From time to time, I am asked by parents about Central Auditory Processing Disorder (CAPD) as a possible cause for their children’s attention problems or difficulties at school.
Since this condition doesn’t get a lot of coverage, I thought it would be a good topic to cover in this column.
CAPD is described as a problem in the communication between the ear and the brain. Individuals have no hearing deficits, but seem to experience difficulty processing the information they hear in the same way as other people.
Some experts believe as many as five percent of school aged children experience CAPD and that it can be easily confused with ADHD, autism or learning disorders.
Kids with this disorder often do not recognize subtle differences between sounds in words – even if they are loud enough to be heard. Something adversely affects the way the brain recognizes and interprets sounds and especially the sounds involved in speech.
This deficit in coordination between the brain and the ears seems to be worst in situations with a lot of background noise – which encompasses many of the regular activities of an average child.
Although children with CAPD do not have a problem with hearing sensitivity, if their disorder is not managed early, they may experience speech and language delays as well as academic problems.
Some of the main symptoms to watch for in CAPD include: being easily distracted; getting upset or bothered in noisy environments or sudden loud noises; improved behaviour and performance in quieter settings; difficulty following directions; reading, spelling, writing or other speech-language difficulties; difficulty comprehending abstract information; difficulty with verbal math problems; forgetful and disorganized; and difficulty following conversations.
Obviously, many of these symptoms are hallmarks in other common childhood disorders including ADHD and this has contributed to the diagnosis and even the existence of CAPD being somewhat controversial even among the professionals who deal with it.
Diagnosis may be difficult and should be done by an audiologist – although this usually can’t happen until the child is at least eight or nine years old.
Once a diagnosis has been made, children usually work with a speech pathologist and visit the audiologist once a year for follow up.
It would likely also be a good idea to have a child with these symptoms screened for other disorders including ADHD and it is possible for both conditions to exist simultaneously.
This could be ruled out by monitoring the child’s progress with the treatment and aid of the audiologist. If measures such as giving the child a quieter school environment, moving him or her to the front of the room for less distraction, and other specific CAPD treatments are not effective, it might be wise to consider other issues as contributing to the problem.
By now we all know that schoolyard and cyber bullying is a serious subject with serious consequences for those involved. Preventing and stopping bullying continue to be important priorities in our quest to provide physical and emotional safety for our children.
Bullying among children is recognized as a major public health problem and studies indicate between 20 and 30 percent of school aged children are frequently involved in bullying – either as victims or bullies.
All of these children are at increased risk for a variety of problems including low self-regard, depression, anxiety and violent behaviours among other things.
A review study, published in the Canadian Journal of Psychiatry, confirmed that bullying in childhood is significantly associated with suicidal ideas and attempts later in life.
Study authors compared and analyzed results from 31 studies examining the association between bullying and suicide. Data from all studies point to a clear association between bullying and suicidality.
Some particularly interesting findings came out of this review study. It was found that not only victims, but bullies themselves are at increased risk of suicide later in life. This risk is particularly present if the childhood bully experienced comorbid psychiatric problems. A recommendation stemming from this finding is for children involved in bullying behaviour to be actively screened for psychiatric problems and suicidal thoughts.
Evidence shows bullying victims exhibit high levels of suicidal ideation and are more likely to have attempted suicide than non-victims. Similarly, those who do the bullying also have higher levels of both ideation and attempts and the individuals who exhibit the highest risks are those involved in both bullying and being bullied.
Studies have inconsistent results when it comes to the different risk for girls versus boys. Some studies claim the increased risk of suicide for bullies is only evident among girls and not boys. Conversely, another study found the same for boys and at least one study found no difference between boys and girls. Clearly, more study in this area will need to be done before it is clear what, if any, the differences are between boys and girls.
Some experts suggest a different threshold for girls and boys when it comes to bullying and suicidal thoughts. It seems even infrequent bullying is associated with increased risk among girls, whereas for boys only frequent bullying led to an increased risk.
Whatever the individual differences between the sexes, it is clear from all studies that both girls and boys experience negative mental health effects from bullying in all forms.
With suicide rates among young people on the rise around the world, it is imperative for all influential adults – parents, teachers, health care providers and the media to do whatever we can to minimize risk factors. Preventing and stopping bullying is an important step as is ensuring mental health issues are not taboo so our kids know when to ask for help and can be assured they will get help when they do.
It has long been observed that children of parents with schizophrenia and other disorders involving psychosis seem to be more likely than average to develop similar disorders themselves.
Research has also shown there is a familial link, but to date there has been little study into the specificity of risk or observance of these children into their mid-adulthood as most studies stop following the individuals once they get through the mid-twenties when onset peaks for these conditions.
A recently published study examined these things and found that children are indeed at a significantly higher risk of developing the same condition their parents have.
Compared with controls, offspring of parents with schizophrenia psychosis spectrum have six times the risk of developing the disorder themselves and a doubled risk for developing affective psychoses (such as bipolar disorder).
