‘My 11-year-old daughter cannot tolerate the sound of her sister’s breathing or the voices of her mother and teacher’

Question

I think my daughter who recently turned 11 has developed misophonia (strong and negative reactions to sounds most people do not notice). For a couple of years, she has been very sensitive to certain sounds.

Firstly, her younger sister’s breathing – who can be a bit nasal – used to bother her a lot to the point it affected their relationship. We had to put them in separate bedrooms and since then the problem has subsided.

However, last year, my daughter took issue with her teacher’s voice, to the point it caused her great anxiety, anger and frustration while affecting her ability to concentrate. We got through the year hoping it would pass, but after only a couple of weeks into this academic year she had the same issue with the new teacher’s voice. It has now spread to her mother’s voice and, on rare occasions, mine.

I know, at face value, this may seem trivial or normal not to like voices of authority, but the scale of distress it causes my daughter is extreme. She struggles to calm herself, fidgets to try to regulate and, at home, inevitably lashes out at her mother.

She is aware of the issues, and hates feeling that way and is asking me to find her help to stop it. Which brings me to this point of finding someone suitable to help. It may be worth mentioning that she is dyslexic, but not diagnosed with any other condition. She is very sociable, sporty otherwise happy girl, but concerningly getting less so, and regularly expresses she is not happy and does not like her life.

Any help would be appreciated from a desperate father.

Answer

Misophonia is characterised by an extreme sensitivity to certain sounds or noises. This means a person with misophonia can find everyday noises such as people chewing, swallowing or even breathing irritating, distressing and often unbearable to listen to. Misophonia is closely related to hyperacusis which is characterised by extreme sensitivity to certain tones and sounds (whereby you might hear them louder or in more pronounced or painful ways) and which sometimes has a physical cause such as an illness. It might be significant that your daughter has dyslexia as misophonia is much more common in children with neurodevelopmental differences such as autism or ADHD or dyslexia who often experience heightened sensory sensitivities.

In the first instance, it might be useful to contact your GP for an assessment to out rule any physical causes. Your GP could make a referral to an audiologist who is familiar with assessing hyperacusis and misophonia or to another specialist if you feel your daughter might benefit from another developmental assessment.

Responding with compassion

In helping your daughter, the most important thing you can do is respond with understanding and compassion. Many people with misophonia, experience anger and irritation from others who think they are making a “big fuss about nothing” and who don’t appreciate the upsetting sensory agitation they are genuinely experiencing. Sometimes people can be insulted or take the misophonia personally (“what do you mean you don’t like my voice?”), which can put stress on relationships.

It is great that you are validating your child’s experience and taking her misophonia seriously. It is a good sign that she is talking to you openly about how the condition affects her and that she is asking you for help.

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Modifying the environment

Sometimes, there is scope to change the environment to reduce triggers. For example, in your situation, changing the sleeping arrangements has helped your daughter and her sister. With her sensitivity to your own or her mother’s voice, is there scope to change your tone or pitch when you speak to her? You could explore with your daughter whether speaking quietly or more slowly might help. Invite her to tell you early on when she is getting bothered so you can adjust accordingly.

Collaborating with the teacher

Taking time to explain misophonia to the teacher might help them be more understanding and to accommodate your daughter in the classroom. Share what you think might help your daughter such as quieter tones of voice, and explore with the teacher what they can do to help (such as picking a quieter seating position at certain times). They might be open to making modifications such as allowing your daughter to take a break when overwhelmed or to use headphones if needed (see below).

Physical devices

Some audiologists treat misophonia with sound therapy, using earpieces or headphones to cancel out the trigger sounds or to provide alternative sounds to change the sensory experience. Given how common the use of ear defenders is now, this may be an acceptable strategy your daughter could use at trigger times and possibly in the classroom.

Helping your daughter manage

There may be some scope for your daughter to learn ways to reduce her distress and the impact of misophonia. She may have learned some strategies already. Invite her to talk about how she manages in the classroom. Are there times when the teacher’s voice bothers less? What is happening then? How did she get through the last year? What helped her?

Maybe there are some relaxation visualisation or distraction techniques that can help her. There is some evidence that cognitive behavioural therapy (CBT) can help people understand their reactions to triggering sounds as well as to develop coping strategies to manage negative reactions.

• John Sharry is clinical director of the Parents Plus Charity and an adjunct professor at the UCD School of Psychology. He is author of several parenting books, including Positive Parenting and Parenting Teenagers. See solutiontalk.ie