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

Communication breakdown repair skills: Comparison between deaf and hard-of-hearing, and normal-hearing adolescents

OBJECTIVES

Communication breakdowns and their repair by deaf and hard-of-hearing (DHH) and hearing adolescents were examined in conversation with an unfamiliar communication partner.

METHOD

This study compared the number and type of clarification requests and responses to those requests of 16 DHH and 16 normal-hearing adolescents aged 11-16 years, in a 10-minute conversation with an unfamiliar adult. It also analyzed the relationship between speech intelligibility, communication breakdowns, and clarification requests by an unfamiliar adult. the Children's Communication Checklist (CCC) was completed by parents.

RESULTS

DHH adolescents demonstrated significantly higher usage of nonverbal clarification requests and verbal and nonverbal responses to clarification requests compared to normal-hearing adolescents in conversations with an unfamiliar adult. Furthermore, the subscale scores of the CCC and the speech intelligibility of DHH adolescents were significantly lower than those of normal-hearing adolescents. There were correlations between speech intelligibility and the speech subscale score of the CCC, as well as correlations between the pragmatic composite score of the CCC, the number of communication breakdowns, and the number of clarification requests by an unfamiliar adult.

DISCUSSION

The adolescents with DHH experienced more communication breakdowns in conversation with an unfamiliar adult and the number of clarification requests made by adults was higher.

A Review of the Conversational Pragmatic Skills of Children With Cochlear Implants

Many children who use cochlear implants (CI) have strong skills in many aspects of spoken language; however, limited information is available about their mastery of the pragmatic skills required to participate in conversation. This study reviewed published literature describing the pragmatic skills of children who use CIs in conversational contexts. Twenty-five studies met the inclusion criteria, and data were extracted describing participant characteristics, methodology, data type, outcomes, and factors associated with outcomes. Pragmatic skills were described in three broad categories: speech acts, turns, and breakdowns and repairs. Participants showed heterogeneity in age, age at implantation, duration of implant use, and languages used. Studies employed a variety of methodologies, used a range of different sample types and coding strategies, and considered different factors associated that might be associated with children's pragmatic skills. Across studies, children with CIs were reported to have a range of pragmatic skills in conversational contexts, from few to severe difficulties. The body of literature on this topic is small and considered heterogeneous children with CIs with a wide range of skills. Further research is needed to understand the pragmatics language skills of children with CIs and the factors influencing the diversity in skills observed.

The Assessment of Pragmatic Skills in Young Deaf and Hard of Hearing Children

The development of pragmatic skills does not often receive attention by professionals who are recommending or undertaking assessment of deaf and hard of hearing (DHH) children, yet social communication is vital for linguistic, social, emotional, and academic development. We acknowledge the challenges that DHH children have with pragmatic skills, advocate for monitoring of pragmatic development for all DHH children by medical professionals, and provide direction for assessment of pragmatic skills in young DHH children, particularly for clinicians and teachers who are tasked with that work. Pragmatic assessment is challenging because it must involve observations of the child in interaction with a communication partner, either directly during a specific interaction or through the reflections of a familiar adult. In this article, we recommend two complementary assessment procedures for young DHH children who use spoken language. Assessment 1 recommends that a parent or caregiver completes The Pragmatic Checklist to provide a picture of the child's functional communication. In assessment 2, the information gained through the checklist is complemented by using direct observations of a child in interaction with an adult or a peer. The Pragmatic Protocol uses a video-recorded conversation sample between the child and familiar person that is analyzed by a DHH professional for 30 different pragmatic behaviors. We conclude this article with a recommendation for pediatricians and health care professionals to monitor pragmatic developmental milestones in DHH children, to refer them for pragmatic assessments, and to collaborate with researchers to develop valid, reliable tools that adequately capture the pragmatic skill strengths and needs of DHH children.

Understanding Pretend Emotions in Children Who Are Deaf and Hard of Hearing

Children who are deaf and hard of hearing (DHH) and born to hearing parents have delays in their social-cognitive development and in particular in their theory of mind (ToM). These delays are often attributed to the difficulties they encounter in acquiring age-appropriate linguistic and communicative skills. The present study asks whether this developmental delay extends to problems with understanding pretend emotions and if linguistic difficulties are related to this area. A total of 173 children (82 DHH and 91 hearing) between 3 and 8 years of age received a set of emotion and language measures. Results showed that children who are DHH were delayed in understanding pretend emotions, and this was strongly related to their difficulties with expressive vocabulary and pragmatics. In summary, children who are DHH and have experienced reduced access to language and communicative interaction have a restricted understanding of the communicative intentions of emotional expressions. These delays may have implications for their social relationships with surrounding family and other children.