An Automated Online Measure for Misophonia: The Sussex Misophonia Scale for Adults.

Misophonia is a sound sensitivity disorder characterized by a strong aversion to specific sounds (e.g., chewing). Here we present the Sussex Misophonia Scale for Adults (SMS-Adult), within an online open-access portal, with automated scoring and results that can be shared ethically with users and professionals. Receiver operator characteristics show our questionnaire to be "excellent" and "good-to-excellent" at classifying misophonia, both when dividing our n = 501 adult participants by recruitment stream (self-declared misophonics vs. general population), and again when dividing them with by a prior measure of misophonia (as misophonics vs. non-misophonics). Factor analyses identified a five-factor structure in our 39 Likert-type items, and these were Feelings/Isolation, Life consequences, Intersocial reactivity, Avoidance/Repulsion, and Pain. Our measure also elicits misophonia triggers, each rated for their commonness in misophonia. We offer our open-access online tool for wider use (www.misophonia-hub.org), embedded within a well-stocked library of resources for misophonics, researchers, and clinicians.

Investigating the effect of providing monetary incentives to participants on completion rates of referred co-respondents: An embedded randomized controlled trial.

Background: The use of a second informant (co-respondent) is a common method of identifying potential bias in outcome data (e.g., parent-report child outcomes). There is, however, limited evidence regarding methods of increasing response rates from co-respondents. The use of financial incentives is associated with higher levels of engagement and follow-up data collection in online surveys. This study investigated whether financial incentives paid to index participants in an online trial of a parenting-focused intervention, would lead to higher levels of co-respondent data collection. Methods: A study within a trial (SWAT) using a parallel group RCT design. Participants in the host study (an RCT of an online intervention) were randomised into one of two SWAT arms: received/did not receive a £15 voucher when referred co-respondent completed baseline measures. Primary outcome was completion (No/Yes) of Spence Children's Anxiety Scale (SCAS or SCAS-Pre) at baseline. Additional analysis explored impact of incentives on data quality. Results: Intention to treat analysis of 899 parents (183 co-respondents) in the no-incentive arm, and 911 parents (199 co-respondents) in incentive arm. Nomination of co-respondents was similar between incentive arms. The RR for the incentive arm compared to the no incentive arm was 1.13 (95% CI: 0.91 to 1.41, p = 0.264) indicating that incentives did not impact completion of outcomes by consented co-respondents. There were no indications of different data quality between arms. Discussion: The finding that payment of financial incentives to index participant does not lead to greater levels of co-respondent outcome completion suggests that careful consideration should be made before allocating resources in this way in future trials. Trial registration: The host study was registered at Study Record | ClinicalTrials.gov and the SWAT study was registered in the SWAT Store | The Northern Ireland Network for Trials Methodology Research (qub.ac.uk): SWAT number 143: Filetoupload,1099612,en.pdf (qub.ac.uk).

An Open Science MRI Database of over 100 Synaesthetic Brains and Accompanying Deep Phenotypic Information.

We provide a neuroimaging database consisting of 102 synaesthetic brains using state-of-the-art 3 T MRI protocols from the Human Connectome Project (HCP) which is freely available to researchers. This database consists of structural (T1- and T2-weighted) images together with approximately 24 minutes of resting state data per participant. These protocols are designed to be inter-operable and reproducible so that others can add to the dataset or directly compare it against other normative or special samples. In addition, we provide a 'deep phenotype' of our sample which includes detailed information about each participant's synaesthesia together with associated clinical and cognitive measures. This behavioural dataset, which also includes data from (N = 109) non-synaesthetes, is of importance in its own right and is openly available.

Mental imagery and visual attentional templates: A dissociation.

There is a growing interest in the relationship between mental images and attentional templates as both are considered pictorial representations that involve similar neural mechanisms. Here, we investigated the role of mental imagery in the automatic implementation of attentional templates and their effect on involuntary attention. We developed a novel version of the contingent capture paradigm designed to encourage the generation of a new template on each trial and measure contingent spatial capture by a template-matching visual feature (color). Participants were required to search at four different locations for a specific object indicated at the start of each trial. Immediately prior to the search display, color cues were presented surrounding the potential target locations, one of which matched the target color (e.g., red for strawberry). Across three experiments, our task induced a robust contingent capture effect, reflected by faster responses when the target appeared in the location previously occupied by the target-matching cue. Contrary to our predictions, this effect remained consistent regardless of self-reported individual differences in visual mental imagery (Experiment 1, N = 216) or trial-by-trial variation of voluntary imagery vividness (Experiment 2, N = 121). Moreover, contingent capture was observed even among aphantasic participants, who report no imagery (Experiment 3, N = 91). The magnitude of the effect was not reduced in aphantasics compared to a control sample of non-aphantasics, although the two groups reported substantial differences in their search strategy and exhibited differences in overall speed and accuracy. Our results hence establish a dissociation between the generation and implementation of attentional templates for a visual feature (color) and subjectively experienced imagery.

