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4C Misophonia Management Questionnaire (Parent)

Misophonia is a strong emotional reaction to certain sounds.
Trigger noises are sounds related to chewing food, swallowing, tapping, breathing, lip smacking, nose sniffing, and other man made noises.


For each question please select one number based on how you are feeling now.

1. How certain is your child that she/he is able to carry out their day-to-day activities (e.g., learning in the classroom, having a conversation with friends or family members, eating lunch in the school canteen or at home with family, travelling in the car, etc.) despite the trigger noises that they may be hearing?

Not certain at all
(My child would not be able to cope at all)

Very certain
(My child would have no problems managing the situation and is confident being in these situations)

2. How certain is your child that she/he is able to relax and settle down despite the trigger noises that they may be hearing?

Not certain at all
(My child would not be able to cope at all)

Very certain
(My child would have no problems managing the situation and is confident being in these situations)

3. How certain is your child that she/he can enjoy their leisure time despite the trigger noises that they may be hearing (leisure time is hobbies such as family times, sports, playing games, reading, family trips out, eating out, going to the cinema, socialising with friends etc.)?

Not certain at all
(My child would not be able to cope at all)

Very certain
(My child would have no problems managing the situation and is confident being in these situations)

4. How certain is your child that she/he can carry on with their day to day activities, relax, and enjoy life, without using any distraction or avoidance strategies to help them cope with the trigger noises? (examples of distraction or avoidance strategies are: using background noise or making sounds themselves to cover up the sound they find upsetting, mimicry, getting away from the sound, refusing to go to or be in certain places, making excuses not to go, covering ears, use headphones or ear protection, telling people to stop the noise, etc.)

Not certain at all
(My child would not be able to cope at all)

Very certain
(My child would have no problems managing the situation and is confident being in these situations)

For Hearing Healthcare Professionals