Misophonia in autism: A systematic review of prevalence, clinical features, and comorbidities.
A systematic review of 14 studies finds misophonia is common in autistic people and frequently co-occurs with anxiety and OCD, so screen for sound triggers.
01Research in Context
What this study did
Aldakhil et al. (2025) looked at every paper on misophonia in autism. They wanted to know how common it is and what other problems ride along.
The team pulled data from many small studies and counted cases. They also noted links to anxiety, OCD, and other sensory issues.
What they found
About 13 to 36 percent of autistic people also have misophonia. That is roughly one in every four clients you see.
Most of these clients also battle anxiety, obsessive thoughts, or both. Yet almost no studies test sound-based treatments for them.
How this fits with other research
Gillberg et al. (2016) followed 50 men with Asperger for 20 years. Ninety-four percent picked up extra mental-health diagnoses, showing that extra conditions are the rule, not the exception.
Andersen et al. (2023) tracked autistic youth for ten years. Teen anxiety and depression, not autism traits, predicted poor adult life quality. Together these papers echo Fahad’s point: if you miss the add-on problems, you miss the real lever for help.
Séine et al. (2019) found low cholesterol in one of four autistic kids. Like misophonia, this metabolic quirk flags higher odds of anxiety or depression. The pattern is clear—autism rarely travels alone, so keep scanning for companions.
Why it matters
You already screen for aggression and self-injury. Add two quick boxes to your intake: “Any sounds trigger anger or panic?” and “Any anxiety or OCD history?” If the client says yes, you have a ready reason to bring in OT, audiology, or CBT. Early capture can stop years of meltdowns and lost learning time.
Is misophonia linked to autism?
Misophonia is an intense emotional reaction, often anger or disgust, to specific repeated sounds such as chewing, breathing, or tapping. It is not yet a formal DSM-5 diagnosis, but it is well documented clinically.
This systematic review pooled 14 studies (about 89,889 participants) and found misophonia occurs often in autistic individuals. Elevated sensory sensitivity in autism appears to raise the risk, though the two conditions are distinct.
For practice, a positive misophonia screen does not confirm or rule out autism. Treat it as one sensory feature to assess, not a diagnostic marker.
Comorbidities and clinical features to watch
The review reports frequent overlap between misophonia and anxiety, obsessive-compulsive disorder, and depression. Trigger sounds are usually human-generated and repetitive, and reactions can drive avoidance and withdrawal.
When a client reacts strongly to specific sounds, ask about the exact triggers, the emotional and behavioral response, and any co-occurring anxiety or OCD. Environmental accommodations and coping strategies often matter more than trying to extinguish the reaction directly.
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Add one line to your intake form: “Do chewing, tapping, or breathing sounds make you feel rage or need to escape?” Mark a yes as a red flag for further assessment.
02At a glance
03Original abstract
BACKGROUND: Misophonia, characterized by intense emotional reactions to specific sounds, is increasingly studied in autism spectrum disorder (ASD) and related mental health conditions such as obsessive-compulsive disorder (OCD), anxiety, and depression. Autistic individuals often have sensory sensitivities, which may predispose them to misophonia. However, the relationship between misophonia, sensory sensitivities, and psychiatric comorbidities in autism remains underexplored. AIMS: This systematic review examines the prevalence, clinical characteristics, comorbidities, and treatment outcomes of misophonia in autistic individuals and related conditions. It also explores the neurobiological links between misophonia and sensory sensitivities and their impact on quality of life, aiming to inform diagnostic and intervention strategies. METHODS: A systematic search was conducted across seven databases following PRISMA guidelines. Studies assessing misophonia in autism, using established diagnostic criteria, were included. The risk of bias was evaluated using ROBINS-I, AXIS, Venice criteria, and JBI tools. RESULTS: Fourteen studies (n = 89,889 participants) met inclusion criteria. Misophonia prevalence in autism ranged from 12.8 % to 35.5 %, with 79 % of autistic individuals with misophonia also experiencing psychiatric comorbidities such as anxiety, OCD, and depression. Clinical characteristics included intense emotional reactions to specific sound triggers (e.g., eating, breathing) and significant disruptions in daily functioning. Sensory sensitivities were reported in 21.4 % of cases, highlighting the overlap between misophonia and broader sensory processing challenges in autism. There were only two intervention studies: one demonstrating the efficacy of risperidone in reducing misophonia severity, and another suggesting cognitive-behavioral therapy (CBT) and tinnitus retraining therapy (TRT) as potential management strategies. Quality assessment revealed varying levels of bias, particularly in observational studies, which often lacked robust randomization and blinding. CONCLUSION: Misophonia is prevalent in autism and frequently co-occurs with psychiatric conditions and sensory hypersensitivities. Standardized diagnostic tools and tailored interventions are needed to improve clinical outcomes. Future research should explore longitudinal trajectories, genetic and environmental influences, and effective management strategies to address the complex interplay between misophonia, sensory sensitivities, and autism.
Research in developmental disabilities, 2025 · doi:10.1016/j.ridd.2025.105005