Associate Professor Michigan State University East Lansing, Michigan, United States
Background: Hearing difficulties and hypersensitivity to loud sounds are commonly observed in the ASD population. Contributions of hearing problems to this phenomenon are unclear because their association with ASD are not well-characterized. This knowledge gap has implications for diagnostic assessment and intervention strategies for ASD and co-occurring conditions. Objective: We investigated links between caregiver-reported hearing problems and ASD in a large, representative sample of children from the United States. Design/Methods: We analyzed cross-sectional, caregiver-reported data from the National Survey of Children’s Health (2016-2020). Our sample included children with data on the presence or absence of hearing problems and ASD (ages 2-18; n=150,327). We used logistic regression to evaluate the association between hearing problems and: 1) ASD diagnostic status (no, yes), 2) ASD symptom severity (none, mild, moderate/severe), and 3) the co-occurrence of ASD with intellectual disability (ID) which includes 30% of children with ASD (neither, ASD only, ID only, both). Analyses were weighted for the study sampling scheme; the no diagnosis group for each outcome served as the referent. Results: Approximately 1% (SE=0.1) and 3% (SE=0.1) of children had hearing problems and ASD, respectively. Hearing problems were associated with ASD (OR=2.7, 95%CI 1.8, 3.9), with 4% (SE=1.3) of children with ASD having hearing problems compared to 1% (SE=0.1) of children without ASD. These associations were stronger in the context of moderate/severe ASD symptoms (OR=3.5, 95%CI 2.1, 5.7) relative to mild symptoms (OR=1.8, 95%CI 1.1, 3.1) and among children with co-occurring ID (OR=5.0, 95%CI 2.8, 9.0) or ID only (OR=8.6, 95%CI 6.0, 12.4) relative to ASD only (OR=2.4, 95%CI 1.5, 3.8). Findings persisted after adjusting for socio-demographics, insurance status, and preterm birth.
Conclusion(s): Hearing problems are associated with ASD, particularly- though not exclusively- among children with more severe symptoms and co-occurring ID. Future research is needed to determine whether hearing problems in ASD are driven by hearing loss (sensory) and/or attentional processing of auditory inputs (cognitive), along with how these factors impact the timing of hearing loss and ASD diagnoses.
