The Safe and Sound Protocol: Supporting Regulation and Listening in Young Autistic Children

By Heather Hodgins-Chan, OT Reg. (Ont.), Psychotherapist
On The Ball Pediatric Physio and Occupational Therapy serving families in Kanata and Orleans, Ottawa

Before children can focus, communicate, and learn, their nervous system must first feel safe. The Safe and Sound Protocol is one tool that can help support this foundation.

Over many years of clinical practice as a pediatric occupational therapist, I have had the privilege of working with hundreds of children on the autism spectrum. Many of these children struggle with auditory sensitivity, sensory overwhelm, difficulty with attention, and challenges with social engagement. These challenges are not simply behavioral; they are deeply connected to how the nervous system processes sensory information and detects safety in the environment.

In pediatric occupational therapy, our work with autistic children often includes supporting the development of gross motor skills, fine motor skills, self regulation skills, sensory processing skills, executive functioning skills, and self care skills. However, before children can successfully focus on these areas, the nervous system must first feel regulated and safe. When a child’s nervous system is overwhelmed by sensory input, it becomes very difficult for them to attend to speech, interact socially, or participate in daily activities.

Sensory Processing and Nervous System Regulation in Autistic Children

Research over the past several years continues to show that autistic children frequently experience differences in sensory processing and sensory regulation, particularly when environments become overwhelming. Sensory sensitivities, including auditory sensitivity, can significantly influence attention, social engagement, and participation in everyday activities (Thye et al., 2022; Ben-Sasson et al., 2022; Tavassoli et al., 2023; Marco et al., 2023).

One tool that has been particularly helpful in my clinical practice is the Safe and Sound Protocol (SSP). The SSP is a therapeutic listening program developed by neuroscientist Dr. Stephen Porges, the originator of the Polyvagal Theory. This protocol uses specially filtered music to stimulate the middle ear muscles and the vagus nerve in ways that help the nervous system shift toward a state of safety and social engagement.

The Safe and Sound Protocol is typically delivered as a five hour listening program. These five hours are not usually completed all at once. Instead, the listening sessions are broken into shorter segments and completed gradually over time. The program can be implemented during one on one sessions with an occupational therapist or occupational therapy assistant, or it may be completed at home with the child’s most co regulating adult, such as a parent or caregiver.

A key principle of the program is that safety must come before sound. The child must first feel safe in their environment and with the adult supporting them before beginning the listening sessions. The program may not be appropriate for every child. For example, children with certain neurological conditions such as active seizure disorders may require careful consideration before using this approach. For this reason, the program should always be guided by a trained professional.

How the Safe and Sound Protocol Supports Listening and Social Engagement

To understand why the Safe and Sound Protocol can be helpful, it is useful to briefly understand the Polyvagal Theory developed by Dr. Stephen Porges. This theory explains how the autonomic nervous system continuously scans the environment for cues of safety or danger, a process known as neuroception.

When the nervous system detects safety, the ventral vagal system becomes active. In this state, children are more able to make eye contact, listen to voices, communicate, explore their environment, and engage socially. When the nervous system detects threat or overwhelming sensory input, however, the body may shift into protective states such as fight, flight, or shutdown.

Many autistic children experience the auditory world as unpredictable or overwhelming. Background noise, competing voices, and environmental sounds can make it very difficult for the brain to filter important information such as human speech. The Safe and Sound Protocol works by delivering specially filtered music through headphones that emphasizes the acoustic frequencies of the human voice.

As the child listens to the music, the middle ear muscles are gently stimulated. These muscles are connected through neural pathways to the vagus nerve and brainstem structures involved in regulation and social engagement. In simple terms, the program helps the nervous system practice recognizing the acoustic features of safe human voices.

Over time, this process can help the nervous system become more comfortable with listening and can reduce defensive responses to sound. As the auditory system becomes more regulated, many children find it easier to attend to speech, participate in social interaction, and tolerate everyday environments.

Some people wonder why a five hour listening program would be recommended for a child with autism. The reason relates to the way the nervous system learns through repetition and gradual exposure. By slowly introducing these filtered sounds over time, the auditory system has an opportunity to reorganize its responses in a safe and supportive way.

In my own clinical practice, I have used the Safe and Sound Protocol with hundreds of children with autism spectrum disorder. While every child is unique and outcomes vary, I have observed many encouraging changes in some children following the program. Parents sometimes report that their child begins making more consistent eye contact, shows improved joint attention, tolerates sound more easily, sleeps better, or begins using more language. Some children appear more socially engaged or more comfortable interacting with others.

These changes do not occur because the listening program teaches skills directly. Rather, the listening program may help the nervous system move into a state where learning and connection become easier.

Research on the Safe and Sound Protocol continues to grow, and several studies have found that the intervention may be particularly beneficial for autistic populations, especially in relation to auditory processing, social engagement, and emotional regulation (Porges et al., 2019; Brown et al., 2021; Kolacz et al., 2021).

Pediatric Occupational Therapy Support for Autism in Kanata and Orleans

For families with babies, toddlers, or preschoolers who are showing early signs of sensory sensitivity, auditory overwhelm, or social communication differences, interventions that support nervous system regulation can be an important part of early support. When the nervous system begins to feel safe, children are better able to connect, explore, communicate, and learn.

In occupational therapy, our goal is not simply to change behavior. Our goal is to support the developing nervous system so that children feel safe enough to engage with the world around them.

Families in Kanata, Orleans, and across the Ottawa community who are looking for support for autistic children or children experiencing sensory processing challenges can connect with the team at On The Ball Pediatric Physio and Occupational Therapy. Our pediatric occupational therapists provide individualized therapy that supports sensory regulation, listening skills, and social engagement for young children and their families.

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References

Ben-Sasson, A., Gal, E., & Engel-Yeger, B. (2022). Sensory processing patterns in autism spectrum disorder and their impact on participation and daily life. Autism Research.

Brown, N., et al. (2021). A preliminary evaluation of the Safe and Sound Protocol for improving social communication and auditory sensitivities. Frontiers in Integrative Neuroscience.

Kolacz, J., Porges, S. W., & others. (2021). Evaluating the impact of the Safe and Sound Protocol on auditory processing and social engagement. Journal of Autism and Developmental Disorders.

Marco, E. J., Hinkley, L. B. N., Hill, S. S., & Nagarajan, S. S. (2023). Sensory processing in autism spectrum disorders. Nature Reviews Neurology.

Porges, S. W., et al. (2019). Reducing auditory hypersensitivities and improving social engagement in autistic children through filtered music intervention. Frontiers in Pediatrics.

Tavassoli, T., et al. (2023). Sensory reactivity and sensory processing differences in autism spectrum conditions. Autism Research.

Thye, M. D., Bednarz, H. M., Herringshaw, A. J., Sartin, E. B., & Kana, R. K. (2022). The impact of atypical sensory processing on social communication in autism. Neuroscience & Biobehavioral Reviews.

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