Central Auditory Processing Disorders in Children

The words "central auditory processing" and "auditory processing" are interchangeable and refer to our ability to interpret what we hear. Individuals with central auditory processing disorders (CAPD) often have normal hearing sensitivity but struggle to analyze or make sense of what they hear. Other names for CAPD include auditory perception issues, central deafness, word deafness, auditory comprehension deficiency, and auditory perceptual processing failure.

Central Auditory Processing

Auditory attention, auditory memory, motivation, maturation and integrity of auditory pathways, choice processes, and utilization of language signals such as grammar, meaning in context, and lexical representations are all necessary for auditory processing. Auditory processing comprises functional skills such as differentiating between sounds, detecting speech sounds, sequencing the sounds, auditory figure-ground (listening in the background), auditory closure (filling in missing information), and auditory memory.

CAPDs are defined as difficulties in any of these categories. CAPD causes that mentioned in the literature include loss of function due to injury or disease and brain maturational delays due to otitis media or preterm. There also appears to be a hereditary component, with family members experiencing comparable central auditory processing difficulties.

Prevalence and Prognosis

Because of the comprehensive clinical group in which CAPD is found (e.g., learning difficulties, attention deficit disorders), determining a precise prevalence for children has been problematic. The incidence of CAPD in children is estimated to be between 2 and 3 percent based on the frequency of comorbid disorders and testing referrals. Intervention effectively equips the individual with compensating methods that will be beneficial in whatever scenario they may face. As an adult, the person with a CAPD will have greater control over their surroundings and the experience to assist them in comprehending the message in a communication setting. The factors linked with other impairments will have an impact on the outcome.

Subgroups of CAPD

Several models seek to explain APD. Researchers have sought to describe the varied nature of APDs by subdividing them or characterizing their properties in terms of similarities. APD categories were created based on specific damage locations' functions and test signs. As in most professions, categories allow us to break down complicated issues into smaller, more intelligible parts. While this is useful in management, no sub-grouping approach or model is widely approved.

"The Buffalo Model" was developed at the University of Buffalo. The Buffalo Model examines the association between performance patterns on a single auditory processing test and learning issues in children. This model is divided into four subtypes: Decoding, Memory Tolerance, Integration, and Organisation. The final model represents those who have trouble sequencing events and make mistakes in their sequencing. These people are frequently disorganized at home or school. An individual will frequently display traits of more than one sub-type.

The Buffalo Model

  • Decoding

  • Memory Tolerance

  • Integration

  • Organisation

Bellis/Ferre Model

  • Auditory and Associated Dysfunction in the Primary Auditory Cortex

  • Nonprimary Auditory Cortex

  • Corpus Callosum (Interhemispheric Dysfunction)

Musiek and Gollegly Classification

  • Neuro Morphological Disorders

  • CNS Maturational Delays

  • Neurologic Illnesses And Traumas

The Bellis/Ferre model explains how to sub-profile APD. Each sub-profile is linked to its underlying neurophysiologic area of brain malfunction and higher-level language and learning implications and consequences. There are three significant profiles and two subsidiary profiles in this concept −

  • Auditory and associated dysfunction in the primary auditory cortex (typically left hemisphere),

  • Non-primary auditory cortex (usually right hemisphere), and

  • Corpus callosum (interhemispheric dysfunction),

All these are represented by the three primary profiles (Auditory Decoding Deficit, Prosodic Deficit, Integration Deficit).

Secondary profiles (Associative Deficit and Output Organisation Deficit) represent dysfunction and associated sequelae that may represent higher-level language, attention, and executive function; thus, some may argue that they should not be included under the umbrella of APD. Auditory decoding describes those with "poor auditory closure abilities, as evidenced by poor performance on monaural low redundancy speech and speech-in-noise tests." Integration Deficit refers to problems with the interhemispheric transmission.

Associative Deficit is "an underlying inability to apply language rules to incoming acoustic information." Output-Organization Deficit is a problem in organizing, planning, and sequencing answers. Again, it is conceivable for an individual to have more than one sub-type. Musiek and Gollegly identify three forms of APD among children with learning impairments in addition to these models. These three categories are based on an underlying neurophysiological impairment or neuro maturational delay: neuro morphological disorders, CNS maturational delays, and neurologic illnesses and traumas. Due to the intrusive nature of the necessary study methodologies, these categories are speculative and have not been directly explored.

Assessment of CAPD

Because CAPD coexists with other illnesses, particularly learning problems, determining a differential diagnosis for CAPD is generally an art rather than a science. The ultimate goal of the assessment process should be to discover the individual child's strengths and shortcomings to build an intervention plan. As a result, assessing CAPD requires a collective effort. Assessment should encompass physiological (Auditory Brainstem Response and Middle Latency Response Testing) and behavioral audiological examination, speech-language evaluation, psycho-educational evaluation, and neuropsychological evaluation to detect functional deficits efficiently.

CAPD screening tests are available for children as early as three years old; however, the auditory system grows fast between the ages of three and five, making it difficult to distinguish between a deficiency and average developmental progress. A comprehensive central auditory processing test battery may be performed on a child aged five or older.

Treatment of CAPD

Remediation approaches, compensating tactics, and environmental controls are among the treatment possibilities. Ear training for phoneme and sound recognition, discrimination, sequencing, blending, and increasing auditory memory and closure are examples of remediation strategies. Noise desensitization is an ear-training program that teaches you how to listen to a desired signal when surrounded by background noise. Environmental and technological changes can deal with noise interference.

However, providing practice in a controlled setting by progressively raising the noise level will aid in integrating the individual with CAPD into the everyday environment. Teaching lip-reading abilities adds visual information to the auditory signal and promotes attendance.

The amount of background noise, distance, and signal distortion induced by reverberation that may be present all contribute to environmental issues. Preferential seating to allow the kid to view the teacher's face and the chalkboard, acoustic room treatment to decrease background noise and echo or reverberation, and FM auditory sound systems are all ways to improve the auditory environment. In order to minimize any negative consequences, the device should be fitted by an audiologist. The instructor wears a wireless microphone that sends her voice signal to the child's ear or via a strategically positioned speaker or tiny earbuds.


Central Auditory Processing Disorders (CAPD) affect our ability to interpret what we hear. Causes include loss of function, brain maturational delays, and hereditary components. Prevalence and prognosis for children are estimated to be 2-3 percent.

Intervention is effective in equipping individuals with compensating methods. Central auditory processing disorder (CAPD) is challenging to differentiate from other illnesses, so it requires collaboration among professionals to develop suitable treatment solutions.

Updated on: 09-May-2023


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