Parent-reported auditory difficulties in children with ADHD are associated with attentional and fatigue-related vulnerability, not sound avoidance

Atypical sensory processing is common in attention-deficit/hyperactivity disorder (ADHD), yet decreased sound tolerance has received little attention, and it remains unclear whether it reflects actual auditory sensitivity or a vulnerability to attentional breakdown under acoustic load. The only prior study provided a single overall estimate, unable to separate sensory symptoms such as avoidance and distress from attentional and fatigue-related difficulties under noisy or demanding conditions. Here, we examined whether parent-reported auditory difficulties in children with ADHD are uniform or concentrated within specific symptom domains, and whether they vary with clinical presentation or medication. A total of 226 children (ages 6-12; 162 with ADHD, 64 typically developing controls) were assessed using the parent-report adaptation of the Khalfa Hyperacusis Questionnaire (Turkish version). The ADHD cohort was stratified by medication status and clinical presentation, and total, subscale, and item-level scores were compared across groups. Our findings show that children with ADHD scored higher than controls on the total and hyperacusis-effects subscale, but not on the coping subscale. Only four of the eleven items distinguished the groups, all reflecting concentration in noise or its decline under fatigue; no item reflecting sound avoidance, sensitivity, or distress differed between groups. This pattern was independent of clinical presentation, medication, and age; it persisted after adjustment for parental education. These results suggest that elevated auditory difficulties in ADHD are better explained by attention- and fatigue-related vulnerability than by heightened auditory sensitivity and may warrant environmental rather than audiological interventions.