19 September 2025
House Standing Committee on Health, Aged Care and Disability
By email: Health.Reps@aph.gov.au
RE: Inquiry into the Thriving Kids initiative
Audiology Australia thanks the House Standing Committee on Health, Aged Care and Disability for the opportunity to respond to this inquiry. Audiology Australia is the peak professional body for the health profession of Audiology, representing over 3,500 audiologists across Australia and 94% of all practicing audiologists in the country. This submission emphasises key issues, risks, and recommendations concerning autism, Auditory Processing Disorder (APD), hearing loss as a comorbidity and misdiagnosis, and the importance of linking hearing with developmental screening and milestone tracking.
Without early identification and intervention, APD (or hearing loss more broadly) can lead to cumulative deficits in language acquisition, reading, educational achievement, and social/emotional development. Misdiagnosis can be common: children with hearing loss or APD may be misdiagnosed as having developmental delay, speech/language difficulties, attention problems, or behavioural issues. This misdiagnosis can risk inappropriate treatment, delay in hearing-based remediation, and poorer outcomes.
Conversely, developmental delay often co-occurs with hearing impairment. APD itself often coexists with other developmental or learning disorders, such as autism, dyslexia, ADHD, and language impairment. Some children with developmental disorders have hearing loss (either permanent or temporary) that exacerbates or mimics developmental delay. Unless hearing is assessed carefully, delays attributed to other causes may be worsened by unrecognised hearing issues.
Identification of hearing loss and early, appropriate intervention before 6 months of age can increase the possibility of normal speech and language development in hearing-impaired, non-developmentally delayed children. Therefore, it is important to rule out hearing loss as early as possible as to avoid poorer outcomes and confusion with developmental delay.
Response to terms of reference
Below are Audiology Australia’s response to the terms of reference.
- Examine evidence-based information and resources that could assist parents identify if their child has mild to moderate development delay and support parents to provide support to these children. Audiologists are well qualified in equipping parents with the knowledge and tools to recognise early indicators of developmental concerns, including auditory processing challenges and hearing impairments. This may be achieved through the development
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and distribution of accessible, evidence-based resources, and through strategic engagement with parent networks embedded in community and educational settings.
- Examine the effectiveness of current (and previous) programs and initiatives that identify children with development delay, autism or both, with mild to moderate support needs and support them and their families. This should focus on community and mainstream engagement, and include child and maternal health, primary care, allied health playgroups, early childhood education and care and schools. Hearing, both peripheral hearing and central auditory processing, is foundational to speech, language, learning and social development. Current Australian programs have important strengths, but gaps remain in ongoing monitoring, early identification of auditory processing difficulties, timely referral
Newborn Hearing Screening
Universal Newborn Hearing Screening (UNHS) programs, which are available in all states and territories, is critical, but not sufficient alone. Children have the potential to pass newborn screenings and develop hearing decline later (e.g. middle ear disease, progressive hearing loss, injury/illness-related hearing loss) or develop APD-type difficulties even with normal peripheral hearing.
Ongoing surveillance of developmental milestones in hearing, speech, language, auditory comprehension, listening in noise etc. Tracking these over time enables early detection of atypical trajectories.
- Identify equity and intersectional issues, in particular, children who identify as First Nations and culturally and linguistically diverse. Children who are First Nations or from culturally and linguistically diverse (CALD) backgrounds face disproportionate risks in hearing and developmental outcomes. First Nations children experience some of the highest rates of otitis media (OM) and associated hearing loss globally, contributing to speech and language delay, school disengagement and later inequities. Access to timely audiology services is limited, particularly in rural and remote areas, and culturally safe engagement is not consistently utilised. CALD families may encounter barriers through language, stigma, and screening tools that are not adapted for multilingual contexts, leading to both under- and misdiagnosis.
To ensure equity, the Thriving Kids Initiative should strengthen culturally safe pathways, embed routine hearing surveillance in community-controlled and multicultural services, and guarantee interpreter support to make hearing health a priority in childhood development.
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Identify gaps in workforce support and training required to deliver Thriving Kids. The success of the Thriving Kids initiative relies on a workforce that can recognise and respond to hearing and auditory processing needs.
There is currently a gap in awareness and early identification of APD or hearing loss in children with developmental delays. Maternal and Child Health nurses, GPs, educators and other allied health professionals often have limited training in recognising these signs. This can contribute to misdiagnosis (e.g. assuming developmental delay or behavioural issues) and delayed referral to audiology.
