CAPD or CENTRAL AUDITORY PROCESSING DISORDER

Patti Martin, in her emails to me made reference to a condition she calls 'auditory processing issues' I am assuming she is referring to Central Auditory Processing Disorder.  CAPD is not very well understood by many professionals, no one can 'pin point' exactly where the malfunction may be, and in our experience many professionals question the validity of the diagnosis (site, last ¶).  I am not a believer myself.


The problem that I have with it is the fact that a hearing impairment must be ruled out first.  If you have a patient presenting with a loss like my sons, which apparently is not significantly recognized, then a hearing loss may be over sighted en route to a diagnosis of CAPD. Now all people of any age with a hearing impairment of any degree will have poor auditory skills including attention and memory; hearing impairment presents with the like APD. If you think about it, you don't pay attention to, what sounds like, meaningless noise and you don't remember what you don't hear. That being said, many times the treatment for CAPD will involve an FM system or a hearing aid.  Which says to me hearing impairment.  


CAPD presents with a Pure Tone Average considered in the normal range (25dB yesterday and 15dB today) and a normal ABR.  In other words, the PTA detects normal hearing at the middle ear/Cochlear level and the ABR detects normal hearing at the brain stem level.  So somewhere between the cochlea and the brain stem, the message gets scrambled enough that it is not understood, but it gets to the brain stem. It does not make sense. Now considering that it is much easier to hear a tone and know it was a tone, than it is to hear a message and know what the message said; it is a very hard task to hear a message at the quietest level your ears can hear and understand it.  So consider that the message was just too quiet to understand in the first place;  it may well have been a tone which carried no message. Yet hearing aids or an FM system is a remedy for the problem; turn up the volume and the message is no longer scrambled? Maybe it was never scrambled in the first place.


Before we can invent new diagnosis like CAPD of which validity is questioned by many professionals in the field (site, last ¶), a minimal level and even a more minimal level of hearing impairment needs to be considered.