SSP Frequently Asked Questions
At what age may one use the SSP?
Do session lengths need to be adjusted for younger children?
Are there different listening schedules for younger children and babies? What about for people who have low tolerance to headphones and/or auditory stimulation?
Is it difficult to get people – children especially - to listen to the music?
How old is the oldest client who has done the SSP? Was it successful?
What are some of the features beyond sound sensitivity and social engagement issues that I might consider in choosing the SSP?
Are there any contraindications for using the SSP? For instance, seizures and/or epilepsy and TBI.
Can the SSP be used for clients who experience Tinnitus?
Administering the SSP
What if the child starts singing?
What about using a swing or hammock? I find that helps a child to stay in a calm state.
What if I have a limited duration with my client, and we do not have enough time for my client to be able to complete the daily allotment of intervention AND take short breaks when needed? Is it better to provide breaks, but not complete the entire 1 hour protocol in the same day? Or is it better to complete the entire 1 hour protocol, and not take breaks (even though they are needed?)
What if the child has an ear infection?
Can the intervention be used for children who have had ear tubes inserted?
Can individuals with documented hearing loss, or who use hearing-assisted devices, participate in the intervention?
Can the intervention be delivered in a group setting?
What if the child seems either tired or overstimulated?
Can a different practitioner or parent administer the intervention from day to day?
Would it be helpful for elite athletes and others looking to optimize performance?
What diagnoses are compatible with using the SSP?
Are there any contraindications with using the SSP?
Scheduling & Payment
Is there a limit to the number of clients I use the SSP with per month?
How do I charge for the SSP?
Can I bill insurance for the SSP?
Do you recommend suspending other therapy modalities during the 5 days of doing the SSP?
Any person above the age of 18 months may use the SSP.
Not in general. Most children can listen for the full hour. As always, use your clinical judgement and remember the sessions can be broken up into 30-minute sessions, or even spread out with break days with extremely sensitive clients.
You should wait until the client’s infection has cleared before starting (or continuing) the SSP.
For very young or very sensitive clients, we would recommend breaking the one-hour sessions into two parts. These could be given on the same day or on sequential days. With clients with a low tolerance, our research staff actually moved with the client and held the earphones just off of their ears. This usually resulted in the child accepting the headphones once the sounds were perceived by the child as being safe.
Most children are “tuned in” and interested in the music, as much of it is familiar to them. The Child Playlist includes songs from several familiar Disney movies like Frozen, Madagascar and Despicable Me and music from popular artists like Taylor Swift and Katy Perry.
Adults will find the Adult Playlist soothing. It contains vocal music from artists like Norah Jones, Sarah McLachlan and Simon & Garfunkel.
40-50 years of age. And yes, it was very successful. His capacity for human connection improved tremendously. We are embarking on a clinical trial on chronic pain in Bloomington, Indiana. Participants are living in a retirement home; they are in the 60-80 age range and experiencing chronic pain.
Associates have had good results with clients who have learning and language challenges, inattention, hyperarousal, auditory processing difficulties, vestibular and tactile sensory over-responsivity, anxiety and poor state regulation. These features are seen in many conditions such as autism, ADD/ADHD, Down Syndrome, mild traumatic brain injury, Misophonia and experience with trauma or anxiety.
In our research protocol we never used the SSP with individuals who had seizures, epilepsy, or any form of brain dysfunction. However, as long as the individual is under medical supervision, individuals who experience infrequent or mild seizures could be included. However, we would advise caution when considering individuals with severe seizure disorders.
For those with bipolar disorder, there are no specific contraindications. As with any client, make sure they are monitored carefully and the SSP is adjusted as needed (i.e., breaks or starting with a shorter duration and working up to a full hour by the end of the week).
Can the SSP be used for clients who experience Tinnitus?
Depending on the cause, it is possible that the SSP may bring relief from the symptoms of tinnitus. And even if the tinnitus is not abated, it is possible that resilience could be increased and sensitivity to the ringing may be reduced as a result. This more global influence would enable an individual to deal with several diverse disruptors or disorders.
