I must admit, I didn't know too much about this disorder until
recently when I'd read that observers suspected this as an undiagnosed
condition in Pres. Bush. And you are indeed correct this disorder has
undergone a labeling change from CAPD to APD.
Not being a professional, but tackling your question as if this were
my child, I would probably make sure I had an accurate diagnosis since
the literature states that this disorder can be both misdiagnosed and
"Although the exact cause(s) of CAPD remains unclear, it does not
appear to be caused by peripheral hearing impairment. The diagnosis of
CAPD remains controversial, largely because of the purported
co-morbidity with associated conditions such as
attention-deficit/hyperactivity disorder, learning disabilities, and
speech-language impairment, as well as the diversity of signs and
symptoms associated with this disorder. Some of the more common
diagnostic tests for CAPD include Staggered Spondaic Word (SSW) Test,
the SCAN Screening Test for auditory processing disorders, and the
Multiple Auditory Processing Assessment (MAPA). Moreover, there is no
clear acceptance of a "gold standard" test battery for evaluating this
As you probably already know, there are also various subtypes within
the APD umbrella diagnosis, so it's important to have that information
outlined for you before discussing any educational setting
Tolerance/Fading Memory subtype, Decoding subtype, Integration
subtype, and Prosodic subtype.
Armed with that information, I went looking for some expert advice on
classroom size. Admittedly, I thought I would find evidence that
smaller *is* better, but I found just the opposite; however, the jury
seems to still be out on that. There are some studies that point to
smaller classrooms benefitting the overall student population, though,
but even those studies are open to controversy when the subject of
money is mentioned.
"An awful lot of attention is being paid to a few studies --
especially Project STAR. But do a few studies make a definitive case
for small classes? skeptics ask, adding, researchers have published
findings from more than 1,100 studies on class size over the years.
Those studies offer mixed and contradictory findings."
Further, from the ldonline website in a conversation with a parent,
Larry B. Silver, M.D., a Washington, D.C. Child and Adolescent
Psychiatrist, (bio here:
http://www.ldonline.org/article.php?id=52&loc=4 ) addresses the topic
of class size:
"A compromise, if it is offered in your school system, is a K/1
program where he could move into the first grade curriculum when he is
ready. The worse option would be to place him in first grade before
his disabilities have been addressed. He will really struggle with the
demand of this grade. A private school with smaller classes is not the
answer either. In some ways, he will have a harder time hiding and his
falling behind will be more apparent. Use your consultants to design
the interventions needed. If the principal cannot find an excellent
teacher or speech pathologist, complain. Unfortunately, you may need
to get the help you need privately."
Also, from a site on hyperlexia:
The classes should be small (but not too small).
(10-15) Kindergarten or Developmental
(18-25) Elementary years (if in regular class)
These children need a peer group from whom they can learn but are
often overwhelmed by to much input.
The small class size is most important as the children first enter
school programs. Some have been managed in regular classrooms from
Rather than class size in particular, the emphasis seems to be on a
cross-disciplinary teaching approach to learning, environmental
modifications, and coping strategies for the student with APD. There
is quite a bit of information on the internet that speaks to the need
for better acoustics in classrooms and that this may be more of an
issue over classroom size.
"Difficulty discriminating words against background noise can be a
significant problem for school children as teaching is largely
performed through the medium of the teacher's voice and classrooms
usually have extremely poor acoustics. Researchers have found that
typical classroom noise levels far exceed the level recommended by
ASHA and that the signal-to-noise ratio, which is the most important
environmental factor that affects classroom communication, is also
typically substantially below what is needed for speech recognition
(Crandell & Smaldino, 2000 p.363)."
However, Gail Chermak, Ph.D., CCC-Audiology, Professor and Chair of
the Speech and Hearing Sciences Department at Washington State
University and author of several books on CAPD offers a few common
sense (and low budget) suggestions before we go ripping out the
ceilings and undertaking huge remodeling projects in public schools.
"While the most effective means of reducing noise levels and limiting
reverberation is through proper planning and architectural design,
noise levels can be reduced after construction through inexpensive
modifications. Such modifications include: installation of carpet,
curtains, acoustic paneling, rubber tips on chair legs and desks, and
use of corkboard as bulletin boards and bookshelves as room dividers
to produce quieter spaces for communication and instruction."
Also, teachers and administrators need to be educated on the special
need requirements for an APD student so they may do what is humanly
possible in a classroom setting.
