Abstract
Although major strides have been made in supporting the linguistic development of deaf and hard of hearing (DHH) children, a high risk of pragmatic delay persists and often goes unrecognized. Pragmatic development (the growing sensitivity to one's communication partner when producing and comprehending language in context) is fundamental to children's social-cognitive development and to their well-being. We review the reasons why DHH children are vulnerable to pragmatic developmental challenges and the potential to create positive change. In this call to action, we then urge (1) medical providers to recognize the need to monitor for risk of pragmatic difficulty and to refer for timely intervention (beginning in infancy), (2) allied health professionals involved in supporting DHH children to incorporate development of pragmatic abilities into their work and to foster awareness among caregivers, and (3) the research community to deepen our understanding of pragmatics in DHH children with investigations that include pragmatics and with longitudinal studies that chart the paths to positive outcomes while respecting the diversity of this population. By working together, there is substantial potential to make rapid progress in lifting developmental outcomes for DHH children.
Highlights
Dr Szarkowski coconceptualized the manuscript, cowrote the initial draft of the manuscript, contributed to subsequent drafts, managed the edits, reviewed the literature, provided conceptual and content expertise, and critically reviewed and revised the manuscript; Prof Young coconceptualized the manuscript, cowrote the initial draft of the manuscript, contributed to subsequent drafts, reviewed the literature, provided conceptual and content expertise, and critically reviewed and revised the manuscript; Drs Matthews and Meinzen-Derr contributed to the conceptualization, wrote portions of the manuscript, reviewed the literature, provided conceptual and content expertise, and critically reviewed and revised the manuscript; and all authors approved the final manuscript as submitted
Pragmatic delays are common among deaf and hard of hearing (DHH) children
In the absence of plentiful “real interaction” experiences, there is a risk that DHH children will struggle to master the natural dynamics of conversation
Summary
Pragmatic delays are common among DHH children. From infancy through to adulthood, differences in developmental trajectories or delays have been observed in a range of skills, including maintaining joint attention, turn taking, topic maintenance and responding contingently to a partner during conversation, asking questions, repairing misunderstanding, and understanding jokes, deception, and sarcasm.[21,30,31,32,33,34].
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