STRATEGIES for auditory challenges

AUDITORY OVER RESPONDERS

Behaviors that you will see when a child is over responsive includes:

• Ear Covering
• Strong startle response followed by
• Screaming and Crying 
• Fight /Flight Behavior

Usually, the behavior lasts a while because the neuro response is intense and long lasting.

Try these strategies:

1. Modifications to the environment (environmental awareness)

• Turn off the TV
• Put slides on chairs legs.
• Carpet on floors and curtains on walls help to keep noise from bouncing all over.
• Pick up or don't have a barking dog.
• Wait until the child is away to use household items that cause the child excessive fear (blenders, vacuum cleaners, blow dryers are some common offending items).
• Bumpers on cabinet doors.

2. Modify your approach and proximity.

• Know thy self...are you an offending sound to the child? If you or caregivers are loud and/or frequent talkers, this may be overwhelming. Try to talk in a softer tone.
• Remind grandparents/friends to use softer voices with the child.
• If in a classroom, pay attention to other children who may be offending to the child and create more distance between them. 
• If you go to a fair or amusement park where there is a bandstand or noisy zone, try to stay further away or use noise cancelling headphones.

3. Offer ear protection.

• The child may need time to get familiar with wearing something over their ears but can be helpful to diminish loud noises when in community settings where you know it will be loud (ball games, parades, concerts).
• Teach them to cover their ears when you expect a loud offending sound.

4. Make noise predictable or alert when a loud noise is expected.

• If the child can tolerate a noise but startles at onset, then it would be best to give them a warning of when it is coming so that it is not a surprise. 
• When you see a train coming, alert the child to a potentially loud sound. This goes for any noise that is anticipated including the noise from hair clippers, the sound of toilet flushing, the blender being turned on.

5. Slowly desensitize.

•  Show them the item (but do not turn it on in front of them).
• Show videos of the item being used (either homemade or some from YouTube. Start showing with the sound turned way down, then over time turn the volume up.
• Use funny videos using the item. For one child I worked with that was so scared of the vacuum cleaner, I found a video of a cat riding on the front of the vacuum that he though was hilarious. We found a stuffed animal cat and secured it to the family vacuum so he would be reminded of the funny video when he saw the vacuum.
• Keep in mind that these items not only have sound, but they seem to have a vibration. Work on introducing a vibratory input (handheld massager, z-vibe, etc).
• From another room, play a game like “on”/ “off” or “go”/”stop”

6. Offer control over offending item. 

•  Let the child turn it on so it is expected and better tolerated. 

AUDITORY UNDER-RESONDERS AND SEEKERS

Behaviors that you will see when a child is under responsive includes:

• Don’t respond when name is called. 
• Slow to respond to questions or with information being said.
• Constantly make noise to add to the auditory input because this is helping me stay alert or because I need the silence filled with noise.
• Need background noise such as TV or radio.

Try these strategies:

1. Maintain close proximity-First, you will be louder if you are closer and second, you will want to gain eye contact (if possible) or use a touch cue and gesture cue during the interaction. 

2. Eye Contact  

It is vital for you to understand that I can hear you and you can hear me without eye contact. However, eye contact is a condition of joint attention and engagement and something we would love to see with our children with sensory processing difficulties. When we make eye contact, we can begin to get information… visual information which may mean the difference between understanding someone is being sarcastic or not. Eye contact should not be forced. 

