Auditory perception and visual perception in children: A scoping review

ABSTRACT

Purpose:  to report on global scientific literature about the relationship between auditory perception and visual perception in children.

Methods:  a scoping review conducted using the following national and international databases: PubMed, SciELO, LILACS, Scopus, Cochrane, ScienceDirect, and Web of Science. The eligibility criteria for this review included studies that addressed the relationship between auditory perception and visual perception in children.

Literature Review:  six articles that met the eligibility criteria were selected. The assessment methods, objectives, and child samples of the studies were diverse. Three of the six articles demonstrated the relationship between auditory and visual perception in children with or at risk for dyslexia, one demonstrated audiovisual asynchrony in children with developmental language disorders, and two observed the association between auditory and visual perception in children with and without central auditory processing disorders.

Conclusion:  the review identified scientific studies demonstrating the relationship between auditory and visual perception in children. However, the literature still has few records reporting this correlation. Hence, further research is necessary to benefit children and fill gaps in the literature.

Keywords:
Auditory Perception; Visual Perception; Child; Audiology; Learning

RESUMO

Objetivos:  reportar as produções científicas sobre a relação entre percepção auditiva e percepção visual em crianças na literatura mundial.

Métodos:  trata-se de uma revisão de escopo realizada nas bases de dados nacionais e internacionais: Pubmed, Scielo, Lilacs, Scopus, Cochrane, Science direct e Web of Science. Os critérios de elegibilidade adotados para construção desta revisão abrangeram os estudos que abordassem a relação entre Percepção Auditiva e Percepção Visual em crianças.

Revisão de Literatura:  oram selecionados seis artigos que cumpriram os critérios de elegibilidade. Observou-se que as formas de avaliação, objetivos e o público infantil dos estudos foram diversificados. Dos seis artigos, três mostraram a relação entre percepção auditiva e visual em crianças com dislexia ou com risco para dislexia, um mostrou a assincronia audiovisual em crianças com Transtorno do Desenvolvimento da Linguagem, e dois observaram a associação entre percepção auditiva e visual em crianças com e sem alteração do Processamento Auditivo Central.

Conclusão:  foram identificadas produções científicas que mostram a relação entre a percepção auditiva e percepção visual em crianças. Apesar disso, é válido considerar que, a literatura ainda possui poucos registros referindo a essa correlação, sendo importante que novas pesquisas sejam realizadas, a fim de beneficiar a população infantil e preencher lacunas deixadas na literatura.

Descritores:
Percepção Auditiva; Percepção Visual; Criança; Audiologia

INTRODUCTION

Perception is extremely important to humans and is generally defined as the ability to associate sensory information with the senses, hence, the terms visual, auditory, and somesthetic perception. Perception involves complex processes linked to memory, cognition, and behavior, and is the basis for language development¹. Thus, a disorder in perception disrupts all subsequent levels of experience².

The auditory system consists of sensory structures and central connections responsible for the sensation and perception of sound stimuli. This system can be divided into two distinct, interrelated parts, defined as the peripheral auditory system and the central auditory system. The peripheral part comprises structures of the outer ear, middle ear, inner ear, and peripheral nervous system (vestibular-cochlear nerve)³. The central system refers to the auditory pathways located in the brainstem and cortical areas related to hearing⁴.

Auditory perception refers to the processing of an audible acoustic signal, initiated by receptor cells sensitive to specific sound stimuli. Given such complexity, these stimuli are processed through a series of neuroanatomical connections originating in the neurons of the cochlea and terminating in the cerebral auditory cortex⁵. After being detected by the inner ear, sound undergoes several physiological and cognitive processes before being decoded and understood in the brain. These processes consist of a set of auditory abilities on which the person relies to interpret the sound message⁶.

Thus, assessing auditory functions goes far beyond simply measuring hearing thresholds. The acoustic signal must be analyzed and interpreted to transform it into a meaningful message. Therefore, the organic and functional integrity of the entire auditory system⁷ is essential to enable efficient auditory comprehension.

Impairment in this process causes central auditory processing disorder (CAPD). This term describes a deficit in the complete perception or analysis of verbal or nonverbal auditory information due to a failure in the central auditory system⁸, whose mechanisms and processes also interfere with and influence higher functions, including language and learning⁹. Children with CAPD tend to have difficulties in school and can often be characterized as distractible, forgetful, restless, talkative, and have difficulty with the concept of time¹⁰. Thus, they tend to ignore relevant auditory information.

