The missing link in language learning of children who are deaf or hard of hearing: Pragmatics Christine Yoshinaga-Itano Department of Speech, Language & Hearing Sciences, University of Colorado, CO, USA Keywords: Deaf, Hard of hearing, Hearing impaired, Hearing loss, Pragmatic language development

Introduction Early identified children who are deaf or hard of hearing who have immediate and appropriate early intervention services, have demonstrated development of language, including vocabulary development and comprehension of English syntax to the age of 7 years that is similar to their typically developing peers (Yoshinaga-Itano et al., 2010). However, many children who have been found to have language development on standardized norm-based assessments within the normal range may find that they are not qualified for special education services, and they may have language skills that are qualitatively different from their peers with normal hearing. Unfortunately, current language assessment tools for these children who have been able to achieve age-appropriate language skills in some aspects of language do not adequately assess the development of expressive pragmatic skills.

Methods A Pragmatics Checklist with 45 items was developed in order to capture language skills of children who are deaf or hard of hearing that teachers of the deaf and speech/language pathologists identified as areas of concern for children in the preschool years (Goberis et al., 2012). The items for the checklist were adapted from Simon (1984), a teacher observation tool, to a teacher/parent questionnaire format. Additionally, the original checklist had presence versus absence of the skill (Yoshinaga-Itano, 1999) and the revised Pragmatic Checklist included scoring for absence, presence with one to three words and presence with complex language. A category between absence and presence with one to three words, demonstration of the pragmatic skill through non-verbal Correspondence to: Christine Yoshinaga-Itano, Department of Speech, Language & Hearing Sciences, University of Colorado, Campus Box 409, Boulder, CO 80309-0409, USA. Email: [email protected]

© W. S. Maney & Son Ltd 2015 DOI 10.1179/1467010014Z.000000000237

gesture or mime was included for instructional purposes. The Pragmatics Checklist was based on the theoretical work of Halliday (1975) and included seven pragmatic categories: (1) Instrumental (‘I want’), (2) Regulatory (‘Do as I tell you’), (3) Interactional (‘You and Me’), (4) Personal (‘Here I come’), (5) Heuristic (‘Tell me why’), (6) Imaginative (‘Let’s Pretend), and (7) Informative (‘I’ve got something to tell you’). Participants included 109 children with normal hearing between the ages of 2 and 7 years of age and 129 children who were deaf or hard of hearing between the ages of 3 and 7 years of age. Mastery of the item was defined as any item for which 75% of the children mastered the item with complex language.

Results Children with normal hearing demonstrated significant growth in pragmatic language development between the ages of 2 and 4 years. By 4 years of age, all but two of the pragmatic language items on the checklist were demonstrated with complex language by children with normal hearing and typical language development. However, for children who are deaf or hard of hearing only 3 of the 45 items were mastered with complex language by age 6 years. Thirty-one of the 45 items were mastered with complex language by 7 years of age. Even at the age of 7 years, there was a significant difference in the percentage of children who mastered the items when compared with children with normal hearing at 4 years of age. Children who are deaf or hard of hearing mastered 69% (31 of 45 items) at the age of 7 years. Children with normal hearing mastered 95.5% (43 of 45) at 4 years, 98% (44 of 45) at 5 years of age and 100% at 6 years of age. The 14 items not mastered by children who are

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Missing link in language learning of children who are deaf or hard of hearing

deaf or hard of hearing by 7 years of age (1) provide information on request; (2) repair incomplete sentences; (3) end conversations; (4) interject; (5) apologize; (6) request clarification; (7) make promises; (8) ask questions to problem solve; (9) ask questions to make predictions; (10) retell a story; (11) tell four- to six-frame story in right order; (12) create original story; (13) explain relationships between objects, actions, and situations; and (14) compare and contrast. Children’s pragmatic development differs by degree of hearing loss. Children with mild hearing loss had faster development than children with other degrees of hearing loss. However, at 4 years of age, children with mild hearing loss had mastered fewer than 50% of the items as compared with 95.5% of the items mastered by children with normal hearing. Children with moderate, moderate–severe, severe, and profound hearing loss had mastered fewer than 20% of the items at 4 years of age. For children with moderate, moderate–severe, severe, and profound hearing loss, significant development of pragmatic language skills occurred between 5 and 7 years of age. By 7 years of age, children with mild and moderate hearing loss had mastered almost 100% of the items, while children with moderate–severe, severe, and profound hearing loss had mastered about 80% of the items.

