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How do you tell the difference between APD and ADD?


SKL
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I'm pretty sure my dd has a problem with auditory processing. She hasn't been formally tested, but I have been told all of the following by different folks:

  • Yes, she definitely has APD.
  • There is no such thing as APD; it's just another name for ADD.
  • It is very hard to distinguish between APD and ADD.

 

My dd is 6. Here's an example of what I see in school-related work:

 

Me: "Give me an example of how schools were different in the past compared to the present."

She: "In the past, there were no telephones."

Me: "Listen again. Give me an example of how SCHOOLS were different in the past."

She: "Oh. They didn't have computers in the schools in those days."

 

Her teacher comments that she's often more aware of what's going on with her classmates than what's on her paper. However, she happens to be a very social girl and interested in her friends. When not in school, she'll often wonder aloud what her friends are doing, including her old friends and teachers at the daycare she attended last year. I don't think that in her case, curiosity about her classmates indicates ADD.

 

Then again, I don't know what ADD looks like. I just know my dd does not get what she's being asked to do in school.

 

Do any of you have any idea how to tell the difference?

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#3 is what we've been told by both an audiologist who specializes in CAPD testing and also our family's pediatric neurologist. The AudD. wouldn't perform the second part of the CAPD testing until oldest DD had first gotten a full neuropsychological evaluation to rule out attention and/or working memory issues. We haven't yet done the NP eval for a number of reasons, but I do plan on it before she gets to H.S.

 

One thing you should be aware of is that most audiologists will not test for CAPD until the child is 7 or 8 because before then it can be difficult to distinguish between natural "late bloomers" and those who actually have CAPD.

 

Given other things you've mentioned about your DD in some of your other posts, you may want to consider having her evaluated by a neuropsych at some point.

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Girl adhd at age 6? Short, super-short lessons. Needing physical activity between. Impulsivity. Clutter. Extreme, off the charts creativity. Imaginative play beyond the norm (which you may not realize if it's your first). Caffeine flip (tired with caffeine, even in small amounts like hot chocolate). Prefers to move/play during read alouds.

 

I'd look at the extreme creativity and the caffeine flip as pretty definitive, personally. The former shows brain dominance and the latter shows the chemical side.

 

PS. Not a doc, just what I say. ;)

 

She definitely isn't hyperactive, though; she's always been pretty calm (when she isn't sugared up). She's pretty organized and neat; a great planner, but a late bloomer when it comes to imaginative play. She does need physical activity to be really centered, but not all through the day. She can sit through an hour of Singapore math (which is very slow-going for her) without becoming difficult.

 

Not sure about the caffeine. I haven't noted any effect on her at all. It certainly doesn't wire her.

 

I am sure she doesn't have ADHD, but I was wondering about ADD. I have heard people speak as though ADD looks a lot different from ADHD.

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A critical difference is that ADD effects attention on all activities.

But with APD, it's not an underlying attention problem.

With APD their is a difficulty with processing sound, so that extra attention needs to be devoted to it, to process the sound.

Which reduces the amount of attention that can be given to understanding what we are hearing.

 

Though you wrote that she's pretty organized and neat, a great planner. Where difficulties with organizing and planning are primary indicator of ADD, as this involves a great deal of attention.

You also wrote: 'I just know my dd does not get what she's being asked to do in school.'

But I would suggest that this isn't a problem when 'shown' what to do ? As no auditory processing is involved.

So that the key point, is that ADD effects attention globally.

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My son has CAPD without ADD or ADHD. It's what Geodob said- his issues have to do with sound processing, whether its over processing or under processing sound. At the worst (he's improved with therapy), he would intermittently be unable to understand speech and would guess at what people were saying. Btw, this "blanking out" of words when he's listening is inconsistent, so that at times, he hears perfectly, but not at other times. He also has attention issues when there is sound present - the whirring of an overhead fan is enough to crowd out what the teacher is saying in a classroom. Change the conditions and his attention issues go away (largely). It's a complex situation with many co-morbidities, and poor auditory processing may not be the only symptom.

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I'll share a bit of our journey. Very hyper as younger child. Not good in group situations. Would often play alone rather than integrate in group activities. Not good at following directions. Difficulties transitioning. Somewhat creative, but not especially so. Quiet. Very strong academically and great test performance. Started to have difficulties in class work in 4th and 5th grades in ps, before hsing.

