Auditory processing and auditory rehabilitation approaches in autism

  • Abdollah Moossavi Department of Otolaryngology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  • Marziyeh Moallemi Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
Keywords: Autism spectrum disorder; auditory processing; auditory rehabilitation


Background and Aim: Concerning the prevalence of autism spectrum disorder, many studies have examined the various aspects of this disorder. One of the major problems in autism is the sensory processing deficit, and in particular the abnormalities of auditory processing. In this review article, we have tried to explain the neurological features of auditory processing and abnormalities in auditory evoked responses in autism, finally recount some of the main methods of auditory rehabilitation.Recent Findings: We searched for articles in databases with keywords of “autism,” “auditory processing” and “auditory rehabilitation.” A total of 102 articles were initially found in this field. Some articles were not about our study topic, thus in the end, only 79 articles were entered the study published from 1989 to 2018. Based on these studies, autism associates with a weakness in sensory integration due to abnormal interactions between different neural networks. This condition of auditory modality are being manifested as different abnormalities in evoked responses, especially for complex stimuli at the level of the brainstem and cortex. Language and speech problems are prevalent in many patients with autism, which has already been mentioned in numerous studies. To treat these deficits, appropriate auditory rehabilitation techniques (often using music to improve the symptoms) have been developed.Conclusion: In order to know more about autism and adopt appropriate interventions, doing audiometric, behavioral and electrophysiological evaluations are recommended on a regular basis. Rehabilitation in this disorder generally include music therapy, signal-to-noise enhancement strategies, and cognitive behavioral therapies.


1. Sokhadze EM, Casanova MF, Tasman A, Brockett S. Electrophysiological and behavioral outcomes of berard auditory integration training (AIT) in children with autism spectrum disorder. Appl Psychophysiol Biofeedback. 2016;41(4):405-20. doi: 10.1007/s10484-016-9343-z
2. Mikic B, Jotic A, Miric D, Nikolic M, Jankovic N, Arsovic N. Receptive speech in early implanted children later diagnosed with autism. Eur Ann Otorhinolaryngol Head Neck Dis. 2016;133 Suppl 1:S36-9. doi: 10.1016/j.anorl.2016.01.012
3. Sinha Y, Silove N, Wheeler D, Williams K. Auditory integration training and other sound therapies for autism spectrum disorders: a systematic review. Arch Dis Child. 2006;91(12):1018-22. doi: 10.1136/adc.2006.094649
4. Foss-Feig JH, Schauder KB, Key AP, Wallace MT, Stone WL. Audition-specific temporal processing deficits associated with language function in children with autism spectrum disorder. Autism Res. 2017;10(11):1845-56. doi: 10.1002/aur.1820
5. Demopoulos C, Lewine JD. Audiometric profiles in autism spectrum disorders: does subclinical hearing loss impact communication? Autism Res. 2016;9(1):107-20. doi: 10.1002/aur.1495
6. Azouz HG, Kozou H, Khalil M, Abdou RM, Sakr M. The correlation between central auditory processing in autistic children and their language processing abilities. Int J Pediatr Otorhinolaryngol. 2014;78(12):2297-300. doi: 10.1016/j.ijporl.2014.10.039
7. Brandwein AB, Foxe JJ, Butler JS, Frey HP, Bates JC, Shulman LH, et al. S. Neurophysiological indices of atypical auditory processing and multisensory integration are associated with symptom severity in autism. J Autism Dev Disord. 2015;45(1):230-44. doi: 10.1007/s10803-014-2212-9
8. Case-Smith J, Weaver LL, Fristad MA. A systematic review of sensory processing interventions for children with autism spectrum disorders. Autism. 2015;19(2):133-48. doi: 10.1177/1362361313517762
