Central Auditory Processing Eval vs. Neuropsychological Eval

Re: Central Auditory Processing Eval vs. Neuropsychological Eval

• CaptainSerious member

  August 2013

  Thanks, auntie.

  To be honest, I could swear we did a CAPD when J first came home to us, last summer.  He had a very long evaluation by an audiologist (about 2 hours), and petered out at the end.  He was newly adopted, in a new environment with a new language, and only 5 years old.  They said his hearing was fine, but the processing results weren't reliable because of the things mentioned above and his lack of cooperation towards the end.

  Both the developmental pediatrician and the audiologist (who just retested his hearing a few weeks ago) said that he's on the very young side for a CAP eval, and that they typically like the results better in older 7-8 year olds.

  -auntie- said:

  CaptainSerious said:

  J's developmental pediatrician seems to believe that most his issues are anxiety-related, and recommended we see  a psychiatrist for a treatment plan.  

  
  

  A psychiatrist typically means that meds are a piece of how your dev pedi seeing the solution. I'm impressed that he hasn't offered to trial meds but has suggested seeing an expert. If meds are on the table, a behavior mod/talk therapy component should be as well. What sort of behavior approach is chosen is going to depend on your son's level of maturity and cognitive abilities. 

  
  

  We are concerned that anxiety is only part of the picture, and that he's anxious because he's having processing difficulties and doesn't want to make mistakes.  

  
  

  Why do you feel it's that? It's not a conclusion I would make based on the kids I know with major anxiety. Speaking for my own son who not only has an ASD w/the usual anxiety piece, his psychiatrist recently added GAD to his files- anxiety just is. It's a baseline or temperament that is a big part of the child's unique mix of strengths and weaknesses. It's part of who they are like their musical talent, love of ice cream and the color blue. There's not usually an antecedent that can be traced as a cause except to the degree that it runs in families. Anxious parents tend to have anxious kids.

  
  

  I feel like it's related to his fear of doing/saying the wrong thing, because he's still attaching to us, and he panics whenever someone asks him something that he's not sure about or when he thinks he's in trouble.  Outside of that, his anxiety seems to be solely about needing order, and may have more to do with the OCD tendencies he's exhibiting.

  
  

  We don't want to medicate the anxiety and cover up other symptoms/issues without figuring out the full picture first.

  
  

  IME, and YMMV, anxiety relieved may allow you to more clearly see the bigger picture. With complicated kids, sometimes what works best is to remediate the piece you can which will confirm that piece and make the others more easily observed. For us, remediating DS's reading with Orton fixed a lot of behavior we assumed was ASD related but left others. Medication for his impulsivity and focus helped us see what ASD challenges were truly ASD related and were able to isolate the anxiety and social imaturity more effectively with therapies targeted to that precisely instead of taking a scattershot approach.

  
  

  Plus, anxiety just sucks. I would and did do all I could to give DS the tools he needs to overcome his own anxiety issues. Meds were a part, early on they allowed him to drop the hypervigilence enough to access the Social Thinking, cognitive and social integration therapies we put in place for him.

  
  

  You know your child best, but I wouldn't withhold anxiety medication from an anxious kid anymore than I would glasses from a nearsighted one. 

  
  

  I appreciate you view on this, and will keep it in mind as we consider our options.  As I mentioned in one of my previous posts, I'm very nervous about the possible side-effects of many of these medications and the fact that many of them haven't been tested on children.  Add to that the fact that J is so young and has gone through some major traumatic things, I hesitate to jump right to medication before trying to treat through therapies, etc.

  
  

  For example, it's taken since March of last year, but my husband and I feel he's finally opening up to us on a deeper emotional level and allowing for more real attachment.  This is something we've been working on through therapy and at home non-stop.  I just feel like he's starting to let go some of his fears, and I'd like to see how far he can go with out medication that might mess with his body/brain chemistry.

  
  

  Both our family therapist and our pediatrician support us in taking the time to have the other evaluations done first, and revisit the possibility of medication once we have a more complete picture.

  
  

  So, we are in the process of scheduling a neuropsychological evaluation.  We have our psychologist's and pediatrician's full support in this, and thought it would help us flush out what processing difficulties J might be having.

