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Journal Article Review

Emily Edwards

Audiology

Journal Article Review

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Journal Article Review
The journal I chose to review is “Pragmatic Abilities of Children With Hearing Loss Using

Cochlear Implants or Hearing Aids Compared to Hearing Children.” This study examined the

pragmatic abilities of 24 children aged 6.3–9.4 years with hearing loss (HL), including 13 using

hearing aids (HAs) and 11 using cochlear implants (CIs). A comparison was made with 13

hearing children of similar chronological and language ages. All children with HL utilized spoken

language, attended mainstream schools, and received communication therapy twice weekly.

Their only disability was hearing loss. Pragmatic abilities were evaluated using the pragmatic

protocol developed by C. A. Prutting & D. M. Kirchner, encompassing verbal, nonverbal, and

paralinguistic aspects. Pragmatic behavior is about understanding and using the rules of

language to interact effectively. This includes things like taking turns in conversation, staying on

topic, sharing information, and asking questions. Due to hearing loss, numerous children using

spoken language may encounter communication challenges in their daily interactions. Whether

struggling to understand speech as listeners or facing difficulties with intelligibility as speakers,

these communication hurdles can impact their pragmatic communication. The aim of this study

was to create a pragmatic profile for school-age children with hearing loss (HL) who are

individually integrated. This profile was then compared to children with normal hearing (NH)

who were matched based on both chronological and linguistic ages. It was hypothesized that

children with hearing loss would exhibit diverse pragmatic communication skills, but those with

normal hearing would display superior abilities. Additionally, it was explored whether children

with cochlear implants would demonstrate better pragmatic skills compared to those using

hearing aids.
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Technique/Design

To ensure a fair comparison, language proficiency of children was evaluated using three

subtests from the MAASE linguistic test: categories, resemblance, and difference. The MAASE

linguistic test was created in Hebrew to evaluate the sophisticated semantic language skills of

school-age children. The categories subtest involved verbally presenting children with 10

categories and prompting them to name three different objects related to each category. A fully

correct response (e.g., ring, bracelet, and earrings for jewelry) received a score of 2, a partial

response (e.g., diamond and gold) received 1, and an incorrect answer (e.g., glasses) or no

response at all received a score of 0. Same things for resemblance, 2 for they are both animals’’

for the resemblance between cat and dog, 1 for “they both have fleas”, and 0 for “the eyes.” As

well as the difference test, 2 for stating, "the dog barks and the cat meows", 1 for saying, "the

dog makes the cat run-away", and 0 for saying they dislike each other. The MAASE linguistic test

assessed children's language abilities through three subtests: categories, resemblance, and

difference, with scores ranging from 0 to 20. Higher scores indicated better language

proficiency. The average of these scores was converted to a language age based on grade level.

Norms were derived from 376 Hebrew-speaking children aged 5 to 12 with typical language

development.

The pragmatic protocol (Prutting & Kirchner, 1987) was created to characterize

pragmatic behaviors in both individuals with and without disabilities, focusing on the interactive

aspects of language use. In this study, the tool was employed to evaluate the pragmatic profile

of children in the context of spontaneous communication with a familiar adult serving as the

communication partner. Communication consists of three main components: verbal,

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paralinguistic, and nonverbal. Verbal includes pragmatic behaviors expressed through words,

such as responding appropriately, maintaining a coherent conversation, and choosing relevant

topics. Paralinguistic elements cover how words are delivered, including speech clarity,

intonation, voice modulation, and fluency. Nonverbal behaviors, on the other hand, encompass

aspects that do not involve spoken words, such as eye contact, facial expressions, and physical

gestures. For each participant, the protocol was executed using 15 minutes of video recorded

spontaneous conversation. The analysis focused on the utilization of the 29 distinct pragmatic

abilities observed in the specific interaction. This approach generated a comprehensive profile

of both pragmatic strengths and weaknesses in discourse behavior across these 29 parameters.