 

Once I learned about CAPD, right away I thought, "This is it!" We went to a local audiologist for a screening who said, "It's not CAPD, so with those behaviors, it must be ADHD." I wasn't convinced but thought it could be. A few years later, I decided to get an educational evaluation. The WISC was all I could afford. There was scatter on the test, but nothing definitive. I asked the psychologist, "Is it ADHD?" And she said, "That's a medical diagnosis so I can't tell you." She certainly did not encourage me to pursue that avenue either.

 

Meanwhile, a couple more years passed and it became clearer that the behaviors that I thought of as ADHD, the hyperactivity, impulsivity, and inattention seemed to resolve. She was planning and carrying out tasks well, though slowly. Her attention span was excellent. She just missed verbal instructions and the content of discussions to an unnerving degree, particularly in group situations like coop classes. That's when I realized I had to follow up again and get to the bottom of it because I knew this would hurt her in the future. This time I went to a children's hospital that I trusted that had an audiology department and people who knew CAPD. After hours of specialized testing, we got the CAPD diagnosis.

 

After more time passed, I decided to get a neuropsych evaluation to make sure all our bases were covered, that there wasn't some ADHD in the mix, or any other learning disability. I haven't received the report yet, but I've met with the neuropsych and we know without a doubt, she does not have ADHD.

 

I'm telling you this story to confirm that it's really hard to figure out the difference. It wasn't until dd was in her mid-teens that issues seemed to become clarified through careful observation of her behavior in different situations. And I still needed the evaluations by the audiologist and neuropsych to be sure.

 

I wish you luck on your own journey. It's not easy. I never had these boards when dd was younger. It took a long time to find out about different quirks, and I'm still learning. I always want to encourage moms with younger kids to follow their instincts and find good professionals to help. My dd had to endure a lot of criticism and correction because we had no idea what we were dealing with. We didn't know what was in her control and what wasn't. How hurtful it must have been for her to hear, "Could you please try to listen?!!" and "I told you...." again and again. It's hard enough for a child to have to manage with a disability without having their family make it worse for them.

 

HTH!

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I am concerned that there is too much readiness to diagnose ADHD without even considering APD. I am trying to get a referral to an audiologist, but it seems to be very hard to accomplish. I guess if I could have a list of traits that could rule out one or the other, that might help me to get to the next step.

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You know, Tiramisu, when you list it all out like that, it looks NOTHING like my list, eh? I mean literally, for thing after thing, your list is the total inverse, the opposite. Social withdrawal vs. life of party. Extreme creativity and over the top xyz vs. very typical level creativity. Not hyperactive (adhd subtype inattentive) vs. hyper levels of activity (CAPD). No difficulty following directions if she remembers them (adhd) vs. difficulty following directions (CAPD). Needs extra work for connections and basic facts, can seem oddly challenged and bright at the same time academically (ADHD) vs. strong academically (CAPD).

 

So really, on every major point, when you look at the *profile* of the kids, not just activity level (hyper, not hyper), it's a pretty different. I understand though what you're saying about that hyper level of activity being confusing. I knew a dc when she was young who was wilder than wild, like uncontrollably wild. The dc started with an ADHD label and did eventually get that tossed for CAPD when the mother perservered. I think, like you've found, that the outward behaviors were a form of sensory defensiveness.

 

Your list got me thinking. ;)

 

And I love your comment about sensory defensiveness. Oh, if I knew then...

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I am concerned that there is too much readiness to diagnose ADHD without even considering APD. I am trying to get a referral to an audiologist, but it seems to be very hard to accomplish. I guess if I could have a list of traits that could rule out one or the other, that might help me to get to the next step.

 

There should be a list online with traits of APD and ADHD lined up next to each other. At least, I think I've seen one before. Maybe I'll go look for one.

 

Also, you are right on about your comment regarding readiness to dx ADHD without considering APD. APD is supposed to be as prevalent as AHDH, something like 5 to 10% of the population has it, but most people have not even heard of it before.

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I recently attended an APD teacher workshop presented by Dr. Jay Lucker. He also indicated how difficult it is to distinguish ADD from APD attention problems. He did give an example situation to help us understand the difference. A child is sitting in class listening to the teacher and some kids start playing outside. The child with APD attention problems will change focus to the children outside, but will revert focus back to the teacher. The competing outside sound will make it difficult to "hear" the teacher. This child will have got about 50% of what the teacher discussed. On the other hand, the child with ADD will change focus to the children outside and never revert back to the teacher. The ADD child will have got 0% of what the teacher discussed. I know this is a simple example, but it provides some ideas.

