Agitation in Nonverbal Patients With Autism: The Role of Sensory Evaluation in Diagnosis and Management

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition often associated with communication barriers, sensory sensitivities, and behavioral challenges, including agitation. Identifying the underlying causes of acute agitation in nonverbal individuals with ASD can be difficult, leading to diagnostic delays and unnecessary medical interventions. We present a case of a 36-year-old nonverbal male with ASD who was admitted for severe agitation, self-injurious behaviors, and increased aggression towards family members. His medical history included epilepsy, hypertension, and prior otitis media with tympanostomy tubes. Initial evaluations, including CT imaging and laboratory tests, were unremarkable. Despite escalation of psychiatric medications, including haloperidol and ziprasidone, along with dexmedetomidine infusion and physical restraints, his agitation persisted. Given his history of ear infections, further examination revealed cerumen impaction in his right ear. Following ear lavage, the patient's behavior significantly improved, agitation resolved, and he was safely discharged home. This case underscores the importance of a thorough diagnostic approach when evaluating agitation in individuals with ASD, particularly those with communication limitations. Sensory disturbances, such as cerumen impaction, may be overlooked contributors to distress. Additionally, maintaining a familiar environment and involving caregivers played a crucial role in the patient's stabilization. While pharmacologic and physical interventions were initially necessary for patient and provider safety, restraints may have exacerbated distress. This highlights the need for alternative strategies, including early sensory evaluations, behavioral interventions, and specialized ASD-friendly healthcare protocols. Agitation in ASD patients requires a multidisciplinary approach that considers sensory, medical, and environmental factors. Healthcare providers should remain vigilant for treatable conditions like cerumen impaction and prioritize nonpharmacologic interventions to minimize distress and improve patient outcomes. Incorporating a sensory-first bedside check, including an ear exam, can prevent unnecessary escalation and reduce restraint exposure.