Children referred for audiology evaluation due to speech and language delays represent a neurodevelopmentally high-risk group. The audiology evaluation is a behaviorally-challenging encounter early in the diagnostic process. We assessed interfering behaviors (IB) that complicated completion of audiometry as predictors of autism spectrum disorder (ASD) diagnosis. This retrospective cohort study using the Military Health System electronic medical record included 296 children aged 18 to 71 months. Children who displayed IB had increased odds of receiving an ASD diagnosis compared to those who did not (OR = 5.6, 95% CI 2.6-12.1). Interfering behaviors had a high specificity (81%) and negative predictive value (94%) for ASD. The audiology evaluation may represent an opportunity early in the diagnostic process to stratify risk for ASD.