WWYD -- suspected CAPD

[Staceyshoe]

I'm suspecting CAPD in my 5 year old.  He's always been somewhat delayed with speech and still has some issues (words in the wrong order in sentences, trouble with pronouns, mild pronunciation errors that don't respond to gentle correction, and just very "immature" speech *constantly* using words such as "go-ed" instead of "gone" etc).  At this point, he's a little behind in speech but nothing that causes me great concern.  He has begun to receive some speech therapy from the public school.  Apparently, the teacher noticed issues and referred him, but the speech therapist told me that he has advanced language skills.  (I suspect that he is doing better than many of her cases, but there's no question that he's below "normal" in his language---probably hovering near that boundary.)

My REAL concern is not his speech but his ability to understand speech and remember what he hears.  I am realizing more and more that this is really beyond "normal."  I suspect that the speech issues are a symptom of an auditory processing problem.  He is quite bright and picks up very well on non-verbal cues.  Just recently, I realized that we were having entire conversations and he was answering questions without having the first clue what we were talking about.  He's quite the master at gauging what an appropriate response would be when he has no idea what was asked.  He's made huge strides in his auditory processing and speech this past year.  (Learning to read seemed to "awaken" that part of his brain, and he does not have any issues with phonics though there are a few sounds he cannot distinguish from each other.)  He absolutely cannot follow multi-step directions.  He cannot hold more than one sentence in his head at a time, so if I make a statement followed by a question--he has no idea what I stated before the question.  He doesn't follow conversations.  Yet many other common aspects of CAPD are not present.  I am concerned that the symptoms he does have will negatively impact his life if we don't address them.

My gut feeling is that it's time to seek an evaluation to confirm or rule out CAPD.  What do you think?  Am I jumping too far ahead?  How would I find someone who specializes in this?  Does it make sense to do the evaluation now or try some techniques at home to see whether he improves?  (And, if so, what would I try? 

ETA:  I should mention that this is not a focus issue.  I can get right down at his level and ask him to listen, say a simple sentence, and ask him to repeat it.  50% of the time, he can't.  (A year ago, this was 100% of the time even after multiple repetitions.)  He can look at me and concentrate with furrowed brow and still not know what I've said sometimes.  He *tries* to follow multi-step directions but can't hold them in his head long enough even if he was able to repeat them back to me (which he usually can't).  His attention span is unusually long for a child his age.

[Lecka]

"There are a few sounds he cannot distinguish from each other."

 

This is a problem. It can be called things with phonological like phonological processing or awareness.

 

There are things to do for it ranging from less to more intensive.

 

Most intensive is speech therapy aimed at this (ask, don't assume it is a goal). Or, LIPS by Lindamood Bell. People also like Earobics a computer software but I have reservations bc I tried a competing program called Hear Builder from Super Duper and my son couldn't do it. But those are both medium-intense I would say.

 

Least intense but possibly a great fit are to look at phonemic awareness games.

 

Also look for or make sorting games with "minimal pairs." This is when there are pictures of two things, like cap and cat, and words ending in the "t" sound go in the "t" pile. Of course maybe starting with the first sound instead of the last.

 

I would not have been able to figure out all of my son's confused pairs (and triples like s/sh/ch) without the speech therapist. But if it is just b/p then it might not be so bad.

 

There are games for this stuff. "Sound bingo" and stuff.

 

Everything I put is just for the sound discrimination.

 

It was a huge issue for my son but he is great with it now and reading at grade level. He did have trouble with phonics, too. And phonemic awareness.

 

Separately -- there are many visual supports you can incorporate. Let him follow directions from a picture list or something. Or present both and the visual support can be a scaffold.

 

Edit: I don't know anything about sequencing or other aspects of CAPD. Just that one part, and I feel very fortunate that my son has made such improvement. I still do a lot of visual support-type things. He does well with lists sometimes and with making lists with me to think things through. He does need time, too.

[geodob]

With CAPD, one type of difficulty, is with 'dichotic listening'?

With this, the problem is that their is a very slight delay in hearing in one ear.  Which despite being very slight, confuses hearing.

You could test for this by adapting your test of 'asking him to listen to you say a sentence, and then repeat it back to you', 

But this time, you have him block one ear, and then you sit on his other side, and say the sentence, for him to repeat.

Though have him look straight ahead, so that he can't read your lips.