Aphantasia within the framework of neurodivergence: Some preliminary data and the curse of the confidence gap.

Aphantasia is a neurocognitive phenomenon affecting voluntary visual imagery, such that it is either entirely absent, or markedly impaired. Using both the social and medical models of disability, this article discusses the extent to which aphantasia can be understood as a disorder or just a form of neutral neurodivergence, given that imagery plays a central role in thinking and memory for most other people. Preliminary school performance data are presented, showing that low imagery does not necessarily complicate life, especially given compensatory strategies and low societal barriers. In addition, we discuss the consequences of labelling aphantasia a disorder with regard to self- and public stigma, and we provide further data regarding a confidence gap, by which aphantasics perceive themselves as performing worse than they objectively do. We conclude that aphantasia should be understood as neutral neurodivergence and that labelling it a disorder is not only wrong, but potentially harmful.

The role of visual imagery in face recognition and the construction of facial composites. Evidence from Aphantasia.

People with aphantasia have a markedly impaired ability to form visual images in the mind's eye. Here, by testing people with and without aphantasia, we examine the relationship between visual imagery and face processing. We show that aphantasics have weaker face recognition than people with visual imagery, using both self-report (Prosopagnosia Index) and behavioural measures (Cambridge Face Memory Test). However, aphantasics nonetheless have a fully intact ability to construct facial composites from memory (i.e., composites produced using EFIT6 by aphantasics and imagers were rated as equally accurate in terms of their resemblance to a target face). Additionally, we show that aphantasics were less able than imagers to see the resemblance between composites and a target face, suggestive of potential issues with face matching (perception). Finally, we show that holistic and featural methods of composite construction using EFIT6 produce equally accurate composites. Our results suggest that face recognition, but not face composite construction, is facilitated by the ability to represent visual properties as 'pictures in the mind'. Our findings have implications for the study of aphantasia, and also for forensic settings, where face composite systems are commonly used to aid criminal investigations.

Mental Health Difficulties in Children who Develop Misophonia: An Examination of ADHD, Depression & Anxiety.

Misophonia is a sound sensitivity disorder characterized by unusually strong aversions to a specific class of sounds (e.g., eating sounds). Here we demonstrate the mental health profile in children who develop misophonia, examining depression, anxiety and ADHD. Our participants were members of the birth cohort ALSPAC (Avon Longitudinal Study of Parents and Children). We screened them for misophonia as adults, then analysed their retrospective mental health data from ages 7 to 16 years inclusive, reported from both children and parents. Data from their Development and Wellbeing Assessments (7-15 years) and their Short Mood and Feelings Questionnaires (9-16 years) show that our misophonia group had a greater likelihood of childhood anxiety disorder and depression in childhood (but not ADHD). Our data provide the first evidence from a large general population sample of the types of mental health co-morbidities found in children who develop misophonia.

A symptom network model of misophonia: From heightened sensory sensitivity to clinical comorbidity.

OBJECTIVES: Misophonia-an unusually strong intolerance of certain sounds-can cause significant distress and disruption to those who have it but is an enigma in terms of our scientific understanding. A key challenge for explaining misophonia is that, as with other disorders, it is likely to emerge from an interaction of traits that also occur in the general population (e.g., sensory sensitivity and anxiety) and that are transdiagnostic in nature (i.e., shared with other disorders). METHODS: In this preregistered study with a large sample of participants (N = 1430), we performed a cluster analysis (based on responses to questions relating to misophonia) and identified two misophonia subgroups differing in severity, as well as a third group without misophonia. A subset of this sample (N = 419) then completed a battery of measures designed to assess sensory sensitivity and clinical comorbidities. RESULTS: Clinical symptoms were limited to the most severe group of misophonics (including autistic traits, migraine with visual aura, anxiety sensitivity, obsessive-compulsive traits). Both the moderate and severe groups showed elevated attention-to-detail and hypersensitivity (across multiple senses). A novel symptom network model of the data shows the presence of a central hub linking misophonia to sensory sensitivity which, in turn, connects to other symptoms in the network (relating to autism, anxiety, etc.). CONCLUSION: The core features of misophonia are sensory-attentional in nature with severity linked strongly to comorbidities.

A phenomenological cartography of misophonia and other forms of sound intolerance.