•  Be face-to-face –  Make sure you are in a physical position that will encourage eye contact – that is, being face-to-face and at his physical level. If your child is lying on the floor, get down on the floor with him and face him. If he is sitting at a table, sit directly across from him, maybe on a low chair so you can be eye-to-eye with him. 
• Wait, wait, wait – By waiting right before a key part of an activity – like right before you let the car go down the ramp, or right before you blow some bubbles – it builds anticipation and gets your child’s attention. If you are face-to-face when you wait during these moments, it’s more likely your child will look at you to see what’s coming next and use his eyes to ask you to keep the activity going. 
• Give your child a reason to look – Doing something unexpected or doing it the wrong way is a great way to get your child’s attention and encourages eye contact. Put the playdoh on your nose, try to balance a ball on your head, or put a puzzle piece in the wrong spot, it will likely get a reaction and encourage your child to look. 
• Choose the right activity – Many children with sensory processing differences find it difficult to shift their attention between a toy and a person while they play. This means that encouraging eye contact while playing with a toy can be tricky. An easier time to encourage eye contact is during People Games, like tickles, chase, or hide and seek, when it’s just you and your child playing together...without a toy to steal the attention, the focus can be on the people in the game. 

3. Repeition-(Repeating a name call is not effective!! Even if you begin screaming it.)John….John…John…John!! When I see people doing this, I want to say, “Get your tail up, put your phone down, and walk over to the child to get his attention!!" 

• Repeat what you said but offer additional cues (touch cue to get attention, visual cue, model, gesture). 
• You can try in a different tone or cadence. 
• Use a different word to get attention, possibly, “WOW! Look at this!” or “What is that?”
• Use exaggeration.  

4. Speed- Slow the communication speed you are using. If you know the child is processing slowly, make sure that your gesture cues or visual supports are timed with his/her “looks”. 

5. Visual Supports (written directions, visual schedules, gestures)

• Visual supports can be something as simple as a point (gesture)
• Visual supports can be using your hands to be expressive (putting your hand over your mouth, bouncing your body up and down as you are laughing or touching your temple as you are saying, “I wonder.”)
• Visual supports can be a “First/Then” board, A “visual schedule”, a “Picture Selection Board”.
• A visual support can be picture directions or written directions for children who can read. 

6. Tactile Cue-touch to get attention.

AUDITORY SEEKERS / CRAVERS

Behaviors you may see with children who are seekers/cravers include:

• Making noise any way they can (with my body, with my mouth, with my toys, etc.) so excessively that it is disruptive and interferes with participation for myself or others. 

Try these strategies:

1.  Offer Vestibular Input:    

• The Labyrinth -The portion of the ear located within the temporal bone that is involved in both hearing and balance and includes the semicircular canals, vestibule, and cochlea. If the child needs extra help to "fill his cup" then sprinkle with a little vestibular input to help them. Keep this in mind:  movement can either stimulate or calm. Make selections that are appropriate to the desired outcome. Review the Vestibular section to get more information. 

2. Offer Proprioceptive Input:  

• The proprioceptive system is the "most powerful" system, SO... when in doubt, start here!! Proprioceptive Input is detailed in the action button below.

3. Noise Making Activities:

• An auditory craver will be less interested in popping bubbles as they will be in blowing up a balloon (which is heavy proprioceptive work for the mouth) and letting the air out to listen to it squeal or letting it go to speed across the room in various directions or intentionally popping it. Gets then up chasing it and moving (another great heavy proprioceptive activity) or letting the air blow into their face unexpectedly which is silly and often highly unexpected.  I am sure you can think of many, many ways to make noise. If you cannot, just let them take the lead!

4. Experient with Suprise! Offer Unpredictable Noise:

• It is fun to have something unexpected happen and auditory cravers will love things like the hum of a vibrating toy, the pop of a balloon, the pop your mouth can make when you forcefully smack lips together. Tap out the rhythm of ABC song on the table. Sing, "Three Little Monkeys Swinging in a Tree" song because they "SNAP! Ate that monkey right out of that tree." There is simply nothing more fun than being silly with a "craver/seeker".

5. Be Extra Animated:   

• Some of us have a natural way with working with kids on this level while some of us have trouble with amping up this high. You need to fit your style to the sensory needs of the child. Occupational Therapist’s refer to this as “therapeutic use of self”. See yourself as an intervention of sorts. Keep in mind, that our cravers can spiral out of control sometimes and we can animate without using a loud voice. Exaggerated facial expressions or gestures might be sufficient. It is important to modulate yourself in response to what you are getting from the child.