Much of this will probably be familiar to those who are raising a
child with ADHD/ADD but some may be new and of interest
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From June 30, 1997 "ADVANCE" for Speech-Language Pathologists &
Audiologists.
EXPLORING LINK BETWEEN ADHD AND CAPD
Audiologists and speech-language pathologists (SLP) need to be aware
when attention deficit hyperactivity disorder (ADHD) and central
auditory processing disorder (CAPD) present comorbidly and their
symptoms overlap.
Clinicians and researchers are exploring the correlation between
ADHD and CAPD, including those cases in which a history of otitis
media (OM) is present.
The underlying issue is that all children with AD have
problems with information processing, according to William Koch, MD, a
child psychiatrist and developmental specialist in NYC. Parents and
some clinicians may not believe children have ADHD if they have no
difficulty talking in one-on-one conversations, he noted, but when the
children are placed in a situation where there is noise, hyperactivity
and inattentiveness frequently result. Many children diagnosed with
ADHD do poorly on auditory processing tests, reported Kerry Ormson,
EdD, CCA-A, a private practitioner in Amarillo, TX.  He questions the
labeling of children in some cases with ADHD under the DSM-IV which
divides children with ADHD into three subcategories: hyperactive,
impulsive and inattentive. Children who are classified as inattentive
or impulsive tend to do better on auditory processing tests than those
labeled hyperactive. Children in the latter group "need to be screened
more closely by a SLP, audiologist or psychologist to differentiate
them as ADHD, CAPD or both", Dr. Ormson advised. A child who is truly
hyperactive cannot sit still, pay attention, or stay on task in all
situations. Children who can take a hearing test without distraction
and complete it with a minimal amount of coaxing may be misdiagnosed
by psychologists as being ADHD/hyperactive, he noted, when CAPD is
really the case.  These children perform well in low-stimulation
situations but show hyperactivity in settings with visual, auditory,
motor and tactile distractions. "Children disconnect from an
environment when the perceptual system is overloaded with input or
they have difficulty processing the information whether it is
auditory, visual or tactile," Dr. Ormson said.  "That is when you see
situational hyperactive behavior pop up." Symptoms common to both ADHD
and CAPD are poor attention, difficulty following directions,
hyperactivity, distractibility, frustration and difficulty maintain
relationships with friends or family, he said. One of the major
problems facing psychologists charged with diagnosing ADHD, Dr. Ormson
said, is "there is not one specific performance test you give a child.
It is a compilation of many tests in a complete psychological battery
as well as observations in school, at home, at play, and in interviews
with teachers and parents." Because diagnoses of ADHD and CAPD are
multifaceted, they require the full cooperation of all professionals
associated with the child, including SLP's, audiologists,
psychologists and educators. "SLP's and audiologists are able to bring
in their expertise to augment a complete psychological exam," Dr.
Ormson said.  Before diagnosing ADHD, psychologists must rule out
hearing loss and CAPD through an audiologist and cognitive and
language involvement with a SLP.  Similarly, these clinicians should
refer a child with behavior problems to a psychologist for an
evaluation. Dr. Koch believes that all children with CAPD should be
referred to a psychologist or child psychiatrist for an evaluation,
and all children diagnosed with AD should be referred for CAPD
testing.  "By not evaluating these kids you are missing them." he
said. Instead of relying just on a questionnaire for parents and
teacher, Dr. Koch recommends that all disciplines be aware of
neurological "soft signs."  These non-specific signs do not indicate
brain damage but show some underlying neurological problem.  Among the
most important soft signs are disdiadochokinesis, poor eye hand
coordination, poor fine motor control and synkinesis. A SLP needs to
evaluate language functioning because the language system interprets
whatever enters the learning areas of the brain.  When a school
psychologist refers a child for a language disorder, a SLP should pick
up clues of potential CAPD and then ref the child to an audiologist
for peripheral and central auditory test batteries. Audiologists can
choose from among more than 50 auditory processing tests to correctly
diagnose a child with CAPD and assist other professionals in
differentiating between CAPD and ADHD.  However, it is up to
clinicians to determine which tests suit the needs of their
population, said Dr. Ormson.
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