Not only auditory but also visual perception alterations have been described in children with learning disabilities¹¹. Visual perception is the ability to process visual stimuli and is composed of a set of visual perceptive skills essential for reading and learning. These skills analyze and process visual information to provide comprehension of what is seen¹² and construct experience and awareness of the visual world based on attention to guide motor actions^3,4. Adequate visual perception requires intact visual functions and cortical structures¹³.

Visual perception develops rapidly during childhood and approaches adult development around 11 to 12 years old¹⁴. Visual-motor perceptual function results from a combination of visual-motor skills, motor and cognitive planning, visual perceptual skills (such as eye-hand coordination), position in space, spatial relations, figure-ground, and form constancy¹⁵. Therefore, children with learning disorders are prone to visual perceptual alterations due to dysfunctions in brain areas responsible for the visuospatial perception necessary for writing¹⁶.

In addition to the common complaints and characteristics reported in children with changes in auditory or visual perception, anatomical-physiological relationships can be found between the two systems by studying the central hearing pathways in more detail^17-19.

The inferior colliculus is an auditory structure of the midbrain serving as an auditory transmission station, also related to auditory-visual reflexes¹⁷. It is likely the place where information from various sensory pathways is modulated and integrated, altering auditory information¹⁸. The medial geniculate body is a structure responsible for the auditory pathway, and the lateral geniculate body is responsible for the visual pathway. Both are located in the thalamus and constitute the first place where the auditory and visual pathways intersect. A dysfunction in this connection can lead to complications in reading¹⁹.

It is known that much of a child's learning is related to their ability to integrate sensory information. Incoming information is sent through the sensory systems to the central nervous system, where sensory processing occurs. People learn through this perception and the exchange of information between the environment and the various nerve centers. For instance, children develop and learn reading and arithmetic based on sensory integration²⁰.

Given the importance of sensory integration for learning, it is crucial to understand and investigate whether the literature correlates auditory perception with visual perception. This discovery can contribute to a deeper understanding of this integration and the possible simultaneous impact of changes in these systems. It can also aid in more informed and comprehensive speech-language-hearing diagnoses and interventions, as well as in other fields that address learning issues in children. Therefore, this study aimed to report on global scientific literature about the relationship between auditory and visual perception in children.

METHODS

This scoping review followed the PRISMA recommendations for writing scoping reviews (PRISMA-ScR)²¹, registered on the Open Science Framework (OSF) with DOI 10.17605/OSF.IO/RBXQD.

The scoping review used the following research question to meet its objective: "Is there a relationship between auditory perception and visual perception in children in global literature?". The research employed the population, concept, and context (PCC) strategy to include studies: a) Population: studies with children aged 2 to 12 years; b) Concept: studies addressing the relationship between auditory and visual perception; c) Context: original research and clinical cases available in full, without language restrictions.

The following databases were consulted to identify relevant studies: PubMed, SciELO, LILACS, Scopus, Cochrane, ScienceDirect, and Web of Science. Search terms were defined using subject descriptors from the Health Sciences Descriptors (DeCS) and Medical Subject Headings (MeSH), which facilitate the search and retrieval of articles in healthcare bibliographic databases. A filter was applied to search for articles published in the last 10 years and available in full.

Searches used AND, OR, and All Fields tags, crossing the English and Portuguese descriptors in DeCS and MeSH. Chart 1 presents the search strategies used in the databases.

Chart 1
Search strategies used for each database

DATABASE	SEARCH STRATEGY
PUBMED	(“Auditory perception” [All Fields] OR “Visual perception" [All Fields] OR [All Fields] “Child”)
SCIELO	(“Auditory perception” AND “Visual perception" AND “Child” AND “Percepção auditiva” AND (Percepção visual” AND “Criança”)
LILACS	(“Auditory perception” AND “Visual perception" AND “Child” AND “Percepção auditiva” AND (Percepção visual” AND “Criança”)
SCOPUS	(“Auditory perception” AND “Visual perception" AND “Child”)
COCHRANE LIBRARY	(“Auditory perception” AND “Visual perception" AND “Child”)
SCIENCE DIRECT	(“Auditory perception” AND “Visual perception" AND “Child”)
WEB OF SCIENCE	(“Auditory perception” AND “Visual perception" AND “Child”)

• Source: The authors.

Eligibility criteria

The eligibility criteria for this review were original research and clinical case studies addressing the relationship between auditory and visual perception in children. Exclusion criteria were studies with adults and older adults, duplicates, studies without free access, literature reviews, and scientific abstracts.

