Communication abilities in children with hearing loss - views of parents and daycare professionals

Development of Social-Pragmatic Understanding in Children With Congenital Hearing Loss and Typical Hearing Between the Ages of 4 and 6 Years

PURPOSE

This prospective longitudinal study aimed to explore (a) the development of social-pragmatic understanding of children with bilateral hearing aids (BiHAs), bilateral cochlear implants (BiCIs), and typical hearing (TH) between the ages of 4 and 6 years and (b) group differences between children with BiHAs, BiCIs, and TH.

METHOD

The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years.

RESULTS

The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, but most children with hearing loss (HL) still did not meet age expectations at the age of 6 years. Children with BiHAs and BiCIs both showed large-scale inferential difficulties, including utilizing theory of mind, utilizing verbal and visual information, and understanding conversational norms and emotions in context.

CONCLUSIONS

Children with BiHAs and BiCIs are at risk of delays in social-pragmatic understanding despite early detection of HL, early amplification, and cochlear implantation. Therefore, the social-pragmatic abilities of children with HL should be assessed regularly, and the children with HL should have early access to social-pragmatic interventions where utilizing contextual information is practiced comprehensively.

Acquisition of Pragmatic Skills in Paediatric Cochlear Implant Users

Pragmatic language skills are one of the most complex language skills. Children with hearing loss face difficulty in social participation and effective communication during mainstreaming. Without mastery of these skills, children may encounter significant challenges with abstract conversational communication and literacy. This study aimed to explore the age and pattern of acquisition of pragmatic skills in hearing-impaired children. Twelve (12) children with Cochlear Implants (CI) in the age range of 5 to 10 years with minimum 1-year post-implantation regular therapy and twelve (12) age-matched normal hearing children participated in the study. All participants were administered the 'Test of Pragmatic Skills' (Shulman, 1986) comprising different domains of pragmatics. Their responses were rated on a six-point rating scale from 0 to 5. A qualitative analysis of various domains revealed that paediatric cochlear implant users used varied pragmatic skills at approximately 3 years on average during the post-implantation period compared to the typically developing children who acquired the skills well below 3 years on average. Pragmatics is very well correlated to the child's cognition; hence, the higher the cognitive age, the earlier the acquisition of pragmatic skills. The results prove that pragmatic skills developed proportionately to their implant age but need to be at par with their cognitive age. Rehabilitation of CI children, thus, should levy heavy focus on varied pragmatic domains, which will facilitate contextually appropriate communication at the earliest possible time during the post-implantation period.