"Traditional educational and therapeutic approaches can be employed to
remediate areas of need in language, reading, and writing. Many
techniques that have shown to be effective with children with APD
would be beneficial to all children, with and without APD, if the
strategies employed are specific to the child's areas of need (Bellis,
1996; Chermak & Musiek, 1997; Sloan, 1998). Some of these are
1. Modify the environment by reducing background noise and enhancing
the speech signal to improve access to auditory information.
2. Eliminate or reduce sources of noise in the classroom (air vent,
street traffic, playground, hallway, furniture noises, etc.).
3. Teach the child to use compensatory strategies, "meta" strategies,
or executive functions to teach how to listen actively.
4. Provide auditory training to remediate specific auditory deficits.
Without a doubt, the bulk of the responsibility will fall on parents
to ensure their child is placed in an environment most conducive to
their learning style. However, since APD may manifest in difficulties
with listening, thinking, speaking, reading, writing, spelling, and
doing mathematical calculations, besides carrying a psychosocial
stigma, it's imperative that parents find knowledgable professionals
to guide them through this maze of the sometimes contradictory
information. From what I've read on this subject, these may include
audiologists, speech-language therapist, occupational therapists,
psychiatrists/counselors, tutors, GA researchers, and possibly a rabbi
to help parents cope with a special needs child.
As for your specific question on classroom studies, I found no study
indicating the size of the classroom is *necessarily* the best
environment for APD students -- individual attention and
accommodation, yes, indeed -- with classroom size not playing that
much of a factor.
Here are a few books addressing this topic and, as a parent, I'd
probably want to read everything on this subject so I could make
From a professional persective:
When the Brain Can't Hear : Unraveling the Mystery of Auditory Processing Disorder
by Teri James Bellis
Assessment and Management of Central Auditory Processing Disorders in
the Educational Setting: From Science to Practice
Teri James Bellis
Central Auditory Processing Disorders: New Perspectives
Gail D. Chermak, Frank E. Musiek
And from a lay perspective:
Like Sound Through Water: A Mother's Journey Through Auditory Processing Disorder
by Karen J. Foli, Edward M. Hallowell
And here is the Tomatis technique that you might want to consider:
"The recommended treatment for his processing deficit is a program
called Tomatis. It is listening therapy for 2 hours a day, 5 days a
week for 2 week blocks with 3 week rest intervals. The theory is
two-fold. First, there is a weak inner ear muscle that interferes with
the processing of sounds coming in. Second, if his left-ear is
dominant the sound goes primarily in the left ear to the right brain
where there is no language center, then back across to the left brain
language centers across the corpus collosum, adding further
communication delay. The therapy uses ?gated? Mozart and Gregorian
chants through both bone and air conduction to strengthen the inner
ear muscle and train the right ear to be dominant. Tomatis claims to
have global effects on processing in general, and not just on speech
CAPD and the Gifted Child
Auditory Processing Disorders in Children
An interesting Q&A with Gail Whitelaw, Ph.D., CCC-AUD, Director of
Clinical Instruction and Research in the Department of Speech and
Hearing Science at Ohio State University.
Technical Assistance Paper on Auditory Processing Disorders (you'll
have to cut and paste this link into your browser)
http://www.asha.org (enter CAPD or APD in the search index; certain
articles require registration)
Rosie, I hope I've helped in some capacity to illuminate the many
sides of this very complex disorder. I wish both you and your son
much hope and patience in your difficult journey ahead. It was my
pleasure to research this topic for you. The good news is that
despite his disability, he might just grow up to be president of a
very large country someday -- you never know.
Clarification of Answer by
17 May 2004 08:39 PDT
Hello again Rosie,
Not to belabor this point too much but you asked about what experts
say specifically about class size and APD. When Dr. Silver, who I
would classify as an expert in learning disabilities, answered this
question outright and concluded, "A private school with smaller
classes is not the answer either," this seemed to be exactly what you
requested, although his is but one opinion.
The hyperlexia site recommends a smaller class size when a student
first enters school but suggests that information, including social
cuing information, is assimilated through a student's peer group as
long as the stimulus is not too overwhelming. Again, this falls on
the student and parents as to what strategies they've implemented
*outside* the classroom to ensure the child isn't overwhelmed by that
stimuli, so this seems too child-specific in which to base any
I also provided you with several links to studies suggesting smaller
class sizes benefit students in the *general* population and there
seem to be thousands of studies to investigate from *that* angle, but
nothing geared to APD students specifically.
Since you were already aware of these pieces of information and could
have found them on your own, this is where researchers have no clue
and start drifting into mind-reading territory on the 'where you've
been/what you know' front.
