Language Underperformance in Young Children Who Are Deaf or Hard-of-Hearing: Are the Expectations Too Low?

Meinzen‐Derr, Jareen; Sheldon, Rose; Grether, Sandra; Altaye, Mekibib; Smith, Laura E.; Choo, Daniel I.; Wiley, Susan

doi:10.1097/dbp.0000000000000509

Cited by 20 publications

(19 citation statements)

References 26 publications

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“…3,4 Many deaf and hard of hearing (DHH) children demonstrate lags in pragmatic skills, even when they possess average cognitive abilities and average performance in other aspects of language functioning. 5,6 Recognizing that pragmatic skill development inevitably occurs within the context of the child's environment, emerging research has logically begun to explore factors in the DHH child's world to better understand these developmental gaps and to inform targeted interventions. This work is critical.…”

Section: Defining Pragmatics and Relational Factorsmentioning

confidence: 99%

Relational Factors in Pragmatic Skill Development: Deaf and Hard of Hearing Infants and Toddlers

et al. 2020

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In this article, we review relational factors in early childhood believed to contribute in unique ways to pragmatic skill development in deaf and hard of hearing (DHH) infants and toddlers. These factors include attending to infant interactions with caregivers and others, supporting development of theory of mind through play and use of mental state language (ie, describing one's own or others' thoughts, feelings, and beliefs), and providing accessible opportunities for social interaction. On the basis of a review of the literature and clinical experience, we offer prescriptive strategies for supporting DHH children's development in these areas. To improve outcomes for DHH children, medical care providers and allied health professionals have a responsibility to support the development of young DHH children's pragmatic abilities by understanding these variables, coaching caregivers regarding their importance, and facilitating referrals for support when necessary.

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Section: Defining Pragmatics and Relational Factorsmentioning

confidence: 99%

Relational Factors in Pragmatic Skill Development: Deaf and Hard of Hearing Infants and Toddlers

et al. 2020

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“…[2][3][4] Pragmatic skills are strongly associated with social functioning and academic achievement in DHH children. [5][6][7][8][9] Some DHH children who have average language skills on standardized language tests may still have delayed pragmatic skills. 8,10 Assessment of pragmatic skills is vital to identify DHH children who need additional intervention in the area of social communication.…”

Section: The Assessment Of Pragmatic Skills In Young Dhh Childrenmentioning

confidence: 99%

“…[5][6][7][8][9] Some DHH children who have average language skills on standardized language tests may still have delayed pragmatic skills. 8,10 Assessment of pragmatic skills is vital to identify DHH children who need additional intervention in the area of social communication. Failure to do so may result in underidentifying DHH children in need of targeted intervention to facilitate improved long-term outcomes.…”

Section: The Assessment Of Pragmatic Skills In Young Dhh Childrenmentioning

confidence: 99%

“…12 These screeners often fail to capture the nuanced difficulties with pragmatics described in this article, which are critical for academic, behavioral, and social development in young DHH children. [5][6][7][8][9] As a starting point, health care providers require understanding of the developmental milestones for pragmatic skills in typically developing children. Therefore, we offer a visual representation of pragmatic development in typically developing children with normal hearing based on the work of Paul and Norbury 13 (see Fig 1).…”

Section: Monitoring For Pragmatic Difficulties In Pediatric Practicesmentioning

confidence: 99%

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

et al. 2020

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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. WHAT'S KNOWN ON THIS SUBJECT: Language and developmental screening tools contain few items related to social communication, yet this is an area of vulnerability for DHH children. Two published reviews provide a useful guide for selecting appropriate assessment tools for pragmatic skills in DHH children. WHAT THIS STUDY ADDS: In this review, we identify the challenges associated with assessing social communication. We summarize studies of pragmatic assessment tools with DHH children, provide health care providers with a time line of pragmatic skill development, and recommend two complementary tools to assess pragmatic skills.

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“…3,[5][6][7][8][9][10][11][12][13] Even with appropriate access to sound, DHH children do not have the same quality of auditory experience and do not perceive speech and acquire language in the same way as individuals with hearing. 14,15 Research shows that ∼40% of DHH children aged #6 years may have significant language gaps, 16,17 which negatively affect social functioning and behavioral, academic, and employment outcomes. 6,[18][19][20][21][22] DHH adolescents have alarmingly high rates of low literacy and suboptimal educational attainment.…”

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confidence: 99%

A Technology-Assisted Language Intervention for Children Who Are Deaf or Hard of Hearing: A Randomized Clinical Trial

et al. 2021

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BACKGROUND AND OBJECTIVES: Children who are deaf or hard of hearing (DHH) often have persistent language delays despite early identification and interventions. The technology-assisted language intervention (TALI), which incorporates augmentative and alternative communication technology into a speech-language therapy model, was designed to support language learning. The study objective was to evaluate the impact of the TALI on spoken language outcomes in DHH children. METHODS: Children aged 3 to 12 years with mild to profound bilateral hearing loss were enrolled in a single-site randomized controlled trial. Children were randomly assigned to receive the TALI or treatment as usual (TAU) (with no change in current care) and were followed for 24 weeks. Primary outcomes included spoken language measures elicited from language samples. Secondary outcomes included standardized assessments. Intention-to-treat analyses were used. RESULTS: Analyses focused on 41 children randomly assigned to TALI (n = 21) or TAU (n = 20). Among all participants, mean age was 6.3 years (SD 2.5). Over 24 weeks, children in the TALI group, compared with those in the TAU group, had significantly greater increases in the length of phrases they used to express themselves (β = .91 vs .15, respectively; P< .0001). Similar findings were seen with conversational turn-taking and number of different words spoken. CONCLUSIONS: Providing visual supports for language concepts that are typically challenging for DHH children to acquire allowed children to process and comprehend spoken language more fully. Such strategies can mitigate persistent language delays with the goal of improving lifelong outcomes and independence across settings.

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Language Underperformance in Young Children Who Are Deaf or Hard-of-Hearing: Are the Expectations Too Low?

Cited by 20 publications

References 26 publications

Relational Factors in Pragmatic Skill Development: Deaf and Hard of Hearing Infants and Toddlers

Relational Factors in Pragmatic Skill Development: Deaf and Hard of Hearing Infants and Toddlers

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

A Technology-Assisted Language Intervention for Children Who Are Deaf or Hard of Hearing: A Randomized Clinical Trial

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