Auditory Processing Difficulties and Listening Challenges Among Children with Autism

Abstract

Background: Auditory processing difficulties are frequently observed in children with autism and often manifest as reduced speech perception in noise, sound hypersensitivity, and difficulty filtering competing auditory information. Emerging in childhood and often persisting throughout life, these difficulties contribute to communication, educational, and psychosocial challenges. Purpose: This study examined auditory symptom profiles and auditory processing performance in children with autism who presented to a tertiary audiology clinic for an assessment of listening difficulties and explored associations between reported symptoms, comorbidities, and auditory processing outcomes. Research Design: This retrospective cross-sectional study used routinely collected clinical data, including semi-structured questionnaires, audiological assessments, and a comprehensive auditory processing test battery. Study Sample: Thirty-seven children with autism who were 6–17 years of age (16 female and 21 male children) and referred to a tertiary audiology clinic for an assessment of listening difficulties. Data Collection and Analysis: Clinical data were collected from questionnaires, interviews, audiological assessments, and auditory processing tests. Questionnaire and interview responses were analyzed using a qualitative thematic analysis to identify auditory and neurodevelopmental symptom domains. Quantitative data were analyzed using descriptive and nonparametric statistical methods. Results: The most frequently reported difficulties were hearing-in-noise (75.7 percent), hyperacusis (72.9 percent), poor attention (62.2 percent), speech and language concerns (62.2 percent), and poor memory (51.4 percent). Twenty-nine children (78.4 percent) met the diagnostic criteria for auditory processing disorder, and the remainder demonstrated specific auditory processing deficits. Difficulties were most commonly identified on speech-in-noise, spatial listening, and auditory pattern recognition measures. Children who reported hearing-in-noise difficulties performed significantly more poorly during a speech-in-noise task (p = 0.013). Anxiety was significantly associated with auditory temporal processing performance (p = 0.036), and attention-deficit hyperactivity disorder (ADHD) was associated with poorer dichotic listening outcomes (p = 0.019). Co-occurring neurodevelopmental conditions were common, particularly ADHD (35 percent) and dyslexia (32 percent). Conclusions: Auditory processing differences were frequently observed among children with autism within this clinical cohort and appeared to be influenced by comorbid conditions. Clinical Relevance Statement: Children with autism who present with listening difficulties frequently demonstrate auditory processing deficits despite satisfactory peripheral hearing. A comprehensive audiological assessment including speech-in-noise and auditory processing measures may improve diagnostic accuracy and support more targeted management strategies.