Many frontline workers also lack clear guidance on when and how to refer children to audiologists for hearing screening or diagnostic testing. Standardised referral protocols and training in their use would improve timely access, reduce misdiagnosis and improve diagnosis of comorbidities.
Another barrier is a shortage of paediatric audiologists and clinicians trained in APD, particularly outside of metropolitan areas. This results in inequitable service access and longer wait times for a very vulnerable cohort.
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Draw on domestic and international policy experience and best practice. In the context of this inquiry, AudA emphasises the importance of incorporating relevant policies and framework, such as the emerging Best Practice Framework for Early Childhood Intervention and Autism CRC’s National Guideline for Supporting the Learning, Participation, and Wellbeing of Autistic Children and Their Families in Australia. As the former continues to be developed, it is essential that it establishes a clear and authoritative definition of the workforce qualified to provide evidence-based services. The latter demonstrates a strong example of how evidence-based, co- designed guidelines can shape high-quality, family-centred support and provides a model that could be adapted to ensure hearing and listening needs are consistently integrated into developmental care.
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Identify mechanisms that would allow a seamless transition through mainstream systems for all children with mild to moderate support needs. To support children with developmental delay or disability, such as autism or APD, the system of care must be accessible, coordinated, and well-connected so families can move smoothly between services. From an audiology perspective, this requires a shared national child development record that captures audiology assessments and intervention history, reducing the risk of information being lost when children move between providers.
Assessments should be streamlined and multidisciplinary, with audiologists contributing alongside other allied health professionals, and delivered consistently in hospitals, maternal and child health, general practice, early childhood education and care, and school settings.
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Clear referral pathways and feedback loops are needed so that children identified with hearing or listening concerns receive timely follow-up, while care coordinators and navigation supports can guide families through complex systems.
Ensuring cultural safety, interpreter access and strong partnerships with Aboriginal Community Controlled Health Services and multicultural health providers will promote trust and equity for First Nations and CALD families.
Collaborative transition planning, bringing together audiologists, educators, allied health and families, will ensure that hearing and communication needs are consistently addressed as part of children’s developmental and educational journeys.
Hearing is fundamental to every non-Deaf child’s ability to communicate, learn, and thrive, yet it is too often overlooked in developmental policy. Undetected hearing loss and auditory processing disorder can mimic or compound developmental delay, leading to misdiagnosis, educational disadvantage and poorer life outcomes. By embedding hearing and listening milestones into developmental surveillance, strengthening workforce training and referral pathways, and ensuring culturally safe, accessible services for First Nations and CALD families, the Thriving Kids Initiative can address these risks early and equitably.
Yours sincerely,
redacted
Leanne Emerson
CEO
Audiology Australia
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References
- Nixon, G. (2015, July 2). 9 Surprising Consequences of Auditory Processing Disorder. Gemm Learning. https://www.gemmlearning.com/blog/auditory- processing/9-consequences-of-auditory-processing-disorder-in-children/
- Ahmmed, A. U. (2020). Auditory processing, co-morbidities, and parental report of sleep disturbance in children with auditory processing disorder (APD). International Journal of Pediatric Otorhinolaryngology, 135, 110117. https://doi.org/10.1016/j.ijporl.2020.110117
- Moore, D. R., & Hunter, L. L. (2013). Auditory processing disorder (APD) in children: A marker of neurodevelopmental syndrome. Hearing, Balance and Communication, 11(3), 160–167. https://doi.org/10.3109/21695717.2013.821756
- Lawton, S., Purdy, S. C., & Kalathottukaren, R. T. (2017). Children Diagnosed with Auditory Processing Disorder and Their Parents: A Qualitative Study about Perceptions of Living with APD. Journal of the American Academy of Audiology, 28(7), 610–624. https://doi.org/10.3766/jaaa.15130
- Effects of Hearing Loss on Development. (2025). Asha.org. https://www.asha.org/public/hearing/effects-of-hearing-loss-on- development/?srsltid=AfmBOorc8JxKMcUW1GZ_2UR- sS8fZbtTTZnODpjTa6Gjt1jiOFNBqNnI
- Shojaei, E., Jafari, Z., & Gholami, M. (2016). Effect of Early Intervention on Language Development in Hearing-Impaired Children. Iranian Journal of Otorhinolaryngology, 28(84), 13. https://pmc.ncbi.nlm.nih.gov/articles/PMC4735612/
- Bower, C. M., Reilly, B. K., Richerson, J. E., & Hecht, J. L. (2023). Hearing Assessment in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening. Pediatrics, 152(3). https://doi.org/10.1542/peds.2023-063288
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