Some children may not only be diagnosed with autism but also have other issues and diagnoses as well. A common secondary diagnosis for some children with autism is Auditory Processing disorder or Central Auditory Processing Disorder (CAPD.) CAPD or auditory processing issues does not mean a child cannot hear. In brief, the child most likely has hearing issues. Hearing issues in CAPD or auditory processing issues could be some of the following:
- They may not hearing all pitches of sounds (e.g., high sounds or low sounds.)
- They may have significant issues with background noise
- They may have auditory processing issues (for example: confusing the questions “How are you?” and “How old are you?”
An audiologist specializing in auditory processing issues or CAPD would be able to do a complete evaluation on your child much further beyond a audiology hearing exam. In fact, many parents do both the audiology exam AND an auditory processing or CAPD exam. In addition current providers such as a speech pathologist, a neuropyschologist or behavioral in-home provider of ABA can provide important clues about this issue for a child.
This document attempts to outline one parents findings (not a professional) for a dual diagnosis of autism and auditory processing issues. Outlined are web resources, reading materials and personal findings via the process and treatment of auditory processing issues.
Testing for a Central Auditory Processing Disorder (CAPD)?
Testing for Central Auditory Processing Disorder or auditory processing issues in general takes a dedicated and educated audiologist that understand autism and the hearing disorder. Testing generally involves a parent intake evaluation and a hearing evaluation that includes back ground noise, distractions and similar sounding word commands. Testing also includes an office evaluation and typically a “hearing booth” assessment while the child wears head phones.
Resources – What Are Some Treatments for CAPD/Auditory Processing?
There are tools to help the children with Auditory Processing Disorder and Central Auditory Processing Disorder hear better, exercise their brain, or assist in neural re-training. Some of these include:
- Random rotation of WH? Questions in home and school settings
- Fast ForWord Levels 1-4
- Linguisystems CAPD booklets (a list is available in the Personal Experiences section below)
- Tomatis Sound Listening Therapy
- Interactive Metranome
- Earobics Software
- Acquiring and using a auditory trainer (see notes below for details and recommended vendors)
There are many other therapies and protocols available. It is important to work with a team of professionals that will evaluate the unique needs of the child to make recommendations appropriately designed for them. The above listing are a few suggestions.
Some Personal Experiences for Auditory Processing/CAPD
The auditory processing route both in testing and treatment has done some wonderful things for my son Jeff. Jeff is currently diagnosed as autistic and now also has an auditory processing diagnosis as well.
Jeff had an auditory processing disorder and CAPD (Central Auditory Processing Disorder) exam with a local provider in early December 2003 and found that he had big-time issues distinguishing sounds in his right ear with any background noise. Clues were coming from us, his parents, and in addition his behavorial supervisor and speech pathologist recommended an audiological / CAPD exam.
It is important to note, he does not have a hearing problem. It is the issue of background noise and processing. Basically, ours and other professional observations are that Jeff was only “getting” every 2 words of a typical sentence and not hearing all the words or directions people gave him. There is a lot more to the diagnosis; I am just paraphrasing the highlights of the findings. Please consult your professionals for detailed information and research as it relates to your child.
Since the complete evaluation and report were completed, we got him fitted with an auditory trainer, commonly referred to as a “FM device.” Jeff used to use the auditory trainer in therapy sessions and school. Now he uses the device only at school. The teacher (or aide, if they are on the playground) wears a device that resembles a microphone, while_my son wears something that resembles a hearing aid.
The data and personal observations demonstrate that this trainer has been a big help for him. There is a large difference with the trainer IN his ear and his listening abilities and now even more so, with the trainer out of his ear. He is talking more, definitely hearing more by his responses, especially to first requests. What the strangest thing is that it is like Jeff is hearing entire sentences for the first time versus only partially hearing them. I have found he is hearing even better without the trainer due to knowing how to concentrate and what hearing is like. More information on auditory trainers can be found at: www.phonak.com.
At the time, the initial evaluation and report was $350 and the trainer was $1800. The reports and device had a prescription from Jeff’s doctor and 70% of costs were reimbursed by health insurance (PPO.)
