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

Experiences of “auditory hyperreactivity” 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 regulation are common in both autism and ADHD. While ADHD is traditionally defined by inattention, and while the monotropism hypothesis posits that autism is characterized by intense focus, increasing evidence suggests both hyper-focus and susceptibility to distraction are elevated in both diagnoses. It is currently unclear whether hyper-focusing on stimuli or having one’s attention captured by them could lead to sensory hyperreactivity; therefore, this study investigates associations between auditory hyperreactivity and hyper-focus and inattention. 492 adults (122 ADHD-only, 130 autistic-only, 141 autistic+ADHD, 99 comparison) completed questionnaires indexing hyper-focus, inattention, and various forms of auditory hyperreactivity; participants also completed a psychoacoustic misophonia measure. Per questionnaires, auditory hyperreactivity was markedly elevated in either 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). Numerous associations between forms of self-reported auditory hyperreactivity and attention variables were found in neurodivergent groups, though fewer associations attained significance in the comparison group. However, self-reported misophonia was only modestly related to psychoacoustic misophonia scores (.22≤ Spearman’s ρ≤.31), and psychoacoustic misophonia scores were not significantly associated with attention (.02≤ Spearman’s ρ≤.20). These findings generally support the idea that attention may be connected to many neurodivergent people’s auditory hyperreactivity, but also emphasize the need for improved measurement of sensory experiences.