The role of assessment type in the variability in pragmatic language in deaf and hard-of-hearing adolescents.

PURPOSE: Children who are deaf/hard of hearing (DHH) and use spoken language often demonstrate differences in pragmatic language abilities relative to age-matched typically hearing (TH) peers, but inconsistencies in methodological approaches make comparisons among studies difficult. The degree to which assessment methodology impacts conclusions about pragmatic abilities in this clinical population has not been measured. This study aims to examine whether observed differences are related to variability in pragmatic skills (e.g., linguistic, paralinguistic, or extralinguistic pragmatics) or pragmatic assessment tool (e.g., behavioral, observation, parent questionnaire).

METHOD: Twenty-six TH and eight DHH adolescents (ages 10-13) participated in this study. Pragmatic language was assessed using a norm-referenced behavioral assessment (Test of Pragmatic Language, Second Edition), parent questionnaire (Children's Communication Checklist, Second Edition), and examiner observation (Pragmatics Protocol). Non-parametric tests of group differences were conducted on all pragmatic assessments to compare performance between hearing groups. A principal component analysis was run to identify shared variability within or across assessments.

RESULTS

There were significant differences in pragmatic language scores between the TH and DHH groups in two out of the three assessments: The Children's Communication Checklist-2 and the Pragmatics Protocol. Principal component analysis revealed that subcomponents covaried based on assessment type rather than underlying pragmatic skill.

CONCLUSIONS

Pragmatic language abilities are often overlooked when considering eligibility for speech-language services in DHH children. Children who score within one standard deviation of the mean on assessments can have delays in their pragmatic abilities that can impact their quality of life, which could be revealed with assessment of pragmatic abilities in more challenging social contexts (e.g., group conversations). These preliminary data suggest that clinicians and researchers should be cautious in using only one assessment to draw conclusions on pragmatic language abilities, when certain assessment types may reveal both nuanced and context-dependent information on pragmatic language abilities.