Literature on sound sensitivity in individuals with and without autism spectrum disorders (ASD) is reviewed in this article. Empirical evidence is examined, and physiologic and psychoemotional-behavioral perspectives are described. There is virtually no evidence of true physiological differences in auditory systems of individuals with ASD. It is evident, however, that many people with ASD (a) feel fearful and anxious about sound, and (b) may experience unpleasant physiological sensations because of autonomic and/or behavioral responses to nonpreferred sounds, but (c) can learn to react in less stigmatizing, more effectively self-regulating ways. Current assessment and intervention practices are discussed, and a case is presented. Heightened understanding of this issue among caregivers and interventionists may ultimately improve life participation for individuals with ASD.