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

> **NIH NIH F30** · VANDERBILT UNIVERSITY · 2021 · $30,776

## Abstract

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 pr...

## Key facts

- **NIH application ID:** 10229243
- **Project number:** 1F30DC019510-01
- **Recipient organization:** VANDERBILT UNIVERSITY
- **Principal Investigator:** Zachary James Williams
- **Activity code:** F30 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $30,776
- **Award type:** 1
- **Project period:** 2021-07-01 → 2025-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10229243

## Citation

> US National Institutes of Health, RePORTER application 10229243, Investigating the Phenomenology and Physiologic Underpinnings of Decreased Sound Tolerance in Adults with Autism Spectrum Disorder (1F30DC019510-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10229243. Licensed CC0.

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