Sensory sensitivity is common in itself but an overreaction to sound in particular is often the most obvious and severe struggle that ASD children face.
However, it won’t affect all children equally. For a great number of children with autism, the opposite is true, with them actually showing signs of being under-sensitive to noise. In this case, they may be unresponsive when you call their name, seemingly unable to hear you.
For those children who are over-sensitive to sound, noise that seems at a suitable level to you may be overwhelming to them. This is because their senses are taking in too much information. In contrast, under-sensitive children will have senses that take in too little information. The exact reasons behind this are unclear.
Loud noises may be painful. The din of a city street or a mall can be too much. When overwhelmed, people on the autistic spectrum may cover their ears to try to block out the noise. They may also start up self-soothing stimming behaviors such as rocking or shaking their hands.
Some children can have both oversensitivities and undersensitivities in different senses, or even the same sense. For example, they might be oversensitive to some sound frequencies and undersensitive to others. Undersensitive children might turn up music or speak loudly. Oversensitive children might cover their ears to block out loud noises.
Some people with autism also have central auditory processing disorder (CAPD), a condition that makes it difficult for them to perceive subtle differences in sound and language.
○Signs and symptoms of sound sensitivity in a child with autism:
A reluctance to visit places with high noise levels, especially ones typically enjoyed by children such as the cinema, a funfair, or concerts. If your child likes to visit quieter places like museums while acting out against trips to the cinemas, then you should consider whether sound sensitivity is the cause
A keen attention to detail. Does your child point out noises that you didn’t even notice? If he/she is picking up on the tiniest details, then it’s likely to do with an over-processing of sensory information
Becoming agitated around low, droning sounds. It’s common that a low hum, such as that made by your refrigerator, annoys a child with autism. Note down moments in which he/she starts acting out and list the noises that were present at the time
Being easily startled. If your child frequently jumps at sudden noises, such as alarms, sirens, and slamming doors, then he/she may be experiencing these sounds more intensely than others do
Complaining about loud noises. Many children won’t complain when they hear fireworks or a fire engine alarm. If your child does, then ask him/her to explain their problem further. Sound sensitivity is a likely cause
Reacting to high pitched sounds. Most daily high-pitched sounds shouldn’t cause discomfort. While many children are over-sensitive to low humming noises, other ASD children find high-pitched noises the most irritating
Becoming easily distracted. For example, a child in a class that he/she normally enjoys may find him/herself becoming distracted when an air conditioning unit is switched on. If you find your child cannot concentrate in scenarios that involve a particular noise, then sound sensitivity is often the cause
Covering his/her ears. Though this isn’t the response of all ASD children who experience sound sensitivity, it’s common to respond to noise by covering ears. This is the natural response to unpleasant sounds: blocking them at the source. If your child seems to do this even when there are no noticeable loud noises, then consider sound sensitivity as a cause
Do any of the above signs and symptoms sound familiar? Then it’s likely, though not certain, that sound sensitivity is the reason behind such behavior.
It’s important to watch your child closely and make a note – either mental or physical – of the situation. Once you start to spot patterns then the cause of such behavior becomes clear. This is the first step needed before you can start finding solutions to these struggles.
1. Hyperacusis
Hyperacusis is characterized by decreased sound tolerance – an increased sensitivity to normal environmental sounds.
This can have a significant impact on many aspects of a person’s life. It can disrupt a person’s career, dismantle their social life, and perhaps even rattle their peace of mind. Very normal activities like talking to a friend, watching TV, driving a car, or vacuuming your home may feel difficult, uncomfortable, or perhaps even impossible. Some people even find the sound of their own voice or their spouse’s voice intolerably loud.
If you live with hyperacusis, you may feel like the whole world’s volume is unbearably and painfully high.
You may experience physical pain in your ear or a feeling of fullness (pressure) that is especially irritating. In addition, many people find that tinnitus (ringing in the ears) accompanies their sensitivity to sound, and some also lose their dynamic range of hearing (the ability to deal with sudden changes in volume).
