Auditory Sensitivity

  • Strategies for Tolerating Loud Voices, Sounds and Crowds

    Gabrielle Perelmuter, OTR/L

    Children with varying degrees of sensitivities to sounds and auditory input present differently. This condition becomes distressing when the sensitivity prevents them from fully participating in their daily lives such as birthday parties, crowded restaurants and classrooms.


    Children who have sensory processing challenges and/or autistic spectrum disorders often operate in “fight or flight” mode. In such cases, the brain interprets loud or high-pitched sounds as threatening and noxious. The child may respond to such auditory input by engaging in disorganized behavior in order to break free from the distressing sensory environment.

    When these sensitivities impact full participation in daily living it’s clinically considered “abnormal” or “impacting function”.

    Hypersensitivity to loud voices and sounds occurs for a variety of reasons:

    •                 Auditory processing disorder

    •                 Sensory processing challenges

    •                 Auditory hypo or hypersensitivity

    •                 Tactile sensitivity and/or anxiety

    The top 10 ways to support auditory sensitivity:

    • Seek the help of professionals so that you can understand the reason for the sensitivity. There could be various underlying causes such as: Autism, Anxiety Disorders and Sensory Processing Disorder, Hyperacusis (impaired functioning of the ear or auditory reception pathways in the brain) and/or Phonophobia (state of developing an emotional reactivity or fear of sound and reacting to emotional distress versus physical causes).

    • Use of noise reduction headphones, earplugs, beanie hat and/ or wearing a hooded sweatshirt to modulate the incoming auditory stimulus.

    • Warm up the ears with graded desensitization by listening to music with headphones for 15 minutes prior to being in a noisy environment.

    • Know the child’s signs of “sensory overload”. In order to interpret the stimuli correctly, observe when sensory experiences from the environment overwhelm the nervous system. Signs of “sensory overload” can include irritability, limited eye contact, red cheeks, feeling dizzy and nauseous, disengagement and hyper or hypo arousal level. Signs related to auditory input and hypersensitivity to noises may include covering ears, complaining about the noises, inability to focus on an activity in noisy environments and difficulty with social interactions.

    • Provide calming input. Allow the child to chew or suck during outings to auditory rich environments. Sucking on a thick smoothie through a straw or chewing gum can be calming when faced with stress.

    • Provide structure & predictability. Talk about the noise level prior to entering the environment (i.e. balloon popping, children crying and singing of happy birthday).

    • Identify safe environments. Point out and strategize with the child where a safe and auditory free input is located for decompression and relaxation when feeling overwhelmed.

    • Cognitive Behavioral Therapy/Systematic Desensitization can be used to help the child develop self-regulation techniques.

    • Try listening therapy. Sound therapy soothes the auditory pathway nerves and balances the middle ear muscles, allowing the natural sound dampening ability of the ear to function properly. Example program: The Listening Program & Therapeutic Listening. (The programs should be facilitated under the supervision of a trained practitioner)

    • Occupational Therapy: 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 in noisy environments. 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.

    The ideas presented in this article are for informational purposes only and are not medical advice. An article can never replace an individualized treatment plan developed as the result of in-person assessment, clinical observation, and collaboration between therapist and caregiver. If you are concerned about the development or functional abilities of a particular child in your life, then the child’s parent should talk with their pediatrician or seek out the services of a developmental pediatrician or a local occupational therapist.



                      Gabrielle is the Owner and Clinical Director at Little Hands Occupational Therapy in Marin County and San Francisco and ​has been providing pediatric occupational services since 2005. She has advanced certification in the treatment, evaluation and management of sensory processing dysfunctions and supporting children with a broad range of developmental challenges.


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