Accommodating CAPDs – The Tripod System – Part 1 of 3
In working with clients with CAPDs we need to be aware of the three areas that assist our clients with their central auditory processing deficits. A tripod representing (1) compensatory strategies, (2) corpus callosum maturation, and (3) therapeutic measures; are all necessary to support the CAPD. Otherwise the central auditory skills will not be supported as efficiently as they can be! Let’s begin with compensatory strategy recommendations that support the CAPD.
There is a suggestion (often referred to from the 1970s) that a person with CAPD should be offered seating in the front row (such as in a school setting) or close to the speaker. In this case there is no visual assistance to figure out the message that is misunderstood. A teacher may give directions, “Take out your math book, turn to page six, do problems one to six, but skip seven, eight and nine and the complete the rest of the questions.” The client will have more success in responding to these lengthy directions, if he is able to look at the person in front of him or beside him for visual cues. A child, who sits in the front of the row, may turn around for visual cues from the child seated behind him. The teacher may regard this as a child who is not paying attention, when in fact it is a child who needs to compensate for a CAP problem. To alleviate a misunderstanding of the child's action of turning to the child seated behind him for visual cues, and to enhance his auditory processing abilities, it is imperative for him to sit in the second or third row, and not at the very front.
Preferential seating is important to benefit from both acoustic and visual cues. We should try to be seated away from fan, hall and other environmental noises to reduce the detrimental effects that background noise has on our listening ability. A distance of 6-to-10 feet from the teacher/speaker is considered most beneficial. And a common recommendation is to sit in the second or third row to enhance visual cues from persons seated in front and who properly hear the lengthy auditory message.
Lengthy Auditory Information Increases Frustration
Professionals and family members need to be reminded that the client with CAPD might have difficulty in understanding what is asked of them, and they may forget lengthy information, especially if the auditory message is presented rapidly. This problem could cause him to miss important verbal information and become frustrated. Directions should be provided in short, direct sentences. He should be encouraged to ask for repeated directions, when necessary and be provided extra time to respond, if necessary. The use of visual information during lectures will assist him in understanding large amounts of auditory information, especially if the speaker utilizes a fast rate of speech. Also, he may either exhibit fatigue or hyperactivity by the afternoon, because of his high concentration level that he must exert in order to understand throughout the day.
Repetition and Misunderstanding the Message
When working with clients with CAPD – we need to say what we are going to state – then say it – then say what we just stated! This is especially true for clients with a Decoding type of CAPD as they usually misunderstand several parts of the spoken message. You probably have heard them state, “What?” several times during your conversation, which gives them the time to decipher the message. When this happens – the speaker may try to repair the ‘broken message’ and deliver more information than needed. Here is an example:
Speaker: “Please help me set the table for a party of six. We need extra drinking glasses and napkins”.
Listener with CAPD: “What?”
Speaker: “Find the six black dinner plates with the polka dots, for six guests coming to our home, and place a napkin next to their plates”.
Listener with CAPD: “Please repeat the first direction before giving me another one.”
The solution is to avoid giving more vocabulary to repair the conversation. Instead, repeat the first direction with the same semantic content, but with less wording, if possible: “Please set the table for six people.”
Another form of repetition is pre-tutoring for the client in a school setting. If the ‘heads up’ information on next week’s topic, osmosis, is presented to the client with CAPD prior to the presentation on “Osmosis,” then the client may have a better opportunity to accurately understand the topic when presented to the class. This strategy works when the teacher/speaker is organized and genuinely understands the need of pre-tutoring.
One of the most common recommendations for those with CAPD is to offer an auditory trainer. It is inappropriate to indicate that every client with CAPD should have an auditory trainer. Usually those with a significant Decoding type of CAPD or speech-in-noise issues are the candidates who would benefit from a trial period of six weeks to observe if the client improves in hearing accurately. Actually, everyone benefits when the signal to noise ratio is enhanced, whether we are on a museum tour or sitting in a classroom. For this reason, school districts should offer the sound field system in all classrooms! When should we recommend the removal of the use of the auditory trainer? Often, another six-week trial period (without the auditory trainer) may provide this information to the user.
On occasion parents will desire to purchase the auditory trainer for their child to have during recreational activities. Sarah, age 6, with significant decoding and speech-in-noise issues used the auditory trainer at all of her karate lessons for two years. After successfully completing CAPD therapy she found she did not need the auditory trainer; and she won several karate competitions during these two years!
Academic Setting Accommodations
One of the most common academic strategies is to provide extensive test taking time, which is usually 50% more time on all examinations, including standardized testing. For some, a reduced list of spelling words relieves frustration while therapeutic measures improve in the ability in discriminating vowel sounds and phonemic skills. And on occasion an extra set of text books may be provided for the home environment.
Teaching the student how to ask for redirection and where to be seated in the auditorium or classroom are essential advocacy strategies. A student who inquires in this manner, “I heard the information on who was the first Canadian prime minister, but I did not hear the rest of the sentence.” The speaker immediately understands what to repeat and that the student was paying attention. Role playing is a fun way to learn this skill, and parents can continue the lesson at home.
A fun way to learn the benefits of preferential seating is to present situations that require environmental alterations to properly hear the message. For instance, “What would you do if you were at the airport and you could not hear what your father was saying?” An obvious response would be, “I will move closer to my dad.” And then compare how one can easily do that in some settings but not in other settings. Thus, we need to be prepared that this will happen and be seated in specific arrangements to assist us.
Students starting at grade 4 should be taught these strategies.
In the next issue of Canadian Audiologist I shall bring the other two areas of concern: callosum maturation and therapeutic measures.