Hyperacusis is rare. It affects 1 in 50,000 people. Most people who have it also have another condition called tinnitus, which is a buzzing or ringing in your ear.
Hyperacusis is a hearing disorder. But a lot of people who have it also have normal hearing. Some people are only mildly bothered by these sounds. Others have severe symptoms such as a loss of balance or seizures.
By taking this in-depth Hyperacusis Impact Survey, you can determine the severity of your decreased sound tolerance: https://www.soundrelief.com/hyperacusis-impact-survey
☆Types of Hyperacusis
There are two types of hyperacusis: cochlear and vestibular.
Cochlear, the most common form, causes pain in the ear, frustration, and a general feeling of intolerance to everyday sounds.
Vestibular hyperacusis, on the other hand, causes feelings of nausea, dizziness, and imbalance when particular sounds are present.
Both types of hyperacusis can cause anxiety, stress, depression, social isolation, and phonophobia (fear of normal sounds).
Do not confuse hyperacusis with recruitment, a condition that causes an exaggeration in one’s perception of sounds located in their frequency range of hearing loss. Where recruitment makes certain loud noises uncomfortably loud, hyperacusis makes all sounds too loud. A loudness discomfort test by an audiologist specializing in these conditions can help determine which type of sensitivity you may be experiencing.
☆Treatment
If you think you have Hyperacusis, you’ll see an ear, nose, and throat doctor (ENT, or otolaryngologist).
2. Tinnitus
Tinnitus is the conscious awareness of a sound in your ears or head not caused by external noise.
People who experience tinnitus describe hearing different and sometimes variably changing and intertwining sounds like ringing, hissing, roaring, crickets, screeching, sirens, whooshing, static, pulsing, ocean waves, buzzing, clicking, dial tones and even music. The loudness of this sound varies.
Tinnitus is not a condition, it is a symptom of an underlying condition, such as a nervous system disorder, hearing loss, or an ear injury. Too often associated with hearing loss, the fact is more than 50 percent of people living with constant ringing in the ears do not have measurable hearing loss. Since there are many causes, it can be associated with a variety of health problems.
Because there is such a range in the sounds of tinnitus, each person experiences tinnitus a little bit differently and needs support attuned to their specific case.
How severe is your tinnitus? Answer these 25 questions to find out.
In all cases, tinnitus involves the brain’s auditory cortex, which is responsible for hearing. Certain nerve cells and neural circuits are “tuned” to a specific pitch, like keys on a piano. When we experience hearing changes, our brains attempt to compensate, setting the cycle of tinnitus into motion.
No matter what the cause, it interrupts the transmission of sound from the ear to the brain. Some of the neural circuits no longer receive signals. Strangely, this does not cause hearing loss. Instead, when neural circuits do not receive stimulation, they react by chattering together, alone at first and then synchronous with each other.
Once the nerve cells become hyperactive and occur at the same time, they simulate a tone the brain “hears” as tinnitus. Analogous to a piano, the broken “keys” create a permanent tone without a pianist playing the keys.
☆Treatment & Tips
Everyone living with tinnitus experiences it differently. It can be a low or high frequency, and its volume and pitch may change over time, with the severity varying from person to person.
Those with chronic tinnitus may suffer insomnia, struggle to focus and work harder than usual to communicate with others. In such cases, treatment plays a crucial role in helping an individual regain control of his or her life.
Sometimes tinnitus dissipates on its own, but sometimes it continues on endlessly. Regardless of the extent of your symptoms, please review the following tips from tinnitus experts for tinnitus relief.
○Avoid silence
It is very important to have some sound in the background to create contrast with your tinnitus. Low-level music or a sound generator that plays various soundscapes are helpful, even while sleeping. The brain is still active while we sleep; therefore, creating contrast to the tinnitus brain activity can improve our ability to stay in deep sleep cycles longer. Click here for free Soothing Sounds for temporary tinnitus relief.
