![]() 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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