 

Where as you have already tested him doing this with both ears, you have your '50% of the time' benchmark, to make a comparison.

This may not be an issue, but if it is, then you will observe an improvement on the 50%.

[Tiramisu]

With CAPD, one type of difficulty, is with 'dichotic listening'?

With this, the problem is that their is a very slight delay in hearing in one ear.  Which despite being very slight, confuses hearing.

You could test for this by adapting your test of 'asking him to listen to you say a sentence, and then repeat it back to you', 

But this time, you have him block one ear, and then you sit on his other side, and say the sentence, for him to repeat.

Though have him look straight ahead, so that he can't read your lips.

 

Where as you have already tested him doing this with both ears, you have your '50% of the time' benchmark, to make a comparison.

This may not be an issue, but if it is, then you will observe an improvement on the 50%.

 

Very interesting. 

 

My dd's problem is primarily in dichotic listening, and I always wondered how this could be tested without a sound booth. Cool idea!

 

This makes me want think of a method for figuring out if there's a speech-in-noise problem. 

[Tiramisu]

CAPD usually isn't tested for until age 7 or 8 because the timetable for the normal development of the auditory system. It's not considered reliable to test before then. You may want to start looking around your area in case you need to get on a waiting list. I had a good experience in a children's hospital because the audiologists were pediatric specialists who understood CAPD. I did not have such a good experience in a local audiology center.

 

ETA: You can still seek the advice of an audiologist for how to handle this situation. The audiologist can still do a thorough hearing evaluation, which they would do before a CAPD eval anyway.

[geodob]

Tiramisu, I've been doing some study and research into the 'speech in noise' problem, for some years.

Where I've been conducting trials into a remedial model.

A crucial factor with hearing, is that it can be focused in a similar way to vision.

As with 2 ears, we can use them to locate the direction a sound is coming from.

 

The trials simply involved a person sitting in the center of room, with their eyes closed.

Then a second person moves to different points around them, and then makes a noise.

Where the person sitting on the chair has to point in the direction that sound came from?

Most people involved in the trial had varying degrees of difficulty with locating the source of the sound.

Though when they practiced locating the sound, for a couple of minutes a day, most often the ability to locate the sounds, rapidly improved.

 

But from this, a second background sound was introduced, with a radio or TV at a low volume.  

Then pointing at the direction of a sound, from a second person is repeated.  

But this is done with the competing sound from the radio/TV.

Where one locates the sounds from the other person, despite the radio or TV?

Then the radio/TV volume is gradually increased. 

 

Which then changes from the other person making sounds, to them speaking a stream of words.  With the radio/TV in the background.

So that the person in the chair, practices holding their hearing focus on the speaker.

With the radio/TV volume being gradually increased.

Then a further exercise, simply involves having the TV and Radio on opposite sides, and to practice shifting the focus of our hearing from one to the other.

 

Though it basically just involves practicing to locate and focus our hearing at a point, which shifts other sound into the background.

 

[LaughingCat]

My REAL concern is not his speech but his ability to understand speech and remember what he hears. He absolutely cannot follow multi-step directions.  He cannot hold more than one sentence in his head at a time, so if I make a statement followed by a question--he has no idea what I stated before the question. 

 

  I can get right down at his level and ask him to listen, say a simple sentence, and ask him to repeat it.  50% of the time, he can't.  (A year ago, this was 100% of the time even after multiple repetitions.)  He can look at me and concentrate with furrowed brow and still not know what I've said sometimes.  He *tries* to follow multi-step directions but can't hold them in his head long enough even if he was able to repeat them back to me (which he usually can't).  His attention span is unusually long for a child his age.

 

This part sounds like Auditory Memory to me rather than CAPD (although certainly if he's not hearing it right he is going to struggle with this as well).    Most of the suggestions I've seen for auditory memory involve having the child repeat back  - number strings, follow directions etc, slowly up-ing the amount of data to be held in the brain.  Super duper has various products and Auditory Sequential Memory Instructional Workbook by Addie Cusimano  has number strings.

 

For pronunciation errors where she couldn't get the  correct pronunciation and sounds she couldn't distinguish (based on the Barton test)  - LIPS is what made a huge difference here.  

[Staceyshoe]

This part sounds like Auditory Memory to me rather than CAPD (although certainly if he's not hearing it right he is going to struggle with this as well).    Most of the suggestions I've seen for auditory memory involve having the child repeat back  - number strings, follow directions etc, slowly up-ing the amount of data to be held in the brain.  Super duper has various products and Auditory Sequential Memory Instructional Workbook by Addie Cusimano  has number strings.