In addition, I realize that it may haven been also possible that the district COULD have covered the costs of the device, but we chose to go the health insurance route instead. This is a personal decision and of course, your decision is up to you. It was well worth the process and fees to get the equipment and tests, regardless of whether or not we got any money back.
Some Additional Important Suggestions
- Device used was a FM Auditory trainer by Phonak. It is the Micro Ear Auditory Trainer & X2T transmitter from www.phonak.com
- The initial test period for the auditory trainer started December 15, 2003 for one week before the holiday break and has been used continually since that time. I did have Jeff NOT wear the device for two following days. People working with Jeff at school noticed the difference of Jeff not wearing the device on these days.
- The evaluation forms were completed by Jeff’s teacher and his two school aides. All forms suggested a positive response to the auditory trainer and recommended continued usage of the device.
- Our program specialist and speech pathologist made the recommendation for Jeff to be evaluated by a CAPD specialist.
- Update: Jeff continues to use this device In fifth grade for the 2008-2009 school year with continued benefits.
- Our observations, prior to the use of the device, were that Jeff was only hearing 2-3 words of 7-8 word sentences. He would often fill in the blanks and guess at the requests, with his response based on the few words heard.
- After the use of the device (using both in-home with parents, in-home with aides and at school), we have found Jeff listens better with and without the device.
- From Carol Atkins’ CAPD report and findings, we notice when there is any background noise, Jeff has a harder time paying attention and responding to a request.
- Jeff is using the Linguisystem–CAPD kit book 2, “Scissors, Glue & Concepts Too” and “Scissors Glue, and Grammar, Too” in the home program with great success. He is distinguishing much better between multi-step and similar instructions and responding appropriately. Practicing listening and following directions are good things to reinforce with children who have auditory processing issues.
- The device has been wonderful for playground interaction/social skills, group activities (auditorium, library visits, and school assemblies) and class instruction as a non-invasive way to remind Jeff what to do or get him back on task and assisting with social skills.
- Some auditory trainers can pick up cell phone conversations from drivers passing by the school, kids with walkie talkies playing in their backyard behind the school, a hand radio operator across the street and other radio frequencies. (TALK ABOUT OUR POOR KIDS BEING CONFUSED ENOUGH AS IT IS!) There are lots of inexpensive options where feedback like the ones above can be a problem. There are more expensive ones (about 2x to 3x increase in the price) that operate on different frequencies that are more reliable at not allowing interruptions by these interference examples.
- The ear piece on a more expensive model can be something that is fit to the child’s ear. It is a very small device that you can see if you really look at Jeff’s ear, otherwise you wouldn’t notice it right away. The ear piece is worn in one ear therefore allowing the child to hear with his other ear and interact with the other environment sounds: conversations, other kids, the school bell for lunch, etc.
- We saw such benefits with Jeff and this device so we bought two devices for the teacher and Jeff’s aide that could be programmed onto the same unique frequency. This does not confuse him to have two people microphoned in his ear as long as they turn their microphone off when talking to other kids or teachers, or have conversations not involving the class/Jeff. The microphones can be acquired as small clip-on mics with a small transmitter (the size of a beeper) attached to the belt. It is pretty easy to wear and walk around and talk without knowing it is there. The 2nd device I bought for the aide is a much larger device that can be worn around the neck (the aides call it a Bolero!). The device can be taken off the chain and placed on the table for when a librarian reads a book or a school assembly to pick up the sound into Jeff’s receiver.
I was once asked: “I’d also like to know how they diagnosed the problem and how it went undiagnosed for so long.” I don’t think I would recommend this route really early on in the autism diagnosis. There are other things that can be evaluated first. In addition, many professionals don’t like to evaluate or diagnose CAPD issues until after the age of 6 due to key brain milestones that should occur on or about that time frame. Again, these are just my uneducated thoughts as a parent. Please talk with your doctor about any concerns or questions you might have.
As with any treatment or therapy for autism, it may not always work for every child. Please work with your doctor and professional team in identifying and meeting their unique needs.
For our son, his auditory processing disorder has greatly benefited from daily exercise and a variety of therapies to help him better hear and understand the world around him.