The study selection process occurred in four stages. The first stage began in November 2023 and was updated in June 2024, searching for studies in all databases with descriptors and filters. After collecting from the databases and excluding duplicates, the next stage selected articles whose titles mentioned the relationship between auditory and visual perception in children. This was followed by a third stage, in which the study abstracts were read. In the final stage, the articles selected independently in the previous one met the research criteria and the research question.

Two reviewers (ACM and NCOL) screened the articles independently and selected them based on their titles and abstracts. After selecting these studies, the same reviewers read the articles in full. Another two reviewers (VNM and DFF) were available to reach a consensus decision along with the first two reviewers in cases of disagreement regarding abstracts and full texts. An additional reviewer participated in the final phase to discuss and resolve any possible conflicts.

LITERATURE REVIEW

The article search process is presented in Figure 1, through the PRISMA selection flowchart, describing the collection steps and quantity of articles within the research scope.

Figure 1
Flowchart with the different phases of the review based on the PRISMA 2020 guidelines for new systematic reviews that included searches of databases, registries, and other sources

The search initially identified 775 studies with the combined descriptors in their respective databases. Following the predefined steps described above, eight articles were eligible for full-text reading after excluding duplicates and reading the titles and abstracts. Two of the eight articles were excluded for not addressing the relationship between auditory and visual perception in children. Thus, the final sample totaled six articles. A chart was created to summarize them, including the article title, year of publication, author, methods, and main results (Chart 2).

Chart 2
Data extracted from articles selected for review

Author and year of publication	Country	Scientific journal	Title	Age range	Methods	Outcome
Karipidis et al. (2017)22	Switzerland	Human Brain Mapping	Neural Initialization of Audiovisual Integration in Prereaders at Varying Risk for Developmental Dyslexia	Mean of 6.13-7.17 years	The study simulated the learning process of letter-sound correspondences in 20 pre-literate children with varying risk for dyslexia. Parents completed the ARHQ, and the highest parental score was used to determine family risk. Artificial letter-sound correspondences were practiced with the children in a single experimental session. Subsequently, ERP and fMRI scans were acquired simultaneously during implicit audiovisual presentation of trained and untrained pairs.	The audiovisual integration of trained pairs correlated with individual learning rates in the right superior temporal, left inferior temporal, and bilateral parietal areas, and with phonological awareness in the left temporal areas. The left-lateralized parieto-occipitotemporal ERP at 400 ms for trained pairs correlated with learning performance and familial risk. A late posterior negativity (650 ms), indicating audiovisual congruence of trained pairs, was associated with increased fMRI activation in the left occipital cortex. Thus, electrophysiological data provide insight into the time course of audiovisual integration in the early learning phase, and that initially diminished neural responses in brain networks crucial for later integration between letters and speech sounds may impair the learning process of reading.
Kaganovich, N. (2017)23	United States	Journal of Speech, Language, and Hearing Research	Sensitivity to Audiovisual Temporal Asynchrony in Children with a History of Specific Language Impairment and Their Peers with Typical Development: A Replication and Follow-Up Study	Mean of 7.7-13.8 years	Nineteen children with SLI and 19 TD children performed an audiovisual temporal asynchrony task in a simultaneity judgment task. The stimuli were a 2-Hz tone and a red figure depicting an explosion, both lasting 200 ms. They were presented at six stimulus onset asynchronies: 0, 100, 200, 300, 400, and 500 ms, with the sound preceding the figure on half of the judgments (auditory-visual) and the figure preceding the sound on the other half (visual-auditory). The experiment consisted of five blocks, yielding 25 responses for each judgment type.	Children with SLI are impaired in detecting audiovisual temporal asynchrony; they perceived asynchrony significantly less frequently than TD children at stimulus onset asynchronies of 400-500 ms. Audiovisual temporal processing is impaired in children with SLI, and the degree of this impairment is a predictor of language skills.
Gori et al. (2020)24	Italy and Poland	Developmental Science	Temporal representation impairment in developmental dyslexia for unisensory and multisensory stimuli	7 to 14 years	The contribution of unisensory cues to audiovisual multisensory integration was investigated in 32 dyslexic and 32 typical children. Using non-linguistic stimuli, the children performed a temporal task using three different classes of stimuli: visual, auditory, and bimodal, which were presented sequentially for a total duration of 1 s. Participants were asked to indicate, by pressing a button, whether the middle stimulus appeared closer to the first or third stimulus. In the visual task, the participant was presented with a sequence of three lights, and in the auditory task, with three sounds. In the bimodal task, the participant was presented with a sequence of three lights associated with three sounds (like the unisensory stimuli).	Children with dyslexia had poorer unimodal thresholds than typical children, requiring greater temporal distance between items for correct judgments, while multisensory thresholds were well predicted by the Bayesian model. This result suggests that the multisensory deficit in dyslexia is due to impaired auditory and visual inputs, rather than impaired multisensory processing per se.
Ortiz et al. (2014)25	Spain	Research in Developmental Disabilities	Visual and auditory perception in preschool children at risk for dyslexia	5 to 6 years	A group of 72 pre-literate children with and without risk of dyslexia were compared in auditory and visual temporal order judgment tasks and same-different discrimination tasks. Identical visual and auditory, linguistic and non-linguistic stimuli were presented in both tasks.	The results revealed that visual and auditory perception is impaired in children at risk for dyslexia. A comparison between the groups in auditory and visual perception shows that the performance of children at risk was lower than that of children without risk for dyslexia on temporal tasks.
Buffone FRRC, Schochat E. (2022)26	Brazil	CoDAS (Communication Disorders, Audiology and Swallowing)	Sensory profile of children with Central Auditory Processing Disorder (CAPD)	7 years to 10 years and 11 months	Hearing, central auditory processing, and sensory processing were evaluated in 60 children. Hearing was assessed by inspection of the external auditory canal, pure-tone audiometry, and acoustic immittance measurements. The Raven's CPM and Child Sensory Profile 2 (CSP2) were administered, and all children underwent cognitive screening and CAP assessment and were divided into two groups: 1) CAPD and 2) normal CAP.	According to the normative CSP2 results, children with CAPD appear to have more sensory differences than those with normal CAP. In the association between CAP and SP, none of the CSP2 results indicated statistical significance between the variables; however, the effect size of the differences between them was moderate for the visual system, indicating an association between visual and auditory sensory information. Thus, we can infer that because the auditory information reaching these children is not precise, they use visual information as a supplementary resource to perform their daily tasks, not only those related to school, but also all self-care and leisure activities.
Garcia et al. (2019)27	Brazil	CEFAC	Association between auditory temporal and visual processing in reading skill	9 to 12 years	Sixty eight children were evaluated using the Duration Pattern Test (screening of auditory temporal ordering ability), the Visual Reading Perception Scale (questionnaire on visual stress symptoms and selection of spectral slides), and the Reading Rate Test (number of words read correctly per minute).	Participants screened for auditory processing disorders had more symptoms of visual stress and lower reading rates than their peers with normal auditory processing. Among children with impairments on the Duration Pattern Test, 58% improved their reading rates with the spectral overlay, compared to 29% of the control group. Thus, students screened for temporal auditory processing disorders are three times more likely to be associated with visual processing disorders, as they share the magnocellular pathway.