Discussion The children who were deaf or hard of hearing between the ages of 4 and 7 years, were children whose language scores on the Expressive One Word Picture Vocabulary Test and the Test of Comprehension of Language demonstrated similar mean performance with distributions similar to children with normal hearing. Although their language scores on these standardized and normed tests indicated that the majority of the children had language skills at age level, the children had significant delays in their pragmatic development. Even at 7 years of age, there were 14 items on the 45-item checklist that had fewer than 75% of the children who were deaf or hard of hearing who had mastered the item with complex language. The results of this study indicate that although children who are deaf or hard of hearing may demonstrate that they have some language skills comparable to their peers with normal hearing, that they have other language skills that indicate significant delay when compared with their typically developing peers with normal hearing. Delayed development in their expressive syntax resulting in shorter sentences and significantly impact the ability of the children to master pragmatic language skills using complex language.

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The development of some of the earliest pragmatic language skills in children with normal hearing seems to emerge between 2 and 3 years of age, and are mastered quickly between 3 and 4 years of age. In order to assure that children who are deaf or hard of hearing acquire these pragmatic language skills at ages similar to their typically developing peers, these skills should be introduced between 2 and 3 years of age. Pragmatic language skills that emerge between two years of age include (1) make polite requests – 70% by age 2–3 with one to three words; (2) make choices – 60% by age 2 years with one to three words; (3) give description of object wanted – 60% with one to three words by age 2 years; (4) express a specific personal need – 60% with one to three words by age 2 years; (5) request help – 55% with one to three words by age 2 years; (6) changes the style of commands or requests – 55% with one to three words at age 2 years; (7) give directions to make something – 35% with one to three words at age 2 years; (8) identify feelings – 60% with one to three words by age 2 years; (9) complain – 40% with one to three words by age 2 years; (10) ask questions to get information; and (11) ask questions because of curiosity. The last two items are the earliest pragmatic characteristics to emerge in the normative data. Although children did not display this skill with one to three words between the age of 2 and 3 years, they were mastered by the age 3 years with complex language, demonstrating that this skill develops very quickly in normal language development. The pragmatic checklist and development of children with normal hearing and children who are deaf or hard of hearing by item can be found at the following website http://www.mariondowns.com/prag matic-language.

References Goberis D., Beams D., Dalpes M., Abrisch A., Baca R., YoshinagaItano C. 2012. The missing link in language development of deaf and hard of hearing. Seminars in Speech and Language, 33(4): 297–309. Halliday M.A.K. 1975. Learning how to mean. London: Edward Arnold. Simon C.S. 1984. Functional-pragmatic evaluation of communication skills in school-aged children. Language Speech and Hearing Services in Schools, 15: 83–97. Yoshinaga-Itano C. 1999. Assessment and intervention with preschool children who are deaf and hard-of hearing. In: Alpiner J, McCarthy P, (eds.) Rehabilitative audiology children and adults. Philadelphia, PA: Lippincott Williams & Wilkins, 140–177. Yoshinaga-Itano C., Baca R., Sedey A. 2010. Describing the trajectory of language development in the presence of severe to profound hearing loss: a closer look at children with cochlear implants versus hearing aids. Otology & Neurotology, 31(8): 1268–1274.

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The missing link in language learning of children who are deaf or hard of hearing: pragmatics.

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