Auditory attention in autism: following one voice amongst other sounds

Hearing and following a message are different tasks

The ear detects sound, but understanding a conversation involves further steps. A person has to locate the voice, maintain it as the target, separate its changes from other sounds, recognise the words and retain enough information to understand the sentence.

Someone may have expected results on a pure-tone hearing test and still find speech difficult to follow in a classroom, meeting or restaurant. They may also understand well at first and miss more information as tiredness increases.

Background noise does more than add volume

A fan, traffic or several conversations may mask parts of the signal. When the competing sound also contains speech, the brain must separate voices that are changing at the same time and decide which one to follow. This competition can be particularly difficult because the other voices also contain meaningful words.

A 2023 systematic review found results that varied with age, language and type of noise, but it identified speech-in-noise difficulties in some autistic samples. Later studies have also found differences in neural tracking of speech and sentence processing when other sounds compete. These are group trends and do not describe every autistic person.

Auditory attention and reactivity to sound are not the same

A sound may be painful or cause overload; this relates to sensory reactivity. A sound may also be neither painful nor distressing but still compete with a voice and prevent some words from being understood; this affects selection and speech processing.

Both difficulties may occur together. The person then has to follow the message whilst regulating distress caused by other sounds. The effort rises even if, from the outside, the conversation appears to be continuing normally.

How it may appear

• Asking for the last part to be repeated, particularly when several people are speaking.
• Answering after a delay because the sentence has to be reconstructed.
• Understanding isolated parts and losing the relationship between them.
• Turning towards a sound or movement that has interrupted tracking of the voice.
• Needing to see the speaker’s face or lips to complete the information.
• Becoming quiet or leaving a conversation after time in a noisy setting.
• Remembering spoken instructions less accurately when other sounds were present.

These signs do not establish an auditory-attention difference by themselves. They may also occur with hearing loss, language difficulties, ADHD, anxiety, fatigue, medication or unfamiliarity with the language or voice.

Ways to make one voice easier to follow

• Reduce background noise and avoid several conversations at once.
• Stay near the speaker and away from constant sources of noise.
• Say the person’s name and wait before giving the information.
• Use clear sentences, separate the steps and pause between ideas.
• Repeat the main information without criticism and provide it in writing.
• Check understanding with a specific question rather than asking for everything to be repeated from memory.
• Allow breaks or continue the conversation in a quieter place.
• At school, consider acoustics, seating and remote-microphone technology when recommended by a professional.

Speaking more loudly does not always solve the problem. If every voice and the background noise continue to compete, increasing the volume may add more input without making the message clearer.

When hearing should be assessed

Hearing should be checked when there are concerns, frequent infections, pain, tinnitus, dizziness, a new response or difficulties that substantially affect communication. An audiological assessment can rule out hearing loss and examine performance with speech and noise. Language, attention or auditory-processing assessment may also be appropriate, depending on the individual situation.