  
  

  A full neuropsych would be my first choice. I might also do a learning evaluation if there are suspected learning differences.
  

  
  

  He has had two complete learning evaluations by the school district, including educational evals, psychological evals, speech evals, PT and OT evals.  He has a severe speech delay (suspected apraxia) and a learning disability.

  
  

  I mentioned our concerns and the pending neuropsychological evaluation to the speech pathologist today, and she said that it sounds like an auditory processing issue, and that the neuropsychological evaluation is likely to just send us back to her.  

  
  

  Call me confused, but why would you SLP try to dissuade you from starting with an evaluation that should help you understand your son's intellectual potential, his academic achievement so far, where he is relative to peers in terms of social, emotional and adaptive skills?  A screening for CAPD could be a part of a full workup, but it's one small piece. And frankly, when it comes to advocating within the school district many don't recognize CAPD as something about which to get excited. All pre-pubescent kids have emerging auditory processing- schools don't tend to get excited about this. It's not a classification under IDEA, some schools act as if it isn't educationally relevant, others will address it if it impacts reading as a "learning difference" if the student has average or higher IQ.

  
  

  Why would your SLP think you'd return to her for this evaluation? CAPD testing is done by audiologists. I'm really side-eyeing a professional who has her heels dug in so firmly rather than keeping an open mind. More information is always good.

  
  

  She wasn't really trying to talk us out of the evaluation, and she didn't say she'd be doing it.  She did say it would be administered by an audiologist, and that she would be working with J for the therapy.  It sounded to me like she was saying that the neuropsych would recommend asking the SLP if a CAP eval was necessary.

  
  

  She mentioned that we need a central auditory processing evaluation instead, but that at almost 7 (September birthday), he's still on the young side for that.

  
  

  DS had some basic processing evals as part of his work-up at Lewis when he was about 7. 

  
  

  So, what's the difference?  I thought the neuropsychological would incorporate auditory processing among other things, but she implied it wouldn't.  What will each evaluation look for, and do I have to have both?  Are we barking up the wrong tree with the nueropsych?

  
  

  Neuropsych is going to typically look at IQ, achievement, and a range of behavioral/developmental markers around adaptive, reasoning, social and emotional development. CAPD is generally done out side of that and by an audiologist.

  
  

  If I could only afford one- it would be the neuropsych all the way. It's just a more comprehensive evaluation compared to looking at a single thing.

  Thank you.  I guess we will continue on our path for the neuropsych and go from there.  Maybe we'll do a CAP eval afterward if we still think it's necessary.

  
  

  Report0 Reply
• Loading the player...
• Assembly_Reqd member

  August 2013

  It sounds like you already are going ahead with the neuropsych and I agree that it the best route. If he is too young for a CAPD diagnosis anyway, you would always question those findings. There is no point in evaluating for it at this time.
  
  I also agree that the school district will give you a big shrug on a CAPD diagnosis. I met a parent from NJ who suspects her son has this and the district refuses to evaluate him, or accept a CAPD dx until he is 9. She is up shit creek until then. Basically her kid will languish for the next three years in school without accommodations. (according to her) She has decided to learn sign language and would love it if she could send him to a deaf school.
  
  A neuropsych will at least give your DS's teachers information on his strengths and weaknesses. I think you will get your money's worth. Good Luck!
  

  WAY 2 Cool 4 School
  

  
  

  
  

  

  Report0 Reply
• Ginlyn0 member

  August 2013

  I would definitely go with a neuropsych exam. They are vary indepth and the information you gain from them about your child is priceless IMO.

  DD(14),SD(13),SS(11),SS(9),DS(3)
  
  

  Report0 Reply
• CaptainSerious member

  August 2013

  -auntie- said:

  Are you still planning to move? 

  
  

  
  

  Yes.  We are planning to move to Vermont sometime in the next two years.  When we do, we will likely transfer all the boys' hospital medical care from CHOP to Boston.  As I mentioned in the other post, Vermont is very highly ranked for disability services, which is one reason we chose Vermont over other states we were also considering, including Maine, upstate New York, and New Hampshire.

  Report0 Reply