CAPD Treatment Overview
If an auditory processing disorder (APD) is diagnosed what can be done to treat it? CAPD is a complex disorder, often with overlapping, coexisting (called “co-morbid”) conditions such as Attention deficits /Hyperactivity, Memory problems, Language disorders, Reading problems, Sensory Integration & Self-regulation issues, Visual, Motor, Balance, to name some of the main ones.
So, it should be obvious that, while official diagnosis of CAPD must be done by an audiologist specialized in APD diagnosis (not all audiologists are equipped to do this), the remediation and treatment of APD–and its co-morbid issues–often require a multi-disciplinary, team-based approach. Other professionals (Speech/Language, Psychologists, Developmental Specialists; etc.) may do screenings for CAPD (typically a SCAN-C or TAPS test), but their scope of practice does not include formal diagnosis of CAPD. If their screenings indicate possible CAPD, ethical professionals will refer to a CAPD-specialized audiologist for more extensive tests and formal diagnosis. CAPD-specific therapy interventions should not be undertaken without formal diagnosis by an audiologist specialized in APD management.
Complex language & speech problems are the domain of Speech/Language Pathologists. Sensory integration, fine motor, and self-regulation problems are usually treated by an Occupational Therapist. Physical Therapists address balance and movement. Physicians manage any medication-based treatment of AD(H)D. Learning problems are usually supported by classroom teachers and by special educators who specialize in learning disabilities. This is not exhaustive, but these are some of the key professionals involved with auditory (and other) processing disorder .
When an auditory processing disorder (APD) is diagnosed, management usually includes some or all of the following: environmental modifications (especially to improved speech-to-noise ratio), communication techniques (to improve the quality and delivery of auditory information), teaching modifications (to help students access classroom information more effectively), and assistive listening technology (which may include FM systems for classrooms, or mild-gain, open-ear personal hearing aid technology and/or other hearing enhancement technology) for improved signal delivery. Finally, therapies specific to the various specialists on the professional “team” (Audiology, Speech/Language, OT, Educators; etc.) may also be recommended.
Specific Auditory Therapies for CAPD
All therapy involving the central nervous system is based upon the well-documented process called neuroplasticity. This simply means that the central nervous system, rather than being hard-wired, is capable of changes through growth and development of the neuronal networks in the brain. If this capability in the brain and nervous system didn’t exist, it would be technically impossible for any nervous system condition or injury to ever improve. Thankfully, we know that frequent and focused stimulation of the nervous system does indeed encourage development of the neuronal networks via new connections and improved myelinization (myelin is the fatty sheath which coats the neurons and improves speed and efficiency of neural transmission. For more detail about deficit-specific therapy offered at EAR-Central, PLLC, please click here.
Therapy for CAPD usually falls into two groups:
Therapies aimed at particular processing deficits like noise sensitivity, phonemic awareness, auditory memory, dichotic training, speech in noise exercises; etc. These can be computer-based, or done face-to-face with a therapist. With certain types of CAPD, there is often a need to address foundational weaknesses in the discrimination and use of phonemes, the “building blocks” of linguistic skills (phonics, reading, spelling; etc.). We have recently added Phonemic Auditory Reinforcement Training (PART) to our therapy services. These techniques are widely used around the country and the outcomes for most patients with CAPD are very favorable. For specific deficit-specific therapies offered at EAR-Central, PLLC, click here.
Multi-modal Stimulation Therapy. In addition, there are auditory (what I call “broad-spectrum”) stimulation approaches which especially seek to engage neuroplastic changes through multi-input stimulation. Specially-mastered and filtered classical music selectively stimulates the brain through both air-conduction earphones, and a bone-conduction vibrator. While the music stimulation is in progress, various movement activities are employed for part of the listening session to provide multi-modal stimulation to the various parts of the brain. For the remainder of the session, quiet play or other focusing activities are engaged in.
Most versions of the music-based therapy have derived from the 1950’s-1990’s work of Dr. Alfred Tomatis, a French ENT physician who did extensive research in this field during his lifetime. Since then, various others have adopted the Tomatis-based theories in their own music-stimulation systems: Berard-Auditory Integration Therapy (AIT), The Listening Program (TLP), and Integrated Listening Systems (iLs), to name the best-known of these.
EAR-Central, after researching the various methods, chose the iLs system for several important reasons. 1) It combines the traditional air- and bone-conducted music with visual, balance, and body movement activities, which provides a more pervasive and robust stimulation to the brain and resultant opportunity for neuroplastic changes. 2) Ron Minson, M.D., iLs founder, is a dually-certified Neurologist and Psychiatrist, and brings that medical training and perspective to the iLs system. Further, Dr. Minson spent several weeks in France with Dr. Tomatis, who helped Minson’s dyslexic daughter achieve breakthroughs which traditional therapies in the U.S. had failed to achieve. This inspired Dr. Minson to incorporate the principles of music-based therapies into his work with patients in the States. 3) The iLs system makes the therapy devices available for use in the clinic AND in the home (through an affordable rental program). As a result, the price-tag of some other Tomatis-like therapies is very high because the therapy is only available via expensive in-clinic equipment used while being billed for clinic time.
Lastly, (and this deserves its own paragraph), certain of the methods have adopted some, I believe, scientifically unsupportable theories of the nature and causes of APD, and utilize these unfounded ideas as guiding principles for APD therapy. This is not to say that the music stimulation is without value in such cases, but any therapy method should be based on sound foundations and realistic goals, otherwise time and money may be wasted pursuing eclectic, misguided outcomes which have no basis in science. I’m happy to report that iLs avoids that unfortunate practice. Certain of these methods will also grant “practitioner” status to individuals without any graduate education or recognized specialization requiring state licensure. Don’t be fooled by letters after a name. They do not necessarily indicate a professional degree, but may be invented by a group to give the impression of professional legitimacy. Be careful! Do your own research into these things.
Music-based therapy programs, when appropriately and professionally administered, have a tremendous volume of anecdotal* evidence in support of their general value and effectiveness. In order to be accorded high levels of scientific recognition and acceptance–called “efficacy” in research circles–a scientific concept must undergo research in carefully-designed, rigorously-controlled studies. The nature of APD and of music therapy makes those studies difficult to design and carry out, especially given the high cost of funding research projects of that type.
Though considered “experimental” the outcomes of Tomatis-based therapy over 50 years attest to its widespread benefits for some neurological-based conditions. Music Therapy doesn’t “cure” disorders, however it often supports improved neurological function, which may improve behaviors and the outcomes of other therapies. When used in the context of an appropriately-diagnosed auditory problem, by a qualified professional, with the realistic goal of supporting cognitive and behavioral remediation through improved auditory processing, it is a valuable addition to the APD treatment “toolbox.”
[*Anecdotal evidence means information obtained from test results and clinical observations by professionals, by reports from patients/parents/teachers, from outcomes of questionnaires, and other informal sources of assessing the value of treatments. “Informal” doesn’t mean the information isn’t valuable or reliable, it simply means it was not subjected to a “formal” research design and process. This, of course, is the ideal, however strong anecdotal evidence forms the basis for much good clinical decision, and is the “raw material” of future formal research. Research usually starts at the the grassroots–the clinical community–and works its way up to the formal research community for more rigorous investigation.]
For more information about CAPD therapy options, please call EAR-Central at 1-877-508-1130.