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The Missing Link in Language Development of Deaf and Hard of Hearing Children: Pragmatic Language Development

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The Missing Link in Language Development of Deaf and Hard of Hearing Children: Pragmatic Language Development The Missing Link in Language Development of Deaf and Hard of Hearing Children: Pragmatic Language Development Dianne Goberis, M.A.,1 Dinah Beams, M.A.,2 Molly Dalpes, Au.D.,4 Amanda Abrisch, Au.D.,3 Rosalinda Baca, Ph.D.,5 and Christine Yoshinaga-Itano, Ph.D.5 ABSTRACT This article will provide information about the Pragmatics Checklist, which consists of 45 items and is scored as: (1) not present, (2) present but preverbal, (3) present with one to three words, and (4) present with complex language. Information for both children who are deaf or hard of hearing and those with normal hearing are presented. Children who are deaf or hard of hearing are significantly older when demonstrating skill with complex language than their normal hearing peers. In general, even at the age of 7 years, there are several items that are not mastered by 75% of the deaf or hard of hearing children. Additionally, the article will provide some suggestions of strategies that can be considered as a means to facilitate the development of these pragmatic language skills for children who are deaf or hard of hearing. KEYWORDS: Deaf, hard of hearing, pragmatic language development Learning Outcomes: As a result of this activity, the reader will be able to (1) identify the pragmatic language skills that children who are deaf or hard of hearing have the most difficulty mastering by 7 years of age; (2) identify the pragmatic language skills that are the latest developed with complex language for children with normal hearing; (3) differentiate the rate of pragmatic language development by age and degree of hearing loss; (4) compare and contrast the pragmatic language skills of children with normal hearing and children who are deaf or hard of hearing by age; and (5) develop teaching strategies for preschool-aged children who are deaf or hard of hearing to develop specific pragmatic language skills that are typically developed significantly This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. later than children with normal hearing. 1Mountain View Elementary School; 2Colorado Home Maximizing Intervention for Children Who Are Deaf and Intervention Program, Colorado Springs, Colorado; 3Lu- Hard of Hearing; Guest Editors, Cheryl DeConde John- cile Packard Children’s Hospital, Palo, Alto, California; son, Ed.D. and Christine Yoshinaga-Itano, Ph.D. 4Marion Downs Hearing Center; 5Department of Speech, Semin Speech Lang 2012;33:297–309. Copyright Language, and Hearing Sciences, University of Colorado, # 2012 by Thieme Medical Publishers, Inc., 333 Seventh Boulder, Colorado. Avenue, New York, NY 10001, USA. Tel: +1(212) 584- Address for correspondence and reprint requests: 4662. Christine Yoshinaga-Itano, Ph.D., Department of Speech, DOI: http://dx.doi.org/10.1055/s-0032-1326916. Language, and Hearing Sciences, University of Colorado, ISSN 0734-0478. CB 409, Boulder, CO 80309-0409 (e-mail: Christie.yosh- [email protected]). 297 298 SEMINARS IN SPEECH AND LANGUAGE/VOLUME 33, NUMBER 4 2012 Early identified children who are deaf or loss are disorders that greatly impact commu- hard of hearing (DHH) who are enrolled in a nication, yet have not been widely studied in the timely manner into appropriate early interven- realm of pragmatic development. Thus, it is tion programs with providers who have special- essential that researchers understand the prag- ized skills and knowledge in developmentally matic skills of DHH children to determine appropriate, parent-centered intervention with whether there is a need for pragmatic skills specialization in deafness and hearing loss have intervention to support communication. developed language skills in some areas that are One study in particular, which looked at similar to their typically hearing peers. Yoshi- 11-year-old children with SLI, found a signifi- naga-Itano et al1 found that children who are cant correlation between pragmatic language DHH with normal cognition who are identified difficulties and poor social outcome as well as and receive intervention prior to 6-months of expressive language related to victimization.2 age, develop language skills at 7 years of age These researchers assessed a group of 242 within the normal range of normally hearing 11-year-old children using a variety of ques- peers on tests of expressive and receptive lan- tionnaires, which were administered to the guage—the Expressive One-Word Picture Vo- children as well as their teachers. Pragmatic cabulary Test and the Test for Auditory difficulties were determined using the Child- Comprehension of Language. Unlike the gen- ren’s Communication Checklist, which is a eration