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

Objective: 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. Method: 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. Result: 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. Conclusion: 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.