1. Auditory Decoding Deficit: Children with “Classic CAPD;” typically described as having a hearing problem even without physical evidence; process information slowly and inaccurately, working harder than other children to interpret what they hear

·  Poor performance on tests:

-  Monaural low-redundancy

-  Speech in noise

-  Phonemic synthesis

·  Poor auditory closure abilities noted on other tests where the errors are similar to the target word. (Closure is the ability to guess a word based on information received at the time and the child’s experience (exposure and long-term memory of similar words)).

·  Tend to mis-hear words  (e.g., mouth for mouse, eighteen for eighty); have difficulty with differentiating and analyzing the differences between speech sounds

·  Weak vocabulary, syntax (plurals, verb tenses) and semantics (multiple meaning words, understanding who, what, why, when and where questions)

·  Have difficulty if information is presented without sufficient contextual or visual cues

·  Trouble understanding speech in noisy environments

·  Become overloaded in an auditory situation, with listening behavior deteriorating over time 

·  Perform better in subjects where phonic/phonological decoding is not required (e.g., math computations)

·  Usually poor readers, spellers, and note-takers; unable to divide time appropriately between listening and writing

·  Change the physical environment to decrease noise level.

·  Improve acoustic access by seating the child appropriately and by blocking out other noise with a personal or classroom amplified sound system.

·  Repeat information only if you can say the information more clearly.

·  Provide visual cues.

·  Use attention-focusing devices.

·  Pre-teach (using an aide or parent) new information, particularly vocabulary.

·  For instructions, use clear, concise, explicit language; provide a written copy; use a buddy if necessary.

·  Modify oral tests (i.e., always give spelling words in a sentence).

·  Use assistive technologies (high-quality tape recorder, computer, books on tape, and note takers).

·  Give children two sets of books so they have one at home.

·  Use speech/language therapies to improve auditory phonic and meta-phonological skills as well as listening and noise-tolerance skills. Recommended programs:

-  A phonemic synthesis program

-  Rhyming, syllable, and phoneme segmentation programs

-  Auditory Discrimination in Depth Program (Lindamood)

-  Fast ForWord

-  Earobics

-  Hooked on Phonics.

·  Use therapies to improve lip reading and non-auditory strategies (such as using context or listening for
meaning).

·  Teach children how to:

-  Listen (active versus passive listening)

-  Recognize adverse listening conditions and how to address them

-  Clarify auditory instructions

-  Use visual cues to augment auditory information

-  Advocate on their own behalf.

2. Associative Deficit Tolerance Fading Memory: Children with trouble applying rules of language to sounds they hear; often have intolerance for background noise and show a marked decline in understanding of speech when noise is present; tend to perform less well with language demands in the classroom

·  Usually diagnosed in 3rd or 4th grade when language requirements become more difficult

·  Good performance on temporal patterning

·  Good sound decoding and discrimination but word recognition may be poor

·  Bilateral deficits on dichotic listening tasks

·  Poor performance on speech-in-noise discrimination tasks

·  Poor auditory memory, receptive vocabulary, and  reading comprehension

·  Difficulty understanding complex sentences (Their language is very concrete with little syntax.)

·  May have language difficulties with: categories and labels; multiple meaning words; antonyms, synonyms and homonyms

·  Difficulty following directions and in making associations needed to understand verbal jokes, riddles, jargon

·  Often ask for clarification

·  

·   

·  Change the physical environment and improve acoustic access as previously stated.

·  Use a structured, systematic, multi-sensory, rule-based approach to language and learning.

·  Avoid or minimize classroom techniques that require self-monitoring of learning behavior.

·  Impose external organization and structure.

·  Pre-teach new vocabulary.

·  Use clear, concise, explicit language.

·  Rephrase a message more simply instead of repeating it.

·  Get child’s attention.

·  Use multiple-choice tests.

·  Use assistive technologies.

·  Provide quiet study areas.

·  Use a tape recorder to record instructions and lectures.

·  Check comprehension by having child paraphrase or demonstrate what is expected.

·  Language therapy is a key component.

·  Use traditional receptive and expressive language techniques.

·  Give training in use and meaning of words that imply relationships (first, last, next), casual words (because, since),  and adversative words (but, however, although).

·  Use strategies that aid in retention of complex messages such as chunking, verbal rehearsal, and paraphrasing.

·  Make use of:

-  Metacognitive strategies

-  Methods to improve noise tolerance skills

-  Auditory memory enhancers.

