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Hyperesthesia and Autism


Have you ever washed your face and instead of feeling a gentle trickle as hands touch the surface of your skin lathered with your favorite face wash, the motion of your hand touching your face causes an involuntary painful sensation? This form of experience is known as tactile hyperesthesia. Hyperesthesia is a condition defined by heightened sensory experience in any of the five senses causing pain stimulation.

Hyperesthesia and Autism https://www.autismparentingmagazine.com/hyperesthesia-autism/

The sensory experience of autistic people is often spoken of in the autism community as either hypersensitivity (over-reactivity), or hyposensitivity (under-reactivity) to sensory input. However, due to the similarity in the sensory experience of hyperesthesia and autism, this article will determine if there is a link between hyperesthesia and autism, and whether a person on the autism spectrum can have hyperesthesia.

What is human hyperesthesia?

Hyperesthesia syndrome is caused by pain (referred as neuropathic pain) caused by damage or disease in the somatosensory nervous system (NS). The somatosensory nervous system is the part of the NS that deals with the conscious perception of touch, pressure, temperature, etc. The neuropathic pain has various symptoms expressed differently across different people.

The two most common forms of hyperesthesia are allodynia and hyperalgesia. Allodynia is the sensation of pain to a stimulus that doesn’t normally hurt. For example, feeling pain when washing your face etc., and hyperalgesia is an exaggerated sense of pain that would normally not be as severe in other individuals.

The unusual heightened sensibility can occur in any of the senses i.e. touch, sound, sight, and smell. If only one of the five senses is heightened, a specific name for that type of hyperesthesia is assigned—for example, tactile hyperesthesia, auditory hyperesthesia, and so  on… 

The different types of hyperesthesia include:

  • Tactile (touch) sensitivity
  • Optic (sight) sensitivity
  • Auditory (sound) sensitivity
  • Gustatory (taste) sensitivity
  • Olfactory (smell) sensitivity

The increased sensitivity in any of these senses may cause pain in the specific sense that is affected.

Most symptoms due to hyperesthesia are hallucinatory—meaning that a person with auditory hyperesthesia may experience pain to a sound that isn’t there. A possible explanation for this is that since hyperesthesia is caused by the sensory nerves in the peripheral nervous system, which includes the peripheral nerve that runs outside our brain and spinal cord, if this nerve is damaged (peripheral neuropathy), it may possibly cause the hyperesthesia experience. 

In severe cases, this condition can affect the nervous system and lead to inflammation of the nerves, and possibly seizures.

Is hyperesthesia common in autism?

One of the symptoms of autism spectrum disorder (ASD) under the DSM-5 is sensory sensitivity such as hypersensitivity or hyposensitivity to sensory input, in addition to unusual responsive reaction to sensory input such as an indifference to temperature, unfavorable response to specific sounds or textures, excessive smelling or touching of objects, and visual fascination with lights or movement.

From this criteria, the sensory experience of autistic individuals can be heightened sensibility to sensory stimuli which describes the experience of hyperesthesia. Since autism is a spectrum, these experiences can vary in sensibility at different senses. Due to the lack of research linking hyperesthesia to autism, parents should seek the help of a qualified neurologist to confirm a diagnosis of hyperesthesia.


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Treatment options for hyperesthesia

Here are a few suggestions of treatment options if your autistic child has symptoms of hyperesthesia.

Cognitive behavioral therapy (CBT)

  • Cognitive behavioral therapy is a psychological treatment method that has been proven to be effective in improving the quality of life and functioning of individuals by changing thinking patterns, and reevaluating the reality vs psychological experience of people
  • To treat hyperesthesia, a training technique known as sensory retraining could help individuals who suffer from hyperesthesia
  • Sensory retraining helps the person with a nerve injury or abnormal sensory reaction to learn how to interpret the neural impulse when the altered sensory experience is stimulated

Pain management specialist

  • A pain management specialist curates treatment plans specific to clients; this care depends on the type of pain the patient experiences
  • A psychiatrist with training in Interventional Pain Management (IPM) is a type of specialist with training in treating pain related disorders. The goal of this specialist is to help relieve, reduce or manage pain so that the person is able to function optimally without the need for medication or surgery

Occupational therapist

  • The goal of occupational therapy is help regulate the sensory experience of the child through physical activities 
  • A technique that an occupational therapist can introduce is sensory integration therapy (SIT). SIT can help the child integrate and respond to his/her sensory experience more appropriately by stimulating the sensory stimuli in a structured and repetitive pattern. The idea behind this is so that the brain adapts and, in return, the child responds to it more efficiently

Neurologist

  • A neurologist is a medical doctor who specializes in treating conditions that affect the nervous system. The nervous system (NS) consists of the central NS, and the peripheral NS. The latter is the part of the NS that is shown to be affected in hyperesthesia and other sensory disorders 
  • Consulting with a neurologist is possibly the first step in seeking a diagnosis of any nerve related conditions or abnormalities

In summary

Hyperesthesia is a form of sensory abnormality that could possibly be linked to autism, but due to the lack of research to support this, its relationship sits as a hypothesis. The sensory experience of hyperesthesia and autism are similar but in hyperesthesia, that sensibility leads to pain in the specific area that is affected.  

Parents with autistic children who suspect their child has a sensory abnormality should consult with a medical doctor or specialist to receive an accurate diagnosis of hyperesthesia.

References

Centers for Disease Control and Prevention, (2020). Autism Spectrum Disorder (ASD). https://www.cdc.gov/ncbddd/autism/hcp-dsm.html 

Phillips, C., Blakey, G., 3rd, & Essick, G. K. (2011). Sensory retraining: a cognitive behavioral therapy for altered sensation. Atlas of the oral and maxillofacial surgery clinics of North America, 19(1), 109–118. https://doi.org/10.1016/j.cxom.2010.11.006 

Maldonado RJ, De Jesus O. Hyperesthesia. [Updated 2021 Feb 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563125/ 

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