When it hurts to listen…

Supporting Children with Auditory Defensiveness

Robyn Wu, OTD, OTR/L, BCP

Imagine parents who are unable to use the vacuum cleaner because the noise pushes their young daughter into an emotional meltdown. Or a preschooler who refuses to enter the bathroom because the sound of a flushing toilet causes severe distress. Or a child who breaks into tears whenever the neighbors run their noisy lawn mower.

The parents and children in these scenarios are coping with sensory defensiveness, a condition that causes ordinary, harmless sensations to be perceived as painful or harmful. This defensive response is believed to be due to a sensory processing disorder in which the brain misinterprets innocuous sensory input as potentially threatening (Wilbarger & Wilbarger, 2012), activating a fight-or-flight response. Fear, anxiety, aggression, and emotional meltdowns — all are common reactions among people with sensory defensiveness. The condition is frequently seen in children with autism; in fact, a recent study reported a prevalence rate of 96 percent (Silva & Schalock, 2012).

Auditory Input, Emotional Reaction

Sensory defensiveness may involve various senses such as touch, smell, or hearing. Auditory defensiveness — an over-sensitivity to sounds — can have a profound effect on a child’s participation in daily life activities. Common household sounds — a hair dryer, a garage door opening, , a toilet flushing — can trigger severe responses in affected children, leading family members to make significant adjustments to their household routines. Uncontrollable sounds from the outside environment — a siren, a neighbor’s lawn mower, the recess bell at school — might bring an affected child to tears. A youngster may avoid eating lunch in the school cafeteria or attending a sibling’s basketball game in a gymnasium because the sounds are just too painful to bear.

Occupational therapists are trained to work with children who have auditory defensiveness. Current best practice advocates a comprehensive therapeutic approach that includes both compensatory and remedial strategies.

Compensatory Strategies at Work

Compensatory strategies involve modifying a child’s environments and routines to minimize the aversive sounds and to support participation in activities the child might otherwise avoid. To illustrate the possibilities, I offer one example from my practice as an occupational therapist: My young client had a diagnosis of autism and regularly exhibited hitting behaviors on school field trip days. A comprehensive evaluation indicated that he had significant auditory defensiveness, with the noise level on the bus as a possible trigger.

My strategy for making school field trips less overwhelming for this child included several tactics. We arranged for the child to sit at the front of the bus; in addition to placing him where the noise level was slightly lower, this approach enabled him to get on last and get off first, minimizing total time on the bus. During the bus ride, the child used ear buds from his iPod as earplugs — a buffer against the noise which looked socially-appropriate. He placed his backpack in his lap to function as a weighted blanket, promoting a calming effect on his nervous system. With these adaptations in place, the youngster was able to participate in school field trips with much less distress and no hitting.

Current research supports the use of such compensatory strategies for managing auditory defensiveness. For example, researchers found that installing sound-absorbing walls in a classroom resulted in improved attention, comfort, mood, and classroom performance in a group of students with autism (Kinnealey et al., 2012).

Remedial Approaches

In addition to deploying compensatory strategies, occupational therapists can put remedial techniques into action. These therapeutic approaches are based on the principles of Ayres Sensory Integration (ASI) (Parham & Mailloux, 2010). In ASI, the therapist engages the child in sensory-based play to improve the nervous system’s efficiency and ability to interpret sensations . Over time, it is believed that auditory defensiveness decreases because the child is better able to distinguish harmless sensations from potentially harmful ones, avoiding unnecessary activation of fight-or-flight responses.

More recently, occupational therapists have begun to use sound-based interventions to remediate sensory defensiveness. For example, Therapeutic Listening, a sound-based program developed by an occupational therapist, uses specialized music to train the middle ear muscles. These muscles protect the ear from excessively loud sounds, filter out background noises and allow focus on foreground sounds (May-Benson et al., 2013). With middle ear muscles functioning more efficiently, children are better able to process and tolerate sounds in their environments, and auditory defensiveness decreases. A growing body of research supports the efficacy of using Therapeutic Listening with children who have sensory processing challenges (Hall & Case-Smith, 2007).

Next Steps for Parents

If you believe your child may have auditory defensiveness, what can you do? Start by learning more about the condition on the Sensory Processing Foundation’s website http://www.spdfoundation.net. You can also learn more about Therapeutic Listening at http://www.vitallinks.net/. You may also wish to consult with a pediatric occupational therapist trained in sensory integration.

References

Hall, L. & Case-Smith, J. (2007). The effect of sound-based intervention on children with sensory processing disorders and visual-motor delays. American Journal of Occupational Therapy, 61, 209-215.

Kinnealey, M., Pfeiffer, B., Miller, J., Roan, C., Shoener, R., & Ellner, M.L. (2012). Effect of classroom modification on attention and engagement of students with autism or dyspraxia. American Journal of Occupational Therapy, 66, 511-519.

May-Benson, T.A., Carley, K., Szklut, B., & Schoen, S., (2013, June). Sound therapy: A complementary intervention for individuals with sensory integration and processing disorders, part II. Sensory Integration Special Interest Section Quarterly, 36(2), 1-4.

Parham, D.L., & Mailloux, Z. (2010). Sensory integration. In J. Case-Smith & J.C. O’Brien (Eds.), Occupational therapy for children, 6^th ed. (pp.325-372). Maryland Heights, Missouri: Mosby Elsevier.

Silva, L.M.T., & Schalock, M. (2012). Sense and Self-Regulation Checklist, a measure of comorbid autism symptoms: Initial psychometric evidence. American Journal of Occupational Therapy, 66, 177-186.

Wilbarger, P., & Wilbarger, J., (2012). Sensory defensiveness: A comprehensive treatment approach. Santa Barbara, CA: Avanti Educational Programs, Inc.

About the Author

Robyn Wu has been practicing occupational therapy since 1994 and is board certified in pediatrics by the American Occupational Therapy Association. She is certified in sensory integration and trained in Therapeutic Listening. She is a pediatric occupational therapist at Communication Works and Assistant Professor of Occupational Therapy at Samuel Merritt University.