Also it would have been beneficial if you'd stated, "I've read every
source book available on this topic so I want nothing *other* than a
case study, I think we wouldn't have wasted each other's time. Clear
communication goes a long way in getting specific information and
*only* that information that you require. I also accept
responsibility for not finding out beforehand how well you'd
researched this topic and so I also learned a valuable lesson. I
apologize for my error.
I wouldn't hesitate to say that in our combined efforts of combing the
internet that if a study on class size existed, our pursuits would
have unearthed it. If there are offline sources that might contain a
study, I honestly don't have the time to hunt them down for you, but
maybe another researcher would.
However, I respectfully disagree that I gave you a course in "APD
101." The audiology experts seem to agree that an APD learning
environment has more to do with the problem of classrom acoustics,
educating teachers on their role for special needs children, and
teaching the parents and the child coping methods for adjusting to
this diagnosis. There is also a consensus that these children should
be mainstreamed in regular classrooms but with the above
recommendations in place. I, also, thought I would find evidence to
the contrary on smaller class sizes, but this wasn't the case.
Since my research is not up par in what you expected, I would be more
than happy to request that the editors remove my answer so another
researcher can take a stab at this. It's my wish that you are
assured that everything that can be done is being done for your son in
the reseach area. Please let me know since all the researchers at GA
strive for good customer service and I've obviously fallen short in
Again, my very best wishes to you and your son,
Clarification of Answer by
18 May 2004 08:49 PDT
Some bad news, Rosie. My request to have my answer removed has been
declined by the editors. Your only option left is to write them
personally and request a refund. If you believe another researcher
can deliver you a 5-star answer that is more on point, I sincerely
encourage you to do so. Yours would be my very first refund it, but I
would wear it with honor knowing I did the very best I could for a
customer and as a researcher that is always my intent.
Should you choose that path, I have copied my answer and will repost
my research as a courtesy to my colleagues so there won't be any
duplication of effort and that they may gear their research in another
direction. They would then be aware of the depth of your own
knowledge on this subject and know that your *only* desire is the
production of a study on APD and classroom size. I shudder to think
what rating you may have given to: "No, there are no studies
addressing this issue" as that is the 'answer' to your specific
I choose my research topics carefully knowing that I won't be
satisfied with my effort unless I look under every vitual internet
'rock' for my clients. The subject matter must also interest me or I
can't muster the enthusiasm to give you my best. I did that.
As I'm sure you're aware through your research on this topic (and my
own initiation to the literature), CAPD/APD has been around since the
1950s, but it's only now that the disorder is becoming more clearly
understood. However, as this Duke University site on Child and
Family Policy suggests "optimal strategies for solving child
development problems lag behind."
"Today a major gap exists between basic research on children?s
development and the public policies and practices that affect children
and their families. One reason for this gap is that researchers have
failed to direct adequate scholarly attention to topics of direct
relevance to society?s concerns about children. Researchers have
focused on children?s development without adequate consideration for
the ecological context in which children grow and relate to society.
As a result, even though knowledge is growing about children?s
development, an understanding of optimal strategies for society to
solve children?s problems lags behind. For example, knowledge is
growing regarding the effects of unsupervised peer interaction on
children?s adjustment, but knowledge lags behind regarding optimal
after-school care arrangements for children with working parents."
Similarly, from the Aetna website mentioned in my answer:
"Given the problems associated with diagnosing CAPD, any therapies
should be viewed cautiously. The National Institute on Deafness and
Other Communication Disorders (2001) stated that it is important to
know that much research is still needed to understand auditory
processing problems, related disorders, and the best interventions for
each child or adult. This is in accordance with the review on this
subject by Chermak (2002) who concluded that ***additional controlled
case studies and single-subject and group research designs are needed
to ascertain systematically the relative efficacy of various treatment
and management approaches****."
I realize this is of small comfort to frustrated parents who need
their questions answered now and not in the future. If you're looking
for case studies to present to a school administrator documenting your
son's need for a smaller classroom, I can't provide that for you. If,
on the other hand, as a parent you're looking for the best learning
environment for your son, at this juncture at least, you will have to
rely on basic instinct and what your gut tells you. Experts will
always disagree over any study -- both in its methods and its overall
interpretation. Only a parent knows their child intimately insofar as
determining and locating an environment and specialists best suited to
their child's individual needs.