 

I don't believe it is possible via a forum to rule one out over the other...even the professionals have difficulty. If you decide to see an audiologist, I would find an audiologist VERY experienced in dealing with APD. Don't just find an audiologist who can test for it, but someone who can INTERPRET the results. So many will say they can perform an APD evaluation, but they don't know how to interpret the scores. Performing the evaluation is the easy part (we could do it with a couple of hours of instruction). Unfortunately, this is all too common and in the end you will have scores, some canned printout of what to do next and lots of confusion. The APD tests will include an Auditory Continuous Performance Test. This is a screening test for ADD. A good audiologist will know enough about ADD and can interpret your results enough to refer you to a psych for further ADD testing if necessary.

 

BTW: There are different types of APD and it is really important to determine what type of APD (if any) your daugher has. Just saying a child has APD is not enough to determine what issues the child has and more importantly how to treat.

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I think a lot of things look like ADD.

 

I think it means the teacher is concerned and knows something is off.

 

I just went last week to my son's IEP meeting where there were concerns from his teacher and she thought ADD, but when we went to the meeting, the school psychologist said our questionairres didn't reflect that (he has more than average distractible behavior but not particularly high). Then the OT gave her report and that has turned out to be a big problem area. I literally had no idea, and neither did his teacher.

 

I totally think his teacher did the right thing in bringing it up. But she is not the one to be more specific, she just knows there is a problem.

 

So anyway -- maybe you are at the teacher concern level, and will have a better chance to get into this stuff in a more appropriate context?

 

I hope so at least!

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I have not. I don't think he has symptoms, though what do I know, lol. He is just now 7 so he is young. (I mean, issues outside of sound discrimination..... He really seems to hear fine in all environments, with the ocassional misunderstanding, and then always involving his most intransigent speech sounds -- certain short consonants.)

 

He has lingering problems with his sound discrimination but it is minor now and I have hopes of it becoming more minor as he reads and gets to know what letters are in words.

 

But it is something where he is working a little harder than other people when listening, still.

 

For this latest thing, his distractible behavior, in retrospect, seems to really coincide with being asked to write or at a time involving a motor task he would not be good at.

 

Or so it seems for now, and I can only do one thing at a time, and this raises OT and VT as things to pursue now.

 

Edit: I was trying to make a point, that teacher suspicion of ADD seems to have worked out well for my son, so maybe it will work out that way for op also.

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/serial

 

I had a disagreement with my husband, he didn't want to allow the screening for ADD/ADHD, and I did.

 

He thought they would try to pressure me into putting him on medicine, and that I would cave to their pressure/authority.

 

Not the best.

 

So I would say -- no need to cross that bridge at this point. I would not expect a classroom teacher to know more than that there is a problem and the behaviors she sees in class are x and y. With nothing at all against teachers, saying that. I am very happy with my son's teacher this year.

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My ds4 has verbal apraxia, which of course always begs the question of whether there are any auditory processing issues. I've thought of taking him at least to be screened. The idea that I could get what amounts to an ADD screening *and* the APD in one place, well that's even better. It hadn't occurred to me they had such a test, but it makes sense. Is the screening typically 1 hour? 2? Affordable or expensive?

 

I took my oldest to see an audiologist who specializes in CAPD testing for the local children's hospital. It was a 3 hour appointment, and included a whole bunch of brief tests (including one for ADD, which my DD did pass) to narrow down the areas for further testing. The audiologist did recommend the second round, but only after a full neuropsych eval to rule out attention and/or working memory issues. The cost of the first part of CAPD testing was ~$1800 after the insurance discount, and we paid our normal 10% cost-share. I live in an expensive area, so I would imagine that where you live in the Midwest the cost would be lower.

 

The audiologist we saw won't test kids younger than 8.

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Just to be clear, the teacher has not stated that she thinks my kid has ADD. She made some comments on her report card:

 

1st quarter: "potential is much higher than this, but needs to try harder and pay attention."

 

2nd quarter: "has trouble following directions." ... "easily distracted or disinterested."

 

And the teacher has repeated many times that she is always a step behind the class. (My daughter says the same thing.) She hears the oral instruction, fails to process it, and then tries to figure out the answer herself as the class moves on. My daughter feels she needs more time to process the instruction compared to the other kids.

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I found this interesting:

 

http://www.smartspee...l-age-children/

 

 

Yes, much of this is what Dr Jay Lucker discussed at the workshop I attended. Dr. Jay couldn't stress enough that if we leave with knowing only one thing it is that APD is not singular auditory processing disorder. It is auditory processing disorders (plural). Which reaffirmed what I heard in another workshop with a psychologist that presented on APD. She had indicated that of all the clients she has tested with APD, no two looked alike.

