Neurophysiological Biomarkers in Children with Autism Spectrum Disorder and an Auditory Processing Disorder-Like Phenotype: A Review of Studies from 2000 to 2025

Abstract

Background: A subset of children with autism spectrum disorder (ASD) shows difficulties understanding speech in noise and with audiovisual integration despite normal peripheral hearing, forming an auditory processing disorder-like phenotype.Aim: To summarize the neurodevelopmental and neurophysiological basis of this phenotype and its clinical implications.Methods: A structured narrative review of studies published between 2000 and 2025 was performed using PubMed/MEDLINE and citation chasing. Studies involving participants under 18 years of age were included if they reported neurophysiological or neuroimaging markers related to language, speech-in-noise perception, or audiovisual integration. Due to study heterogeneity, a narrative synthesis was conducted.Results: The most consistent findings included prolonged ABR wave V latency, reduced FFR precision, particularly in noise, attenuated or delayed MMN/MMF, P3 alterations, and atypical activation and connectivity of superior temporal regions during speech tasks. Evidence on audiovisual gain was mixed and depended on age and study paradigm. These markers were associated with language abilities and speech-in-noise performance.Conclusions: A tiered assessment in children with ASD appears justified, including peripheral hearing evaluation, speech-in-noise and audiovisual measures, and selected biomarkers. Early management may include improving classroom listening conditions, supporting the visual channel, and targeted auditory training.