9. Rance G, Chisari D, Saunders K, Rault JL. Reducing listening-related stress in school-aged children with autism spectrum disorder. J Autism Dev Disord. 2017;47(7):2010-22. doi: 10.1007/s10803-017-3114-4
10. Kargas N, López B, Reddy V, Morris P. The relationship between auditory processing and restricted, repetitive behaviors in adults with autism spectrum disorders. J Autism Dev Disord. 2015;45(3):658-68. doi: 10.1007/s10803-014-2219-2
11. Visser E, Zwiers MP, Kan CC, Hoekstra L, van Opstal AJ, Buitelaar JK. Atypical vertical sound localization and sound-onset sensitivity in people with autism spectrum disorders. J Psychiatry Neurosci. 2013;38(6):398-406. doi: 10.1503/jpn.120177
12. kuta N, Iwanaga R, Tokunaga A, Nakane H, Tanaka K, Tanaka G. Effectiveness of earmuffs and noise-cancelling headphones for coping with hyper-reactivity to auditory stimuli in children with autism spectrum disorder: a preliminary study. Hong Kong J Occup Ther. 2016;28:24-32. doi: 10.1016/j.hkjot.2016.09.001
13. Haesen, B, Boets B, Wagemans J. A review of behavioural and electrophysiological studies on auditory processing and speech perception in autism spectrum disorders. Res Autism Spectr Disord. 2011;5(2):701-14. doi: 10.1016/j.rasd.2010.11.006
14. Hames EC, Murphy B, Rajmohan R, Anderson RC, Baker M, Zupancic S, et al. Visual, auditory, and cross modal sensory processing in adults with autism: an EEG power and BOLD fMRI investigation. Front Hum Neurosci. 2016;10:167. doi: 10.3389/fnhum.2016.00167
15. Stevenson RA, Siemann JK, Schneider BC, Eberly HE, Woynaroski TG, Camarata SM, et al. Multisensory temporal integration in autism spectrum disorders. J Neurosci. 2014;34(3):691-7. doi: 10.1523/JNEUROSCI.3615-13.2014
16. Yu L, Fan Y, Deng Z, Huang D, Wang S, Zhang Y. Pitch processing in tonal-language-speaking children with autism: an event-related potential study. J Autism Dev Disord. 2015;45(11):3656-67. doi: 10.1007/s10803-015-2510-x
17. Bouvet L, Mottron L, Valdois S, Donnadieu S. Auditory stream segregation in autism spectrum disorder: benefits and downsides of superior perceptual processes. J Autism Dev Disord. 2016;46(5):1553-61. doi: 10.1007/s10803-013-2003-8
18. Levy F. Theories of autism. Aust N Z J Psychiatry. 2007;41(11):859-68. doi: 10.1080/00048670701634937
19. G Rajendrana, Mitchell P. Cognitive theories of autism. Developmental Review. 2007;27(2):224-60. doi: 10.1016/j.dr.2007.02.001
20. O'Connor K. Auditory processing in autism spectrum disorder: a review. Neurosci Biobehav Rev. 2012;36(2):836-54. doi: 10.1016/j.neubiorev.2011.11.008
21. Taş M, Yılmaz Ş, Bulut E, Polat Z, Taş A. Otoacoustic emissions in young children with autism. J Int Adv Otol. 2017;13(3):327-32. doi: 10.5152/iao.2017.3105
22. Yoshimura Y, Kikuchi M, Hiraishi H, Hasegawa C, Takahashi T, Remijn GB, et al. Synchrony of auditory brain responses predicts behavioral ability to keep still in children with autism spectrum disorder: Auditory-evoked response in children with autism spectrum disorder. Neuroimage Clin. 2016;12:300-5. doi: 10.1016/j.nicl.2016.07.009
23. Collet L, Roge B, Descouens D, Moron P, Duverdy F, Urgell H. Objective auditory dysfunction in infantile autism. Lancet. 1993;342(8876):923-4. doi: 10.1016/0140-6736(93)91969-S
24. Khalfa S, Bruneau N, Rogé B, Georgieff N, Veuillet E, Adrien JL, et al. Peripheral auditory asymmetry in infantile autism. Eur J Neurosci. 2001;13(3):628-32. doi: 10.1046/j.1460-9568.2001.01423.x
25. Prieve BA, Fitzgerald TS, Schulte LE, Kemp DT. Basic characteristics of distortion product otoacoustic emissions in infants and children. J Acoust Soc Am. 1997;102(5 Pt 1):2871-9. doi: 10.1121/1.420342
26. Liu J, Wang N. Effect of age on click-evoked otoacoustic emission: A systematic review. Neural Regen Res. 2012;7(11):853-61. doi: 10.3969/j.issn.1673-5374.2012.11.010
