FASD and Central Auditory Processing Disorder
2002 Teresa Kellerman

Robin laDue, PhD, a well-known expert on Fetal Alcohol Syndrome and Fetal Alcohol Spectrum Disorders, made this statement during a presentation at a national FAS conference: "FAS is an information processing disorder." She repeated, "FAS is an information processing disorder." I paid attention and took notes.

Fetal Alcohol Syndrome and Fetal Alcohol Effects are collectively referred to as Fetal Alcohol Spectrum Disorders (FASD). Processing deficit disorders are common along the entire spectrum, from those with full FAS to those with invisible yet serious effects. The damage from the prenatal exposure to alcohol causes problems in many areas of neurological function. Memory processing is affected and is quite evident to those who live with children or adults with FASD. There may be a breakdown in processing information as it comes in through the senses, as it is filtered and organized, as it is stored, and when it is retrieved. All information we learn comes to us through our senses. Sensory integration disorder (SID) is a common disorder, but one that is often not recognized. When auditory information is not processed correctly, we call this Central Auditory Processing Disorder (CAPD). Children and adults with FASD may have hearing loss, but most have no hearing loss at all, and some can actually hear better than unaffected individuals. CAPD is not a hearing problem, per se, but a problem with processing the information that is heard.

The person with FASD may have attention deficits, trouble focusing and paying attention. They may have learning disabilities such as dyslexia (visual reading disorder). These difficulties are compounded when the person has CAPD as well. The child may not hear or process all of the verbal directions given by a teacher or parent or employer. They may process only the last part of what they hear, or every other word, or bits and pieces. CAPD slows down the learning process. Even when the person is trying to pay attention and listen, they may not be able to process as much information as their peers.

Verbal directions and instructions can be given in written form as well. Statements should be concise, concrete, and in terms that are easy to understand. I have to remind myself to give cues for behavior in positive statements. If I tell John, "Don't push your sister... Stop pushing your sister... Quit pushing your sister." What he will process is "...push your sister." Those words will be recorded in his brain and could affect his behavior in the manner totally opposite of my intended response. What I need to say is, "Hands to yourself." If I send John to his room to pick up his CDs that are strewn all over the floor, I will not get good results if I say, "John, go to your room and pick up your CDs and then you can listen to your music." He is more likely to process "go to your room" and "listen to music" and space out the important direction and will get in trouble later for still having CD's all over the floor.

His ability to hear and process what he hears can vary from day to day, from minute to minute, and depends on many factors, such as how his meds are working, what he had to eat, how stimulating the environment is, how well he slept the night before, how much stress he is experiencing, etc. I can try to determine how well he is processing what he hears by asking him to repeat back to me what he hears. The news reporter on the radio the other day said, "Today there were false reports from an undisclosed source that Bin Laden was killed in gunfire yesterday." I asked John to repeat what the news reporter said, and he told me, "Bin Laden was killed yesterday." That's how he processes what he hears, at times.

CAPD is a disorder that is not understood well by all doctors or therapists. A child can be evaluated by a speech pathologist who is trained in CAPD and can give suggestions to parents and teachers to help the child process more efficiently what is heard by the child. It is beneficial for all those who care for or provide services to children or adults with FASD to read the articles at the links below. If you would like to help others understand what it is like to be a student with FASD and CAPD in the classroom, you can administer this CAPD "test" that I designed for use in workshops on FASD:

CAPD Test (PDF File)

Feel free to use this in your presentation or workshop. Just credit the source please. To add to the experience of having processing deficits, you may throw some Sensory Integration Disorder into the mix: Ask your audience to take off their shoes and to put the right shoe on the left foot and the left shoe on the right foot. Then ask them to take off their watch and put it on the opposite wrist. They can take off their glasses and hold a paper over one ear. To add attention deficits you can have someone flick the light switch on and off, or open and close the window coverings, or tap-tap-tap or make some other unexpected distractions while they try to complete some simple task like completing a pre-test.

Be prepared for some professionals who were not taught about CAPD in their college years that there is no such thing as CAPD. Print out this and one of the articles linked below that might apply to the person in question.

CAPD: When is Evaluation Referral Indicated?
Understanding Processing Deficits
Article on CAPD by Steven Cook, MD

Living and Working with CAPD
CAPD Links
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