Stop Slurping Your Soup! Understanding Misophonia and Hyperacusis (Sound Sensitivity)
If that’s our two-month-old’s reaction when you turn on the mixer or the vacuum cleaner, most of us wouldn’t be too surprised. And we’d probably pick up our frightened, crying baby and try to soothe him.
But what about when your eight-year-old refuses to sit at the supper table because the sound of chewing drives him insane? Or when your teenager insists that she can’t fall asleep in her room because she hears the hum of the refrigerator from the kitchen?
If you would roll your eyes and say, “Oh, give me a break!”, you’d be in the good company of many parents.
However, unusual as it may seem, sound sensitivities are real things, and they can make innocent sounds like chewing or refrigerator hums as physically and emotionally arousing as fingernails screeching down a blackboard. (You just cringed, right? You’re in good company.)
Sound sensitivities are so real that they even have hard-to-pronounce diagnostic names like “misophonia” and “hyperacusis.”
Fancy terminology aside, let’s take a straightforward look at the auditory system and understand what’s going on when a child (or adult!) is unusually sensitive to sounds – and what you can do to help the situation.
I Hear Ya’
The auditory system is up, running and processing sound even before a baby is born.
The sense of sound develops during the third trimester. Fascinating studies (like this one, this one and this one, too) conducted with infants aged one to four months indicate that newborn babies already recognize their mother’s voice from that point, showing how fine-tuned and sensitive this particular sense is from the get-go.
The way we hear is extremely nuanced, with different receptors interpreting sounds and how we perceive them. This is why speaking to babies in “motherese”-the cooing and crooning that crosses cultures almost universally-early on is so helpful to their auditory development. Contrary to the belief that speaking to babies childishly will hinder development, this natural way of relating to them actually enables infants to pick up on nuances and frequencies of sound and become accustomed to what a specific tone in language implies.
In the beginning of a baby’s life, a lot of sensory information is perceived as overwhelming and, therefore, threatening. This phenomenon can be observed when a baby cries fearfully from the appearance of a sudden bright light or loud sound. Similarly, many newborns cry during their baths in early life. Later on in their development, when they are able to process and integrate all the sensory information coming at them properly, they will begin to identify the warm bath as pleasurable rather than threatening and actually enjoy the experience.
This integration happens in all the senses, enabling children to be properly regulated and not overly sensitive in any of the body’s sensory areas. This allows children to perceive information properly and stop reacting fearfully to normal experiences. After approximately four months of age, a baby should acclimate and no longer startle or begin to cry when the mixer or vacuum cleaner is turned on; they should, rather, perceive the sound as related to Mommy and completely nonthreatening.
I Hear You (Too) Loud and (Not) Clear
Sometimes this integration and subsequent ability to regulate doesn’t take place as expected. The result? Hypersensitivity to specific sounds or groups of sound, based on frequency, volume, tone or negative associations.
Sensitivity to sound in children and, later, adults is very real. Sound sensitivity can be categorized either as
hyperacusis: physical sensitivity to general categories of sound, usually manifesting as hearing them louder than normal (e.g. a passing train sounds like a jackhammer, normal speech sounds like shouting). The trigger only depends on the physical auditory signature of the sound, and is not dependent on context, timing or any other factor.
misophonia: emotional or psychological sensitivity to specific sounds, causing either emotional and/or physical discomfort upon exposure (e.g. anxiety upon hearing the sound of a blowdryer, pain when hearing people chew food)
A child may suffer from one or both of these conditions. While most adults with hyperacusis or misophonia have learned to control their reactions to hearing a triggering sound, children in the same situation usually show a very impulsive, emotional and often aggressive reaction. Those children covering their ears and running from the room or climbing the walls during an otherwise calm family meal are not necessarily blowing things out of proportion. There is a physiological-and painful-phenomenon going on in their neurological systems that leads to these seemingly extreme reactions.
Let’s take a look into the ear and see what’s going on.