• Captions: ARHQ = Adult Reading History Questionnaire; ERP = Event-related potentials; fMRI = Functional Magnetic Resonance Imaging; SLI = Specific Language Impairment; TD = typical development; CAP = central auditory processing; CAPD = central auditory processing disorder

Three^22,24,25 of the six articles showed the relationship between auditory and visual perception in children with or at risk for dyslexia, one showed audiovisual asynchrony in children with developmental language disorders (DLD)²³, and two observed the association between auditory and visual perception in children with and without CAPD^26,27.

Reading is a complex multisensory process that is impaired in people with dyslexia²⁴. Reading involves visual perception/processing, visual memory, visual-auditory association, auditory memory/recognition, phonological processing, oral expression, and verbal processes²⁸.

One of the studies selected in this review evaluated a group of children at risk for dyslexia with auditory and visual temporal order judgment tasks. They performed worse in temporal tasks than children without risk for dyslexia²⁵, corroborating the evidence that children with impaired temporal auditory skills are more susceptible to having language and learning changes²⁹.

Another study evaluated pre-literate children at risk for dyslexia, using functional magnetic resonance imaging (fMRI) and event-related potentials (ERP). The audiovisual tasks involving target matching between trained and untrained grapheme-phoneme pairs revealed changes in the temporal and occipital brain regions for the trained pairs, areas known to be involved in audiovisual integration. This result provides important additional information about the temporal course of audiovisual integration in the early learning phase²² and the correlation between these two systems.

In addition to articles correlating auditory and visual perception in children with or at risk for dyslexia, this correlation was also observed in children with specific language impairment (the former term for the current DLD), assessing audiovisual temporal asynchrony in a simultaneity judgment task. Children with DLD had impairments in detecting audiovisual temporal asynchrony, perceiving asynchrony significantly less often than typically developing children²³.

Thus, imprecise audiovisual temporal processing can pose a significant disadvantage for children with DLD. Successful integration of the auditory and visual senses provides significant benefits during a series of tasks, including speech perception in noise, a task commonly encountered in everyday life²³. However, a deficient audiovisual temporal function can be improved through audiovisual temporal training to improve language skills in schoolchildren with DLD³⁰.