 

For pronunciation errors where she couldn't get the  correct pronunciation and sounds she couldn't distinguish (based on the Barton test)  - LIPS is what made a huge difference here.  

 

Yes, the auditory memory is definitely a lot of what I'm seeing.  Thank you for sharing these resources!  Since it sounds like he may be too young for a CAPD evaluation, perhaps we can work on some of this and see whether it's still an issue.  I've been at a loss for how to help him improve in this area, and this looks like exactly the guidance I was needing!

 

[LaughingCat]

Also linguisystems is having their bi-yearly sale right now (if you sign up for their email list you get the code) - you might want to look there.  They have lots of stuff  --  like Differential Processing Training Program Acoustic Tasks (never used this but at one point I was really thinking about it )

[Staceyshoe]

Also linguisystems is having their bi-yearly sale right now (if you sign up for their email list you get the code) - you might want to look there.  They have lots of stuff  --  like Differential Processing Training Program Acoustic Tasks (never used this but at one point I was really thinking about it )

 

Wow!  They do have a lot!  There's a whole world of resources out there that I never knew about.  Do you know how long the sale lasts?

[SandyKC]

When you say, "He absolutely cannot follow multi-step directions.  He cannot hold more than one sentence in his head at a time, so if I make a statement followed by a question--he has no idea what I stated before the question.  He doesn't follow conversations."

 

I am more inclined to agree with the auditory memory issues or it may be short-term working memory issues. Screening for auditory processing issues wouldn't be a bad plan, but this particular piece definitely sounds like a memory issue.  To evaluate for that you'd want a neuropsychological evaluation, and if you suspect any other issues, you would want to go for a comprehensive evaluation.

 

That said, five is young to get solid test results from a comprehensive evaluation.  If there are issues, you might have to get an updated evaluation when he is eight or nine if they aren't able to give definitive answers.  

 

My inclination would be to play a lot of memory types of games with your son.  Even the simple game of flipping and matching pairs of cards can help with working memory because your child has to try to remember which cards are where in order to match the pairs.  

 

It's nice to hear your DS is getting speech services from the school!  Not all school districts will do that for homeschoolers. ;-) 

[Staceyshoe]

SandyKC, the more I read and think about this, the more I realize that auditory memory is probably the biggest issue we have.  What made me wonder about auditory problems is that his visual memory is AMAZING.  He recalls things with accuracy that he saw once months ago, and he's always really excelled at puzzles and other visual activities.  Last year we started playing around with homeschooling, and it became very apparent that he could see something and know it.  I actually stopped answering his question "what is this word?" because he had memorized a huge inventory of sight words, and I felt he needed to learn some phonics as well.  Meanwhile, we sang the same song about the days of the week every day for 9 months before he learned them.  Two days of not singing the song, and he was clueless--didn't even recall it when I sang it for him again.  He memorized our phone number in a few days (because he could "read" the numbers), it took 2 months and more than 100 repetitions to learn the name of our street (me saying it and having him repeat it back each time).  I honestly think he would have remembered right away if he could have read the word.  There are many other examples.  At first, I thought he had an extreme learning preference, but now I'm suspecting that it isn't just that he excels at visual learning--he *really* struggles with any auditory input.  Would this be more indicative of a memory issue or an auditory issue--or a combination of the two?   

[Tiramisu]

Tiramisu, I've been doing some study and research into the 'speech in noise' problem, for some years.

Where I've been conducting trials into a remedial model.

A crucial factor with hearing, is that it can be focused in a similar way to vision.

As with 2 ears, we can use them to locate the direction a sound is coming from.

 

The trials simply involved a person sitting in the center of room, with their eyes closed.

Then a second person moves to different points around them, and then makes a noise.

Where the person sitting on the chair has to point in the direction that sound came from?

Most people involved in the trial had varying degrees of difficulty with locating the source of the sound.

Though when they practiced locating the sound, for a couple of minutes a day, most often the ability to locate the sounds, rapidly improved.

 

But from this, a second background sound was introduced, with a radio or TV at a low volume.  

Then pointing at the direction of a sound, from a second person is repeated.  

But this is done with the competing sound from the radio/TV.

Where one locates the sounds from the other person, despite the radio or TV?

