Gifted Issues Discussion homepage Forums Twice Exceptional CAPD and autism

Does anyone know if central auditory processing disorder is (or can be) part of autism spectrum disorder? My DS7, in particular, has an ASD diagnosis but shows almost all of the typical symptoms of CAPD, and I'm not sure whether to follow up on it or not. One symptom list I have for CAPD (and he ticks every box on this list) is

• Difficulty following directions
• Sensitive to loud sounds
• Easily distracted, frustrated, and/or confused
• Overwhelmed in noisy places
• Exhibits a short attention span
• Struggles to complete assignments
• Easily upset in new situations
• Labeled as an underachiever or daydreamer
• Experiences anxiety or tension
• Lacks self-confidence
• Forgetful
• Shows restlessness and has problems sitting still
• Difficulty with transitions and/or changes in routine

But almost all of those are also ASD symptoms, right? I don't want to go travelling all over the place just to get a further alphabet soup of diagnoses, but if it would help him to get an ear filter or something, I don't want to not do that. I've been recommended to go to ABLE Kids in Colorado, which is a good long way to travel but not totally out of the question. Is it worthwhile?

Most of those are ADHD-inattentive type symptoms as well. DD9 gets so distracted by noises that sometimes I wonder if an auditory processing issue is really her issue (or in addition to ADHD). If she's trying to focus on something, even someone chewing food in the next room is enough to send her over the edge. I have no idea how she functions at all in school with 30 kids in a classroom.

Most of these can be symptoms of many things - the list reads like an exact description of my older dd from 4-7 years old - when she was living with an undiagnosed vision issue.

Different root causes can result in similar outward symptoms - things like "anxiety" and "forgetful" or "lacks self confidence" aren't really definitive descriptors as much as they are actions of a child who is struggling because they can't do what they want to or are attempting to do - no matter what the *reason* is or the task is. It's a bit like a very young child who isn't old enough to know how to speak to communicate needs and wants - the child cries to communicate - that could mean the child is hungry, or that his diaper is wet, or that he's scared or lonely or etc

My gut feeling is that the best thing to do is to rely on a comprehensive evaluation of the full child's functioning - which I am guessing you already have - I suspect that's how you arrived at the ASD diagnosis. If there was a reason to suspect CAPD, I suspect it would have been noted by your evaluator.. however, if you were in the position that you feel like you took your dd to a specialist who only deals with autism and only looks for that one specific diagnosis vs evaluating the whole child, then perhaps it's possible something else was missed. Before seeking a CAPD eval, however, I'd first really dig in and read and try to understand what CAPD actually is and look at your dd through that filter before just assuming that the behaviors on the list above indicate a reason for concern (re CAPD).

On the flip side, my older dd (mentioned earlier in this reply, the dd with the vision challenge and who was exhibiting all the list of symptoms/behaviors above) *was* referred for a CAPD assessment by a psychologist when she was 5 years old. We took her to the psych for testing because she could *not* follow a multi-step direction if her life depended on it, she had a ton of sensory issues, and she became so anxious in new locations that she would have epic meltdowns that I can't even begin to describe. The CAPD assessment didn't find anything - but I mention it because it also didn't cost much (relative to many of the other types of testing we've been through), and I am fairly certain our insurance covered it. It was fun for dd (except for the hearing test inside a sound booth), and it only lasted about an hour. Soo... in other words, if you are worried about it, go ahead and get an assessment. If you find out it's not CAPD, that's a *good* thing, and if you find out it *is*, you'll be happy you had the eval when you did and didn't wait.

Best wishes,

polarbear

I have wondered that exact thing about my DS! Are there interventions that differ dramatically from what you are already doing, if it is CAPD? I googled the ear filter--and my first thought was, that might work for a seven year old, but doubt a much older child would be willing to use them in the classroom.

Sometimes I wonder if ALL these diagnoses that are so related are just really the same thing, through different lenses. I guess Quirky Wiring isn't a comprehensive enough label. I've seen (noise canceling?) headphones on autism supplies websites. I know the ear filter is somehow different, but it's interesting to me that noise is such a problem for ASD, ADHD, CAPD, SPD and as polarbear mentions above, even vision issues.

Would it be possible to experiment with headphones, before making a trip and spending more money in search of answers?

Earlier this year DD10 went through an extremely comprehensive eval with a 2E specialist recommended by the Eides and we came out with a list a mile long of evaluations to follow up on. CAPD was at the top of the list. I couldn't understand why since she learns everything auditorally and matches very few things on the list above. Sure enough she was diagnosed with CAPD. I was shocked. She is not on the spectrum but I thought our experience might be helpful.

Some things I learned: Very few places in my state still evaluate for CAPD. I had to start with the ENT who said her hearing was perfect and she had no processing issue as far as he could tell. Because we have known him since before DD was born he followed through for us and gave me the names of the only 4 places in my state that still evaluated for CAPD. I called them and found out there is a high standard of review you need to pass to even be consider eligible for a CAPD eval. We had it all but it otherwise could have taken many months to gather all the documentation to even be considered.

