Current Research in Pragmatic Language Use Among Deaf and Hard of Hearing Children.

In this article, we provide a narrative review of research literature on the development of pragmatic skills and the social uses of language in children and adolescents, with a focus on those who are deaf and hard of hearing (DHH). In the review, we consider how pragmatic skills may develop over time for DHH children and adolescents depending on age, language context, amplification devices, and languages and communication modalities. The implications of these findings for enhancing intervention programs for DHH children and adolescents and for considering ideal contexts for optimizing the pragmatic development of DHH children are considered.

The Impact of Pragmatic Delays for Deaf and Hard of Hearing Students in Mainstream Classrooms.

Increasingly, across the globe, deaf and hard of hearing (DHH) students are educated in mainstream schools using spoken language for communication. Classroom interactions require the use of sophisticated pragmatic language skills. Pragmatic skills can be delayed in DHH students and create challenges for the social and emotional adjustment of DHH students at school. School-aged DHH children may present to pediatric health care providers with concerns about communicating effectively and forming friendships with hearing school peers. This review of pragmatic research between school-aged DHH students and their typically hearing peers reveals that this group of students displays some well-developed pragmatic skills such as turn taking, questioning, seeking general clarifications, and using a range of turn types. In it, we identify key areas in which DHH students experience significant challenges in both the social use of language and expository interactions (involving descriptions or explanations) that characterize classroom communication. DHH students tend to dominate interactions and have challenges with being contingent on their partners' contributions. In addition, many DHH students display some difficulty with sequencing instructions and may use referents poorly, making it difficult for peers to follow their instructions and fully grasp their meaning. The conversation model is presented in this article as a guide for pediatric health care providers, clinicians, educators, and parents and/or caregivers to understand these pragmatic challenges. The model guides medical and education practitioners with the development of targeted intervention that will support these students' ability to interact with others, learn more effectively, and develop friendships.

Assessing Pragmatic Skills Using Checklists with Children who are Deaf and Hard of Hearing: A Systematic Review.

This paper investigates the use of checklists to assess pragmatics in children and adolescents who are deaf and hard of hearing. A systematic literature review was undertaken to identify all of the published research articles between 1979 and 2018 on the topic of the assessment of pragmatics for this population of children and adolescents. The 67 papers identified in this review were analyzed and all papers that utilized a checklist to assess pragmatic skills were identified. Across the 18 different published papers on the use of pragmatic skills among children who are deaf and hard of hearing, nine checklists were identified. These nine checklists were then compared and contrasted on six key features including identification of a theoretical framework or model; the type of pragmatic skills measured; the age range of the child assessed; the information/outputs generated; the primary informant for the assessment; and reliability, validity, and normative data. The resulting analysis provides a comprehensive guide to aid clinicians, educators, and researchers in selecting an appropriate checklist to assess pragmatic skills for children and adolescents who are deaf and hard of hearing.

Communicative Competence of Oral Deaf Children While Explaining Game Rules.

Classrooms are characterized by interactions in a range of genres. The concise language required by expository interactions can be challenging for children who have atypical language, including children who are deaf and hard of hearing (DHH). This study compared the way three groups of upper primary school students (aged 8-13 years) taught a peer to play a new unfamiliar board game: (a) DHH "experts" teaching a "novice" hearing peer; (b) hearing experts teaching a DHH novice; and (c) a hearing expert teaching a hearing novice. All DHH students were enrolled in mainstream schools and used spoken language as the main mode of communication. All three groups were able to convey game rules and purpose, and navigate clarifications. Differences emerged in the accuracy of the use of referents when instructing their peers how to play the game. The specific content vocabulary and the need to emphasize new concise information also challenged the DHH children. This study highlights the importance of including expository tasks in language support and intervention for children who are DHH.

A comparison of pragmatic abilities of children who are deaf or hard of hearing and their hearing peers.

Pragmatic skills are the key to a satisfying and sustained conversation. Such conversation is critical for the development of meaningful friendships. Previous studies have investigated the conversational skills of deaf children while interacting with adults or when interacting with peers in structured referential tasks. There are few published studies that have compared the pragmatic skills of children who are deaf or hard of hearing (D/HH) in free conversation with their hearing peers. In this study, the conversational skills of 31 children who are D/HH when interacting with a hearing friend were compared with those of 31 pairs of hearing children. Findings suggest that school-aged children (Years 3-6 of study; aged 8-12 years) who are D/HH have a wide range of pragmatic skills that they use effectively when conversing with their hearing peers. Specifically, these children asked more questions, made more personal comments, initiated more topics, and took longer turns in their conversations with a hearing friend. In contrast, the conversations between hearing peers were very balanced with similar topic initiation, length of turn, numbers of questions, personal comments, and minimal answers. These findings will help teachers to provide support for both pragmatic and social skills in children who are D/HH.

The conversational skills of school-aged children with cochlear implants.

