Date Presented 04/21/2023

There is a lack of standardized assessment tools that can be used to measure severity of sound sensitivity symptoms, outcomes of treatment, and diagnostic differentiation. The primary aim of this study was to test the feasibility of using a lab-based protocol to measure physiological reactivity in response to standard tones and unpleasant sounds.

Primary Author and Speaker: Stacey Reynolds

Additional Authors and Speakers: Alyssa Hayman, Kayla Swaringen

PURPOSE: Sensitivity to sound, also referred to as auditory sensitivity or hyperacusis, is defined as an intense response to ordinary environmental sounds that would not cause this reaction in typically functioning individuals (American Speech-Language- Hearing Association, n.d.). This sensitivity to sound is a common challenge for children with sensory processing disorders and particularly in children with autism spectrum disorder (Myne & Kennedy, 2018). Sound sensitivity can cause significant distress that impedes occupational, social, and other daily activities, which can have a significant impact on children and their families (Myne & Kennedy, 2018). There is a lack of standardized assessment tools which can be used to measure the severity of sound sensitivity symptoms, outcomes of treatment, and for diagnostic differentiation (Greenberg & Carlos, 2018). Objective: The primary aim of this study was to test the feasibility of using a lab-based auditory protocol to collect physiological data in response to standard tones and unpleasant sounds. Key feasibility questions posed were 1) What percentage of participants who enroll in the study can complete the entire protocol? 2) What environmental supports, if any, were needed for participants to maintain attention throughout the protocol? 3) Did all technology function correctly? If not, what adjustments needed to be made?

DESIGN: Quantitative; Feasibility Study

METHOD: Recruitment flyers were used to recruit children without reported sound sensitivity. Surveys were imported into REDCap including a demographic questionnaire, the Child Sensory Profile 2, and the Misophonia Assessment Questionnaire to screen for eligibility. Mindware software was used to evaluate sympathetic nervous system activity as measured by skin-conductance level (SCL). Two experimental phases were created in E-Prime (a stimulus delivery software program): Phase I (8 standard tones of increasing frequency) and Phase II (6 unpleasant sounds; 3 standard, 3 individualized). Information on feasibility measures including the ability to participate, functionality of the software, and efficiency of the protocol.

RESULTS: Five children ages 7-12 enrolled in the study; none had identified sound-sensitivity at baseline. All of the enrolled participants were able to complete the entire protocol. Four out of five participants required a visual timer during baseline and recovery phases to promote remaining still and quiet for optimal electrode recording. Two out of five participants required multimodal cueing while attending to the protocol. Mean SCL was higher for all subjects during the unpleasant sounds phase compared to the standard tones phase. Most participants demonstrated a higher SCL in response to the sounds they individually identified as bothersome compared to the standardized unpleasant sounds. The majority of children did not show a return to their baseline level of arousal during the recovery period.

CONCLUSION: Results confirm the feasibility of using physiological data collection instruments in our lab to record and measure changes in sympathetic nervous system activity in response to auditory tones and unpleasant sounds. Future studies will look to confirm these findings in a population of children with identified sound sensitivities, and to examine if the protocol is able to accurately distinguish between children with and without sound sensitivity.


American Speech-Language-Hearing Association (ASHA). (n.d.). Tinnitus and Hyperacusis. The American Speech-Language-Hearing Association.

Greenberg, B., & Carlos, M. (2018). Psychometric properties and factor structure of a new scale to measure hyperacusis: Introducing the inventory of hyperacusis symptoms. Ear and Hearing, 39(5), 1025-1034.

Myne, S., & Kennedy, V. (2018). Hyperacusis in children: A clinical profile. International Journal of Pediatric Otorhinolaryngology, 107, 80–85.