Reduced Neural Speech Tracking in Adolescents with Listening Difficulty.

Objective: To investigate neural mechanisms underlying speech-in-speech listening in adolescents with listening difficulties (LiD). Methods: Neural speech tracking (NST) was assessed using magnetoencephalography (MEG) in 21 adolescents with LiD and 25 typically developing (TD) peers, all with audiometrically normal hearing. Participants performed a cocktail party task involving target speech presented alone or alongside competitor speech streams differing in talker identity and spatial location. NST was quantified using theta-band (4-8 Hz) inter-event phase coherence (IEPC) to acoustic edges. Results: Adolescents with LiD demonstrated significantly reduced NST of target speech relative to TD peers, whereas NST of competitor speech was comparable between groups. Theta-band IEPC correlated with caregiver-reported listening difficulties in both groups, indicating clinical relevance. The presence of both talker and spatial cues synergistically enhanced NST of target speech, an effect more pronounced in TD adolescents and absent for competitor streams. Conclusions: LiD is characterized by impairment in processing attended speech rather than enhanced competitor processing or generalized auditory disengagement. Reduced cue integration observed in adolescents with LiD may contribute to their listening challenges. Significance: These findings suggest targeted therapeutic interventions enhancing selective auditory attention and multimodal cue integration may effectively address listening difficulties in adolescents with LiD.