Autism and auditory needs: looking beyond hearing tests

When people think about autism, they often think about social communication, routines or sensory sensitivities. What is less widely discussed is the role that hearing and listening can play in shaping an autistic person's everyday experiences.

Many autistic children and adults experience significant auditory challenges despite having normal hearing test results. They may struggle to understand speech in noisy environments, feel overwhelmed by everyday sounds, or become exhausted from the effort of listening throughout the day.

In fact, about 70% of autistic children report some auditory difficulties, and these are so common that some autistic individuals first come to the attention of healthcare professionals because of concerns about sound sensitivity or listening difficulties, rather than concerns about autism itself.

When sound becomes a problem

Parents often describe experiences such as:

• Covering ears in response to everyday sounds

• Becoming distressed in busy environments

• Avoiding noisy places

• Struggling to follow conversations in groups

• Missing information in the classroom

• Appearing not to listen despite normal hearing

These experiences are increasingly recognised as important aspects of autism. In fact, sensory differences, including increased or decreased responses to sensory input, are now included within current diagnostic criteria for autism.

Importantly, these challenges are not always related to how well a person can hear. Often, they reflect differences in how auditory information is processed and interpreted by the brain.

Why hearing tests don't always tell the full story

One of the most common misconceptions about listening difficulties is that they should always be detected through a standard hearing test. In reality, many autistic individuals have hearing thresholds within the normal range but still experience significant auditory challenges. For example, they may struggle to understand speech when background noise is present, complain of reduced tolerance for certain sounds, require more effort to process spoken information, or have difficulty hearing the most important sound in complex environments.

This is one reason why families can feel frustrated when hearing tests are reported as "normal" despite their child continuing to experience difficulties.

This highlights the important distinction between hearing and listening. While hearing tests assess the ability to detect sounds, they do not always capture how effectively a person processes, interprets, and uses auditory information in everyday situations.

Auditory needs are part of the bigger picture

One of the key messages emerging from the research is that auditory experiences should not be viewed in isolation.

Listening can be influenced by many factors, including attention, language skills, cognitive abilities, anxiety, environmental demands, and co-occurring conditions such as ADHD. 

This helps explain why two autistic children may have very different auditory experiences, even when their hearing test results appear similar. 

Supporting auditory needs in autism

While there is no one-size-fits-all approach, understanding a child's auditory profile can help identify strategies that make listening, communication, and participation more manageable. Support should always be tailored to the individual's strengths, challenges, and daily listening demands.

Listening strategies

Simple environmental and communication adjustments can often make a meaningful difference. These might include reducing unnecessary background noise, making classroom accommodations to improve access to spoken information, allowing additional processing time, and using visual supports to complement verbal instructions.

The aim is not to remove all auditory challenges, but to create listening environments that are more accessible and less cognitively demanding.

Technology

For some children, assistive listening technologies can help improve access to speech, particularly in educational settings. Remote microphone systems have demonstrated benefits for listening and classroom participation in autistic children with and without listening concerns.

Other hearing device solutions may also be appropriate depending on the person's individual profile and listening needs, and an audiologist can advise on the most suitable options. As no single solution is appropriate for every person, recommendations should always be guided by individual assessment and specific listening needs.

Training 

Targeted training programmes may also be beneficial for some children. Following assessment, an audiologist can help identify the most appropriate areas to target and guide families towards suitable resources.

This may include auditory training activities designed to improve listening skills, speech perception, attention to sound, or the ability to understand speech in challenging listening environments. Depending on the child's age and needs, training may be delivered through structured activities, online programmes, digital resources, or app-based exercises.

There is also emerging evidence that musical training may support auditory and listening skills in some autistic children. While research in this area is still developing, music-based activities may offer an engaging way to support aspects of auditory processing, listening, and communication alongside other interventions.

Ultimately, the goal is not to change how an autistic child experiences the world, but to understand their listening needs and provide practical strategies that support communication, learning, confidence, and wellbeing.

Further reading

If you're interested in learning more about autism and auditory assessment, I recently co-authored a narrative review exploring auditory symptoms, listening difficulties, sound sensitivities, and current approaches to audiological assessment in autistic individuals:

Bamiou, D., Di Bonaventura, S. & Skuse, D.
Navigating Auditory Assessment in Autistic Individuals: A Narrative Review
https://doi.org/10.1136/archdischild-2025-328623

References:

Applewhite, B., Cankaya, Z., Heiderscheit, A., & Himmerich, H. (2022). A Systematic Review of Scientific Studies on the Effects of Music in People with or at Risk for Autism Spectrum Disorder. International journal of environmental research and public health, 19(9), 5150. https://doi.org/10.3390/ijerph19095150

Bamiou, D. E., Di Bonaventura, S., & Skuse, D. (2026). Navigating auditory assessment in autistic individuals: a narrative review. Archives of disease in childhood, 111(3), 229–234. https://doi.org/10.1136/archdischild-2025-328623

Gonçalves, A. M., & Monteiro, P. (2023). Autism Spectrum Disorder and auditory sensory alterations: a systematic review on the integrity of cognitive and neuronal functions related to auditory processing. Journal of neural transmission (Vienna, Austria : 1996), 130(3), 325–408. https://doi.org/10.1007/s00702-023-02595-9

Key, A. P., & D'Ambrose Slaboch, K. (2021). Speech Processing in Autism Spectrum Disorder: An Integrative Review of Auditory Neurophysiology Findings. Journal of speech, language, and hearing research : JSLHR, 64(11), 4192–4212. https://doi.org/10.1044/2021_JSLHR-20-00738

Schafer, E. C., Wright, S., Anderson, C., Jones, J., Pitts, K., Bryant, D., Watson, M., Box, J., Neve, M., Mathews, L., & Reed, M. P. (2016). Assistive technology evaluations: Remote-microphone technology for children with Autism Spectrum Disorder. Journal of communication disorders, 64, 1–17. https://doi.org/10.1016/j.jcomdis.2016.08.003

Tomchek, S. D., & Dunn, W. (2007). Sensory processing in children with and without autism: a comparative study using the short sensory profile. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 61(2), 190–200. https://doi.org/10.5014/ajot.61.2.190