People with misophonia have strong aversive reactions to specific "trigger" sounds. Here we challenge this key idea of specificity. Machine learning was used to identify a misophonic profile from a multivariate sound-response pattern. Misophonia could be classified from most sounds (traditional triggers and non-triggers) and, moreover, cross-classification showed that the profile was largely transferable across sounds (rather than idiosyncratic for each sound). By splitting our participants in other ways, we were able to show-using the same approach-a differential diagnostic profile factoring in potential co-morbidities (autism, hyperacusis, ASMR). The broad autism phenotype was classified via aversions to repetitive sounds rather than the eating sounds most easily classified in misophonia. Within misophonia, the presence of hyperacusis and sound-induced pain had widespread effects across all sounds. Overall, we show that misophonia is characterized by a distinctive reaction to most sounds that ultimately becomes most noticeable for a sub-set of those sounds.

Investigating the effect of providing monetary incentives to participants on completion rates of referred co-respondents: An embedded randomized controlled trial. Study within a trial (SWAT) protocol.

Background: Parent-report questionnaires are a common method of generating data on child outcomes in mental health studies. A second report from another person who knows the child (co-respondent) is implemented to reduce bias and increase objectivity. The success of this approach is dependent on the engagement of co-respondents, which can be difficult. Financial incentives are used to increase data return in clinical trials, and to promote referral rates in online marketing. This protocol describes the use of an embedded randomised controlled trial (RCT) to investigate the effect of financial incentives on rates of co-respondent data completion. In the host RCT (of an online intervention designed to reduce the impact of a parent's anxiety on their child) index participants (i.e. parents) are asked to invite a co-respondent to complete measures on the index child. This study will test the hypothesis that providing monetary incentives to index participants will increase the outcome measure completion rate of co-respondents. Methods: Embedded RCT of two parallel groups. Participants in the intervention arm will be sent a £10 voucher if their chosen co-respondent completes online baseline measures. Participants in the control arm will not be offered payment regardless of their chosen co-respondent's behaviour. 1754 participants will take part. Analysis will compare co-respondent outcome measure completion rates between the two arms at baseline and follow-up. Conclusion: Findings from this study will provide evidence on the impact of offering payment to index participants on return rates of co-respondent data. This will inform resource allocation within future clinical trials.

Effectiveness of a Web-Based Intervention to Prevent Anxiety in the Children of Parents With Anxiety: Protocol for a Randomized Controlled Trial.

BACKGROUND: Anxiety is the most common childhood mental health condition and is associated with impaired child outcomes, including increased risk of mental health difficulties in adulthood. Anxiety runs in families: when a parent has anxiety, their child has a 50% higher chance of developing it themselves. Environmental factors are predominant in the intergenerational transmission of anxiety and, of these, parenting processes play a major role. Interventions that target parents to support them to limit the impact of any anxiogenic parenting behaviors are associated with reduced anxiety in their children. A brief UK-based group intervention delivered to parents within the UK National Health Service led to a 16% reduction in children meeting the criteria for an anxiety disorder. However, this intervention is not widely accessible. To widen access, a 9-module web-based version of this intervention has been developed. This course comprises psychoeducation and home practice delivered through text, video, animations, and practice tasks. OBJECTIVE: This study seeks to evaluate the feasibility of delivering this web-based intervention and assess its effectiveness in reducing child anxiety symptoms. METHODS:  This is the protocol for a randomized controlled trial (RCT) of a community sample of 1754 parents with self-identified high levels of anxiety with a child aged 2-11 years. Parents in the intervention arm will receive access to the web-based course, which they undertake at a self-determined rate. The control arm receives no intervention. Follow-up data collection is at months 6 and months 9-21. Intention-to-treat analysis will be conducted on outcomes including child anxiety, child mental health symptoms, and well-being; parental anxiety and well-being; and parenting behaviors. RESULTS: Funding was received in April 2020, and recruitment started in February 2021 and is projected to end in October 2022. A total of 1350 participants have been recruited as of May 2022. CONCLUSIONS: The results of this RCT will provide evidence on the utility of a web-based course in preventing intergenerational transmission of anxiety and increase the understanding of familial anxiety. TRIAL REGISTRATION: ClinicalTrials.gov NCT04755933; https://clinicaltrials.gov/ct2/show/NCT04755933. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/40707.

Poorer Well-Being in Children With Misophonia: Evidence From the Sussex Misophonia Scale for Adolescents.