27. Kon K, Inagaki M, Kaga M. Developmental changes of distortion product and transient evoked otoacoustic emissions in different age groups. Brain Dev. 2000;22(1):41-6. doi: 10.1016/S0387-7604(99)00114-X
28. Wilson US, Sadler KM, Hancock KE, Guinan JJ Jr, Lichtenhan JT. Efferent inhibition strength is a physiological correlate of hyperacusis in children with autism spectrum disorder. J Neurophysiol. 2017;118(2):1164-1172. doi: 10.1152/jn.00142.2017
29. Alcántara JI, Cope TE, Cope W, Weisblatt EJ. Auditory temporal-envelope processing in high-functioning children with autism spectrum disorder. Neuropsychologia. 2012;50(7):1235-51. doi: 10.1016/j.neuropsychologia.2012.01.034
30. Miron O, Ari-Even Roth D, Gabis LV, Henkin Y, Shefer S, Dinstein I, et al. Prolonged auditory brainstem responses in infants with autism. Autism Res. 2016;9(6):689-95. doi: 10.1002/aur.1561
31. Russo N, Nicol T, Trommer B, Zecker S, Kraus N. Brainstem transcription of speech is disrupted in children with autism spectrum disorders. Dev Sci. 2009;12(4):557-67. doi: 10.1111/j.1467-7687.2008.00790.x
32. Russo NM, Skoe E, Trommer B, Nicol T, Zecker S, Bradlow A, et al. Deficient brainstem encoding of pitch in children with autism spectrum disorders. Clin Neurophysiol. 2008;119(8):1720-31. doi: 10.1016/j.clinph.2008.01.108
33. Grillon C, Courchesne E, Akshoomoff N. Brainstem and middle latency auditory evoked potentials in autism and developmental language disorder. J Autism Dev Disord. 1989;19(2):255-69. doi: 10.1007/BF02211845
34. Buchwald JS, Erwin R, Van Lancker D, Guthrie D, Schwafel J, Tanguay P. Midlatency auditory evoked responses: P1 abnormalities in adult autistic subjects. Electroencephalogr Clin Neurophysiol. 1992;84(2):164-71. doi: 10.1016/0168-5597(92)90021-3
35. Hall JW. eHandbook of auditory evoked responses. Boston: Pearson education Inc; 2015.
36. Engineer CT, Centanni TM, Im KW, Kilgard MP. Speech sound discrimination training improves auditory cortex responses in a rat model of autism. Front Syst Neurosci. 2014;8:137. doi: 10.3389/fnsys.2014.00137
37. Gução ACB, Romero ACL, Valenti VE, Cardoso ACV, Misquiatti ARN, Frizzo ACF. Auditory late responses in asperger syndrome: two case study. J Hum Growth Dev. 2014;24(1):49-53. doi: S0104-12822014000100007
38. Kemner C, Verbaten MN, Cuperus JM, Camfferman G, van Engeland H. Auditory event-related brain potentials in autistic children and three different control groups. Biol Psychiatry. 1995;38(3):150-65. doi: 10.1016/0006-3223(94)00247-Z
39. Gomot M, Giard MH, Adrien JL, Barthelemy C, Bruneau N. Hypersensitivity to acoustic change in children with autism: electrophysiological evidence of left frontal cortex dysfunctioning. Psychophysiology. 2002;39(5):577-84. doi: 10.1017.S0048577202394058
40. Ferri R, Elia M, Agarwal N, Lanuzza B, Musumeci SA, Pennisi G. The mismatch negativity and the P3a components of the auditory event-related potentials in autistic low-functioning subjects. Clin Neurophysiol. 2003;114(9):1671-80. doi: 10.1016/S1388-2457(03)00153-6
41. Lincoln AJ, Courchesne E, Harms L, Allen M. Contextual probability evaluation in autistic, receptive developmental language disorder, and control children: event-related brain potential evidence. J Autism Dev Disord. 1993;23(1):37-58. doi: 10.1007/BF01066417
42. Lepistö T, Kujala T, Vanhala R, Alku P, Huotilainen M, Näätänen R. The discrimination of and orienting to speech and non-speech sounds in children with autism. Brain Res. 2005;1066(1-2):147-57. doi: 10.1016/j.brainres.2005.10.052
43. Lepistö T, Silokallio S, Nieminen-von Wendt T, Alku P, Näätänen R, Kujala T. Auditory perception and attention as reflected by the brain event-related potentials in children with Asperger syndrome. Clin Neurophysiol. 2006;117(10):2161-71. doi: 10.1016/j.clinph.2006.06.709
44. Whitehouse AJ, Bishop DV. Do children with autism 'switch off' to speech sounds? An investigation using event-related potentials. Dev Sci. 2008;11(4):516-24. doi: 10.1111/j.1467-7687.2008.00697.x
