More than Covering Ears: A Clinical Inventory for Characterizing Decreased Sound Tolerance (I-DST) in Autism

Background: Decreased sound tolerance (DST) is among the most common and distressing forms of sensory over-responsivity experienced by children with autism spectrum disorders. DST includes hyperacusis and misophonia, among others, and can limit participation in daily activities. Recently, a new screening tool, the Pediatric Hyperacusis and Misophonia Questionnaire (PMHQ-4) has been developed to allow health professionals to better identify and differentiate these conditions using a single assessment. Additional clinical tools are needed to further characterize DST symptoms to facilitate treatment planning after diagnosis. Methods: In this mixed-methods study n = 15 parents of autistic children 6 to 17 years of age completed an online survey and interviews regarding DST in autism and PMHQ item content. Participants were asked to identify sounds that bother their children and described how their children respond to these sounds. Results: Content analysis revealed two themes for bothersome sounds: (a) the context of sounds and (b) the qualities of sounds, each with their own subthemes; and four themes for responses to bothersome sounds: (a) avoidance, (b) distress/anger, (c) physical and (d) communication. Conclusion: Study findings were compiled into a clinical Inventory to Characterize DST (I-DST) that can be used to develop a detailed clinical profile for client-centered treatment.