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

项目摘要 自闭症谱系障碍(Asd)的个体在感官知觉上表现出多种不同，现在 被认为是该病的核心特征。在这些感官差异中，声音耐受性降低(DST； 例如，无法处理日常声音)尤其突出，在ASD中终生患病率为50%-70% 人口。尽管第一人称描述和经验研究都表明DST是痛苦的主要来源和 ASD的功能损害，对这种症状的现象学或生理学基础知之甚少 目前还没有针对ASD中DST的循证治疗方法。一些研究人员提出， ASD中出现的不良反应是听力亢进的表现，反映了响度感知的紊乱。然而， 其他人争辩说，对特定声音刺激的夸大情绪反应是这些行为的基础，表明 ASD的DST可能是失语症的一种形式，这是一种精神障碍，其特征是对 特定的“触发”声音。到目前为止，很少有实证工作对这些假设进行相互验证，而且它仍然是一种 悬而未决的问题是ASD中的DST是否反映了听力亢进、失声或两者的组合。此外，它还 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，跨越响度的四个理论领域， 疼痛、烦恼(即失语症)和恐惧。现有的DST测量通常只评估响度(听觉过敏症) 或烦恼(发音障碍)维度，未能解决其他一些临床显著症状。利用 对于患有和不患有自闭症的成年人的大量在线样本，我们将改进并通过心理测量学验证我们的问卷 用作跨诊断DST症状的定量测量。在第二阶段，我们将招募患有自闭症的成年人(两者都有 和没有DST)和来自社区的健康对照组，使用一组 心理声学和生理测试。将使用纯音测听、响度 不适程度测试和绝对响度测量。潜在的听觉生理学将从 使用鼓室导纳、声反射测试、耳声发射联合使用中耳到听觉皮质 抑制、脑干/皮质听觉事件相关电位和听觉稳态反应。客观听觉 将比较诊断组之间的测量，以及这些测量与主观DST之间的关系 症状学(基于已建立的调查和在阶段1中制定的新的自我报告)将在 完整的阶段2样本。此项目将回答ASD中的DST是否代表 听力亢进、失声或两者兼而有之。此外，通过将DST症状与潜在的生理联系起来， 我们将根据它们的生理相关性来确定DST的不同维度是否可以分开。发现 以期阐明ASD中DST的心理和生理机制，改善我们的 了解这一致残症状，并指导为ASD人群制定有针对性的干预措施。

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.