involving the ears). However, in these cases, the ear hears fine but the brain does not process the information it receives accurately or quickly enough. The brain just needs more time to process the information, or a different way to process. It depends on the diagnosis and situation.
Some of the following signs may be indicative of someone with an APD: ASHA describes it as auditory mechanisms (must include difficulty with some aspect of hearing) that underlie the following abilities or skills: 1. sound localization and lateralization; 2. auditory discrimination; 3. auditory pattern recognition; 4. temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; 5. auditory performance in competing acoustic signals (including dichotic listening - essentially doing two things at once while listening to something or someone); 6. and auditory performance with degraded acoustic signals (ASHA, 1996; Bellis, 2003; Chermak & Musiek, 1997). Numbers 1 - 6 are the parameters that define what CAPD are, however there are as I said earlier behaivors and/or language behaviors that differentiate the difference between CAPD and Language Disorders defined by The Source of Linguisystems. As always when diagnosing anyone with anything you must consider individuality and factors such as chronological and developmental age; language age and experience; cognitive abilities, including attention and memory; education; linguistic, cultural, and social background; medications; motivation; decision processes; visual acuity; motor skills; and other variables can influence how a given person performs on behavioral tests.
The five primary components of
Central Auditory Processing Disorders are:
1. RETENTION AND ORGANIZATION: This component involves the ability to listen to something, remember it, and repeat it in the original order. Difficulties in
this area limit a person’s ability to follow directions, to remember information, and to retell or describe events. People with deficient retention and organization skills often have trouble completing tasks at home, in school, or at work.
2. AUDITORY DISCRIMINATION: This component enables the listener to differentiate among auditory signals. On an advanced level, auditory discrimination
helps a person hear differences among speech patterns in conversation as well as in pitch changes. Poor discrimination is apparent when a person misunderstands what he hears, confuses one word for another, misarticulates various sounds in his own speech, or experiences difficulty in learning to read.
3. SEQUENCING: This component is directly related to the ability to follow directions. Since most of us, especially students, spend a great deal of our day
following directions in school or at work, disturbances in this area are usually fairly obvious. Inattentiveness, incomplete paperwork, and learning difficulties may be
directly related to poor sequencing skills.
4. CONCEPTUALIZATION: Conceptualizing auditory messages enables the listenerto give meaning to what he hears. Effective conceptualization is crucial to abstract concepts such as time, direction, and space. Disturbances in this area can create the impression that a student is disorganized and unable to adapt to new situations. Such a student is apt to be considered inflexible, concrete, and confused.
5. SYNTHESIS OF INFORMATION: This auditory processing component is fundamental for pulling together all the language skills that are necessary to
communicate effectively. These skills include the ability to learn to read, to anticipate spoken messages, to grasp the main idea of a conversation or story, and to
fill in missing information in a conversation.
• Behaves as if there is a hearing loss despite normal hearing abilities • Is easily distracted by background noise • Has difficulty following both simple and complex directions • Displays poor reading and spelling skills • Requires several repetitions or says “huh?” or “what?” often. • Does not seem to understand what is required of him/her – does not “get it”. • May have difficulty understanding abstract information, sarcasm or humor. • May display some sensitivity to loud sounds (hyperacusis)
Behaviors of CAPD
1. Behaves as if there is a hearing loss despite normal hearing abilities
2. Is easily distracted by background noise
3. Has difficulty following both simple and complex directions
4. Displays poor reading and spelling skills
5. Requires several repetitions or says “huh?” or “what?” often.
6. Does not seem to understand what is required of him/her – does not “get it”.
7. May have difficulty understanding abstract information, sarcasm or humor.
8. May display some sensitivity to loud sounds (hyperacusis)
2. Is easily distracted by background noise
3. Has difficulty following both simple and complex directions
4. Displays poor reading and spelling skills
5. Requires several repetitions or says “huh?” or “what?” often.
6. Does not seem to understand what is required of him/her – does not “get it”.
7. May have difficulty understanding abstract information, sarcasm or humor.
8. May display some sensitivity to loud sounds (hyperacusis)
Prerequisites for Language Processing
"Poor verbal & organization can be a significant signal for a language processing problem... Delayed vocabulary and concept aquistion are relativiely inconsisitent on formal testing" (Linguistystems, 2001).
"Three requirements should be met in order to accurately interpret performance deficits as a language processing disorder (Linguisystems 2001)"
1. Most importantly, a visit to the Audiologist should reveal that the acoustic signal should be received intact in the cortex as well as the primary zone, in other words, the child should receive a normal Full Audiological Examination results.
2. The child should have near normal aquistion of receptive/expressive language skills. Remembering that acuqisition of vocabulary should be relatively slow, they will have basic age commensurate vocabular yeilding surprising assessment performances abover their age.