Prescriptive sound therapy is most effective in helping to avoid silence because it incorporates individual preferences for a soothing contrast to various manifestations of tinnitus. It also takes into consideration whether or not any boost to the signals – if necessary – in order to reduce input deficiency to the brain, which is a major contributor to tinnitus in most cases.
○Minimize stress
Stress is the #1 tinnitus trigger for an overwhelming majority of our patients, and getting stress under control is usually the key to managing tinnitus. We are not only referring to emotional stress from work or school. Physical stress from an injury or sickness can result in tinnitus for many people. Recovering from injury, surgery, or illness will often time reduce tinnitus.
○Watch your diet
You know if you are eating healthy or not. A healthy diet will not only make you feel better, but certain foods, particularly salty foods (i.e., MSG), can exacerbate tinnitus symptoms. Reducing daily salt intake and incorporating healthy eating habits can be especially helpful.
○Everything in moderation
Caffeine, alcohol, and tobacco are not great for your overall health, and all three can aggravate tinnitus. When we talk to patients about the role these can play in their tinnitus, we oftentimes get a lot of pushback – especially when it comes to the morning cup of Joe. Quitting smoking or drinking and/or eliminating caffeine is not what we are suggesting. Merely cutting back on these items should help.
○“Sleep is the best meditation.” — Dalai Lama
Excessive fatigue can cause tinnitus especially when we don’t get enough sleep. If you struggle to fall asleep naturally, try listening to soothing sounds while you are in bed. Click here for free Soothing Sounds.
○Relaxation, exercise, and meditation
Exercise and relaxation techniques help many people find tinnitus relief. Yoga is a great exercise because it combines meditative breathing and relaxation techniques. Others find that a good cardio workout or spending time in the sauna calms their tinnitus.
○Protect your hearing, but not too much
Protecting our hearing against more damage is important in minimizing tinnitus, such as wearing earplugs while using a lawnmower and power tools, wearing filtered earplugs to concerts or while listening to loud music, and wearing earmuffs with recreational noise exposure like hunting or shooting, etc.
It is not helpful to overprotect the ears from everyday sounds like riding in a car or going to the grocery store. Avoiding everyday sounds or using hearing protection in these situations can heighten the central nervous system’s response to normal levels of sound, making them seem much louder than they really are produced. This can inevitably lead to hyperacusis or hypersensitivity to sound in addition to tinnitus.
○Quickly respond to changes in your hearing.
Consider major changes in hearing a medical emergency. Studies show that if someone with a sudden loss of hearing is treated in the first 72 hours of onset, they often can reverse the loss. If the treatment is not administered until weeks after onset, the loss of hearing is typically permanent and irreversible.
If the sudden loss is due to an infection or viral attack of the inner ear, antibiotics and/or steroids may help, but typically only if administered immediately after the symptoms first appear. Sudden loss may also be present with debilitating vertigo or chronic dizziness. Although many people want to “wait it out” at home in bed, this is a bad idea. Diagnosis and treatment work best immediately following the onset of symptoms. If this happens to you, please get to Urgent Care or an ER as soon as possible.
○Realistic Expectations
Only work with tinnitus experts and plan on at least a year, possibly 12 – 24 months of treatment. Tinnitus typically does not develop overnight and cannot be reversed that easily in most cases.
Tinnitus Retraining Therapy is not difficult; it just requires persistence and patience. TRT is a process, but the long-term benefits of preventing louder tinnitus perception or more disturbance to the tinnitus are key outcomes that are important to consider even if we feel the tinnitus is unchanged.
If the tinnitus is not increasing in volume over time, and we are reacting less to its presence, we know we are experiencing less of a nervous system response to the tinnitus, which is essential to the process of finding relief.
3. Misophonia
Misophonia can create dysfunctional behaviors, such as anger, rage, and/or self-isolation, due to over-activation of the nervous system and the fight or flight response.