Children of parents with an affective psychosis had a 14-fold elevated risk for a similar condition compared with controls and a doubled risk for schizophrenia psychosis spectrum disorder.
The study, published in Archives of General Psychiatry this year, examined 203 high risk offspring of parents with psychoses and 147 offspring of control parents. These individuals were followed into their mid-adulthood because although the peak age of onset for these conditions is between 18 and 30, sometimes a person is not affected until their 30s or 40s.
As our understanding of human genetics grows, we are learning more about the cause of many psychiatric conditions including schizophrenia. Although we now know genetics do play an important role in this condition, this does not account for all cases of schizophrenia or psychosis. Other causes are still unclear but likely involve a combination of biological and environmental factors.
There is no cure for schizophrenia. Anti-psychotic medication can control symptoms such as delusions and hallucinations, but other hallmarks of schizophrenia such as lack of motivation and blunted emotions may not respond as well to medication.
When symptoms begin, it is important to seek treatment as early as possible. Obviously, this disease is very upsetting to the individuals experiencing it and the sooner it is treated, the better. There is also a belief (supported by some research) that early intervention may lead to better functioning and more independence in the long run.
Schizophrenia tends to develop slowly as a gradual deterioration in the brain’s ability to process information or communicate with itself. Because of this gradual onset, family members may think the individual is simply going through a phase or rebelling and may not realize for some time that there is a serious problem.
Some early warning signs to be aware of include: bizarre or unusual behaviour; an inability to sleep or mixing up of day and night; social withdrawal or isolation; hyperactivity or inactivity; inability to concentrate; unusual preoccupation with religion or the occult; hostility, suspicion or fearfulness; over-reaction to peer or family disapproval; deterioration in personal hygiene; excessive writing or childlike printing with no clear meaning; flat, expressionless gaze; and peculiar use of language.
Although one of these symptoms in itself may not constitute a serious problem, if you have a loved one who is exhibiting several of these behaviours, it may be worthwhile to seek medical advice.
Certainly, if you have a parent with a psychotic disorder, you are at increased risk of developing the condition yourself. If you notice any of the above symptoms, speak with your doctor about it.
Depression is one of the unfortunate conditions affecting a fairly large percentage of the human population for which there is no obvious evolutionary advantage. The common occurrence and persistence of a trait like clinical depression with such negative effects early in life is difficult to explain.
The discipline of evolutionary psychiatry views modern human behaviors as products of natural selection that acted on the psychological traits of our ancestors. Likewise it tries to find evolutionary explanations for mental disorders.
If it isn’t useful and doesn’t boost our survival opportunities, why hasn’t depression just died out over the millennia?
Roughly seven or eight percent of Canadians will experience depression and the condition seems to be flourishing everywhere on the globe. The World Health Organization has named depression as the world’s leading cause of disability and says that in 10 years it will be second only to heart disease in contributing to death and years lost to illness.
Its prevalence and persistence in human life leads to questions of whether depression has some usefulness to us as a species.
This is hard to believe since depressed people – really depressed people – can barely get out of bed, have no motivation or energy and experience no joy in anything. What good could this possibly be doing for humanity?
It has been suggested that depression is an evolved response to complex problems – perhaps there is some benefit derived from focusing on complex issues to the exclusion of all else.
Unfortunately, this theory flies in the face of the considerable evidence that cognitive functioning in almost all domains is impaired during depression and that these impairments persist even after the depression lifts. Everything from immediate memory, visual-spatial construction, language, attention and delayed memory seems to pay a toll during depression. These impairments can contribute to lower social and occupational functioning and a diminished quality of life.
Further, depression can be associated with declines in problem solving abilities on neuropsychological tests. Typical depressive thinking about common life situations usually leads depressed individuals to make decisions that increase social isolation and establish a vicious circle or positive feedback loop. The more depressed one is the more socially isolated they become and the more socially isolated they are the more depressed they are.
It seems more likely to me that the persistence of depression must be associated with some other characteristic that does have an evolutionary advantage. Just as psychosis has been hypothesized to be an unfortunate by-product of the evolutionary changes leading to our ability for language, depression may be a by-product of some other special trait unique to the human species.
If that is the case, there may be nothing we can do to eliminate depression in our population, and efforts will have to be focused on helping people function in their daily lives. This is essentially what we do now. It might explain why we have had so little success in pinpointing the precise genetic basis of the disorder.
Read more Mental Health articles
- Gender differences & aggression Feb 5
- Addiction and psychiatric treatment Jan 29
- Why does schizophrenia exist? Jan 22
- Mental health first aid Jan 15
- Keeping your New Year's resolution Jan 8
- How depression affects men vs. women Jan 1
- Cognitive Behaviour Therapy Dec 25
- Mental health tips for the holidays Dec 18
- Goals are good for you Dec 11
- Synesthesia Dec 4
- Depression and bipolar disorder Nov 27
- Diagnosis is often the easy part Nov 20
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