1. Why are your CAPD services “Cash Only” and not contracted with insurance providers other than Medicare and Tricare?
Quite simply, the third-party payment system does not reimburse adequately for many medical services, but for CAPD services it only reimburses a tiny fraction of what is billed–not enough to begin to pay for the time and expensive equipment involved. (Medicare and some others exclude it altogether.) On average, each CAPD evaluation process takes anywhere from 4 – 6 hours (interviews, records review, evaluation procedures, report-writing, and follow-up consultation to cover the results and recommendations). I am passionate about processing disorders and put a lot of experience, time and heart into each patient’s case. Yet frequently I may be reimbursed for hours of work what a specialty physician might receive for an initial 15 – 20 minute consultation. (And remember, that specialty physician usually has 3-5 patients scheduled concurrently to increase reimbursement. We see one patient at a time for up to two hours per appointment.
Bottom line: a professional practice is expensive to operate. There must be reasonable payment for services provided. Unfortunately the third-party system doesn’t always deliver that. CAPD practice cannot remain viable, much less increase its quality and scope of service offerings, on that basis. We will do everything reasonable to help you find a way to access our services, including exploring payment options if needed. But without appropriate reimbursement, we can’t do it. Few offer CAPD services for this very reason. But there’s a huge need that I want to help address here in Southern Arizona. Thanks for your understanding.
2. At what age can you test children for CAPD?
For officially diagnosing CAPD, we usually recommend that a child be at least 7 years old. We do have some APD test batteries which have norms down to age 5 years, and we also administer the Geffner/Goldman “Auditory Skills Assessment (ASA)” on children as young as 3.5 years (if they are able to perform the test). The ASA is an inventory which can show whether a young child is on target for certain receptive auditory skills as compared to their peers. Poor performance doesn’t diagnose CAPD, but it can indicate children who may be “at risk” for CAPD and can help parents, educators, and other specialists to focus efforts on target areas and get a “head start” in working to strengthen questionable areas, whether they are C-APD related or not. If deficits are early indications of CAPD, the first 3-5 years of life are highly influential in properly “wiring” the brain (neuroplasticity) for optimum efficiency. Early intervention can be extremely useful as a “jump start” for children who are at risk, building a better foundation for later successes.
3. Can people with regular (peripheral) hearing loss be evaluated for CAPD?
Yes, but there are a few considerations. The greater a person’s peripheral hearing loss, the less certain we can be that any positive “central ” findings are purely attributable to central processing problems. Also the selection of tests which can be performed reliably for APD is more limited in the presence of peripheral hearing loss. We typically limit CAPD testing to marginally normal peripheral hearing or mild peripheral hearing loss. In some cases we can test someone with up to moderate loss, but as indicated earlier, the ability to clearly delineate central from peripheral effects becomes much more difficult, if not impossible. Truth be known, most–if not all–persons with peripheral hearing loss will also experience resultant central auditory processing difficulty due to lack of auditory stimulation from the end organ (ear) downstream.
4. ADHD, Dyslexia, Language Disorders, and other issues have common characteristics with CAPD. How can we know what’s what?
That is an ongoing discussion in audiology research, education, medical circles–anywhere sensory and learning problems are considered. The simple answer is that there is no simple answer. The cognitive and sensory systems of our body are incredibly complex and inter-related. There are not simplistic “brain boundaries” that clearly delineate functional areas within the brain, because the various areas cooperate and coordinate differently for different types of activities. Truth be known, there are rarely disorders that “stand-alone.” There are usually overlaps–called “comorbidity” in professional circles, which co-exist. The best approach to assessment is a multidisciplinary one, which has specialists representing the various symptoms or weaknesses evaluating the abilities covered by their particular speciality. The team can then address the respective “pieces of the puzzle” to create a whole diagnostic and treatment plan (where needed).
It’s like the Indian fable of the six blind men trying to describe an elephant. Each perceives and describes a part of the whole–but the whole is too big to describe that way. Only by each contributing his part of the puzzle can the true picture emerge. The same is true for diagnosing complex issues involving communication, language, learning, and other developmental concerns. It requires a team approach. And if a patient’s issues include auditory and listening concerns, a CAPD assessment should be part of the plan.