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 developmentLearning 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 later than children with normal hearing.

A sample of children from Spanish-speaking homes who are hard-of-hearing demonstrated less than optimal outcomes following cochlear implantation. The authors developed a unique diagnostic protocol to identify potential causes. Inclusion criteria included hearing loss identified by 3 months of age, amplification, a Spanish-speaking home, and enrollment in the statewide early intervention system by 6-months of age. The authors collected extensive demographic data from participants, and the participants completed the same language assessments in 6-month time intervals, examining receptive and expressive language as well as parent-child interaction. Additional assessments included cortical auditory-evoked potentials (i.e., P1), infant speech perception, auditory skill questionnaires, and audio recordings taken over a 12–16 hour period in the child's natural language environment. This auditory spoken language matrix allowed identification of good auditory performers who performed poorly on expressive language measures and poor auditory performers with poor expressive and receptive language outcomes. The comprehensive nature of the assessment allowed examination of spoken language input and helped determine if poor language outcomes were associated with a lack of spoken language input (Hart & Risely, 1995). This matrix allowed the authors to rule out audibility, discrimination, auditory development, and quality of exposure to auditory spoken language as causes of delayed development. The article discusses additional benefits of using this protocol.