Two studies^26,27 assessed auditory perception using tests specifically for central auditory processing (CAP). The first study found that students with auditory temporal processing impairments are three times more likely to also have visual processing impairments, as they share the magnocellular pathway. Children with central auditory impairments had more symptoms of visual stress, lower reading rates, and greater chances of improving their reading speed with the use of colored overlays than the control group²⁷.

Therefore, this study correlates with an essential aspect of reading proficiency, the temporal sequential processing of auditory and visual information, which enables the formation of precise representations of the order of sounds in a word and the visual sequencing of letters³¹, demonstrating an important association between auditory and visual processing²⁷.

Another study used CAP assessment tests to evaluate the sensory profile of children with CAPD. It found that these children appear to have more sensory differences than those with normal CAP. In the association between CAP and sensory profile, none of the results indicated statistical significance between study variables, but the differences between them had a moderate effect size for the visual system²⁶.

It can be inferred that the auditory information that reaches children with CAPD is not accurate; they use visual information as a supplementary resource. Thus, individuals automatically resort to other sensory systems to compensate for the inefficiency of auditory function in their daily academic, self-care, and leisure tasks. This may occur because sensory information is interconnected through the neurological structures of the central nervous system and the colliculi, a primarily visual structure that contains an auditory spatial map with neurons from different regions that respond to auditory stimuli³².

Although the included studies relate the two sensory processes, it is important to mention the limitations of the review, as it did not find many studies whose methods described specifically and in detail how auditory and visual abilities are assessed in this population, correlating them and, in case of changes, directing them to some specific type of intervention.

For instance, the CAP test can assess various auditory skills - sound detection, localization and discrimination, recognition, temporal ordering, figure-ground for verbal and nonverbal sounds, auditory synthesis, integration, binaural interaction and separation, auditory closure, and temporal pattern recognition - and thus classify it as normal or abnormal³³. In turn, visual skills can be assessed with the Developmental Test of Visual Perception (DTVP-2). It is a battery of eight subtests that measure different visual perception and visual-motor skills, namely eye-hand coordination, position in space, copying, figure-ground, spatial relations, visual closure, visual-motor speed, and form constancy. The DTVP-2 reveals the child's performance in visual perception skills³⁴.

The literature highlights the importance of sensory integration for childhood learning issues²⁰ and auditory and visual skills assessment, especially in children with learning disabilities^35,36 - this is a common complaint when these two processes are abnormal, as also observed in the studies in this review. Therefore, studies using standardized assessment procedures are needed to develop intervention programs to minimize the impact of the potential harm these changes can cause.

The literature already presents interventions aimed at children with auditory and visual perceptual alterations with positive results^37-40. However, they do so on an individual basis, applying care protocols for one process or another separately - i.e., the studies do not yet address the possibility of interventions that combine auditory and visual perception.

This review makes it possible to infer the relationship between auditory and visual perception in children and their importance for child development, especially for learning aspects. It is also possible to think about new insights for future research aimed at joint evaluations and interventions of these processes.

CONCLUSION

The scoping review identified scientific studies linking auditory and visual perception in children. Even so, few records in the literature refer to this correlation, whether in assessment studies or especially in intervention studies. Therefore, further research in this area is important to benefit children and fill gaps in the literature.

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• A study conducted at the Universidade Federal da Paraíba-UFPB, João Pessoa, PB, Brazil.
• Financial support: Nothing to declare
• Data sharing statement:
  Individual participant data, including data dictionaries, are not available. Information about which specific data will be shared is also unavailable. Additional related documents, such as the study protocol or statistical analysis plan, are unavailable. Data availability and the period during which they would be accessible are not covered. Similarly, access criteria for data sharing are not applicable, including with whom, for what types of analyses, and by what mechanism.

Edited by

• Chief Editor
  Hilton Justino da Silva

• Associate Editor
  Kelly da Silva

Data availability

Individual participant data, including data dictionaries, are not available. Information about which specific data will be shared is also unavailable. Additional related documents, such as the study protocol or statistical analysis plan, are unavailable. Data availability and the period during which they would be accessible are not covered. Similarly, access criteria for data sharing are not applicable, including with whom, for what types of analyses, and by what mechanism.

Publication Dates

• Publication in this collection
  20 Oct 2025
• Date of issue
  2025

History

• Received
  30 Aug 2024
• Reviewed
  02 Nov 2024
• Accepted
  28 May 2025