Hearing
Assess for decreased sound tolerance causing pain or fear (Williams et al., 2021ab). Consider music for autistic children’s recreation (Boerebach et al., 2012; McMurray, 2012; Williams, 2012) and developmental growth (Paul et al., 2015), such as singing with synchronised drum-playing to learn speech (Chenausky et al., 2022). Consider toning down the exaggerated pitch of baby talk to autistic children (Ochs, Solomon, & Sterponi, 2005; Solomon, 2011), as the intonations may distract from the meaning of language. Autism-typical (Rosenhall et al., 2003; Russo et al., 2009) auditory hypersensitivity in infancy predicts difficulty with speech and an autism diagnosis (especially for social interaction traits) at age three (Cohen et al., 2013). Enhanced perceptual processing of speech in autistic children may interfere with processing the linguistic components (Järvinen-Pasley, Pasley, & Heaton, 2008; Norbury, Griffiths, & Nation, 2010), even in tonal languages, as autistic children may experience enhanced simple perception of melodies but poor processing of spoken language (Jiang et al., 2015).SpeechMany autistic children (about two-thirds in early life) may have under-recognized difficulties forming speech sounds (apraxia of speech), which may require assessment (Tierney et al., 2015).
Encourage lip-reading as a strategy to build speech and communication. Autistic people with and without language impairment from infancy through adulthood have shown communicative benefit from attention to speakers’ mouths (Elsabbagh et al., 2014; Falck-Ytter et al., 2010; Klin et al., 2002; Norbury et al., 2009; Tenenbaum et al., 2014). This may occur because the speech sounds and lip motion provide auditory-visual integration (Klin et al., 2009) – an area of challenge across autistics’ lifespan and speech abilities (Iarocci et al., 2010; Saalasti et al., 2012; Smith & Bennetto, 2007).
Additionally, avoiding eye contact when listening may support autistic people’s speech processing. When perceiving auditory-visual speech, the auditory component has shown more influence for autistic children than typically developing peers (Iarocci et al., 2010). Autistic people can process high loads of visual (Remington, Swettenham, & Lavie, 2012; Remington et al., 2009) and auditory (Remington & Fairnie, 2017) information independently (Mottron et al., 2006), but they may find speech’s movements challenging to process alongside sounds. Avoiding eye contact may help autistic children concentrate on the words when listening to speakers, which may explain their pattern of averting eye contact in response to another’s speech but not when speaking (Doherty-Sneddon, Riby, & Whittle, 2012; Falck-Ytter, 2015). Similarly, looking away helps autistic and non-autistic people perform cognitively demanding tasks (e.g. math problems: Doherty-Sneddon et al., 2012; Riby, Doherty-Sneddon, & Whittle, 2012). It may also especially help autistic people in emotionally demanding contexts (Dalton et al., 2005; Kleinhans et al., 2010; Tottenham et al., 2014).