Then the radio/TV volume is gradually increased. 

 

Which then changes from the other person making sounds, to them speaking a stream of words.  With the radio/TV in the background.

So that the person in the chair, practices holding their hearing focus on the speaker.

With the radio/TV volume being gradually increased.

Then a further exercise, simply involves having the TV and Radio on opposite sides, and to practice shifting the focus of our hearing from one to the other.

 

Though it basically just involves practicing to locate and focus our hearing at a point, which shifts other sound into the background.

 

Thank you, geodob. I appreciate this thorough description. 

 

I have a follow up question. Do you think the technique you developed to strengthen the ability to comprehend speech in noise would work with someone who has both a speech in noise problem and a dichotic listening problem?

 

Also, according to your research, speech in noise comprehension can be improved, but have you heard of any studies regarding the development of therapies to improve dichotic listening besides stimulant medication?

[SandyKC]

I'm suspecting that it isn't just that he excels at visual learning--he *really* struggles with any auditory input.  Would this be more indicative of a memory issue or an auditory issue--or a combination of the two?   

 

It sounds like it is definitively an issue rooted in the auditory-memory-recall learning process. The thing with neurological difficulties like that is that neither you nor I can know by observation whether it is an auditory processing issue, an auditory memory issue, auditory comprehension, or a recall issue where the input was auditory in nature.  You really would have to have an evaluation to pinpoint where the process actually breaks down.  There are separate areas of processing based upon each of the elements of processing, and a comprehensive neuropsychological evaluation would be able to pinpoint the breakdown point. Once you know that, you'd be able to work on those skills.  Meanwhile, of course your big clue is to avoid teaching strictly by auditory methods.  Where you use auditory input, you'd want to always include visuals. You'd want to move towards multisensory teaching with a heavy focus on visual input rather than relying on lectures alone. ;-)

 

[LaughingCat]

Wow!  They do have a lot!  There's a whole world of resources out there that I never knew about.  Do you know how long the sale lasts?

The sale is 20% off through Sunday.

[Lecka]

With more details he does not sound similar to my son.

 

I am going to mention something else as a reason to try to find out specifics and target them.

 

With my son I saw symptoms, and for him what was glaring was his articulation. But I thought he understood what I was saying, bc he came across like he did.

 

But really -- he was figuring out a lot from context, not necessarily knowing exactly what I said. With more directions there is more to mess up but it could be partly due to (or compounded by) several things even back to not fully understanding what was said to him.

 

My son had some bits just from phonological awareness problems (hearing letters the same).

 

I think it was like he was always hearing sentences as having several meaning-altering homophones (as he might hear 5 + words the same way with some of his sounds) and he would figure out the meaning of the sentence from context. When he did not have a way around it (copying, visual clues, context, knowing a routine) it could seem like it just came up with following directions.

 

From what you have written it doesn't sound like that ---- but I think when there are so many things that it could be or that could be contributing, it would be easier to find out just what is going on.

 

I feel like -- he was like the kid who didn't see leaves or blades of grass before he got glasses, with his parents never knowing, only with hearing sounds in words instead of seeing leaves.

 

With his visual strengths (which sound great!) he could be covering (compensating) to an unbelievable level, using his strengths to get around his weak area, and not knowing he is doing so, thinking it is the same for everyone.

 

It can be stressful for kids so I am glad you are looking into it.

[geodob]

Tiramisu, with dichotic listening issues, the primary issue is with an inability to shift attentional focus from ear to ear.

But shifting our focus of attention from ear to ear, isn't something that we ever directly practice.

So that practicing it directly, can help to develop the ability to shift attention.

 

Though the key to it, basically involves listening with our eyes closed.  As with our eyes closed, we become aware of the direction of a sound. 

So that if a sound is coming from one side or the other, we can shift the focus of our hearing to the side the sound is coming from.

 

[Tiramisu]

Tiramisu, with dichotic listening issues, the primary issue is with an inability to shift attentional focus from ear to ear.

But shifting our focus of attention from ear to ear, isn't something that we ever directly practice.

So that practicing it directly, can help to develop the ability to shift attention.

 

Though the key to it, basically involves listening with our eyes closed.  As with our eyes closed, we become aware of the direction of a sound. 

So that if a sound is coming from one side or the other, we can shift the focus of our hearing to the side the sound is coming from.

 

Thank you, geodob.