Deafness and Hearing Problems and Their Association With Autism Spectrum Disorder Diagnosis and Symptoms

Problems with hearing feature prominently in autism spectrum disorder (ASD) but remain poorly characterized within population-based samples and according to symptom heterogeneity.

We analyzed cross-sectional, caregiver-reported data from the National Survey of Children's Health (2016-2020). Our US-based sample included children with data on the presence/absence of "deafness or problems with hearing" (DPHs) and ASD (ages 3-17 years; n = 150,327). We used weighted logistic regression to examine the association between DPHs and (1) ASD diagnosis (no, yes), (2) ASD symptom severity (none, mild, moderate/severe), and (3) co-occurrences of ASD with intellectual disability (ID) (neither, ASD only, ID only, both) or attention deficit/hyperactivity disorder (ADHD) (neither, ADHD only, ADHD only, both). We also assessed effect modification by sex and preterm birth.

Deafness or problems with hearing were associated with greater odds of ASD (OR = 2.7; 95% CI, 1.8-3.9), with 4% of children with ASD having DPHs versus 1% of children without ASD. Associations were stronger for: moderate/severe ASD symptoms (OR = 3.5; 95% CI, 2.1-5.7) versus mild symptoms (OR = 1.8; 95% CI, 1.1-3.1); 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); and children with co-occurring ADHD (OR = 4.3; 95% CI, 2.5-7.2) than for ASD only. Findings persisted after adjustment and were stronger for females versus males but were not modified by preterm birth.

Deafness or problems with hearing 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 DPHs in ASD are driven by sensory, cognitive, and/or motivational processes or residual confounding (e.g., congenital anomalies).