While rare, if Tinnitus is caused by an acoustic neuroma (a benign tumor on the 8th cranial nerve), it is best not to use the SSP.
Great question! Many children love the music and often want to join in. Singing and dancing is a form of play that can be very positive, but it is a mobilized state. And since the intervention is addressing the autonomic nervous system, we don’t want stimulation to that system other than the intervention itself. Also, feedback from their own voice may interfere with the processed music they are listening to. Gently redirect them to calm down or sit down and listen. A good idea is to let them know in advance that it’s best not to sing and dance along, but better to focus on the music and even try to remember which songs were their favorite so they can tell you about it later.
It really is important to make the child feel the most safe and comfortable. If a swing or a hammock is helpful, then by all means let them use one. In general, you’ll want to discourage too much stimulation, though. As a rule of thumb: if an activity raises a client’s heart rate or causes them to perspire, then it is too stimulating.
The SSP will be more effective when administered when the client is in a calm state. It is better to reduce the daily allotment of intervention, in order to allow for breaks when needed.
If the child has an active ear infection, it’s best to wait until it has cleared for the intervention to be the most effective. If the intervention was already started, it is best to restart from the beginning once the infection is resolved, since the fluid may have been accumulating before the infection was evident.
Yes, you may use the SSP if the client is cleared to wear headphones. If there is any question, ask the parent to contact the physician who performed the surgery. If you have questions about a specific case, please submit a Case Consultation Request form. We suggest waiting about a week post surgery before beginning the SSP.
Yes, you can use the SSP. Pay attention to the response of the client and take good notes. If you have questions about a specific case, please submit a Case Consultation Request form.
Scar tissue may affect the intervention and results; however, we have not seen that be the case with iLs Focus programs. Proceed cautiously and take good notes. The intervention may not be as effective if there is scar tissue present, but it is worth trying.
First, you will need to verify that the hearing loss is documented. Difficulties with auditory processing can be perceived as “hearing loss”, and these are NOT the same. As auditory processing difficulties can be improved following use of SSP, you do not want to exclude individuals who may benefit.
When using the SSP with individuals with hearing devices, we recommend following the recommendations for iLs systems with hearing assistive devices (Available online). The general guideline is the removal of hearing aids and bone anchored hearing aids (BAHA's) due to the feedback they may emit. Cochlear devices, however, should be left powered on with the iLs/SSP headphone earcup placed over the cochlear implant microphone as much as possible. Dr. Porges’ research does not include those who use hearing devices to date. However, iLs programs have been observed to enhance many areas of functioning in children with hearing devices. We are very interested in your feedback.
While the intervention can potentially improve a child’s social engagement with other children, it’s better to deliver the intervention individually since other people may distract or activate the child.
The intervention involves 5 days of one hour of listening per day. Listening to the two half-hour segments consecutively is preferred. Most children can accommodate this length, but if they seem to need a break, by all means, do take one. Signs of needing a break are: looking bored, fussing, whining, posture shifts indicating a lack of interest. If you notice these, pause the music, offer a snack, get them to move their body, take a bathroom break and then start the listening again. The best time to take a break is between the “a” and “b” segments within each day’s playlist (at the half-hour mark). If necessary, the two half-hour sessions can be done separately in a single day with more than just a few minutes break separating them. It’s best to take your cues from the client as to what they can accept.
While it’s ideal for the same practitioner to be present for all five days of the intervention, we understand that schedules may not allow for that. It is more important to keep up the consecutive five days of listening than to wait for the same person to proctor it each time.
This program seems to be useful in fine-tuning the Autonomic Nervous System.
Indeed, better autonomic regulation is helpful for all people and certainly enhances performance. In our research, we have yet not worked with high performers wishing to do better, but we are very interested in feedback if you use it this way.
We have chosen to focus on features of disorders rather than diagnostic categories. So it’s best to refer to the features that seem to be helped by the SSP. Those are: anxiety; auditory hypersensitivity, inattention, behavioral dysregulation, experience of trauma and difficulty with social communication.
