BACKGROUND: Poor follow-up compliance from school-based hearing screening typically undermines the efficacy of school-based hearing screening programs. Onsite diagnostic audiometry with automation may reduce false positives and ensure directed referrals. PURPOSE: To investigate the validity and time efficiency of automated diagnostic air- and bone-conduction audiometry for children in a natural school environment following hearing screening. RESEARCH DESIGN: A within-subject repeated measures design was employed to compare air- and bone-conduction pure-tone thresholds (0.5-4 kHz), measured by manual and automated pure-tone audiometry. STUDY SAMPLE: Sixty-two children, 25 males and 37 females, with an average age of 8 yr (standard deviation [SD] = 0.92; range = 6-10 yr) were recruited for this study. The participants included 30 children who failed on a hearing screening and 32 children who passed a hearing screening. DATA ANALYSIS: Threshold comparisons were made for air- and bone-conduction thresholds across ears tested with manual and automated audiometry. To avoid a floor effect thresholds of 15 dB HL were excluded in analyses. The Wilcoxon signed ranked test was used to compare threshold correspondence for manual and automated thresholds and the paired samples t-test was used to compare test time. Statistical significance was set as p ≤ 0.05. RESULTS: 85.7% of air-conduction thresholds and 44.6% of bone-conduction thresholds corresponded within the normal range (15 dB HL) for manual and automated audiometry. Both manual and automated audiometry air- and bone-conduction thresholds exceeded 15 dB HL in 9.9% and 34.0% of thresholds, respectively. For these thresholds, average absolute differences for air- and bone-conduction thresholds were 6.3 (SD = 8.3) and 2.2 dB (SD = 3.6) and they corresponded within 10 dB across frequencies in 87.7% and 100.0%, respectively. There was no significant difference between manual and automated air- and bone-conduction across frequencies for these thresholds. CONCLUSION: Using onsite automated diagnostic audiometry for children who fail hearing screening may improve the efficacy of school-based screening programs by reducing false positives and ensuring directed referrals for audiological or medical intervention or both.