Wednesday, February 23, 2011

Helping the Auditory Defensive Child

When a child's body is neurologically wired to operate in fight or flight mode, the brain interprets loud or high pitched sound as threatening and noxious.  So the child is going to respond by becoming disorganized or by acting out, hoping that he will be removed from the situation that is causing him so much distress.

If a child runs aimlessly around in his classroom, and is oppositional, disorganized, confused, or combative, or shuts down in a noisy atmosphere, the noise is too much for him and he doesn't know how to tell you what's wrong.

  Other signs that a child is adversely affected by sound:  covering his ears, yelling at other people to shut up {one child I know used to slug his brother at the dinner table because he couldn't bear the sound of other people eating} chewing on things other than food, hyperfocusing in an attempt to leave his body, or trying to hide.

What causes auditory defensiveness?  There are several possibilities.  One is a history of ear infections.  The inner ear is responsible for the initial filtering and dampening of sound, and if the physical mechanism is impacted due to scar tissue or a residue of pus, the sound can actually build up in the child's eardrum and become painful.

As someone who spent most of the 70's in a fetal position, with my fingers stuck firmly in my ears, I can sympathize.  I'm a bit auditory defensive myself.   Going to rock concerts, which I did from time to time in order to please my friends, was never fun for me.  I hated the sheer volume of noise, which felt like a physical assault.   The whine of the electric guitars made me feel as if a dentist was drilling directly into my eardrums.   The entire experience was always one of pain and misery.  I tell parents and teachers now that expecting an auditory defensive child to learn in a noisy environment is like expecting him to be able to concentrate at a construction site.

Another reason for auditory defensiveness is poorly integrated postural reflexes.  These reflexes, when they are working properly,  are what give us our effortless uprightness against gravity, and set our muscle tone.  When the tone is too low,  the muscles in the inner ear, which dampen sound, are not strong enough to do their job.

I've had children in my practice who have  run out of their classrooms and onto the street, thrown things, punched their classmates,  and tipped over their desks in response to being forced to sit in noisy environments.

If your child doesn't seem to hear you when you are speaking to him, or his teachers report that he doesn't understand what is being said, it could be that he's tuning out voices, or that he simply doesn't have the ability to distinguish between foreground and background sound and can't pick your voice out from among all the other sounds in the room.

There are several ways that sensory integration therapy can help a child with auditory defensiveness.

One is by improving ability of the inner ear  to do the job of filtering and dampening sound.  We do this by providing the child with intense movement experiences.  Movement affects the workings of the inner ear, which in addition to filtering sound, is responsible for monitoring where we are in space.  As one system improves, so does the other.

Occupational therapists with additional training can prescribe special filtered music that trains the ear and brain to be less sensitive to sound.  This music can be very helpful to children who have trouble attending in noisy environments.

Delays in the the child's neurological development can cause all kinds of difficulties in the child's ability to use his body and process sensory information correctly, including sound sensitivity.  Sensory integration therapy works on improving the way that the nervous system functions.  A therapist who can employ specific techniques for integrating primitive reflex patterns can often make dramatic changes quite quickly in the child's sensitivities.

In addition to what I do in the clinic, I often recommend that the child be treated by an osteopathic practitioner who specializes in manual therapy techniques.  There may be problems with the child's internal structure that are preventing ears from functioning correctly, and manual therapy can be remarkably effective in normalizing the child's internal workings and improving the child's behavior.  Unfortunately American osteopathic training does not emphasize manual techniques, so if you are interested in finding a manual therapy practitioner for  your child, you may have to do some research to find one who has completed additional training.

At school, an auditory defensive child can wear noise canceling headphones or earplugs, chew gum, and take breaks from the noise when needed.  I try to arrange when possible for the child to be excused from eating in noisy cafeterias, and for him to be given a pass from participating in indoor recess or gym when it's obvious from his behavior that it's too much for him.

A smaller, quieter, more structured classroom is a better fit for a sensory defensive child in general.

I advise parents not to expect the child to be able to tolerate concerts or to endure long stays at noisy family gatherings until the problem is corrected.

I am often asked if the problem is permanent.  It may or may not be always present, but with appropriate intervention, it should diminish.  Sometimes children grow out of their defensiveness and sometimes sensory integration therapy can eradicate it completely. Having good coping strategies in place, like something to chew on and keeping a stash of earplugs in his backpack, helps the child feel more in control.


Debra said...

Lauren helps adults as well as children. After a month of limping around on a VERY sore foot from a hiking injury, Lauren spent just a few minutes working on my foot. I had immediate relief and practically skipped to work the next morning. A pleasant and patient manner made the experience all the better for someone like me who is quite wary of doctor visits.

michelle said...

my son is 4 years old and has always been sensitive to noise. it seems to be getting worse as he gets older. he has frequent ear infections and see's an audiologist every year. he has down syndrome and i worry that the tests are not accurate. his ear canal is so small. his school teacher seems to think that putting his hands over his ears is a behavior learned from other students in his class. his speech is greatly delayed also. do you have any advice on what i should be asking the school or pediatrician in terms of diagnosis and treatment?

Loren Shlaes said...

Michelle, please email me. You can find the address on my profile page.

Anonymous said...

My 11 month has always been hypersensitive to loud sounds (someone sneezing, coughing, laughing loudly). It seems to be getting worse. Is he too young for therapy?

Anonymous said...


After reading this article I feel there is so much similarity to my son who is going to be 4yr. He is sensitive to loud cheering. Loud sound and music is Ok for him but loud cheering and clapping upsets him. Till last month he used to cry for the happy birthday song. We thought that the song upset him but last month we went to a birthday party and after the song they did not clap or cheer. He was Ok with that. We have taken an appointment with a Occupational therapist. After reading this article I am positively motivated that he will improve.