How are the symptoms of hyperacusis managed in children?

For children with hyperacusis, auditory desensitation is usually used as part of a five-step programme.

The programme consists of:

1. Profile of hyperacusis in the child's everyday life
2. Evaluation of impact of the problem on individual/family/others
3. Understanding of the condition by all carers (leading to consistency in the approach to managing the condition)
4. Behavioural desensitisation
5. Auditory desensitisation

The programme will normally conclude with a follow-up and assessment element.

How and why is a profile of the child developed?

The hyperacusis management programme will usually begin with the gathering of information on the way over-sensitivity to sound is affecting the life of the child and his/her family, usually derived from careful discussion with the family and other carers. The aim is to identify the different factors which trigger the adverse reactions to sounds.

Although treatment will be based around the five-point plan, not every child will need all levels of intervention - the child's profile of responses to sound will help determine how the programme should be adapted to fit the needs of the child and the family. Often an explanation of the hyperacusis and subsequent behaviour patterns will indicate specific changes which need to be made to the child's environment, aimed at reducing exposure to certain noises.

How is the impact of hyperacusis on the child's life evaluated?

Diary sheets are often used to record the sounds that the child finds uncomfortable, and the times and places where these were experienced. These diaries, lasting a week, can be helpful in enabling parents and teachers to identify potentially uncomfortable situations for the child. The diary should not be kept for longer than a week as it may become a negative focus of attention for the child.

Wider discussions will also allow different people involved with the child to develop an understanding of the specific types of sounds which cause problems. Through this information, it should be possible to determine how tolerable certain types of sounds are to the child.

How important is it for parents and teachers to understand the condition?

Children with hyperacusis can often feel isolated and misunderstood, so it is important that adults understand the nature of the condition and how it affects the child.

Many parents are relieved to know that hyperacusis is a recognised condition, both in adults and children, and that it not a figment of their child's imagination or the result of attention-seeking. Parents are often given written information on the condition and encouraged to play an active part in developing strategies for helping their child cope with noise. If hyperacusis is not impacting on the child's life significantly, this may be sufficient.

It is vital that parents, teachers and all other carers of the child are consistent in their way that they respond to the child when an uncomfortable sound occurs.

It is also important that adults learn to understand that, for the child with hyperacusis, exposure to noise can cause actual physical pain - it is not enough to view hyperacusis as simply a phobia of noise.

What is behavioural desensitisation?

Adults with hyperacusis often describe hearing noise as feeling like 'knives through the head'. The pain can trigger panic and can lead to anxiety and stress. They also describe the condition as isolating, and the inability of others to understand their hyperacusis can lead to depression and withdrawal. For a child with limited communication skills, that feeling of isolation can be even more intense.

In order to break down the child's association of anxiety with noise exposure, a desensitisation programme may be necessary. A clinical psychologist can develop a programme of behavioural desensitisation, but the following suggestions can be used by everyone:

1. When the child becomes distressed by exposure to sound, move him/her away from the sound (if possible) and comfort them.
2. Try to explain the source of the sound to the child.
3. The child's fearful reaction to the sound will often diminish if s/he can exercise some control over the noise. Encourage the child to clap his/her own hands, to play with toys that make a noise and to stop/start the vacuum cleaner at home.
4. Repeated gentle exposure to the noise may help to reduce the child's anxiety and desensitise them to the sound. Tape record a number of the uncomfortable sounds and play them with the tape recorder set to a very low volume. Gradually, over a period of days or weeks, the volume can be increased. Practice with the sounds while playing, in a way that the child can control. By exposing the child to sounds in controlled conditions, the association of noise with fear can be gradually broken.
5. Children should not be forced to stay in a situation that is obviously causing them distress (for example, singing during a school assembly). This may compound their apprehension and make them associate a situation with pain. If fear of a specific situation has become established, it is important to gradually desensitise the child, with time and care.
6. Older children may be reassured if they are told they have the teacher's permission to leave the classroom for a few minutes at any point if they are exposed to an adverse noise. Children can be greatly reassured that they can leave a room, for a short time, if noise becomes distressing to them.
7. The use of ear plugs, muffs or defenders should be avoided except in extreme or short-term, unavoidable situations. Exposure to normal and tolerable sound is crucial if the ear and brain are to establish normal sensitivity.