prior to universal newborn hearing commonly used questionnaire to determine screening with appropriate early intervention pragmatic language impairment separate from services, this population is able to maintain a typical SLI. Victimization was based on scores rate of development established in the early from the My Life in School questionnaire, years of life. As a result, children who previously which is filled out by the child and can predict gained language at a rate of 45 to 65% of the rate whether she or he is at risk for victimization. of normally hearing children, now have the Using regression analysis, the most prominent capability of gaining language at 80 to 100% correlation was found between responses to the rate of children with normal hearing. The these two instruments. focus on the development of language skills for Similar studies have been done to assess children who are DHH has concentrated on “social cognition” of children with SLI. Research vocabulary development and size of the lexicon conducted by Marion Farmer3 assessed social as well as receptive and expressive syntax. cognition of four different groups of 10- and Although these are essential parts of language 11-year-old children: (1) children with SLI development that facilitate communication, attending a special school, (2) children with one important aspect of language development SLI attending a mainstream school, (3) control in this population has been largely overlooked. group with chronological age-matched peers Having the tools of vocabulary, expressive, and without SLI, and (4) control group with language receptive language are indeed essential for age-matched peers without SLI. The results communication. However, it is also important indicated that children with SLI in the special that children are able to use these tools effec- school showed significant deficits in social com- tively in social interactions with peers. This petence in comparison to the other three groups. This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. important component of language development These findings provide insight into the social that addresses an individual’s ability to use language use of children with communication language skills appropriately in social context deficits, such as SLI, who are not integrated into is called pragmatics. It has been an aspect of a mainstream school. These results suggest that language development at the most abstract children who are at risk for communication level. difficulties, such as children with hearing loss, Several studies have assessed the pragmatic should receive intervention in the mainstream development of children with disorders that classroom to prevent lower social competence affect a child’s ability to communicate with than children in specialized schools. peers, such as autism or specific language im- Additional studies have found that chil- pairment (SLI). However, deafness and hearing dren between the ages of 7 and 9 years of age LANGUAGE DEVELOPMENT IN HARD OF HEARING CHILDREN/GOBERIS ET AL 299 who score high on the Children’s Communica- 2000s, included predominantly children who tion Checklist, thus identifying pragmatic lan- were not identified through universal newborn guage impairment, are identified by teachers as hearing screening programs. having socioemotional difficulties.4 Thus, chil- Most et al8 conducted a study of 24 children dren with pragmatic difficulties are likely to be with hearing loss, 13 children with hearing aids perceived as having deficits in social and emo- and 11 children with cochlear implants, between tional development. Children who are DHH the ages of 6.3 and 9.4 years of age compared may also have socioemotional deficits that are with 13 children with normal hearing. Pragmat- manifested in pragmatic difficulties due to ic abilities were assessed with the pragmatic reduced communication abilities impacted by protocol of Prutting and Kirchner.9 Children difficulties in access to both spoken and visual with hearing aids and those with cochlear im- language. The question still remains, however, plants had similar pragmatic language abilities. of how DHH children who were identified Children with hearing loss had significantly less early (prior to 6 months, with the majority by effective and less flexible pragmatic language 3 months of age) develop pragmatically as abilities than their normally hearing peers. compared with normally hearing peers. Preliminary data from Yoshinaga-Itano10 Though research specifically done on prag- described the pragmatic skills of 54 DHH pre- matic development of children who are DHH is school age children (3- and 4-year-olds). Prag- not prevalent, several studies have looked at matic skills were determined using the multiple aspects of language development of Pragmatics Checklist,11,12 which looks at seven DHH children, including language
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