If you'd like to make your voice heard politically, you might try the
League for Special Education Voters:
or the Our Children Left Behind website:
Also there are two support groups mentioned on this resource page:
Multiple intelligence is another angle in which to frame APD and the
core knowledge that each student has their own individual learning
styles and strengths. If not for you personally, you might consider
purchasing this text for your son's teachers. It's an excellent
Multiple Intelligences in the Classroom, 2nd edition by Thomas Armstrong
And one further resource which should be new to you (since it hasn't
been published yet) is by Alan Gertner, Ph.D. who is an ASHA
certified, board certified, licensed audiologist, and Fellow of the
American Academy of Audiology. His website was quite off the beaten
path, so I doubt seriously you've come across this link yet. I found
his name through a New York Daily News article from 11/11/03 titled,
"A Child's Hearing Woe."
"Alan Gertner, an assistant professor in the Communication Disorders
and Deafness Department at Kean University in Union, N.J., and author
of a soon-to-be-released book on the subject, says the disorder is a
disruption or dysfunction in the neural pathways that transmit hearing
information from the ear to the brain."
I found Dr. Gertner's website welcome statement particularly honest
and refreshing and perhaps you'd care to follow up on his email
invitation. He seems devoted to educating parents and teachers about
this disorde, contributing regularly to a newly formed website in the
UK dealing with APD issues.
"Welcome to my site concerning APD. There are a variety of sites
dedicated to APD, some by professionals and some by non-professionals.
For the most part they intend to educate or profess a certain
orientation to APD. Some are excellent family support sites (e.g.,
the NCAPD, which I encourage people to visit). Others are designed to
help "sell" something. Hence, there are biases that may be related to
personal experience, a desire for profit, or a professional treatment
position. I have created this site to be as straightforward and
unbiased as possible. I provide some basic facts about APD. Indeed,
although I try to be impartial, my own biases do creep in. After
reviewing all or part of the information at this site, you are welcome
to call or email me. I attempt to return my contacts as soon as
possible, but I am quite busy so please be patient."
I respect your decision whichever way you decide to handle this
question, but I consider our communication complete from my
Wishing you the best,
Clarification of Answer by
19 May 2004 07:49 PDT
Wow, Rosie, it sounds like you'd make an excellent member on the GA
reseacher squad! Very seldom do two people track identical research
paths, so I'm amazed that we converged on the same links with only two
possible exceptions. I usually head down seriously strange rabbit
As individual freelance researchers but as a supportive team, we've
discussed the risk of answering a question when there are no available
sources on the internet or if the information found is contradictory
to the customer's mindset. It's a gamble; we know that. I lost on
this one, but hopefully another parent will gain having these links at
their disposal. We do, however, take our ratings and our customer
service skills quite personally while at the same time maintaining our
sense of humor about what it is to be human.
I've also sent in a suggestion to the GA editors to have radio buttons
installed on the customer's side indicating a client's knowledge level
so we can tailor our research accordingly. They assure me they will
"take it under advisement" which is usually code for "Get lost, ya bug
me." ;- )
1) I'm a researcher extraordinaire/librarian
2) I have some basic knowledge of this subject and the internet but a
second look by a researcher would be helpful
3) I'm completely clueless on this topic
4) What's Google?
5) Talk to me in short sentences
If I'm unable to locate the *specific* information a client is
requesting, I will hopefully contribute some value-added information
with a fresh perspective. Usually I hit on *something* that a client
hasn't thought of themselves, but that wasn't the case here since
you've obviously been very hard at work on the research trail
And, yes, I agree, Dr. Gertner's site needs some updating, but he
sounds like a very busy man. And then he'll probably be on that book
tour soon. But for him to extend himself on his website for parent
outreach seemed quite unique to me. If an education recommendation,
rather than a particular study would be useful, it certainly couldn't
hurt to drop him a line. Most researchers do not have access to
professional journal articles and, as an audiologist and an author, he
may have knowledge on expert opinions as it relates to education
setting placement. Studies though? I highly doubt it.
When I couldn't locate a specific study on APD, I tried to broaden the
scope for companion disorders to see if there were any data available.
Hyperflexia might be research path to consider since this is also a
neural mechanism disorder. While a zebra of a disorder and not your
son's diagnosis, these kids do face similar educational challenges as
your child. Studies might exist in *those* realms, but I'll leave
that research in your capable hands.
You sound like a fully involved, fully informed parent and I'm sure
this situation is quite frustrating dealing with all the educational
bureaucracy. I'm going to drop these last two links in the off-chance
(ha-ha!) you haven't located them. A cottage industry seems to have
grown up around special education advocacy so you aren't alone in your
struggle by any means. If you're so inclined, you might see what they
have to offer in the way of support.
Center for Special Education Advocacy
Center for Individualized Learning
Good luck (and final ... really)!