He recommends a test that assesses the
ability of the brain to take in one stimulus at a time, block out a
stimulus, or assess temporal aspects of the neurologic system, such as
auditory figure-ground tests, competing message or digit tests, pitch
pattern sequence tests or frequency duration tests. After a diagnosis
has been made, the team of health care professionals and educators
needs to decide on a management plan. Many psychologists and
physicians promote the use of Ritalin for children with ADHD who show
signs of CAPD.  According to Dr. Ormson, research has found that
children with ADHD perform better on auditory processing tests when
using the drug ("Effects of Methylphenidate on the Auditory Processing
Abilities of Children having Attention Deficit Hyperactivity
Disorder," Journal of Learning Disabilities, vol. 24, No 10) Dr. Koch
has used Ritalin with some patients with ADHD and related CAPD from
age 4 into adulthood.  But there is a "huge spectrum" in this patient
population, he said.  Some individuals do so well on medication that
no other intervention is needed, while others may require auditory
training and reading assistance. Some reports indicate that 80% of
children with ADHD and signs of CAPD are helped by Ritalin. However,
"pills do not take the place of skills," observed Dr. Ormson.
"Medication only addresses the attentional component and does not
clean up the processes." He recommends teaching children to connect
with their environment through compensatory strategies such as a
teacher or caregiver first checking to make sure they have child's
attention before speaking.  A child's comprehension also must be
determined, such as asking for information to be repeated.  Finally,
asking "why" questions helps to establish a line of understanding.
"Asking why" taps into the language system in a significant way and
causes it to process what the child has just heard and what it means
to that individual." Dr. Ormson explained.  "That in turn affects
their behavior, interaction and understanding." A diagnosis of ADHD or
CAPD may be further complicated if a child has repeated episodes of
OM. Studies conducted at St. Johns University in Jamaica, NY indicate
a possible connection among the three conditions, according to
researchers Donna Geffner, PhD, CCC-A, a professor in the Department
of Speech, Communication Sciences and Theatre, and graduate student
Ruth Davis, PD, an administrator with the NYC Board of Education. They
found that children who had a combination of ADHD and several
incidences of OM showed signs of CAPD, including difficulty in
phonemic intergration, attending to auditory stimuli, and sensitivity
to loud sounds.  As a result, the researchers believe that children
with a high incidence of OM or otitis media with effusion (OME) should
be closely monitored and tested for CAPD as soon as possible. Dr.
Geffner and Davis conducted a retrospective study of 190 children,
ages 3-16, referred to her by Dr. Koch between 1989 and 1996.  The
children were diagnosed as having ADHD and had three or more bouts of
OM before age 2. Dr. Geffner evaluated each child for speech
discrimination in quite and noise and conducted a complete audiologic
battery that included impedance testing, acoustic reflexes, most
comfortable listening and loudness levels, along with auditory
processing tests. This population of children with OM and symptoms of
CAPD and ADHD "has difficulty attending to auditory stimuli,
especially in noise," Dr. Geffner said. She cited work by Judith
Gravel, PhD, CCC-A of the Albert Einstein College of Medicine in the
Bronx, NY, that showed children with a history of OM may have more
difficulty listening to speech competition than those without OM and
are more likely to be at risk for academic problems in the first year
of school. "Underlying reading is the skill of phonological awareness,
" Dr. Geffner said.  "If these children have early auditory
deprivation or CAPD, I suspect they would have difficulty in the
phonological processes underlying reading." OME may have an impact on
auditory physiology because of early auditory derivations, thereby
altering the neurophysiology of the auditory system.  "Long-term
effects could emerge as more demands are placed on the child.  One's
ability to process or listen in noise is impaired," Dr. Geffner said.
In fact, the greatest number of children who were referred by Dr. Koch
were second graders who were experiencing growing academic demands.
When information becomes more auditory, "these children show
difficulty," she said.  "Up until that time they may compensate." She
predicts the correlation between OM would be even stronger if other
factors such as colds or allergies are factored into the equation
because allergies often result in fluid in the ear. The children in
Dr. Geffner's study showed a tendency toward short term memory
deficits.  "Children with ADHD are known to be more forgetful, but we
are finding children with CAPD and ADHD to have short-term auditory
memory deficits," she said.  "That is a big overlap."
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For more information:
Donna Geffner, PhD and Ruth Davis,
Department of Speech, Communication Sciences and Theatre,
St. Johns University, 8000 Utopia Pkwy., Jamaica NY 11430
(718) 990-6480
William Koch, MD, 20 W. 64th St., New York, NY 10023 (212) 799-8204
Kerry Ormson, EdD, 1600 Coulter, Building A, Ste 105,
Amarillo, Tx 79106 (806) 352-2321
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