Unbalanced and Out of Control
The ear is responsible for two functions:
- the auditory system, which takes in sounds and processes what we hear
- the vestibular system, which controls our sense of balance
“Balance” isn’t only the physical aspect of not falling off a balance beam, or of not falling down when someone turns us around a few times. The vestibular system has a large impact on emotional balance as well, either through its extensive interconnections with the limbic system (the primary regulator of emotions) or its role in regulating the autonomic nervous system (which is responsible for fight-or-flight responses).
Since the mechanisms by which both the auditory and vestibular systems interpret input originate in the ear, sensitivity in one can lead to sensitivity in the other.
If the auditory system is hypersensitive and unduly physically affected by “normal” sounds (=hyperacusis), the overstimulation might impact the vestibular system, triggering the fight-or-flight response.
If issues with the vestibular system cause a child to be emotionally off-balance, those issues might cue the auditory system, causing it to become more sensitive and irritable, especially when the child is in an emotionally triggering situation. That sensitivity and irritability might become associated with certain sounds and contexts, evoking that reaction whenever the child is re-exposed to them (=misophonia).
If that sounds bad, then wait – because it gets worse.
Sometimes these reactions can combine to form an automatic loop response: the auditory irritation causes a vestibular-linked emotional reaction, which then primes the auditory system to be more irritable.
You can guess (or you know from experience) what happens next: the child loses control. Meltdowns, screaming, exploding, totally withdrawing… there’s no one to talk to. Because children are usually unable to access coherent language while in panic mode, they get stuck in trying to flee the discomfort by withdrawing emotionally or trying to fight the discomfort by reacting aggressively.
This, obviously, has major and unpleasant consequences for the family dynamic. Mealtimes, trips, social events – any one of these can become the backdrop for an out-of-control, “what-could-we-possibly-have-done-differently” situation.
Even for children and adults who have learned to control their external reactions to triggering sounds, the physical and emotional pain take a toll. When unavoidable daily sounds like a baby sucking or a washing machine spinning cause a constant state of discomfort and/or anxiety, it can significantly impact quality of life.
So What Can You Do About It?
How can you help Seth stay at the supper table when he’s sensitive to the sound of Danielle’s chewing? How can you keep Rebecca from making a scene during Greg’s daily violin practice time? How will you attend your cousin’s upcoming wedding if Kim becomes explosive from the sound of clanging cutlery?
The following is a list of multiple steps that you can take to address, reduce and treat your child’s hyperacusis and misophonia.
Understanding and Validation
If you now have a better understanding of what your child experiences and why they act the way they do, that itself will make a tremendous difference to both of you! So much of the negativity we feel is because sound sensitivity seems like a behavior problem instead of an internal, physiological issue. Once we understand that just as a child with visual issues will act clumsy in certain settings, a child with sound sensitivity issues will act impulsive and explosive in certain settings, it reduces a lot of our tension.
When you take that understanding and use it in validating your child’s experience, that is an even more significant part of the healing process. Assuring your child that you are aware of what they are going through and are taking the issue seriously is so important. (Indeed, I (Amy) recall my own sensitivities in childhood – not sound per se, but other sensory sensitivities – and I credit my parents’ understanding and validation for how well I was able to deal with them.)
Desensitization and Retraining
Ideally, you would get at the root of misophonia and hyperacusis by directly treating the underlying core issues: the hypersensitivity of the auditory system or the vestibular system. Treatment may involve either desensitizing auditory sensitivities that are triggering an emotional response, or dealing with the activation of the fight-or-flight response that is triggering auditory sensitivities.
Once the core problem is addressed, auditory training is sometimes used to reacclimate children to the sounds they were sensitive to. That way they will be able to handle hearing them without triggering an emotional response.
As an example of how this would practically play out: a child who has been traumatized may have formed a negative association between a specific sound and the trauma. For instance, a train passing the location or the ticking of a clock in the room may have become noxious to the child due to the association with the frightening experience. In such a case, the trauma is the root of the issue and it needs to be dealt with to heal the emotional response. After that core issue is resolved, the child can be retrained to handle that specific sound without the auditory system being triggered.