Objective: Misophonia is an unusually strong aversion to a specific class of sounds - most often human bodily sounds such as chewing, crunching, or breathing. A number of studies have emerged in the last 10 years examining misophonia in adults, but little is known about the impact of the condition in children. Here we set out to investigate the well-being profile of children with misophonia, while also presenting the first validated misophonia questionnaire for children. Materials and Methods: We screened 142 children (10-14 years; Mean 11.72 SD 1.12; 65 female, 77 male) using our novel diagnostic [the Sussex Misophonia Scale for Adolescents (SMS-Adolescent)]. This allowed us to identify a group of children already manifesting misophonia at that age - the first population-sampled cohort of child misophonics examined to date. Children and their parents also completed measures of well-being (for convergent validation of our SMS-Adolescent) and creative self-construct (for discriminant validation). Results: Data show that children with misophonia have significantly elevated levels of anxiety and obsessive compulsive traits. Additionally children with misophonia have significantly poorer life-satisfaction, and health-related quality of life. As predicted, they show no differences in creative self-construct. Conclusion: Together our data suggest the first evidence in population sampling of poorer life outcomes for children with misophonia, and provide preliminary convergent and discriminant validation for our novel misophonia instrument. Our data suggest a need for greater recognition and therapeutic outlets for adolescents with misophonia.

Consensus Definition of Misophonia: A Delphi Study.

Misophonia is a disorder of decreased tolerance to specific sounds or their associated stimuli that has been characterized using different language and methodologies. The absence of a common understanding or foundational definition of misophonia hinders progress in research to understand the disorder and develop effective treatments for individuals suffering from misophonia. From June 2020 through January 2021, the authors conducted a study to determine whether a committee of experts with diverse expertise related to misophonia could develop a consensus definition of misophonia. An expert committee used a modified Delphi method to evaluate candidate definitional statements that were identified through a systematic review of the published literature. Over four rounds of iterative voting, revision, and exclusion, the committee made decisions to include, exclude, or revise these statements in the definition based on the currently available scientific and clinical evidence. A definitional statement was included in the final definition only after reaching consensus at 80% or more of the committee agreeing with its premise and phrasing. The results of this rigorous consensus-building process were compiled into a final definition of misophonia that is presented here. This definition will serve as an important step to bring cohesion to the growing field of researchers and clinicians who seek to better understand and support individuals experiencing misophonia.

How do Different Types of Synesthesia Cluster Together? Implications for Causal Mechanisms.

It is unclear whether synesthesia is one condition or many, and this has implications for whether theories should postulate a single cause or multiple independent causes. Study 1 analyses data from a large sample of self-referred synesthetes (N = 2,925), who answered a questionnaire about N = 164 potential types of synesthesia. Clustering and factor analysis methods identified around seven coherent groupings of synesthesia, as well as showing that some common types of synesthesia do not fall into any grouping at all (mirror-touch, hearing-motion, tickertape). There was a residual positive correlation between clusters (they tend to associate rather than compete). Moreover, we observed a "snowball effect" whereby the chances of having a given cluster of synesthesia go up in proportion to the number of other clusters a person has (again suggesting non-independence). Clusters tended to be distinguished by shared concurrent experiences rather than shared triggering stimuli (inducers). We speculate that modulatory feedback pathways from the concurrent to inducers may play a key role in the emergence of synesthesia. Study 2 assessed the external validity of these clusters by showing that they predict performance on other measures known to be linked to synesthesia.

Using a new video rating tool to crowd-source analysis of behavioural reaction to stimuli.

Quantifying the intensity of animals' reaction to stimuli is notoriously difficult as classic unidimensional measures of responses such as latency or duration of looking can fail to capture the overall strength of behavioural responses. More holistic rating can be useful but have the inherent risks of subjective bias and lack of repeatability. Here, we explored whether crowdsourcing could be used to efficiently and reliably overcome these potential flaws. A total of 396 participants watched online videos of dogs reacting to auditory stimuli and provided 23,248 ratings of the strength of the dogs' responses from zero (default) to 100 using an online survey form. We found that raters achieved very high inter-rater reliability across multiple datasets (although their responses were affected by their sex, age, and attitude towards animals) and that as few as 10 raters could be used to achieve a reliable result. A linear mixed model applied to PCA components of behaviours discovered that the dogs' facial expressions and head orientation influenced the strength of behaviour ratings the most. Further linear mixed models showed that that strength of behaviour ratings was moderately correlated to the duration of dogs' reactions but not to dogs' reaction latency (from the stimulus onset). This suggests that observers' ratings captured consistent dimensions of animals' responses that are not fully represented by more classic unidimensional metrics. Finally, we report that overall participants strongly enjoyed the experience. Thus, we suggest that using crowdsourcing can offer a useful, repeatable tool to assess behavioural intensity in experimental or observational studies where unidimensional coding may miss nuance, or where coding multiple dimensions may be too time-consuming.