○Common Auditory (Sound) Triggers:
People eating (chewing, swallowing, talking with food in their mouth)
People drinking (sipping, swallowing, slurping, saying “ah” after a drink, breathing after a drink)
Other mouth sounds (Kissing, flossing, brushing teeth, lip popping)
At the dinner table (Fork on a plate, fork scraping teeth, the clinking of glasses and plates)
Vocal triggers (dry mouth, whispering, several people taking simultaneously, whistling, singing, humming)
Work/school (Typing, mouse clicks, pencil on paper, pen clicking or tapping, page flipping, tapping on a desk)
Breathing sounds (snoring, hiccups, sniffling, coughing, normal breathing, heaving breathing, nose whistle, hiccups, throat clearing)
When trigger sounds occur, a patient with misophonia is unable to consciously stop their response to the sound. This causes the response to continue to intensify or become worse with time and the vicious cycle can cause multiple psychosocial effects such as anxiety, depression, social isolation, and reduced quality of life overall.
If a specific sound incites your anger, causes you to avoid certain situations, or compromises your mental health, we encourage you to explore treatment for misophonia.
○Emotional responses can vary from mild to severe and include:
Mild
Anxiety
Disgust
Feeling uncomfortable
Having the urge to flee
Severe
Panic
Disgust or irritation turning to anger
Becoming verbally and/or physically aggressive with the person making the noise
Purposefully avoiding people or objects causing trigger sounds
Lashing out physically at people or objects making the noise
Emotional distress
○Those with misophonia also can experience physical reactions including:
Muscle tightness
Increased blood pressure and/or body temperature
Rapid heartbeat
Pressure throughout the body – particularly in the chest
☆What causes misophonia?
Misophonia has been described as an organic brain-based disorder (Kumar, 2017). It is often caused by over-activation of the nervous system, specifically the limbic and autonomic nervous systems in the brain.
Misophonia can cause people to avoid many daily activities such as going to school or work. In severe cases, a person will avoid offensive sounds to the extent that they cannot leave their home or be with their family.
In some cases, misophonia may be a component of Generalized Anxiety Disorder, Autism Spectrum Disorder, Obsessive-Compulsive Disorder, Oppositional Defiant Disorder, Neurodevelopmental Disorders, Attention Deficit Hyperactivity Disorder, or Post Traumatic Stress Disorder.
Since there are many sensory processing disorders where symptoms of misophonia might overlap with other nervous system-related symptoms, it is imperative to have a team-based approach to the assessment and treatment for these patients.
In other words, there may be multiple elements and aspects from more than one medical professional to find an optimally effective treatment plan for misophonia.
☆Treatment & Tips
Misophonia is best treated with a multidisciplinary approach (i.e., primary care physician, psychology, audiology). Audiologists specialize in helping to rewire the auditory portion of the brain while calming the nervous system using prescriptive sound therapy.
Over time, the ultimate goal of sound therapy is to help neutralize the trigger sounds so that the reflex response to them no longer occurs.
Most patients without underlying damage to their auditory system can totally stop the misophonic reactions to their trigger sounds post-treatment. Careful guidance is needed by an experienced professional to help in this process.
4. Hearing loss
How do I know if I have a hearing loss?
Since hearing loss can occur at any stage of life and has many different causes, you may be unaware that you suffer from it.
If you’re uncertain, ask yourself the following questions. If you answer “yes” to three or more questions, you may suffer from a hearing problem.
Consult an audiologist and schedule a hearing exam so that you can identify the issue and explore possible solutions.
Do you have trouble hearing on the telephone?
Do you struggle to hear when there is background noise?
Is it hard for you to follow a conversation when two or more people talk at once?
Do you have to strain to understand a conversation?
Do you often feel like people are mumbling or not speaking clearly?
Do you sometimes misunderstand what others are saying and respond inappropriately?
Do you often ask people to repeat themselves?
Do you have trouble understanding women and children when they talk?
Do people complain that you turn the TV volume up too high?
Do you often hear a ringing, roaring, clicking, hissing, or buzzing sound in your ears?
Do some sounds seem excessively loud?
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