While we don’t believe the SSP will cause seizures, we encourage those with a seizure disorder to check with their neurologist regarding any restrictions around using headphones before beginning the SSP. As always, when using headphones with someone who has a seizure disorder, it is imperative to make sure the headphones are working properly, with sound coming from both ear cups.
No. We hope you find you are able to use it often. If you are sending the system home with clients and/or their families, you will find that it’s possible to use it with four clients per month with careful scheduling. If you use it in the clinic, you’ll have the flexibility to use it with many more clients. In fact, some Associates block out a slow week – such as during the holidays – and book SSP clients all day long.
iLs has a Manufacturer’s Suggested Retail Price (MSRP) for each five-day program. This is a good reference point for at-home use or simply being supervised by someone else in your facility. Many charge their regular fee when they incorporate the SSP into their clinical time.
As with iLs, you may bill for your clinical therapeutic time.
We would recommend suspending other auditory therapies for the five days of the SSP. We also encourage the client to limit experiences associated with loud noises (e.g., concerts, sporting events, movies, etc.) and intense interactions and physical activities. The objective of SSP is to ‘lull’ the body into a physiological state that supports the emergence of the Social Engagement System. This is critical, since many clients will have fragile nervous systems that can be easily hyper-aroused. Even the expression of exuberance and excitement, which frequently is associated with having a good time during an active movement oriented therapeutic session, could negate the positive effects of the SSP. The critical theme is to NOT to over stimulate and over arouse the nervous system; and NOT to encourage body movements that trigger sympathetic stimulation (active movement) or autonomic reflexes due to large posture shifts such as during swinging (passive movement). Very slow, gentle swings could be used to encourage calm behavior; however, small fine motor activities, such as manipulation of modeling clay, kinetic sand, etc., would be preferable.
Therapists are finding it difficult to keep their clients doing only sedentary activities during the SSP. They have found that clients enjoy being in a hammock, on a plank swing, bouncing lightly on a trampoline or other generally calm movement activities. Is this OK?This is an important point. As mentioned above, body movements either actively initiated by the client or passively manipulated by the therapist trigger physiological adjustments that will interfere with the SSP. We dealt with this by having OT materials in our lab to help the child calm first and then use the SSP. Alternatively, I would be less concerned with very minimal passive movements and perhaps using the hammock or other mild swinging movements, but would discourage bouncing on a trampoline.
If so, are there signs a therapist should look for to know that the ANS is getting overly activated with any additional activities? For example, sweating, flushed face, increased heart rate?
I would focus on the other part of the continuum of ANS activation and focus on calming and signals of calmness. If any of the signals of sympathetic activation occur (e.g., sweating, heart rate increases and palpitations) the treatment effect will be negated. I would encourage the therapists to use their skills to calm and that movement strategies need to be considered within this context.
How long after completing the SSP can other therapy modalities be added back in? Is there a difference for sound therapy vs. other types of therapy (i.e. OT, PT, speech)?
If the family can deal with a one-week break from other therapies, it would be optimal. However, in our research we did not disrupt other therapies. Often clients have a complex program (sometimes integrated) of therapies. The intervention models often provide two features: 1) predictability creating a neural expectancy, which we do not want to violate; and 2) overstimulation, which we want to minimize. Since therapists delivering the SSP may not be managing the selection and scheduling of other therapies, I would inform the therapists about the influence of behavioral and physiological states on the effectiveness of SSP. If other therapies were suspended during the delivery of the SSP, they could be added back a few days following the completion of SSP.
How long is it recommended to wait before doing the SSP a second time? How often is reasonable to repeat?
In the past we waited 6 months. We have also provided second treatments when there was a return of auditory hypersensitivities, frequently linked to an illness.
What are the guidelines for determining if repeating the SSP would be a good idea?
If there was a noticeable positive effect to the first treatment and if there was an identifiable disruptor (e.g., illness, loss of a pet, divorce, death of parent etc.) that triggered the degrading in features of the social engagement system.
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