Children with Autism and Noise
By Karen Wang
6 May 2014
One of my son’s most frequent questions is, “What’s that sound, Mommy?”
I often can’t hear what he’s hearing. He can hear the school bus when it’s still half a mile from our house. With all the windows closed inside our home, he can hear the next-door neighbours’ sump pump switch on or their garage door opening. He can hear a whisper in the next room or an air vent in a busy department store or an airplane’s high-pitched engine long before it’s visible in the sky. At a noisy carnival, he can hear his favourite song playing across the park.
The downside to sound sensitivity is that noise quickly becomes painful and can even trigger a panic attack. When a person can hear everything simultaneously, it becomes almost impossible to pay attention to the task at hand. Separating and prioritizing sounds drains a person’s energy, and the constant assault of noise causes a person’s anxiety level to escalate.
When my son was a toddler, he had a panic attack every time our washing machine clicked loudly to change cycles. He developed a phobia of all types of bells. He covered his ears and cried in crowds. But he became calm, even joyful, every single time we went for a walk in the woods, visited the library or entered any kind of religious environment: his stiff, tight muscles would relax instantly in my arms.
Creating a Plan to Deal With Sounds
All of these observations gave me food for thought as I developed a plan to help him cope with his sensitivity to sound. Over the years his ability to tolerate noise has steadily increased, and barking dogs are his only remaining noise-related phobia.
Here are eleven ways to help a highly sensitive person learn how to cope with and enjoy everyday noisy situations.
- Know the types of sensitivity
There are several different types of noise sensitivity, and there are different treatments for each type. Consult with an audiologist to pinpoint which type of sensitivity is affecting your quality of life. These are the 5 most common types of sensitivities, but keep in mind that a person may be affected by more than one issue. For example, my son has hyperacusis in addition to phobias of specific sounds.
Hyperacusis is an intolerance of everyday environmental sounds and is often associated with tinnitus, a ringing in the ears.
Hypersensitive hearing of specific frequencies is often (but not always) associated with autism. A person is able to tolerate most sounds at normal levels, but certain frequencies are intolerable, especially above 70 decibels. For example, a person may have no difficulty being near a noisy dishwasher, but the higher frequency and higher decibel level of the vacuum cleaner will be painful.
Recruitment is directly related to sensorineural hearing loss. It is defined as an atypical growth in the perception of loudness. Hair cells in the inner ear typically “translate” sound waves into nerve signals. Damaged or dead hair cells cannot perceive sound, but at a certain decibel level, surrounding healthy hair cells are “recruited” to transmit, and the person experiences a sudden sharp increase in sound perception that can be shocking and painful.
Phonophobia (also called ligyrophobia or sonophobia) is a persistent and unusual fear of sound, either a specific sound such as an alarm or general environmental sounds. People with phonophobia fear the possibility of being exposed to sounds, especially loud sounds, in present and future situations, and sometimes become homebound due to this anxiety.
Misophonia is an emotional reaction, most often anger or rage, to specific sounds. The trigger is usually a relatively soft sound related to eating or breathing, and may be connected to only one or a few people who are emotionally close to the affected person. For example, my friend Lisa’s son Nate becomes angry and runs out of the dining room because his father makes sounds while chewing food, but Nate does not become angry when his mother and sister make similar sounds.
- Provide relief
Headphones and earplugs offer instant comfort and relief. Noise-canceling headphones are the most effective, because they replace irritating environmental noise by producing calming white noise. Earplugs are usually made of either foam or wax, and it is worth trying both types to determine which is more comfortable.
However, most audiologists, physicians, therapists and educators recommend against frequent use of headphones and earplugs, because a person can quickly become dependent on them. In the long run, blocking out noise can reduce coping skills and increase social withdrawal.
