Investigating the Phenomenology and Physiologic Underpinnings of Decreased Sound Tolerance in Adults with Autism Spectrum Disorder

项目摘要 患有自闭症谱系障碍（ASD）的个体在感官知觉方面表现出多种差异，现在已经 被认为是这种情况的核心特征。在这些感官差异中，声音耐受性下降（DST; 也就是说，不能科普日常生活中的声音）尤其突出，ASD的终生患病率为50- 70 人口尽管第一人称叙述和实证研究都表明夏令时是痛苦的主要来源， ASD的功能障碍，很少有人知道这种症状的现象学或生理基础 群集，目前没有ASD DST的循证治疗方法。一些研究人员认为 在ASD中看到的不良反应是听觉过敏的表现，反映了紊乱的响度感知。但是，在这方面， 另一些人则认为，对特定声音刺激的夸张情绪反应是这些行为的基础，这表明， ASD中的DST可能是一种恐音症，一种以过度情绪反应为特征的精神疾病， 特定的“触发器”声音。到目前为止，很少有实证研究对这些假设进行了相互检验，它仍然是一个假设。 ASD中的DST是否反映听觉过敏、恐音症或两者的结合是一个悬而未决的问题。而且 目前尚不清楚这些症状是否与外周或中枢听觉系统的改变有关。 拟议的研究旨在使用两个阶段的方法来回答这些问题。在第一阶段，我们将构建一部小说 自我报告问卷，评估广泛的DST症状，涵盖响度的四个理论领域， 疼痛，烦恼（即，恐音症（misophonia）和恐惧。可用的DST测量通常仅评估响度（听觉过敏） 或烦恼（恐音症）维度，未能解决许多其他临床上显著的症状。利用 有和没有ASD的成年人的大型在线样本，我们将完善和心理测量验证我们的问卷， 用作跨诊断DST症状的定量测量。在第二阶段，我们将招募患有ASD的成年人（两人都有 没有DST）和健康对照组，使用一组 心理声学和生理测试。将使用纯音测听、响度 不适水平测试和绝对响度缩放。基础听觉生理学将从 中耳到听觉皮层使用鼓室压测试、声反射测试、耳声发射 抑制、脑干/皮层听觉事件相关电位和听觉稳态反应。客观听觉 将在诊断组之间比较这些指标，以及这些指标与主观DST之间的关系 心理学（基于已建立的调查和第1阶段中开发的新颖的自我报告）将在整个 完整的第二阶段样本。这个项目将回答ASD中的DST是否代表 听觉过敏、恐音症或两者的组合。此外，通过将DST症状与潜在的生理学联系起来， 我们将确定DST的不同维度是否可以基于它们的生理相关性来分离。结果 从这项研究中，有望阐明ASD DST的心理和生理机制，提高我们的 了解这种致残症状，并指导ASD人群有针对性的干预措施的发展。

Project Summary Individuals with autism spectrum disorder (ASD) exhibit multiple differences in sensory perception, which have now been recognized as a core feature of the condition. Among these sensory differences, decreased sound tolerance (DST; i.e., an inability to cope with everyday sounds) is particularly salient, with a lifetime prevalence of 50–70% in the ASD population. Despite both first-person accounts and empirical studies indicating that DST is a major source of distress and functional impairment in ASD, little is known about the phenomenology or physiologic underpinnings of this symptom cluster, and no evidence-based treatments for DST in ASD are currently available. Some researchers have suggested that the adverse reactions seen in ASD are manifestations of hyperacusis, reflecting disordered loudness perception. However, others contend that exaggerated emotional responses to specific acoustic stimuli underlie these behaviors, indicating that DST in ASD could be a form of misophonia, a psychiatric disorder characterized by excessive emotional reactions to specific “trigger” sounds. To date, little empirical work has tested these hypotheses against one another, and it remains an open question whether DST in ASD reflects hyperacusis, misophonia, or a combination of the two. Furthermore, it remains unknown whether these symptoms are associated with alterations in the peripheral or central auditory system. The proposed study aims to answer these questions using a two-stage approach. In stage 1, we will construct a novel self-report questionnaire that assesses a wide range of DST symptoms spanning the four theoretical domains of loudness, pain, annoyance (i.e., misophonia), and fear. Available measures of DST typically assess only the loudness (hyperacusis) or annoyance (misophonia) dimensions, failing to address a number of other clinically significant symptoms. Utilizing large online samples of adults with and without ASD, we will refine and psychometrically validate our questionnaire for use as a quantitative measure of transdiagnostic DST symptoms. In stage 2, we will recruit adults with ASD (both with and without DST) and healthy controls from the community, characterizing their auditory function using a battery of psychoacoustic and physiological tests. Auditory perception will be assessed using pure tone audiometry, loudness discomfort level testing, and categorical loudness scaling. Underlying auditory physiology will be assessed from the middle ear to auditory cortex using a combination of tympanometry, acoustic reflex testing, otoacoustic emission suppression, brainstem/cortical auditory event-related potentials, and auditory steady-state responses. Objective auditory measures will be compared between diagnostic groups, and relationships between these measures and subjective DST symptomatology (based on established surveys and the novel self-report developed in stage 1) will be explored across the full stage 2 sample. This project will answer the fundamental question of whether DST in ASD represents a variant of hyperacusis, misophonia, or a combination of the two. Furthermore, by relating DST symptoms to underlying physiology, we will determine whether different dimensions of DST can be separated based on their physiologic correlates. Findings from this study are expected to elucidate the psychological and physiological mechanisms of DST in ASD, improving our understanding of this disabling symptom and guiding the development of targeted interventions for the ASD population.