45. Ciesielski KT, Courchesne E, Elmasian R. Effects of focused selective attention tasks on event-related potentials in autistic and normal individuals. Electroencephalogr Clin Neurophysiol. 1990;75(3):207-20. doi: 10.1016/0013-4694(90)90174-I
46. Dunn MA, Bates JC. Developmental change in neutral processing of words by children with autism. J Autism Dev Disord. 2005;35(3):361-76. doi: 10.1007/s10803-005-3304-3
47. Fishman I, Yam A, Bellugi U, Lincoln A, Mills D. Contrasting patterns of language-associated brain activity in autism and Williams syndrome. Soc Cogn Affect Neurosci. 2011;6(5):630-8. doi: 10.1093/scan/nsq075
48. Kujala T, Kuuluvainen S, Saalasti S, Jansson-Verkasalo E, Wendt LV, Lepistö T. Speech-feature discrimination in children with Asperger syndrome as determined with the multi-feature mismatch negativity paradigm. Clin Neurophysiol. 2010;121(9):1410-9. doi: 10.1016/j.clinph.2010.03.017
49. Müller RA, Behen ME, Rothermel RD, Chugani DC, Muzik O, Mangner TJ, et al. Brain mapping of language and auditory perception in high-functioning autistic adults: a PET study. J Autism Dev Disord. 1999;29(1):19-31. doi: 10.1023/A:1025914515203
50. Kozou H, Azouz HG, Abdou RM, Shaltout A. Evaluation and remediation of central auditory processing disorders in children with autism spectrum disorders. Int J Pediatr Otorhinolaryngol. 2018;104:36-42. doi: 10.1016/j.ijporl.2017.10.039
51. Gage NM, Siegel B, Roberts TP. Cortical auditory system maturational abnormalities in children with autism disorder: an MEG investigation. Brain Res Dev Brain Res. 2003;144(2):201-9. doi: 10.1016/S0165-3806(03)00172-X
52. Magnée MJ, Oranje B, van Engeland H, Kahn RS, Kemner C. Cross-sensory gating in schizophrenia and autism spectrum disorder: EEG evidence for impaired brain connectivity? Neuropsychologia. 2009;47(7):1728-32. doi: 10.1016/j.neuropsychologia.2009.02.012
53. Fauzan N, Amran NH. Brain waves and connectivity of autism spectrum disorders. Procedia Soc Behav Sci. 2015;171:882-90. doi: 10.1016/j.sbspro.2015.01.204
54. Whipple CM, Gfeller K, Driscoll V, Oleson J, McGregor K. Do communication disorders extend to musical messages? An answer from children with hearing loss or autism spectrum disorders. J Music Ther. 2015;52(1):78-116. doi: 10.1093/jmt/thu039
55. Ganaie SA, Bashir A. Global autism: autism, autism etiology, perceptions, epistemology, prevalence and action. Int J Clin Ther Diagn. 2014;2(2):39-47. doi: 10.19070/2332-2926-140008
56. Matson JL, Rieske RD, Tureck K. Additional considerations for the early detection and diagnosis of autism: review of available instruments. Res Autism Spectr Disord. 2011;5(4):1319-26. doi: 10.1016/j.rasd.2011.03.006
57. Hedley D, Uljarević M, Cameron L, Halder S, Richdale A, Dissanayake C. Employment programmes and interventions targeting adults with autism spectrum disorder: A systematic review of the literature. Autism. 2017;21(8):929-41. doi: 10.1177/1362361316661855
58. Germani T, Zwaigenbaum L, Bryson S, Brian J, Smith I, Roberts W, et al. Brief report: assessment of early sensory processing in infants at high-risk of autism spectrum disorder. J Autism Dev Disord. 2014;44(12):3264-70. doi: 10.1007/s10803-014-2175-x
59. Gee BM, Thompson K, Pierce A, Toupin M, Holst J. The effectiveness of auditory stimulation in children with autism spectrum disorders: A case–control study. Int J Ther Rehabil. 2015;22(1):36-46. doi: 10.12968/ijtr.2015.22.1.36
60. Lang R,’Reilly MO, Healy O, Rispoli M, Lydon H, Streusande W, et al. Sensory integration therapy for autism spectrum disorders: A systematic review. Res Autism Spectr Disord. 2012;6(3):1004-1018. doi: 10.1016/j.rasd.2012.01.006
61. Brignell A, Song H, Zhu J, Suo C, Lu D, Morgan AT. Communication intervention for autism spectrum disorders in minimally verbal children (Protocol). Cochrane Database of Systematic Reviews. 2016;8:CD012324. doi: 10.1002/14651858.CD012324