While treating the root of an issue is always the most effective way to address it long-term, it’s not always possible. Availability of appropriate therapies, financial restrictions and other issues may make it infeasible for you to currently treat the root of your child’s sound sensitivities. Frustrating as that is (it always frustrates us!), there are practical compensations that can make life much more manageable for your child and your family, even if the underlying problem is not yet resolved. Here are some of the most effective:
Involve the proprioceptive system
In general, when one of the body’s systems is lacking, a different system will be available to compensate for the lack. In the case of sound sensitivity or other sensory regulation issues, one of the best systems to rely on for compensation is the proprioceptive system. This system gives us a sense of where we are in space and enables us to stay organized and be able to interpret information more easily. Physical actions that give feedback to our body’s joints, like clapping or pressing our hands together or stepping on the floor barefoot, release neurochemicals that stimulate the proprioceptive system. This explains why hugging a child during a tantrum, clasping their hands in your own or giving them other, similar physical feedback will often help them calm down and bring them back into focus.
If your child is going into a triggering situation, teach them to stimulate their proprioceptive system. This can be done through the joints of the mouth (e.g. by chewing on something hard and crunchy, like carrots or big pretzels), through the joints of the arms and hands (e.g. using squeeze balls or fidget toys) or the joints of the legs and feet (e.g. jumping or stamping). Proprioceptive stimuli will give them a better awareness of themselves and increase their ability to stay in control even when faced with triggering sounds.
Is the sound of others singing an irritant for your child? Somehow, having the child sing along with-and often louder than-the others at the table often helps them handle the singing sounds.
The same is true with any other sound they find irritating or bothersome; have your child try chewing, singing softly or humming to themselves. This engagement of the child’s own mouth or voice activities serves to reduce the impact of the distressing sound while helping them feel calmer and regulated.
Yes, of course it’s frustrating to have arranged everyone’s schedules for a family dinner – and now your child is refusing to sit with everyone or otherwise participate! Even so, allowing sensitive children to eat their meal at the far end of the table (or even in a different room), if that enables them to avoid the sounds they can’t tolerate, is one way to convey that you take their difficulty and wellbeing seriously.
Playing soft background music that your child finds pleasant can greatly help reduce misophonia triggers, as it creates a pleasant sound to focus on instead of the irritating one. This gives them a point of focus for regulation and prevents the triggering of the loop response, which is the integral issue.
(Note: while sometimes exposure therapy is used as treatment for anxiety-related issues, it is unlikely to be effective for misophonia. In fact, it may just increase the damage by repeatedly creating the loop response. Also, as misophonia is anticipatory, just thinking of a specific sound or knowing one will be in a situation where such a sound is present later in the day will already create an emotional reaction. Therefore, rather than exposing a child to an intolerable sound again and again, teaching them to focus on a sound they can handle, such as soft music, will be much more effective.)
Working with the mind
Another “focus-shifting” compensation can be done with mindfulness or visualization techniques. Having a tangible, relaxing focus will help quiet the autonomic fight-or-flight response when a triggering situation occurs. For example, if a child is at a table where triggering sounds are present, asking them to visualize a balloon filling with air as they breathe in and out can mitigate the flare-up of the nervous response, even while the sensory irritation remains.
Part of the challenge of addressing misophonia with children is that they often have a hard time pinpointing the source of what’s bothering them. What is it about Shaun’s coughing, for example, that is so intolerable? Cognitive techniques can be helpful here. Cognitive behavioral therapy (CBT), for example, can help children to define what is bothering them and work directly on retraining their thinking about the situation.
All of the above practical solutions can be implemented to adjust the family dynamic, give your child tools to help themselves and avoid the auditory-vestibular loop response whenever possible.
A Word on Overall Regulation
Babies who eat and sleep well are generally happy and content. We’re not too different as children or adults. Being well-rested and eating well are good investments into overall wellbeing, and will inevitably help with the areas where our bodies have a harder time regulating themselves (e.g. sound and other sensory sensitivities).
