Help with Your Misophonic Child
The first step to helping your child is to reduce exposure to the triggers. Your child needs to be free to leave a trigger situation. Enduring triggers (staying where there are triggers) increases the strength of the triggered reflex reaction and causes new triggers to develop. Please do not make your child endure triggers.
Noise in the room helps to reduce the clarity of the trigger and the severity of the reflex reaction. Add noise machines or box fans to your home. Make your home sound like you live beside a waterfall. This is one of the quickest and easiest ways to reduce the severity of the misophonic reaction. Your child can also wear headphones with white noise (or rain sounds) from an iPod. Open ear headphones are preferred, such as a Sony Sport headphone. With the volume set correctly, many children can hear conversations and greatly reduce (but not eliminate) the reaction to the triggers. The treatment provided by an audiologist uses a behind-the-ear sound generator. These are great for masking the trigger sounds, and are virtually invisible. This method will help the child manage the misophonia, but it generally does not eliminate the triggering — it simply makes it bearable. For many children, any strength trigger is too much for them to handle, and so eliminating triggers completely is the only choice (at least at first).
Especially with the type #2 kids (strong-willed), the behavioral issues need to be resolved independently of the misophonia. We call this behavior modification. This involves teaching a child new, positive “rules” and then lovingly implementing them. As a behavior analyst (behavior specialist), Tom Dozier is an expert in these techniques. In fact, helping parents with difficult children is Tom Dozier’s primary career field. He bases his work with parents on the science of human behavior, which is extremely powerful in promoting desired behavior, reducing problem behavior, strengthening relationships, and increasing positive character traits. Addressing behavior issues is a process, which must be done gradually. Usually 10 parent coaching sessions, can help your child. Difficult cases may require more. The goal of behavior modification is to have your child become cooperative, positive, and comply with parent requests. It also addresses problems such as emotional regulation, delay of gratification, and problems with routines such as bedtime, getting ready for school, and mealtime.
Once the child is generally cooperative, positive, and compliant, then the work reducing the triggers can begin. If a child has only a few triggers, then it may be appropriate to use the Neural Repatterning Technique with the Trigger Tamer app. With younger children, the NRT method is conducted with a fun game or activity with the parent. See Trigger Game below for an explanation of this treatment. You, the parent, are the primary treatment provider. This is not a quick treatment. It takes a month or so per trigger, but it is often possible to resolve specific triggers this way. This method only works for specific triggers, so once the triggering spreads to school, then it is too late to use this method. If a child only has one or two triggers, this is a good option.
Sequent Repatterning Hypnotherapy may be suitable for children 10 years and older. This treatment can be provided by internet video-chat. It consists of one session per week for 8 weeks. This treatment may reduce the severity of the miso-emotions that accompany triggers to a level such that the child can function normally. Treatment for children, especially young children with misophonia can be very difficult or even impossible. But if direct treatment of misophonia is “impossible” then behavior modification implemented through parent coaching can help both the child and the family.
If you do not choose to treat your child’s misophonia, you need to help the child manage the misophonia through avoiding triggers, a noisy home (use sound generators and fans in the home), or having your child wear headphones using a noise app. A child may resist wearing headphones with a noise app because they do not want to be isolated from the family. Here again, this can be addressed with behavior modification techniques.
It seems rare that the misophonia goes away. Generally, it gets progressively worse. So, for your child’s sake, please act now, either getting your child treatment help or carefully and thoughtfully helping your child manage her misophonia. Establish a family trigger management plan, when everyone is calm, that defines the roles and responsibilities of all parties. Then try to execute that plan as pleasantly and calmly as possible. The concept of a family trigger management plan is explained in the Management tab of this website.
Parents may want their child to just stop overreacting to the triggers. This is like telling a child to stop having diabetes. It is not in the child’s control. As with a well known condition like diabetes, or maybe a physical handicap, the family is expected to work together. Everyone makes some sacrifice – it is not right for the child to make all the sacrifices.
Misophonia can cause great disruption in a family. But remember, that no matter how hard a misophonic child is making life for their family, it is worse, much, much worse for the child.
This is a way of blocking most initial physical reflexes. The basic requirement for this technique is for the child to hear a trigger, and immediately be engaged in an activity that consumes them physically and emotionally. For example, one person can make the trigger (or it could be a recorded trigger played with the Trigger Tamer app) and another person has an immediate, positive interaction with the child, such as a brief pillow fight, wrestling, or ticking. The goal of the interaction after the trigger is to cause many muscles to be in use in a way that is drastically different from the typical action of muscles after a trigger. When this is achieved, it creates a classical conditioning event that slightly changes the established trigger response.
One family called this game a “cage match” when the child and father were playing. They would face off, and the trigger was the signal to wrestle. The father would attack as quickly as physically possible. After 10-20 seconds, they would pause and wait for the next trigger. When mom played the game, they had pillow fights. This game eliminated the misophonic response for this child. Classical conditioning occurs in the first seconds after the stimulus. For a child, the timing that produces the strongest conditioning is for the response to occur a half second after the stimulus. In middle aged adults, the reflexes have slowed and maximum conditioning occurs at 1 second. If the parent waits a few seconds, then it is too late to have a classical conditioning effect.
The theory behind this treatment is the same as for blocking a reflex. In the 2 seconds immediately following a trigger, the lizard brain is observing the body responses. The theory is that if the lizard brain sees the muscle tightening that is activated by the initial misophonic physical response, then it creates a conditioning event that makes the initial physical response stronger in the future. If the lizard brain sees that muscle relaxing, then it creates a conditioning event that makes the response weaker in the future.
You want this activity to be very positive for the child. You should never coax the child to play this game. If you say, “Do you want to play the Trigger Game?” and your child says, “Maybe later.” Then let it go. This activity needs to be very positive for the child. If the child says he is tired and wants to quit after 2 triggers then it is time to quit.
I recommend playing the game once a day for 10 minutes, where the child hears about 20 triggers. But there is no research behind this recommendation. As long as it is a very positive experience for the child, then you can play it as often and as long as you have the energy and enthusiasm.
You need to be sensitive to the strength of your child’s response to the trigger, and make it appropriate for the game. Start with a stimulus that triggers the child only slightly, and work up from that point. You are better off to waste a few sessions building up the trigger strength (volume, length) than to start too high and have your child run off screaming.
If you can use a recorded trigger as with the Trigger Tamer, then you will have precise control of the trigger strength, and you can tell the treatment is working by having the child rate the severity of the trigger response on a scale of 0-10 where 0 is no misophonic response. I would recommend having a response around 5 on this scale for playing the Trigger Game.
You should focus on one category of triggers (e.g. eating sounds). You will likely need to eliminate at least 3 specific triggers before you would see any real-life improvement. I would appreciate your feedback on how this treatment works for your child.
I am sure there are ways that this treatment can be used for adults. Use your creativity to develop ways to immediately engage in an activity that is all-consuming. I would love to hear successful ways you have adapted this methods for adults.