62. Wan CY, Demaine K, Zipse L, Norton A, Schlaug G. From music making to speaking: engaging the mirror neuron system in autism. Brain Res Bull. 2010;82(3-4):161-8. doi: 10.1016/j.brainresbull.2010.04.010
63. James R, Sigafoos J, Green VA, Lancioni GE, O’Reilly MF, Lang R, et al. Music therapy for individuals with autism spectrum disorder: a systematic review. Rev J Autism Dev Disord. 2015;2(1):39-54. doi: 10.1007/s40489-014-0035-4
64. Chenausky KV, Norton AC, Schlaug G. Auditory-motor mapping training in a more verbal child with autism. Front Hum Neurosci. 2017;11:426. doi: 10.3389/fnhum.2017.00426
65. Bengtsson SL, Ullén F, Ehrsson HH, Hashimoto T, Kito T, Naito E, et al. Listening to rhythms activates motor and premotor cortices. Cortex. 2009;45(1):62-71. doi: 10.1016/j.cortex.2008.07.002
66. Hardy MW, Lagasse AB. Rhythm, movement, and autism: using rhythmic rehabilitation research as a model for autism. Front Integr Neurosci. 2013;7:19. doi: 10.3389/fnint.2013.00019
67. Thaut MH, Kenyon GP, Schauer ML, McIntosh GC. The connection between rhythmicity and brain function. IEEE Eng Med Biol Mag. 1999;18(2):101-8. doi: 10.1109/51.752991
68. Shi ZM, Lin GH, Xie Q. Effects of music therapy on mood, language, behavior, and social skills in children with autism: A meta-analysis. . Chin Nurs Res. 2016;3(3):137-41. doi: 10.1016/j.cnre.2016.06.018
69. Park CH, Pai N, Bakthachalam J, Li J, Jeon M, Ayanna MH, et al. Robotic framework for music-based emotional and social engagement with children with autism. 2015; AAAI Workshop: Artificial Intelligence Applied to Assistive Technologies and Smart Environments.
70. Mohd Amzari T, Siti Patonah M, Rohaida MS, Mohd Yakub Zulkifli Mohd Y, Noor Naemah AR, Durriyyah Sharifah HA. Addressing sleep disorder of autistic children with Qur’anic sound therapy. Health. 2013;5(8A2):73-79. doi: 10.4236/health.2013.58A2011
71. Chenausky K, Norton A, Tager-Flusberg H, Schlaug G. Auditory-motor mapping training: comparing the effects of a novel speech treatment to a control treatment for minimally verbal children with autism. PLoS One. 2016;11(11):e0164930. doi: 10.1371/journal.pone.0164930
72. Dawson G, Watling R. Interventions to facilitate auditory, visual, and motor integration in autism: a review of the evidence. J Autism Dev Disord. 2000;30(5):415-21. doi: 10.1023/A:1005547422749
73. Eshraghi AA, Nazarian R, Telischi FF, Martinez D, Hodges A, Velandia S, et al. Cochlear implantation in children with autism spectrum disorder. Otol Neurotol. 2015;36(8):e121-8. doi: 10.1097/MAO.0000000000000757
74. Gee BM, Thompson K, St John H. Efficacy of a sound-based intervention with a child with an autism spectrum disorder and auditory sensory over-responsivity. Occup Ther Int. 2014;21(1):12-20. doi: 10.1002/oti.1359
75. Denman I, Banajee M, Hurley A. Dichotic listening training in children with autism spectrum disorder: A single subject design. Int J Audiol. 2015;54(12):991-6. doi: 10.3109/14992027.2015.1070308
76. Haddadi P, Haghshenas S, Rostami R. Rehabilitation in autism spectrum disorder (ASD): a mixture of neurofeedback training and auditory integration training (AIT). Procedia Soc Behav Sci. 2011;30:611-4. doi: 10.1016/j.sbspro.2011.10.118
77. Fauzan N, Mahayuddin NA. Brain training to improve sociability and behavior of autism spectrum disorder (ASD) children and young adults. Procedia Soc Behav Sci. 2014;143:308-14. doi: 10.1016/j.sbspro.2014.07.410
78. Danial JT, Wood JJ. Cognitive behavioral therapy for children with autism: review and considerations for future research. J Dev Behav Pediatr. 2013;34(9):702-15. doi: 10.1097/DBP.0b013e31829f676c
79. Alghamdi FM. Role of inclusively designed technology in facilitating communication for children with autism spectrum disorder. [Dissertation]. Toronto: OCAD University; 2013.
How to Cite
Moossavi A, Moallemi M. Auditory processing and auditory rehabilitation approaches in autism. Aud Vestib Res.
Review Article(s)