Robertson & Simmons, 2015 Tavassoli et al., 2014), contributing to workplace difficulties ( Hayward et al., 2019 Hedley et al., 2018 Lorenz et al., 2016 A. DST symptoms in autism are known to persist into adulthood ( Elwin et al., 2013 Kuiper et al., 2019 Landon et al., 2016 A.
Furthermore, aversions to sensory stimuli, such as DST, are often cited as reasons that autistic individuals find it difficult to seek medical care ( Carter et al., 2017 Giarelli et al., 2014 Muskat et al., 2015 Nicholas et al., 2016). Even when not a safety concern, DST contributes significantly to autism-related functional impairment, as many caregivers report that their children’s reactions to sounds prevent them from participating in a wide range of family, school, and community activities ( Hussein et al., 2019 E. The majority of children exhibited DST-related challenging behaviors daily or weekly, and over one third had physically injured themselves or others as a result of these behaviors ( Law et al., 2016). In the largest single study investigating this phenomenon, Law and colleagues (2016) reported current and lifetime DST prevalence rates of 77.6% and 86.6%, respectively, in an online sample of 814 autistic children. A recent meta-analysis estimated that the current prevalence of DST in the autistic population is 38–45%, with 50 to 70% of individuals on the autism spectrum having experienced DST at some point in their lives ( Williams, Suzman, et al., 2020b).
Although this so-called “sensory hyperreactivity” can be present in any modality ( Ausderau et al., 2014 Crane et al., 2009 Hazen et al., 2014 Leekam et al., 2007 Tavassoli et al., 2014), decreased sound tolerance (DST i.e., an inability to tolerate everyday sounds) is among the most prevalent, persistent, and disabling sensory features of autism ( Gomes et al., 2008 O’Connor, 2012 Stefanelli et al., 2020 Stiegler & Davis, 2010). In addition to these cardinal features, autistic 1 people commonly find a number of everyday sensory stimuli to be quite aversive ( Ben-Sasson et al., 2009, 2019 Cascio et al., 2016 Schauder & Bennetto, 2016), now considered a core feature of the condition ( American Psychiatric Association, 2013). We further elaborate our framework by proposing preliminary neurocognitive models of hyperacusis, misophonia, and phonophobia that incorporate neurophysiologic findings from studies of autism.Īutism spectrum disorder (hereafter referred to as “autism”) is a heterogeneous, lifelong neurodevelopmental condition characterized by difficulties with social communication and the presence of restricted, repetitive patterns of behavior, interests, and activities ( American Psychiatric Association, 2013). Notably, we argue against conceptualizing DST as a unified construct, suggesting that it be separated into three phenomenologically distinct conditions: hyperacusis (the perception of everyday sounds as excessively loud or painful), misophonia (an acquired aversive reaction to specific sounds), and phonophobia (a specific phobia of sound), each responsible for a portion of observed DST behaviors. The present article synthesizes a large body of literature on the phenomenology and pathophysiology of DST-related conditions to generate a comprehensive theoretical account of DST in autism. However, relatively little is known about its phenomenology or neurocognitive underpinnings. This symptom is a source of significant distress and impairment across the lifespan, contributing to anxiety, challenging behaviors, reduced community participation, and school/workplace difficulties. Atypical behavioral responses to environmental sounds are common in autistic children and adults, with 50–70% of this population exhibiting decreased sound tolerance (DST) at some point in their lives.
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