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).