A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms

Williams, Z. J., He, J., Cascio, C. J., & Woynaroski, T. G. (2020). A review of decreased sound tolerance in autism: Definitions, phenomenology, and potential mechanisms. Neuroscience & Biobehavioral Reviews, 121, 1-17. https://doi.org/10.1016/j.neubiorev.2020.11.030

Publication date: 4 Dec 2020 Added to AutiHub: 7 Jul 2026 Type: Article Article language: English

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4
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1 / 4 (25.0%)

Abstract

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. 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. However, relatively little is known about its phenomenology or neurocognitive underpinnings. 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. 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. We further elaborate our framework by proposing preliminary neurocognitive models of hyperacusis, misophonia, and phonophobia that incorporate neurophysiologic findings from studies of autism.

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Cited references with an identified autistic author
3 / 340 (0.9%)
Cited author occurrences identified as autistic
3 / 1439 (0.2%)
Among occurrences linked to AutiHub author records: 3 / 193 (1.6%). Distinct cited authors identified as autistic: 2 / 1211 (0.2%).
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Among linked cited-author occurrences only. Across all cited-author occurrences: 190 / 1439 (13.2%). Distinct linked cited authors not identified as autistic: 125 / 127 (98.4%).
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