Williams Zachary J, He Jason L, Cascio Carissa J, Woynaroski Tiffany G
Medical Scientist Training Program, Vanderbilt University School of Medicine, 221 Eskind Biomedical Library and Learning Center, 2209 Garland Ave., Nashville, TN, 37240, United States; Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Avenue South, Medical Center East, Room 8310, Nashville, TN, 37232, United States; Vanderbilt Brain Institute, Vanderbilt University, 7203 Medical Research Building III, 465 21st Avenue South, Nashville, TN, 37232, United States; Frist Center for Autism and Innovation, Vanderbilt University, 2414 Highland Avenue, Suite 115, Nashville, TN, 37212, United States.
Department of Forensic and Neurodevelopmental Sciences, Sackler Institute for Translational Neurodevelopment, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Strand Building, Strand Campus, Strand, London, WC2R 2LS, London, United Kingdom.
Neurosci Biobehav Rev. 2021 Feb;121:1-17. doi: 10.1016/j.neubiorev.2020.11.030. Epub 2020 Dec 4.
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.
对环境声音的非典型行为反应在自闭症儿童和成人中很常见，该群体中有50%-70%在人生的某个阶段表现出声音耐受性降低（DST）。这种症状在整个生命周期中都是显著痛苦和功能损害的来源，会导致焦虑、具有挑战性的行为、社区参与度降低以及学校/工作场所的困难。然而，对于其现象学或神经认知基础，我们了解得相对较少。本文综合了大量关于DST相关病症的现象学和病理生理学的文献，以生成关于自闭症中DST的全面理论阐释。值得注意的是，我们反对将DST概念化为一个统一的结构，建议将其分为三种现象学上不同的病症：听觉过敏（将日常声音感知为过大或痛苦）、恐音症（对特定声音产生后天的厌恶反应）和声音恐惧症（对声音的特定恐惧症），每种病症都导致了一部分观察到的DST行为。我们通过提出听觉过敏、恐音症和声音恐惧症的初步神经认知模型来进一步完善我们的框架，这些模型纳入了自闭症研究中的神经生理学发现。
