New research on ADHD

[ADHD RESEARCH UPDATE]

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Greetings:

I hope you are doing well.

Below is an article that appeared in a prior issue of ADHD
RESEARCH UPDATE. The article summarizes an interesting study
on the relationship between ADHD, Central Auditory Processing
Disorder, and learning disabilities. I think the study presents
data that are important for parents to be aware of.

If you have been finding the information you have been receiving
about new research on ADHD to be helpful, I'd like to encourage
you to become a regular subscriber to ADHD RESEARCH UPDATE.
You'll find information about this at the end of the article
below.


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David Rabiner, Ph.D.
Duke University

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* ADHD, CENTRAL AUDITORY PROCESSING DISORDER, AND LEARNING
DISABILITIES

In recent years, several researchers have suggested
that there is considerable overlap between ADHD and
Central Auditory Processing Disorder (CAPD). In fact,
some have questioned whether CAPD and ADHD are really
distinct disorders, or have suggested that children
diagnosed with ADHD often have CAPD instead. A recently
published study takes a careful look at this issue
(Gomez, R., & Condon, M. (1999). Central auditory processing
ability in children with ADHD with and without learning
disabilities. Journal of Learning Disabilities, 32,
150-158).

Since many people are unfamiliar with CAPD (at least
I was until relatively recently), I'll begin with a
brief overview of what this condition actually is. CAPD
is defined as a deficiency in one or more of the following
processes: sound localization and lateralization (i.e.
being able to determine where sounds are coming from),
auditory discrimination (i.e. being able to detect
differences between sounds), auditory pattern recognition
(i.e. being able to correctly identify/recognize patterns
of sounds), temporal aspects of audition (i.e. being able
to identify the ordering of different sounds), and auditory
performance decrements in the presence of competing sounds
(i.e. being able to screen out extraneous auditory stimuli
to correctly identify important sounds).

Deficits in one or more of these areas are believed to
adversely affect an individual's speech and language
functioning. Thus, someone with CAPD may have unusual
difficulty being able to accurately process spoken language,
particularly in the presence of background noise, and thus
have a difficult time comprehending what is being said.
One can certainly see how such a problem would make it
difficult for a child sitting in a crowded and noisy classroom,
and how this child might display symptoms of inattention and
hyperactivity as a result. This is why some professionals,
professional speech and language specialists, suggests that
CAPD may often be misdiagnosed as ADHD. (Note that it is
certainly been shown than speech and language problems are
more common in children with ADHD.) Prior studies have
shown that children with ADHD tend to perform poorly on
central auditory processing tasks and that as many as 50%
of children diagnosed with CAPD also have ADHD.

The authors of this study were interested in examining
what might account for the considerable overlap between
ADHD and CAPD, and hypothesized that the common link may
be learning disabilities (LD). Children with ADHD and children
with CAPD both have significantly higher rates of LD than is
found in the general population. Although learning disabilities
are defined in several different ways, a commonly used procedure
for identifying a child as LD is to determine the discrepancy
between the child's IQ score and achievement test scores using standardized IQ and achievement tests. When a child is
achievement at a level that is significantly below what the
child should be capable of based on their intellectual level,
the child is considered to have a learning disability (i.e.
the learning disability is what is hypothesized to prevent
the child from achieving at the level he/she should be capable of).
Learning disabilities can occur in a number of areas including
basic reading skills, reading comprehension, math, and written
language. A child may have a LD in one area but not others,
or may have multiple learning disabilities.

In the study, the authors began with 3 groups of 15 school-age
children. One group was comprised of children with ADHD alone;
a second group included children with ADHD with a learning
disability in reading; the third group was made up of children
without either diagnosis. The ratio of boys to girls in each
group was about 3:1. (Note: It would have been nice if they
included a fourth group comprised of children diagnosed with
CAPD but not ADHD, and a final group of children with both CAPD
and LD as this would have allowed for a more complete set of
comparisons).

Each child was given several different tests of central
auditory processing ability. These included being required
to completed words that were presented with portions missing;
an auditory discrimination task in which participants were
asked to repeat words that are presented with background noise;
a dichotic listening tasks in which different words are presented
in each ear, and participants have to repeat both words in a
specified order; and an auditory conceptualization task in
which children had to discriminate different speech sounds
(e.g. the sound of /p/ from the sound of /b/,) and to perceive
and compare the number and order of sounds within a pattern.
All these tasks are elements of determining whether an individual
child has CAPD. All testing was done individually, and care was
taken to be sure that children with ADHD had not received any
medication for at least 48 hours prior to testing.

The results were really quite clear-cut. Based on a composite
score derived from the different auditory processing tests,
children with ADHD alone did not differ from the control group.
Children with both ADHD and LD, however, scored significantly
lower than both control children, and children with ADHD. This
clearly suggests that problems in central auditory processing
ability are associated with LD and not ADHD. It is also provides
strong evidence that ADHD and CAPD are truly different disorders,
rather than being slightly different expressions of the same
basic disorder.

Now, even though these results suggest that ADHD and CAPD are
distinct conditions, it is still quite possible that some
children with CAPD are misdiagnosed as having ADHD. If this
were to occur, it seems less likely that proper treatment would
be unlikely to be instituted, although there is some data to
indicate that stimulant medication is helpful to children with
CAPD. These results also suggest that children with ADHD who
are also learning disabled in reading may be especially likely
to have CAPD. For such children, a careful evaluation of this
possibility may prove to be quite helpful in developing the most
effective treatment plan. The most appropriate professional to
consult for such an evaluation would be a speech and language
specialist. Most physicians and clinical psychologists are not
likely to have much experience in this area.
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Sincerely,

David Rabiner, Ph.D.
Licensed Psychologist
Duke University














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