Purpose of Review <p>This systematic review aimed to examine how auditory comprehension deficits in children with Specific Language Impairment (SLI) are influenced by inferential comprehension skills, auditory processing abilities, and higher-order cognitive functions. We sought to identify the extent to which these factors interact and to clarify their combined impact on language understanding.</p> Recent Findings <p>Nineteen studies published in the last decade were analyzed according to PRISMA guidelines. Evidence consistently shows that children with SLI have marked difficulties in inferential comprehension, often linked to weaknesses in narrative macrostructure, theory of mind, and working memory. Auditory processing challenges—particularly speech perception in noise and temporal resolution—emerged as significant barriers to comprehension, while neurophysiological studies revealed abnormalities in subcortical encoding of rapid speech stimuli. Cognitive factors, including attentional control and fluid reasoning, were found to mediate the relationship between auditory input and language comprehension.</p> Summary <p>Auditory comprehension deficits in SLI are multifactorial, arising from an interaction between perceptual and cognitive processes. These findings underscore the importance of integrated interventions that target both auditory processing skills and higher-level cognitive functions to improve communication outcomes. Future research should investigate these mechanisms in other developmental conditions to refine diagnostic and therapeutic strategies.</p>