Improving outcomes for
children with Central
Auditory
Processing Disorder
What are the indicators a child may
have an auditory processing
disorder?
• Central Auditory Processing Disorder
(CAPD) is a term that covers a variety
of disorders where a person may have
normal hearing but for some reason
their brain cannot always make sense
of what they hear.
• For example, the person may have a
lot of difficulty understanding speech
when it is noisy.
What are the indicators a child may
have Central Auditory Processing
Disorder?
• doesn’t pay attention in class
• frequently in trouble for talking to
classmates
• doesn’t follow instructions well
• seems to do worse when it’s noise
• academic progress is slipping,
• parents are confused and upset
• says he/she can’t hear the teacher
• says he/she gets confused when
everyone’s talking at once
2-3% of children have a Central
Auditory Processing Disorder (CAPD)
• Listening behaviour similar to someone with a hearing loss
– But hearing is NORMAL
– NOT related to cognitive ability
– Occurs in the higher processing sections of the brain
• Greatest difficulties listening under adverse conditions
– Noise
– Reverberation
• many different types of disorders
– Hearing in noise, auditory memory, speech clarity…
• “CAPD testing” can include a range of different tests
Spatial Processing Disorder
• Spatial processing is the ability to use the cues that tell us
where sound is coming from.
• This ability allows us to focus on one sound while ignoring
sounds coming from other directions.
• Spatial Processing Disorder (SPD) is a type of CAPD that lead to a
difficulty understanding speech in noisy situations.
Australian Hearing’s CAPD program, established in 2012,
focuses on identifying SPD, but other areas of CAPD may also
be assessed.
Sophie’s
story
http://www.youtube.com/watch?v=kl8xSYU2Z1I
CAPD Services at Australian Hearing
• Research-based program
• Spatial Processing Disorder (SPD) discovered by research at the
National Acoustic Laboratories
• Hierarchical CAPD test battery
• Tailored to an individual child’s listening deficit
• Deficit specific remediation options
• Auditory training packages
• FM systems
• Fee for service program for children
• Normal hearing
• Aged 6 to 16 years of age
• No middle ear problems for at least
4 weeks
AH CAPD assessment: test battery
Our CAPD assessment battery:
• Hearing screening
• Spatial Processing
• Listening in Spatialized Noise – Sentences test (LiSN-S)
• Short term memory
• Number Memory Forward (NMF)
• Auditory working memory
• Number Memory reversed (NMR)
• Binaural integration
• Dichotic Digits Test
Spatial Processing
• LiSN-S was developed by the National Acoustic Laboratories –
the research division of Australian Hearing
• LiSN-S identifies SPD
• This is an exciting break through
– Many CAPD tests aren’t very specific
in the type of problem/s they identify
and the results can be affected by
other problems.
More information on NAL and LiSN-S can be found at http://capd.nal.gov.au
Memory
•
Number memory forward (NMF) subtest of TAPS – 3
assesses short term auditory memory
•
Number memory reversed subtest of TAPS – 3 assesses
auditory working memory. Auditory working memory is
the ability to store and manipulate auditory information
•
Debate over whether auditory memory is within CAPD
umbrella
•
Does affect children’s academic performance and
“listening ability”
•
Approx. 10% of children have memory deficits
Binaural integration
•
Dichotic Digits Test (DDT) used to assess binaural
integration.
•
Can only be tested for children 7 years of age or older.
•
Poor performance on DDT correlated with greater
difficulty listening in the classroom as well as with
NAPLAN results
•
Results can be affected by memory and attention
Our results…
Most referrals we receive are for children in early
primary school
160
140
120
100
80
60
40
20
0
6
7
8
9
10
11
12
13
14
Age (years)
15
16
17
18
19
Our results …
61.3 % of children referred to Australian Hearing have
been diagnosed with one of the target auditory
processing disorders.
• 19.5% had SPD (130 children)
• 26.1% had memory deficit (174 children)
• 17.6% had binaural integration deficit (104 children)
27.2% passed all tests (181 children*)
* NB: DDT not tested for children under 7 years of age.
Remediation pathways
Depending on the results from the assessment
appointment, we work with families to develop
management options specific for each child.
LiSN & Learn
• for children diagnosed with Spatial Processing
Disorder
Memory Booster
• for children diagnosed with a memory deficit
Personal wireless system (or FM)
Compensatory strategies
LiSN & Learn
• developed by NAL to improve listening ability of children
who have a spatial processing disorder.
• at-home computer-based auditory training program.
• children train with the software for 15-20 minutes per day,
five days per week, for 10 weeks.
This is one of the few CAPD interventions that
has very strong research evidence to prove
that it works.
NAL & Australian Hearing are working at
the cutting edge of CAPD assessment and
treatment
Memory Booster
• to improve listening ability of children who have a
short term memory deficit or auditory working
memory deficit.
• at-home computer-based auditory training
program.
• children train with the software for 20 mins per
day, 3 days per week, for 8 weeks.
• teaches children to use memory strategies such as
visualisation, rehearsal and story telling and
practices these skills.
Personal wireless system (or FM)
• Recommended for children with a binaural integration
disorder and those reporting difficulty listening in noise.
• A range of systems are available.
• Worn in the classroom to improve the child’s ability to hear
the teacher’s voice over classroom noise.
• Reduces listening fatigue
Strategies
Environmental modification and classroom strategies
• Practical activities used in the classroom to improve a
child's immediate listening environment, e.g providing
preferential seating or gaining a child's attention before
addressing them.
Compensatory strategies
• Aim to teach a child skills to operate more effectively in
listening and learning situations, e.g. whole-body listening
approach, self-regulation and problem solving, and verbal
rehearsal.
Our results …
Our results …
Performance in real life, post L&L
(n=34)
Our results …
Memory tests - post-training
• NMF (n=18)
• NMR (n=18)
NB: Excluded scores of children who passed the original test.
Our results …
Performance in real life (n=26)
Our results …
Reasons for FM fitting
COSI – C final scores
Our results …
Both auditory training programs led to significantly improved
test scores
• LiSN-S and NMR both within the normal range after
remediation
• The majority of children showed significant improvements in
real life settings
FM fittings
• yielded improvements in real-life performance
The end result …
Australian Hearing wants to give children (like
Sophie), the chance to help their CAPD problems so
they can get on with their education.
Questions? Or want to know more
To refer a child to Australian Hearing, call 1300 256 874.
For information on Australian Hearing’s CAPD program, visit
http://hearing.gov.au
Please come, get some popcorn and have a chat with our friendly
team in the Exhibitors Hall!
We look forward to working with you