A quarterly publication of the Autism Research Institute

The Autism Research Review International is quarterly publication of the Autism Research Institute

Spring, 2023 | Number 2, Volume 37

ENT problems common in kids later diagnosed with autism

A large-scale study indicates that ear and upper respiratory problems in early childhood are associated with a higher number of autistic traits or a diagnosis of autism. 

Amanda Hall and colleagues analyzed data on more than 10,000 children followed throughout their first four years by the Avon Longitudinal Study of Parents and Children. The children’s mothers filled out questionnaires at three points during this period, recording the frequency of upper respiratory, ear, and hearing problems in their children. 

Hall and her team report, “Early evidence of mouth breathing, snoring, pulling/ poking ears, ears going red, hearing worse during a cold, and rarely listening were associated with high scores on each autism trait and with a diagnosis of autism. There was also evidence of associations of pus or sticky mucus discharge from ears, especially with autism and with poor coherent speech.” These results remained significant after the researchers controlled for a wide range of potential cofounders. 

The researchers say it is not clear whether ear, nose, and throat (ENT) conditions play a causal role in the development of autism or are related to other factors. “One possibility, for example,” they say, “could be the consequence of the increased prevalence of minor physical anomalies in individuals with autism, including anatomical differences in the structure and/or positioning of the ear, with such differences in ear morphology increasing the risk of ENT conditions.” 

No matter what the relationship is, they say, “it is clear from this study of prospectively collected information that children who later develop social communication difficulties are more likely to have early middle ear disease and ENT conditions, and are therefore more at risk of communication difficulties from hearing loss, although temporary. Early detection and intervention of ENT conditions in children with autism is thus likely to be beneficial.” 


“Associations between autistic traits and early ear and upper respiratory signs: a prospective observational study of the Avon Longitudinal Study of Parents and Children (ALSPAC) geographically defined childhood population,” Amanda Hall, Richard Maw, Yasmin Iles-Cavin, Steven Gregory, Dheeraj Rai, and Jean Golding, BMJ Open, April 24, 2023 (free online). Address: Jean Golding, [email protected].