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A child with a central auditory processing disorder can hear, but can’t process what is being heard. We find out more about this ‘broken telephone’ disorder.

How do you know if your child has a central auditory processing disorder (CAPD)? Does background noise distract them? Give a constant “huh?” response when asked a question, even though they’re not hard of hearing? Does the child battle to read, spell and write? If so, they could well have CAPD.

Often confused with other learning disabilities, a child with a central auditory processing disorder can’t process the information they hear in the same way as others because their ears and brain don’t communicate effectively with each other.

What is central auditory processing?

“How the ear talks to the brain and what the brain does with it, is the best way to describe central auditory processing (CAP),” says Heidi Allan, a Durban-based audiologist and speech therapist. “The brain must accurately decode what the ear tells it  for the brain to attach meaning to the sound coming in. When a child’s CAP skills are weak, they may experience ‘auditory overload’, making communication and learning a challenge. This impacts on their listening, speaking, reading, writing and, in turn, their ‘doing’.  A central auditory processing disorder can also affect a child’s confidence as they can’t function effectively in the classroom and socially. To learn language one needs to be able to listen to and separate important speech from all the other noises of daily living,” explains Allan.

Challenges and ways to cope

Cape Town mom *Lynette’s son was diagnosed with a CAPD. “I have always known there was something wrong but doctors couldn’t conclusively diagnose the problem,” says Lynette. “He battled to hear even though tests confirmed his hearing was perfect. His vocabulary was not as extensive as his peers and his language, spelling and reading were very poor. Even after extensive remedial work, there was no real improvement. An audiologist at his school suggested I take him for a CAPD test, which revealed he had a central processing disorder.”

“The biggest challenge is making him understand that he has to work much harder than his peers just to accomplish the same task,” says Lynette. “He gets very confused with vowels so doing homework takes so long. He gets angry, frustrated and tired from the ongoing battle of deciphering every word. We have developed coping mechanisms when we communicate with each other. I talk slower and constantly ask him if he understands what I’m saying. I also make every effort to reduce background noise when he’s doing homework. This includes turning down the TV, moving away from the running dishwasher and not having a discussion with him in the car when the radio is on.”

Quiet time for regrouping

Pietermaritzburg-based *Deidre’s daughter Katie also suffers from a CAPD. Her teachers first thought that  she had attention deficit hyperactivity disorder (ADHD). However, she was later diagnosed with multiple sensory integration disorder – a dysfunction in all seven senses.

“One of my most difficult challenges initially was explaining her condition to other parents. She can come across as rude or disinterested, but has actually ‘zoned out’. This happens when she is distracted by sounds, smells or sights and is trying to cope with all the sensory input she cannot process. Since her diagnosis, we are far more aware of noises that might be distracting her. I also understand her needs now. If she needs her own space, I don’t feel personally rejected as I did previously. She has a ‘special place’ in her room where she can go with her beloved cats when she wants to ‘regroup’ and have some quiet time.”

Both Lynette and Deidre’s children are undergoing extensive occupational and speech therapy.

Assessment and treatment

Conduct a peripheral hearing assessment to exclude hearing loss if a child displays a lack of listening behaviour and auditory attention, advises Allan. If hearing is not the problem, your child should then be assessed by an audiologist and, based on the findings, remediation and management strategies will be discussed.

According to Gauteng audiologist Tammy Henen, treatment for a CAPD is age and severity dependent. “The auditory system only fully matures around 12 years of age so one can’t really establish the degree of a CAPD until then. While a CAPD can be improved with treatment – which often involves a speech therapist, audiologist, educational psychologist, teachers, doctors and parents – one must remember that a CAPD is a disorder, not a disease. Each individual may have co-morbid issues (often individuals with a CAPD may have attention deficit disorder or other influencing factors). Some children may experience an improvement of their difficulties, or seem as though they have ‘grown out’ of their disorders. However, some may be left with a residual degree of deficit forever. However, with appropriate management, all children can become active participants in their own listening, learning and communication environments.”

Signs your child could have a CAPD

  • Behaves as though there is a hearing loss even if a hearing assessment has indicated normal hearing thresholds.
  • Has difficulty learning songs and nursery rhymes.
  • Battles to read, write and spell.
  • Mishears words.
  • Doesn’t participate in class discussions.
  • Cannot tolerate noisy rooms or places.
  • Has trouble understanding stories read aloud.
  • Has trouble with maths word problems.

Strategies to help a child with a CAPD

  • Reduce background noise at home and school.
  • Keep eye contact with your child while speaking to them.
  • Use simple, expressive sentences.
  • Speak at a slightly slower rate and at a mildly increased volume.
  • Provide your child with a quiet study place.
  • Provide additional aids for study, like an assignment pad or a tape recorder.
  • Build your child’s self-esteem.

Read more about hearing health here.

Good to know

  • Three to five percent of school-aged children are affected by a CAPD.
  • An audiologist is the only person who can correctly diagnose if your child has a CAPD.
  • Auditory deficits need to be identified and managed early to prevent speech and language delays and academic problems.
  • CAPD is often confused with other disorders like autism, ADHD and even depression.
  • The causes of a CAPD are unknown, but evidence suggests links to head trauma, lead poisoning and chronic ear infections.

Also read our article on helping children with hearing problems to communicate.

For more information

South African Speech-Language-Hearing Association – 0861 113 297, or visit
South African Association of Audiologists – 082 727 5977 or visit

*Names have been changed for privacy reasons.

Vanessa Papas