Wellbeing differences in children with synaesthesia: anxiety and mood regulation.

Synaesthesia is a neurodevelopmental trait that causes unusual sensory experiences (e.g., perceiving colours when reading letters and numbers). Our paper represents the first evidence that synaesthesia can impact negatively on children's well-being, and that there are likely to be important mental health co-morbidities for children with synaesthesia. We recruited 76 synaesthetes aged 6-10 years who had one of two types of synaesthesia (grapheme-colour synaesthesia and sequence-personality synaesthesia), and compared them to almost one thousand matched non-synaesthete controls. We tested children's wellbeing with two different measures, and found a significant relationship between synaesthesia and affect (i.e., mood), and also between synaesthesia and anxiety. Children with synaesthesia showed evidence suggesting significantly higher rates of Anxiety Disorder, and also displayed a type of mood-moderation in demonstrating fewer extremes of emotion (i.e., significantly fewer negative feelings such as fear, but also significantly fewer positive feelings such as joy). We discuss our results with reference to the emotional moderation of alexithymia (the inability to recognize or describe one's own emotions), and to a set of known links between alexithymia, anxiety, autism and synaesthesia.

Recognizing synesthesia on the international stage: The first scientific symposium on synesthesia (at The International Conference of Physiological Psychology, Paris, 1889).

At the first ever worldwide international conference of psychology in Paris, 1889, one symposium included a round-table event devoted entirely to the neurodevelopmental condition of synesthesia. Details of this seminal gathering on synesthesia and its international reception have been lost to historical obscurity. A synesthesia study committee emerged from this meeting, as well as a new research tool. Moreover, the scientific findings discussed during this symposium would be echoed over a hundred years later, when a new wave of synesthesia research in the late-twentieth century arose. This article sheds new light on this seminal gathering and aims to answer the following historical questions: Why was synesthesia included in this conference? What science was discussed? Who were the members of the committee and how did they come to be involved? What were their contributions to synesthesia research before, during, and after the conference? What has history shown us about the impact of this symposium on the science of synesthesia?

Personality profile of child synaesthetes.

Previous research into personality and synaesthesia has focused on adult populations and yielded mixed results. One particular challenge has been to distinguish traits associated with synaesthesia, from traits associated with the ways in which synaesthetes were recruited. In the current study we addressed recruitment issues by testing randomly sampled synaesthetes, and we looked particularly at synaesthesia in childhood. Our child synaesthetes were identified by a screening program across 22 primary schools in the South East of England (n = 3387; children aged 6 to 10 years old). This identified two types of synaesthete (grapheme-colour synaesthesia and sequence-personality synaesthesia), and we tested their personalities using both child-report and parent-report measures. We found strong support for synaesthesia being associated with high Openness to Experience, a personality trait linked to intelligence and creativity. Both synaesthesia subtypes showed this feature, supporting previous research in adults (1-3). We additionally found low Extraversion in grapheme-colour synaesthetes and high Conscientiousness in sequence-personality synaesthetes. We discuss our results with reference to earlier recruitment issues, and as to how perceptual differences such as synaesthesia might link to trait-differences in personality.

Numeracy skills in child synaesthetes: Evidence from grapheme-colour synaesthesia.

Grapheme-colour synaesthesia is a neurological trait that causes lifelong colour associations for letter and numbers. Synaesthesia studies have demonstrated differences between synaesthetes and non-synaesthetes in ways that extend beyond synaesthesia itself (e.g., differences in their cognition, personality, and creativity). This research has focused almost exclusively on adult synaesthetes, and little is known about the profiles of synaesthetic children. By and large, findings suggest advantages for synaesthetes (e.g., Chun & Hupé, 2016; Havlik, Carmichael, & Simner, 2015; Rothen, Meier, & Ward, 2012; Rouw & Scholte, 2016; Simner & Bain, 2018) although differences in mathematical ability are unclear: some research indicates advantages (e.g., Green & Goswami, 2008) whilst others suggest difficulties (e.g., Rich et al., 2005). In the current study, we tested numerical cognition in a large group of children with grapheme-colour synaesthesia. Synaesthetes with coloured numbers showed advantages over their peers in their sense of numerosity, but not in their curriculum mathematics ability. We discuss how our findings speak to models for synaesthesia, to methodologies for assessing number cognition (e.g., dot numerosity tasks), and to the wider educational practice of using coloured number-tools in schools (e.g., Numicon; Oxford University Press, 2018).