On the day of the evaluation the audiologist was clear that in her mind this was a "rule out" assessment. She had no reason to believe that DD had CAPD but there was enough going on with her it was important to get this one off the table. She was almost as surprised as I was to get the results.

The good news is that it was a relatively easy, fast thing to address, DD had to spend 6-8 weeks training her left ear to listen through increasingly distracting sounds coming in to her right ear. She spent mornings on the school bus listening to an audio book with the earbud only in her left ear. For the first week or so she had the background noise of the bus in her right ear. As the weeks went on she progressed to music in her right ear, softly at first and then getting increasingly louder. Then she moved on to text in her right ear. The last week or so she had the same audio book in her right ear but at a different part of the book so she was listening to the same reader - same voice, same tempo, same type of language being used. Again this started low and got increasingly louder as she filtered through it to listen to the "real" book in her left ear. Relatively painless and inexpensive.

School starts next week and she will occasionally revisit the ear training on the bus but won't be doing it daily. She is in an OOD spec Ed placement so we didn't need a lot of accommodations for CAPD - already a tiny size class and responsive spec Ed teachers. We adjusted her IEP to allow for flexible seating so she can move as needed to adjust to whatever sounds she might have to work around.

I think if there is a concern it's definitely worth checking out. I had to drive a couple of hours to get her tested but it was covered by insurance and provided useful info. The audiologist also picked up on a likely motor speech issue and sent us on for a speech eval that eventually identified dysarthria which may end up being a much bigger piece of the puzzle. So all in all I'm happy we followed through.

As all have noted, auditory processing issues are hard to pin down, because they overlap so much with, well, everything, and most especially ADHD.

The list you have above is particularly generic, in that it focuses on impacts more than symptoms. Before deciding whether you need assessment or not, it would be worth surfing some more in-depth descriptions which pin down some of the more unique-to-ADP issues.

A first question would be, do you find he often seems to hear something quite different than what was said to him? In particular, when he IS listening and engaged, does he still seem to make errors in understanding what was asked of him? Does he answer the wrong question? Do you see frustration in him because he is trying to understand what you say, but can’t, because something is garbled in the translation? What you’re looking for isn’t whether he can stay on task or know how to implement directions, for instance, but rather whether he heard the wrong directions in the first place, even when listening carefully. Does he ask you to repeat yourself a lot?

And if so, does the problem get noticeable worse when there are any kind of competing noise sources, like other people in the room, or TV on, or outdoors or in a restaurant, for example?

Unfortunately, ADP is not particularly remediable, but it can be accommodated. Evidence is poor regarding best practice (but it's a little more complicated than noise-cancelling headphones, alas).

Here’s a couple of sites I have used that seem fairly reliable for starter info:

http://kidshealth.org/parent/medical/ears/central_auditory.html#
http://www.asha.org/public/hearing/Understanding-Auditory-Processing-Disorders-in-Children/
http://hearingloss.ca/pdf/Auditory%20Processing%20Disorders.pdf

Hope this helps!

FWIW, we tested my DD for CAPD for similar issues (in particular, she spaced out/got distracted in noisy places, hated loud sounds, had trouble hearing directions in crowds, had been labeled a daydreamer, and sometimes struggled with multi-part directions) and she aced the test--passed it with flying colors. So whatever her issues are (may be ASD, anxiety, or ADHD), it looked to us like CAPD at the time, but was not. She was tested at a highly regarded university clinic that does many of these assessments. FWIW, she also outgrew some of this stuff. Fire drills used to be a real problem, for instance, but she's acclimated.

I could be off base but I'm guessing that kids with CAPD would have trouble with early reading with phonics...wouldn't they mix up words like bad and dab? Of course gifted kids can probably compensate for this better than most (perhaps covering up the problem), but I'm thinking that the super early readers probably do not have CAPD unless they are reading by the whole-word sight method.

We have tried noise-cancelling headphones with DD, or headphones with music, and she rips them off saying she can't stand it. It's almost like she's seeking out stimuli. One the one hand it causes her to lose focus, but on the other hand she's seeking it out. She has pretty obvious ADHD because of the impulsivity/hyperactivity as well as inattentiveness.

This sounds exactly like DS. Fire drills have historically been a huge problem, also, but better over time. When we walk into his school building together--there is a complete change of affect, immediately. He goes straight into lala land and I can no longer communicate with him. I see some improvement on new med regimen, though.

Ugh! Also sounds familiar. It's so difficult when the child can't stand any of the things we try to do to help. I don't have a point, just commiserating. My DS is very resistant to this type of intervention. Or, as far as that goes, any time of intervention...

This may be completely off base, but DS recent testing said his "auditory working memory" tested in superior range. NP did note that was in a quiet setting with no distractions. I don't know how a child with CAPD performs on that portion of IQ testing--perhaps it's irrelevant since there are no competing stimuli.