Increased Hyperacusis with Risperidone in an Autistic Child

Abstract

Hyperacusis has been defined as "unusual tolerance to ordinary environmental sounds" or "consistently exaggerated or inappropriate responses to sounds" that are neither uncomfortably loud nor threatening to a typical person. In most cases, the underlying medical condition cannot be found, but it can be related with some diseases, syndromes, and developmental and mental disorders (1). Autistic spectrum disorder (ASD) is one of these disorders found to be related with hyperacusis, which is a neurodevelopmental disorder characterized by qualitative impairment in communication skills and social interactions (2). In addition to these core features of ASD, sensory processing (SP) abnormalities such as auditory hypersensitivity have been frequently reported and may be a predictor of maladaptive behavior (3). CASE PRESENTATIONAn 11-year-old boy with ASD presented to our clinic with a complaint of "auditory hypersensitivity" by his parents. He has been attending special education and elementary school. He could read and write. He has been on 1 mg/day risperidone for a year, and his teachers did not mention any behavioral problems after treatment. Hyperacusis has always been present, but its severity increased 3 years ago when 1 mg/day risperidone was prescribed for hyperactivity and behavioral problems. Because of hyperacusis, risperidone was discontinued, and it decreased. Atomoxetine and then aripiprazole were prescribed, but they did not reduce symptoms satisfactorily, so risperidone was prescribed again.According to his parents, he was particularly disturbed by the voice of children and electric appliances. Currently, hyperacusis started to affect his functionality. He refused to go out except to school, and in school, he was very disturbed and could not hold a pencil to write because he was covering his ears.During his clinical assessment, intolerance to the usual noises of our clinic was observed. He was referred to the otorhinolaryngology and pediatric neurology departments to exclude the organic etiology. Physical examination and screening results were within the normal range. Risperidone was discontinued, and hyperacusis decreased to a tolerable level again.Parents of the child were provided previous information about the case report and gave their written consent. DISCUSSIONIn recent years, interest in the SP of children with ASD has grown. Autistic children are frequently reported to exhibit behaviors associated with sensory sensitivity (e.g., covering ears because of loud voices and restricted food preferences), sensory seeking (efforts to provide intrinsic sensory stimulation e.g., hand flapping, rocking, and noise-making), or sensory under-responsivity (e.g., apparent indifference to pain/temperature) (3). Although the previous diagnostic criteria did not consider SP disturbance as a core deficit of ASD diagnosis, in the last edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) 5th edition, sensory abnormalities were appended to the diagnostic criteria for ASD (2).

Hyperacusis in Autism Spectrum Disorders

“…In addition to possible anatomical and physiological causes of hyperacusis, outside factors possibly contributing to hyperacusis in the autism population have been found in the literature, including a recent case study of an autistic 11 year-old boy, whose hyperacusis worsened when he was taking risperidone to treat hyperactivity and behavioral problems [ 47 ]. However, a contrasting case study noted an autistic five and a half year-old girl whose hyperacusis, according to parent report, alleviated after taking the same medication [ 48 ].…”

Treatment of Misophonia with Risperidone in a Patient with Autism Spectrum Disorder

“…However, while everyday sounds can be extremely painful and loud in hyperacusis; in patients with misophonia, it is a specific sound that produces an aversive reaction [ 16 ]. While case reports support using risperidone as a potential treatment option for hyperacusis in patients with autism, we are unaware of published reports on using risperidone to treat misophonia in this patient population [ 17 , 18 ]. Here, we discuss the case of a 32-year-old male with ASD whose misophonia responded dramatically to risperidone.…”

Turkish Validity and Reliability Study of Pediatric Hyperacusis Questionnaire Parent Form: A Cross Sectional Adaptation Study

“…3 Many studies have reported that children with hyperacusis, especially those attending school, feel uncomfortable or anxious due to stimuli, such as classroom noise, physical education class sounds, and fire alarms. 4,5 This may cause children to avoid situations or environments in which they perceive loud noises. 6 In one study, a child with hyperacusis disrupted the other students' concentration during exams due to noise disturbance.…”