Background: Children with listening difficulties (LiD) often face challenges in understanding speech in noisy or reverberant environments, which has the potential to affect their academic performance in the long term. These difficulties may stem from deficits in hearing, auditory processing, language and/or cognitive ability, which complicates the clinical diagnosis. This study applied a structured tri-level listening test battery, ranging from non-speech auditory resolution, nonword identification in noise and reverberation, to sentence comprehension in noisy and reverberant classroom simulations. In addition to the tri-level test battery, language and cognitive assessments were included to explore the relationships between these abilities in typically developing children and those with LiD. The study aims to explore what affects speech perception in noisy and reverberant classrooms in typically developing children and those with LiD. The ultimate goal is to identify the underlying causes of LiD to support targeted clinical interventions.

Methods: Over 200 typically developing children from primary schools and 80 children with parent-reported LiD from clinics, all aged 6 to 12 years and with normal hearing, were recruited for the study. The clinical group included children experiencing a range of listening challenges, such as understanding speech in noisy environments. Participants completed a comprehensive assessment over 2–3 sessions. This assessment evaluated their abilities in a tri-level test battery (including non-speech auditory resolution, nonword identification and sentence comprehension in noise and reverberation), language tests (including auditory cloze tests and sentence recall) and cognitive tests (including memory, attention, and non-verbal intelligence).

Results: In both typically developing and clinical groups, non-speech auditory resolution abilities significantly predicted nonword identification in noise and reverberation. Nonword identification in noise and language abilities significantly predicted sentence comprehension in noise and reverberation. In the clinical group, language abilities were significantly associated with nonword perception in noise, a pattern not observed in the typically developing group. Furthermore, in the clinical group, better performances on the memory task associated significantly with higher sentence comprehension in noise scores.

Conclusion: Understanding children's listening in noise and real-life scenarios requires considering how auditory, speech, language, and cognitive abilities impact both task performance and everyday challenges. Compared to the typically developing group, the LiD group showed a significant association between language and memory abilities with nonword and sentence in noise tests performance, indicating a greater effect of cognitive and linguistic skills for the clinical population. These findings indicate that bottom-up auditory resolution skills and top-down cognitive skills, including language abilities and memory capacity, may affect speech understanding in noisy environments for LiD children. Incorporating multidisciplinary assessments into routine audiology evaluations can help to identify specific deficits, tailor interventions to individual needs, and enhance targeted strategies to improve outcomes for children with listening challenges.