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I took my oldest to see an audiologist who specializes in CAPD testing for the local children's hospital. It was a 3 hour appointment, and included a whole bunch of brief tests (including one for ADD, which my DD did pass) to narrow down the areas for further testing. The audiologist did recommend the second round, but only after a full neuropsych eval to rule out attention and/or working memory issues. The cost of the first part of CAPD testing was ~$1800 after the insurance discount, and we paid our normal 10% cost-share. I live in an expensive area, so I would imagine that where you live in the Midwest the cost would be lower.

 

The audiologist we saw won't test kids younger than 8.

 

 

This leads in exactly to what I always tell my husband. It takes a team of individuals to properly diagnose these complex LDs and wouldn't it be nice if there was some communication between them!! For a 100% complete evaluation of APD I think we need an SLP, OT, audiologist and psychologist.

 

OhElizabeth, just to clarify I’m only a parent and don’t have any authority on this subject. I’m still trying to determine whether my son has ADD in addition to APD. I can forward Dr. Jay’s email address to you. He seemed very open to responding to emails. Not sure if you have heard about him, but he has been working with APD for over 30 years.

 

I've always heard age 7 is the magic testing age for APD . My son was tested at 7. I suspected APD even earlier and he certainly showed clear signs prior to age 7. Dr. Jay referred to working with children as young as 5 (this was in the context of research studies). Dr. Maxine Young, audiologist that moderates an APD yahoo group, says that there are APD tests with normative data for kids as young as 4.5.

 

The ACPT test is really just a screening. The test itself doesn’t take very long (10 minutes)…it is just one of the many tests that are performed during the testing. Again, it is just a screening and that is why I think you need a good audiologist who can look at information from parents/teachers and the results of the other tests to help you determine if further testing for ADD is necessary. I’ve read that some kids have passed the ACPT test and still have ADD and that some young children can fail the test, but not have ADD…helpful right?! Again I think it takes a good Dr to look at everything on a case-by-case basis. My son is one of the latter. He failed the ACPT test, but I’m not convinced that he has ADD. Unfortunately, our audiologist was one that can administer a test but not help with the interpretation. Sighhh. Our audiologist experience is what I have heard from other parents and an area that Dr. Jay also touched on.

 

Finding the right doctor/therapist for my son has been one of the most frustrating parts of this journey. Now, I generally interview the therapists/Drs that I work with. A couple of quick questions with our audiologist would have told me she doesn’t have much experience with APD. I ask questions such as, “How do you test for this?†“How do you distinguish this from this?†“How many kids have you worked with that have this condition?†“How do you generally treat this?†and the most revealing question “Why, do you recommend this treatment?â€

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I took my oldest to see an audiologist who specializes in CAPD testing for the local children's hospital. It was a 3 hour appointment, and included a whole bunch of brief tests (including one for ADD, which my DD did pass) to narrow down the areas for further testing. The audiologist did recommend the second round, but only after a full neuropsych eval to rule out attention and/or working memory issues.

 

 

This happened to us as well. At 7, I took ds to the children's hospital which had a specialist unit for CAPD. The tester was different from the CAPD specialist who was a professor of audiology at the university. The tester did a screen in a room that had all sort of gadgets which my son just couldn't stop fidgeting with because, well, they're really interesting. She didn't even give instructions not to touch the panels (I was in the same room), many of which were not live. After the screen, she recommended that ds be tested for attention deficit before moving on to the full audiology test. I was very confused because, while I knew about ds' issues about sound, here are "experts" telling me it's something else. We didn't continue with the testing because I knew they were off the mark. Still though, I became doubtful about my own understanding. About a year later, we saw a private audiologist where we were told, it was without a doubt that he had CAPD. It took a second audiology test the following year to fully convince me that my intuition was right so many years prior!

 

So yup, I agree. Finding the right professionals who have an understanding of even how kids work is critical. For us, the NP we went to helped to co-ordinate all of ds' issues. They plowed through ds' old reports for OT, vision, and audiology, and integrated our understanding. They even picked out subtle issues that were presented in the charts of the tests but were not highlighted as problems. I'm just glad we didn't stop searching for answers!

 

BTW, we considered seeing Dr Jay Lucker, but settled on our NP for an overall understanding of our child. Dr Jay Lucker's book, "Don't You Get It", is key to understanding what it is like to have CAPD.

 

http://www.amazon.com/Dont-Living-Auditory-Learning-Disabilites/dp/B002QDIYYS

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