- Identify safe environments
One of the first steps that I took for my son was to make a list of his “safe” places and increase his participation there. Depending on an individual’s needs, this could mean:
- volunteering at the library
- attending library storytime
- taking a walk in a nature area every day
- visiting a park that is near a railroad crossing or helicopter landing pad
- attending services, prayers or social events at the Shul more often
- Allow control over some types of noise
At its heart, anxiety is a fear of being unable to control reactions and situations. When my son had a phobia of bells, I gave him several different types of bells to handle and experiment with at home. When we saw bells at customer service desks or in other public places, I allowed him to ring the bell. He gradually became comfortable with the sounds, and he even began identifying speaker systems, alarm systems and other sources of sounds everywhere we went.
- Allow distractions
When my husband and I took a Lamaze childbirth class many years ago, we learned about the power of distraction in pain management. By giving a person something like an iPad to focus on or an unusual privilege such as bringing along a favorite toy from home, it becomes possible to direct attention away from the offending noise.
- Gradually increase exposure and proximity
The cure for a fear of snakes does not involve throwing a person into a snake pit. Similarly, relief from noise sensitivity requires a gradual desensitization and not a sudden exposure. Start by observing something from afar and take a step closer with each opportunity.
My son had a problem with sirens, so we started with pictures of fire trucks and emergency vehicles in a book. I imitated the sound of a siren with my voice. We read books about firefighters and police officers. My son wore firefighter and police costumes. We watched YouTube videos of fire trucks in action. I arranged for our playgroup to get a tour of the local fire station, and my son sat in the fire truck with a big smile. I pointed out fire trucks and ambulances while driving. Eventually, those emergency vehicles became a part of everyday life and the sirens did not bother him as much.
- Alternate noisy and quiet
I discovered that my son’s tolerance for noise increased the most when I scheduled frequent quiet breaks. After a morning out doing errands, we enjoyed a quiet lunch at home. After a playgroup with 7 other children, we made time to snuggle on the sofa. When we felt brave enough to visit a large theme park, we booked a hotel inside the park so that we could retreat as often as necessary. We always take a break before the noise upsets him, so that he will want to return for more fun after resting.
- Hyperacusis Retraining Therapy (Tinnitus Retraining Therapy)
Auditory Integration Therapy (AIT) is sometimes suggested to people with noise sensitivity, but there is very little peer-reviewed research published on the topic of AIT, and the existing research has generally not been favorable.
However, there is plenty of medical research on Tinnitus Retraining Therapy (TRT), which involves listening to broadband pink noise to habituate a person to ringing in the ears. Pink noise contains all audible frequencies, but with more power in the lower frequencies than in the higher frequencies. Most people report that pink noise sounds “flat.” Because of this, it helps to rebuild tolerance to sound.
- Cognitive-behavioral therapy
Physicians widely recommend cognitive-behavioral therapy for phobias and anxiety because it teaches a person to self-manage emotions and coping skills. The goal of the therapy is to reframe a person’s thought processes about the cause for anxiety in order to increase quality of life.
Many people with tinnitus or hyperacusis are deficient in magnesium or other minerals. Consult with a physician to determine if nutritional supplements may be able to help.
- Avoid food additives
Certain food additives, especially those in the salicylate family, are associated with noise sensitivity. In fact, medical literature refers to salicylate as a “tinnitus inducer.” Special diets, such as the Feingold Diet or a diverse whole foods diet, eliminate those additives and may help reduce sensitivity. Consult with a physician or dietician before making any major dietary changes.
The world is noisy, but a person can easily live a full life without fireworks shows, major league sporting events and rock concerts. When sound sensitivity interferes with everyday activities, then it is time to look more carefully and seek guidance. A systematic approach to sound sensitivity can lead to a greater enjoyment of relationships and increased inclusion in community-based activities. The Hyperacusis Network notes that in the end, “The ocean cannot escape its waves.”
Karen Wang is a contributing author to the anthology "My Baby Rides the Short Bus: The Unabashedly Human Experience of Raising Kids With Disabilities"