·  Encourage children to provide themselves with a  framework for understanding (for example: draw diagrams, highlight, make notes in the margin).

·  Teach the use of organization aids such as:

-  Calendars

-  Tape recorders

-  Checklists

-  Assignment notebooks

-  Dictionaries

-  Computers.

·  Help them develop problem-solving skills. 

3. Integration Deficit: Children who demonstrate difficulty across modalities with any task that requires efficient inter-hemispheric communication; have trouble tying together auditory and visual information and frequently exhibit long delays in responding

·  Left ear deficits on dichotic speech tasks

·  Bilateral deficits on tests of temporal patterning in the linguistic labeling condition

·  Scores within normal range for monaural low-redundancy speech tests

·    

·  

·  Have difficulty with multi-modality tasks and sound/symbol relationships

·  Find it hard to recognize and use the patterns of “wholes" necessary for word recognition and spelling due to reading and spelling difficulties

·  May have difficulty with motor skills that require bimanual or bipedal co-ordination

·  Find it hard to determine how to do a task and may have a great deal of difficulty getting started

·  May need a lot of extra time and practice to complete tasks

·  Reduce or avoid multi-modality cues; present information via one modality at a time.

·  Provide note takers and a reader for tests and/or scribe.

·  Pre-teach new information.

·  Tape record classes and make texts on tape available.

·  Encourage the use of word processing programs  with audio spell-check.

·  Never rephrase (this is confusing); repeat and emphasize key points.

·  Avoid giving timed tests.

·  Use these therapies:

-  OT/PT, which focuses on multi-sensory integration and non-auditory inter-hemispheric activities to improve corpus callosum function

-  Speech and language, which focuses on speech and auditory inter-hemispheric activities.

·  Teach children how to:

-  Avoid dividing their attention

-  Focus attention on the task they are presently doing.

4. Prosodic Deficit: Children who talk or read without intonation, stress, or rhythm; often have difficulty with pragmatic communication skills, sequencing, social judgment, gestalt patterning, and spatial abilities; also find it hard to perceive the prosodic cues that underlie humor, sarcasm, and question forms that rely heavily on intonational cues to gauge intent

·  Left ear deficits on dichotic speech tasks (usually slight)

·  Normal performance on monaural low-redundancy speech test

·  Bilateral deficits on tests of temporal patterning in both the linguistic labeling and humming conditions

·  Have poor music skills

·  Use monotone when speaking and reading

·  Have difficulty in social communication situations

·  Have difficulty or inability to perceive prosodic cues such as rhythm, stress, and intonation

·  Place with an "animated" teacher.

·  Give additional visual cues.

·  Pre-teach new information with emphasis on prosodic cues.

·  Use speech and language therapy:

-  Prosody training

-  Key work extraction

-  Pragmatics.

·  Teach children how to read aloud with exaggerated prosodic features.

·  Encourage music and/or dance.

5. Output/Organizational Deficit: Children who have trouble organizing, sequencing, recalling, and/or expressing an answer; have difficulty responding correctly even though they have listened to, analyzed, correctly connected, and pulled together the information; have difficulty, in general, on tasks where success depends on motor and/or planning skills

·  Good performance on monaural low-redundancy speech test

·  Poor performance on tests that require a response with multiple elements (i.e., frequency and duration pattern tests, dichotic speech tests, or phonemic synthesis test)

·  Poor performance on tests with background noise

·  Other indicators:

-  Omitting words on tests

-  Using words that
were given on a previous test item

-  Difficulty with sequencing words in
a response

·  Have difficulty following directions, particularly if they are long

·  Find it hard to start assignments, remember homework, take notes, or organize their papers or work

·  Have difficulty with
sound blending

·  Have good receptive auditory skills, but have trouble acting upon incoming information (i.e., memory based skills such as work retrieval abilities)

·  Often show weaknesses in expressive language skills and/or speech articulation

·  Use repetition or rephrasing only if information is broken down into small units.

·  Use tag words when giving instructions and information.

·  Use organizational tools (i.e., consistent routines, outlines, calendars, checklists, assignment notebooks).

·  Pre-teach new information.

·  Avoid situations requiring self-monitoring

·  Use speech and language therapy for expressive language difficulties and also  use visualization and visual imagery.

·  Train in metacognitive techniques to strengthen memory-based skills (which in turn help item recall).  

·  Teach children to use:

-  Computer technology and organizational aids

-  Good study skills.