Incorporating movements and exercise into daily life helps develop improved body awareness and self-perception. This, too, enhances self-regulation, which will naturally minimize the effects of hypersensitive sound perception on one’s emotional and physical wellbeing.
It’s not simple to be the parent of a child with sound sensitivities. Your auditory system does not need to come into “direct physical contact” with a sound in order to experience it. Sounds in the environment can be perceived whether they’re right next to your ears, across the room or – depending on the sound and level of sensitivity – even a block or two away. Limiting exposure to the irritating sensation is much trickier than it is with tactile sensitivities, visual sensitivities or even olfactory sensitivities.
Adding to the complexity are the other people in the picture, specifically the other children in your family. While “don’t touch your brother with that rough blanket” is a (hopefully) realistic request, and shouldn’t rationally be perceived as an imposition, “don’t chew” and “don’t cough” are decidedly unrealistic and unreasonable. Even behavior modification requests like “don’t sing,” though more doable, can often lead to resentment on the part of siblings.
We’ve seen, however, that this situation – challenging as it is – can be a golden opportunity to teach our children about sensitivity to others, and extending ourselves a little beyond our comfort zone in order to show that sensitivity.
“Tanya, even though the sound of your blow dryer doesn’t bother you or me, it does bother Zach. Can you show sensitivity to his needs and shut the door to your room when you blowdry your hair? And if you can try to time your shower and blow dry after he’s asleep, that would be extraordinarily sensitive of you.”
But sensitivity to others does not only go one way.
When a child’s sensitivity affects his siblings, and especially when it has the potential to cause them discomfort or inconvenience, it’s important to teach him to extend himself for their needs and sensitivities as well.
“Zach, I know the sound of Tanya’s blow dryer is exceptionally uncomfortable for you. But she’s sensitive to her appearance and it’s important for her to look nice. She is going to shut the door to her room, but if it still bothers you, then I would like you to make an effort to show sensitivity to Tanya’s needs and do what you can – like crunch on a carrot, sing your favorite songs, or go play in the yard – to help yourself manage.”
When our children can respect the different needs, perceptions and sensitivities of others – and feel respected and supported in return – they will make our world a better place.
Find out more about the other sensory issues that can impact your child’s development!
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Questions about sound sensitivities? Tips for other parents? Please share your thoughts and experiences in the comments below!
My daughter demonstrates slow processing speed with everything. Her verbal responses are always delayed, as well as her motor movements. Recently, she has started to complain that our chewing at dinner time is bothering her, so she leaves the table. Is all of this related? Everything she does is done at a slower pace. Will proprioceptive input support all of this and how do I work with the slow processing that is interfering with schoolwork, class participation and social interactions?
She is also having an audiologist evaluation next week.
Thank you so much for your share. Regarding your daughter’s symptoms, it’s difficult to ‘diagnose’ online, but yes – many of those components may be inter-related. When our children are in a heightened state of intensity, processing does slow down. The proprioceptive system is helpful in quieting the intensity, but you really do want to have her evaluated by an occupational therapist to see if there may be some sensory systems or reflexes that are also interfering. Additionally, I would recommend trying to help her with some compensatory techniques while pursuing the deeper work. Good luck at the audiologist. I’m sure you will get more feedback from that appointment as well.
Keep us posted!
Hi! You mentioned that an audiologist would be helpful in the treatment of misophonia. What would an audiologist do to help the treatment and is it a must for an audiologist to be involved in the treatment plan or is sensory therapy with a trained OT enough to get to the root of the issue?
Also, because it is so cognitive based ( and i see that you mentioned this in the blog post) would you recommend a child see a social worker to work through this emotionally or with cbt?
Thanks so much in advance! I so appreciate all the resourced you put out there for us!
Thanks for your question! No – it is not a must for an audiologist to work with a child with misophonia but they would be helpful in making sure there is no biological cause for the sensitivity. And yes – a trained OT can help get to the root of the issue. Regarding a CBT approach or a need for a mental health professional, depending on the age of the child, the psychological imprints may need that once the OT has worked on the physiological causes. Again, very dependent on the child and on the case.
We hope that helped!