UNLABELLED: Children with cochlear implants have been shown to have language skills on a par with children with severe hearing losses who have hearing aids. Earlier implants, bilateral implantation, and focused intervention programmes may result in some children with cochlear implants displaying similar language skills to their hearing peers. The development of pragmatic skills is central to communication competence and underpins the development of friendships. Although some studies of pragmatic skills in children with cochlear implants have been reported, most have used a contrived referential communication task rather than free conversation. METHOD: This study investigated the conversational skills of 20 children with cochlear implants, aged between 9 and 12 years, in free conversation with their hearing peers. The pragmatic skills of these 20 deaf/hearing pairs or dyads were compared with the pragmatic skills of 20 hearing/hearing dyads. Pragmatic skills were analysed in terms of conversational balance, conversational turn types, and conversational maintenance. The impact of the participants' level of speech intelligibility was also investigated. RESULTS: Children with cochlear implants tend to dominate conversations with their hearing peers. They initiated more topics, took longer turns, asked more questions, and tended to make more personal comments while their hearing friends tended to use more conversational devices and minimal answers. In contrast, pairs of matched hearing children were very balanced in all of these aspects of conversation. Speech intelligibility did not appear to impact consistently on the pragmatic skills of the children with cochlear implants but all children had a relatively high level of speech intelligibility. DISCUSSION: Rather than being characterized by frequent conversational breakdown as in older studies, children with cochlear implants had a strong grasp of basic conversational rules. They conversed in a similar way to some deaf adults who also have been shown to take control of the conversation. Findings are discussed for their implications for intervention and future research.

The communication skills used by deaf children and their hearing peers in a question-and-answer game context.

Communication is frequently characterized by a sequence of questions and answers. Little is known about how well students who are deaf or hard of hearing (deaf/HH) understand their hearing classmates in the context of an inclusive setting. This study explored the communication skills used by deaf/HH children when asking and answering questions in a "trivia" game with their hearing peers. Thirty-four children with normal hearing and 34 children with a hearing loss ranging from mild to profound (>90 dB HL) participated in this study. Each of the 34 dyads included 1 child with normal hearing and 1 child with hearing loss, matched by gender and grade level at school. Dyads were videotaped and analyzed. Pairs were compared in terms of their capacity to repeat the question, strategies used to seek information, and accuracy of responses. Results showed that the group of hearing children was able to repeat more questions verbatim compared to the deaf/HH children. The deaf/HH group required a significantly greater number of repetitions, sought a greater number of general clarifications, and correctly answered more questions compared with the group of hearing children. The implications of these findings are discussed in terms of peer communication and pragmatic skill development.

The effects of speech production and vocabulary training on different components of spoken language performance.

A group of 21 hard-of-hearing and deaf children attending primary school were trained by their teachers on the production of selected consonants and on the meanings of selected words. Speech production, vocabulary knowledge, reading aloud, and speech perception measures were obtained before and after each type of training. The speech production training produced a small but significant improvement in the percentage of consonants correctly produced in words. The vocabulary training improved knowledge of word meanings substantially. Performance on speech perception and reading aloud were significantly improved by both types of training. These results were in accord with the predictions of a mathematical model put forward to describe the relationships between speech perception, speech production, and language measures in children (Paatsch, Blamey, Sarant, Martin, & Bow, 2004). These training data demonstrate that the relationships between the measures are causal. In other words, improvements in speech production and vocabulary performance produced by training will carry over into predictable improvements in speech perception and reading scores. Furthermore, the model will help educators identify the most effective methods of improving receptive and expressive spoken language for individual children who are deaf or hard of hearing.

The effects of phonological and morphological training on speech perception scores and grammatical judgments in deaf and hard-of-hearing children.

Seventeen primary school deaf and hard-of-hearing children were given two types of training for 9 weeks each. Phonological training involved practice of /s, z, t, d/ in word final position in monomorphemic words. Morphological training involved learning and practicing the rules for forming third-person singular, present tense, past tense, and plurals. The words used in the two training types were different (monomorphemic or polymorphemic) but both involved word final /s, z, t, d/. Grammatical judgments were tested before and after training using short sentences that were read aloud by the child (or by the presenter if the child was unable to read them). Perception was tested with 150 key words in sentences using the trained morphemes and phonemes in word final position. Grammatical judgments for sentences involving the trained morphemes improved significantly after each type of training. Both types of training needed to be completed before a significant improvement was found for speech perception scores. The results suggest that both phonological and morphological training are beneficial in improving speech perception and grammatical performance of deaf and hard-of-hearing children and that both types of training were required to obtain the maximum benefit.

Separating contributions of hearing, lexical knowledge, and speech production to speech-perception scores in children with hearing impairments.

Open-set word and sentence speech-perception test scores are commonly used as a measure of hearing abilities in children and adults using cochlear implants and/or hearing aids. These tests are usually presented auditorily with a verbal response. In the case of children, scores are typically lower and more variable than for adults with hearing impairments using similar devices. It is difficult to interpret children's speech-perception scores without considering the effects of lexical knowledge and speech-production abilities on their responses. This study postulated a simple mathematical model to describe the effects of hearing, lexical knowledge, and speech production on the perception test scores for monosyllabic words by children with impaired hearing. Thirty-three primary-school children with impaired hearing, fitted with hearing aids and/or cochlear implants, were evaluated using speech-perception, reading-aloud, speech-production, and language measures. These various measures were incorporated in the mathematical model, which revealed that performance in an open-set word-perception test in the auditory-alone mode is strongly dependent on residual hearing levels, lexical knowledge, and speech-production abilities. Further applications of the model provided an estimate of the effect of each component on the overall speech-perception score for each child.