One of the most difficult things to wrap your head around when you have a child suffering from misophonia is that there is no “miracle cure.” Of course, as a parent, when you see your child in pain or distress, you are willing to do anything to take that away. However, as in the case with many relatively new and very much under-researched disorders, many practitioners, sometimes inadvertently, advertise treatments for misophonia that are not scientifically based, and may do more harm than good. Without scientific study, it is impossible to know if these treatments have any chance of working, and amount to no more than a shot in the dark. Though it may be appealing to “try anything” with the potential to alleviate your child’s symptoms, exposing him or her to untested treatments or supposed “cures” can leave your child more frustrated than doing nothing at all. Though research into scientifically based treatments continues, at this time, ethical practitioners should be honest with you about your options for counseling: there is no cure for misophonia yet, however developing coping skills can hugely improve the lives of sufferers. Unfortunately, there is no way around the time and effort that it takes for your child and your family to build these skills. However, if you are committed to learning all you can about this disorder, and putting in the work to learn how to cope, you likely will see major changes in your child’s quality of life.
An important way to deal with misophonia is through RRR. This stands for “regulate”, “reason” and “reassure”. Developed by Dr. Jennifer Brout through her work with her own daughter, and then numerous children with misophonia, RRR is a helpful way to manage the response to misophonia.
Regulate, Reason, & Reassure is a training program that I have developed over the course of more than 15 years for parents of children with auditory over-responsivity. It is derived from both personal experiences and from research. Currently, I am adapting it specifically for children and adults with Misophonia at Duke University. A website with a self-help version is currently underway, and it is our goal to train therapists across disciplines to work together, utilizing this method until research reveals specific treatment possibilities.
This is a Management Program that combines methods and techniques across the related disciplines of occupational therapy, family counseling, cognitive therapy and psychoeducational training.
Short Summary of the Parent Version
Regulate: In order to assist a child to regulate (calming the child so that he or she is not over aroused and agitated), it is helpful to identify the source of the sensory over-responsivity or auditory trigger. For example, if your school-age child has just hit her sister because she made a noise that set her off, rather than react punitively, shift her focus to “calming down.” Explain that a particular noise set her off, that her brain is making her feel out of control, and let her know that you don’t blame her. There are numerous strategies for regulating an over-aroused child. Because your child is a person and not a “disorder”, the ways in which you can help her calm down vary. There are a number of evidence-based (or “proven”) ways that the body/brain can be helped to calm down. However, each child is different, as is each adult. Therefore, part of learning how to help your child is about learning what specifically calms them down (and does so quickly). Ways to do this include Occupational Therapy techniques that engage the parasympathetic nervous system (which puts the brakes on fight/flight) as well as many other methods that directly affect physiology and not cognition.
Reason: Later, when your child has reached “homeostasis” (or a calm state), perhaps even hours after the incident, go over what happened and try to focus on your child’s thought processes and feelings. Remember, cognition cannot change when an individual is in the midst of a fight/flight reaction. For example, you might ask “What were you thinking right before you exploded?” If she cannot identify the source of her reactivity, try to suggest possibilities. You might say, “Was it your sister’s whistling that bothered you?” Make sure to identify the sound by name and explain to your child that it was the noise that upset her brain, it wasn’t her sister. Also, point out that even though she could not control her reaction, her behavior still hurt and confused her sister. When you see that she understands this, ask her to apologize to her sister. With consistency, your child will understand your message, what caused her to react this way, and will also learn that when he or she feels out of control, calming down is the first step!
Reassure: Your child does not like feeling out of control. She does not like the fact that she has just hurt her sister, even if she does not seem remorseful. Reassure her that over time she will gain control over her over-responsivity and that you will help her. Let her know that you expect her to try her best, but protect her self-esteem by framing the problem as though it were a “work in progress”. Repairing damaged self-esteem and poor self-image is much more difficult than reshaping a child’s misconstrued ideas about the antecedents and consequences of behavior.