3. The child will reveal normal/near normal intellectual (IQ) functioning.
** "It is not accurate to say that a child who is chronologically ten years old with a developmental age of five should be processing language at ten years, or having a language processing disorder at all. It is not possible to exceed the language development age since the processing conducted on the linguistic developmental knowledge" (Linguisystems, 2001).
"Three requirements should be met in order to accurately interpret performance deficits as a language processing disorder (Linguisystems 2001)"
1. Most importantly, a visit to the Audiologist should reveal that the acoustic signal should be received intact in the cortex as well as the primary zone, in other words, the child should receive a normal Full Audiological Examination results.
2. The child should have near normal aquistion of receptive/expressive language skills. Remembering that acuqisition of vocabulary should be relatively slow, they will have basic age commensurate vocabular yeilding surprising assessment performances abover their age.
3. The child will reveal normal/near normal intellectual (IQ) functioning.
** "It is not accurate to say that a child who is chronologically ten years old with a developmental age of five should be processing language at ten years, or having a language processing disorder at all. It is not possible to exceed the language development age since the processing conducted on the linguistic developmental knowledge" (Linguisystems, 2001).
Different types of Central Auditory Processing Assessments
Children are recommended to wait until the age of 6 ot 7 years old to be tested for a Processing disorder from an Audiologist.
- Auditory discrimination tests: assess the ability to differentiate similar acoustic stimuli that differ in frequency, intensity, and/or temporal parameters (e.g., difference limens for frequency, intensity, and duration; psychophysical tuning curves; phoneme discrimination).
- Auditory temporal processing and patterning tests: assess the ability to analyze acoustic events over time (e.g., sequencing and patterns, gap detection, fusion discrimination, integration, forward and backward masking).
- Dichotic speech tests: assess the ability to separate (i.e., binaural separation) or integrate (i.e., binaural integration) disparate auditory stimuli presented to each ear simultaneously (e.g., dichotic CVs, digits, words, sentences).
- Monaural low-redundancy speech tests: assess recognition of degraded speech stimuli presented to one ear at a time (e.g., filtered, time-altered, intensity-altered [e.g., performance-intensity PI-PB functions]), speech-in-noise or speech-in-competition).
- Binaural interaction tests: assess binaural (i.e., diotic) processes dependent on intensity or time differences of acoustic stimuli (e.g., masking level difference, localization, lateralization, fused-image tracking).
- Electroacoustic measures: recordings of acoustic signals from within the ear canal that are generated spontaneously or in response to acoustic stimuli (e.g., OAEs, acoustic reflex thresholds, acoustic reflex decay).
- Electrophysiologic measures: recordings of electrical potentials that reflect synchronous activity generated by the CNS in response to a wide variety of acoustic events (e.g., ABR, middle latency response, 40 Hz response, steady-state evoked potentials, frequency following response, cortical event-related potentials [P1, N1, P2, P300], mismatch negativity, topographical mapping). The use of electrophysiologic measures may be particularly useful in cases in which behavioral procedures are not feasible (e.g., infants and very young children), when there is suspicion of frank neurologic disorder, when a confirmation of behavioral findings is needed, or when behavioral findings are inconclusive.
Differentiating Behaviors of
CAPD vs. Language Processing Disorders
Central Auditory Processing Disorders
1. Majority are male (75%)
2. Normal pure tone hearing results 3. Difficulty following oral directions, inconsistent response to auditory stimuli 4. Short auditory attention span, fatigues easily during auditory tasks 5. Poor shor term and long term memory 6. Gives impression of not listening even though they are looking at the speaker; (gives impression of daydreaming) 7. Difficulty of listening in presence of background noise 8. Difficulty localizing sound 9. Academic deficits (phonics, reading or spelling) and mild speech - language impairments 10. Disruptive behaviors - distractive, impulsive, frustrated 11. Frequent requests for verbal repetition or often saying, "huh?" or "what?" 12. History of otitis media |
Language Processing Disorders
1. Problems with retrieval of common words
2. Use of neutral, generic, or less-specific labels 3. Misuse of words with similar phonetic structure 4. Generating creative, original language terms, use of descriptors, or decircumlocutions 5. Response latency, use of fillers to buy time. 6. Frequent "I dont know" or "I forget" responses 7. Verbal repetition or rehearsal 8. Inconsistency in learning, requires extensive review of previously learned materials. 9. Recognizes language errors but cannot fix them. 10. Incomplete sentences or thoughts. 11. Pragmatic problems that can include disruptive behavior 12. Most importantly, age commensurate IQ and vocabulary with academic deficits; often receives a learning disability label. Linguisystems 2001 |