A Trans-Diagnostic Investigation of Attention and Diverse Phenotypes of "Auditory Hyperreactivity" in Autism, ADHD, and the General Population.

This study looked at sound sensitivity in autistic people and those with ADHD. Both groups showed much higher sound sensitivity than typical people, but were similar to each other. The research found connections between attention problems (like hyperfocus or trouble concentrating), being overly alert to sounds, and anxiety - these may feed into each other in a cycle. The study highlights that measuring sound sensitivity is complex and needs better tools.

This trans-diagnostic study examined relationships between attention patterns and auditory hyper-reactivity across autism, ADHD, and neurotypical populations (n=492). Results showed markedly elevated auditory hyper-reactivity in both autistic and ADHD participants compared to controls, with small differences between autism and ADHD groups. Path analysis revealed interconnections between hyper-vigilance, hyper-focus, inattention, and auditory hyper-reactivity, with anxiety playing a mediating role in a potentially cyclic relationship. However, psychoacoustic measures of misophonia showed only modest correlation with self-reported misophonia scores, highlighting measurement challenges in sensory research.

Findings suggest clinicians should assess attention patterns when evaluating auditory sensitivities in autism and ADHD. The interconnected nature of attention, anxiety, and sensory reactivity indicates comprehensive treatment approaches may be more effective than targeting symptoms in isolation. Better assessment tools for sensory experiences are needed.

The study acknowledges measurement challenges, particularly the modest correlation between objective psychoacoustic measures and self-reported sensory experiences. The cross-sectional design limits causal inferences about the proposed cyclic relationships. Study type was not clearly specified, affecting interpretation of methodology.

Experiences of "auditory hyper-reactivity" and decreased sound tolerance, which can be separated into phenotypes such as hyperacusis and misophonia, are prevalent in autism and ADHD and impact quality of life and wellbeing. Furthermore, atypical patterns of attention regulations-including hyper-focus and inattention-are common in both autism and ADHD. Prior research also suggests sensory hyper-reactivity can cause anxiety, and anxiety can be associated with hyper-vigilance. It is currently unclear whether hyper-focusing on stimuli, having one's attention captured by them, or being hyper-vigilant toward them could lead to sensory hyper-reactivity.

Therefore, this study investigates relationships among hyper-focus, inattention, hyper-vigilance, auditory hyper-reactivity, and anxiety. Four hundred ninety-two adults (122 ADHD-only, 130 autistic-only, 141 autistic + ADHD, and 99 comparison) completed questionnaires indexing hyper-focus, inattention, and various forms of auditory hyper-reactivity; participants also completed a psychoacoustic measure by rating the pleasantness of misophonic trigger sounds. Per questionnaires, auditory hyper-reactivity was markedly elevated in both autistic and ADHD participants relative to comparison participants (.46 ≤ Cliff's δ ≤ .84), whereas differences between autism and ADHD alone were small (.05 ≤ |Cliff's δ| ≤ .21) and not consistent in sensitivity analyses. Path analysis suggested hyper-vigilance, hyper-focus, and inattention were related to auditory hyper-reactivity, which was related to anxiety, which was related to hyper-vigilance, potentially reflecting a cyclic relationship.

However, psychoacoustic misophonia was only modestly related to self-reported misophonia scores (.22 Spearman's ρ ≤ .31), and contributed little to the auditory hyper-reactivity composite included in the path analysis. These findings generally support the idea that attention may be connected to many neurodivergent people's auditory hyper-reactivity, but also emphasize the need for improved measurement of sensory experiences.