Purpose: School-age children with autism spectrum conditions (ASC) often experience difficulties in speech-in-noise (SiN) perception, leading to increased listening effort that impacts their well-being and academic performance. This study aimed to investigate the SiN processing challenges faced by Mandarin-speaking children with ASC and its impact on their listening effort. Methods: Participants completed sentence recognition tests in both quiet and noisy conditions, with a steady-state noise masker presented at 0 dB signal-to-noise ratio in the noisy condition. We compared recognition accuracy and task-evoked pupil responses from 23 Mandarin-speaking children with ASC to 19 age-matched neurotypical (NT) counterparts to gauge their behavioral performance and listening effort during these auditory tasks. Results: The ASC group demonstrated notably decreased accuracy in noise compared to their NT peers, suggesting poorer SiN perception. Pupillometric data further revealed significantly larger peak dilations in the ASC group than in the NT group under comparable conditions. Importantly, the ASC group's peak dilation in quiet mirrored the NT group's in noise. However, the ASC group exhibited shorter peak latencies and reduced mean dilations than the NT group in similar conditions. Such patterns indicate the ASC group might initially experience a heightened cognitive load but utilize fewer cognitive resources as the task continued, indicating an atypical allocation of cognitive resources and a potential tendency towards relatively superficial and automated auditory processing. Conclusion: Our findings highlight the unique SiN processing challenges children with ASC face, underscoring the importance of a nuanced, individual-centric approach for interventions and support.

Purpose: Hearing assistive technology (HAT) has been shown to be a viable solution to the speech-in-noise perception (SPIN) issue in children with autism spectrum disorder (ASD); however, little is known about its efficacy in tonal language speakers. This study compared sentence-level SPIN performance between Chinese children with ASD and neurotypical (NT) children and evaluated HAT use in improving SPIN performance and easing SPIN difficulty. Methods: Children with ASD (n=26) and NT children (n=19) aged 6-12 performed two adaptive tests in steady-state noise and three fixed-level tests in quiet and steady-state noise with and without using HAT. Speech recognition thresholds (SRT) and accuracy rates were assessed using adaptive and fixed-level tests, respectively. Parents or teachers of the ASD group completed a questionnaire regarding children’s listening difficulty under six circumstances before and after a ten-day trial period of HAT use. Results: Although the two groups of children had comparable SRTs, the ASD group showed a significantly lower SPIN accuracy rate than the NT group. Also, a significant impact of noise was found in the ASD group’s accuracy rate, but not in the NT group’s. There was a general improvement in the ASD group’s SPIN performance with HAT and a decrease in their listening difficulty ratings across all conditions after the device trial. Conclusion: The findings indicated inadequate SPIN in the ASD group using a relatively sensitive measure to gauge SPIN performance among children. The markedly increased accuracy rate in noise during HAT-on sessions for the ASD group confirmed the feasibility of HAT for improving SPIN performance in controlled laboratory settings, and the reduced post-use ratings of listening difficulty further confirmed the benefits of HAT use in daily scenarios.