Understanding Central Auditory Processing Disorder (CAPD)

A Child Can Be at Risk for CAPD if the Child

  • Gets easily distracted or unusually bothered by loud or sudden noises
  • Is upset by noisy environments
  • Performs or behaves better in quieter environments
  • Has difficulty following simple or multi-step directions
  • Has reading, spelling, writing, or other speech-language difficulties
  • Does not comprehend abstract information such as humor or slow to respond
  • Has difficulty in locating the origin of sound in space
  • Is disorganized and forgetful
  • Has difficulty with verbal or word problems in math
  • Has difficulty following conversations.

If these auditory deficits are not identified and managed early, many of these kids will have speech and language delays, adverse effects on academic performance, and impact their self-esteem and ability to grow as normal, self-confident individuals.

Although head trauma and chronic ear infections are amongst the common causes of Central Auditory Processing Disorder (CAPD), sometimes the actual cause is unknown. Whatever the cause or combination of causes for CAPD, it is necessary to evaluate each child individually. Dr. Shaila Nanjundiah is a certified CAPD expert who has treated a number of children with CAPD successfully through her personalized communication intervention techniques.

What is Central Auditory Processing Disorder?

Central Auditory Processing Disorders (CAPD) is a complex problem affecting about 5% of school children, ages 6 through 10, in the US. Undiagnosed and untreated, today nearly 20% of adults are estimated to have the CAPD. Age accompanied bodily changes, as well as brain-related deficits, are implicated in CAPD in elderly patients in whom CAPD is said to be widely prevalent.

Often CAPD children may also be diagnosed with attention deficit disorder, autism, autism spectrum disorder, specific language impairment, pervasive developmental disorder, or developmental delay. In fact, CAPD is known to coexist with other deficits or disorders. Children with Central Auditory Processing Disorders have difficulty in recognizing subtle differences between sounds in words. The problem may worsen in noisy or challenging environments, even if words are spoken louder.

Symptoms of APD can range from mild to severe and can take many different behavioral manifestations including poor vocabulary, poor listening comprehension, and difficulty in following multi-step directions or phone conversations. At times, poor reading or spelling skills, articulation problems, difficulty remembering specific details of events, distractibility, and poor organizational skills are also seen in these children. In some children, poor listening skills due to CAPD can cause speech, language and reading deficits with implications for their academic performance and self-esteem.

CAPD is Colloquially Referred to as a “Listening Disorder.”

It should not be confused with a hearing loss that refers to a loss of acuity as a result of ear pathology. CAPD is a disorder of the auditory centers in the brain. There is a deficit in the way auditory information is being processed or interpreted by the brain. One way to describe auditory processing is “what we do with what we hear.”

CAPD is a complex disorder. It can arise as part of a neurological or disease process such as head injuries, tumours, degenerative disorders, viral infections, surgical compromise, hyperbilirubinemia, concussions and hereditary factors. It can also co-exist with other disorders such as attention deficit disorder, speech and language delays, learning disabilities, autism spectrum disorders, pervasive developmental disorder, sensory integration disorder, visual perceptual deficits and hearing loss.


Detecting CAPD

Teachers and parents are amongst the first people to recognize auditory processing difficulties of a child. However, professional therapeutic intervention by an audiologist and a speech language pathologist is necessary to confirm the CAPD, the severity of the problem, and recommend necessary corrective rehabilitative intervention.

Usually, an audiologist may ask a child to listen to different words in either right or left ear or both ears or have the child listen to sentences of varying loudness at the same time to determine the hearing function problem if any. Note that listening has two components involving hearing sounds and the ability to process those sounds to comprehend what was heard.

A Speech Language Pathologist may assess a child’s ability to understand and use language. As a Speech Pathologist and Audiologist with over a decade of experience, Dr. Shaila Nanjundiah offers a unique perspective to her patients. After detailed analysis of standardized battery of CAP testing using SSW, Phonemic Synthesis, Speech-in-Noise, and competing environmental tests (and sometimes more testing), Dr. Nanjundiah conducts age equivalent performance to determine the type of audiology or speech pathology related CAPD in a child.

Seeking Help

School teachers, study team directors, parents may request more information about CAPD through email or phone. As an advocate for school children who need her services, Dr. Nanjundiah can also make a presentation on CAPD. Parents may also consult with her for an individual evaluation of their child. Modification of environmental acoustics, exercises to improve language or vocabulary building, auditory memory enhancement, and auditory integration training are some of the techniques employed to help children with CAPD.

Please consult with a certified and experienced audiologist to determine individual course of action for your child. In our clinic, we employ one of the several programs such as Earobics, LIPS, Language processing kit, Fast Forward, Listening Program, and Phonemic Synthesis Program as CAPD Management Strategies.

These approaches are aimed at improving an individual’s auditory perception, enhance their speech/language and cognitive skills, in addition to developing academic resources and listening conditions. You may also contact the following audiology and speech language pathology professional associations for more information

We also offer individualized Interactive Metronome(IM) program to improve focus and coordinated performance for children with CAPD, Attention deficit disorders, Autism, Asperger’s syndrome, and balance disorders. For additional information of this program please visit the Interactive Metronome website at

Before Your First Appointment

Please submit completed patient intake form, auditory screening checklist form 1, and auditory screening checklist form 2 to determine whether your child is at risk for auditory processing problems and also determine possible areas of concern. You will be required to provide detailed medical history, preschool, and school performance, background information, and any prior test results before your child’s first appointment is made.


What to Expect During the Appointment?

Auditory processing evaluation is approximately three hours long. The first step of the test includes a hearing evaluation to ensure your child does not have hearing loss. The second step includes several auditory processing tests to determine subtypes of auditory processing problems.

Since this test is of prolonged duration, short breaks may be given to your child. We advise you to bring snacks and water to the appointment. If your child is on any medication prescribed by the doctor, do not skip the medications. If your child has an ongoing ear infection or active ear disease, we may have to reschedule the auditory processing test battery. Please call our office if you have any additional questions.