In the case of children with HL, their speech and language therapist served as the adult partner,

while for children with NH, the adult partner was either a relative or a neighbor.

To assess the pragmatic protocol, two trained judges analyzed videotaped spontaneous

conversations between children and adults. For each of the 29 parameters, judges

independently watched the tapes, identifying instances where the child used the parameter.

The judges categorized the overall use of each parameter as either "appropriate" or

"inappropriate" based on the adult partner's reactions. They also evaluated whether each

parameter contributed to, impaired, or had no effect on the interaction. A child's use of a

parameter was considered appropriate if it consistently contributed to the conversation.

Conversely, it was deemed inappropriate if, at least once during the 15-minute observation, the

child's behavior related to that parameter was judged to impair the conversation or its

continuation based on the partner's negative reactions. For each parameter that the judges did

not agree on, they watched the tape together, discussed it, and reached agreement.
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After obtaining consent from parents, speech and language therapists, and familiar

adults, one experimenter conducted individual sessions with each child lasting 30–45 minutes.

The sessions occurred in a quiet setting after school hours, either at the child's school, the

SHEMA center, or at home. The session began with the children taking three MAASE language

subtests to assess their linguistic level. Following this, the child and a familiar adult engaged in a

15-minute conversation using a box of games and materials, including a magician kit, coloring

book, crayons, pick-up-sticks, a card game, a puzzle, and an art kit. The spontaneous

conversation was recorded with a Sony digital 8 video camera set on a tripod, while the

experimenter exited the room during the interaction.

Population

The population consisted of twenty-four children with hearing loss (eleven of them

being Cochlear Implant users and thirteen of them being hearing aid users) and thirteen with

normal hearing from middle-high socioeconomic families according to parent education,

occupation, and place of residence. Of the 24 with hearing loss, thirteen are girls and eleven are

boys with a mean age of 7.7 years with their hearing loss being detected at a mean age of 1.8

years. All children used spoken language; studied in regular classes with hearing children; had

no disabilities other than the HL; and received communication rehabilitation twice per week

from an SLP. The thirteen children with normal hearing had a mean age of 7.4 years and had no

speech, language, or hearing difficulties or any other developmental disability according to the

parents.

Results
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The children with NH revealed a significantly higher percentage of appropriate

behaviors compared to the two groups of children with HL while no significant difference

emerged between the two groups with HL. It's important to highlight that out of the 29

behaviors, all but one was observed as appropriately used by at least one child with hearing

loss. Additionally, for numerous parameters, more than one child with hearing loss displayed

appropriate use of the behavior. However, a behavior was considered inappropriate even if a

child displayed only one instance of inappropriate use during the 15-minute interaction. As a

result, some behaviors were labeled as inappropriate for multiple children, even though they

were used appropriately at other times during the interaction. Essentially, there was

inconsistency in how children employed certain pragmatic behaviors. Concerning parameters

consistently used appropriately, all children in the HL group exhibited appropriate pragmatic

behavior on six parameters, mirroring the NH children. These parameters encompassed two

verbal aspects—the variety of speech acts and the use of topic selection—and two

paralinguistic aspects: prosody and fluency. However, NH children demonstrated appropriate

behaviors on more than double the number of parameters, encompassing the six parameters

that were appropriate for HL children and an additional seven parameters.

Conclusions

Based on this study, it appears that children with hearing loss can show various

appropriate ways of communicating during conversations. However, they haven't fully

mastered using these behaviors consistently or precisely, unlike their peers with normal hearing

who seem to be more consistent and accurate in how they use these communication skills. The

findings align with earlier research suggesting that children with hearing loss exhibit a delayed
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or different development of pragmatic abilities when compared to their peers with normal

hearing. The findings indicate that children with hearing loss demonstrated appropriate use of

various behaviors in all categories. However, their peers with normal hearing outperformed

them significantly only in verbal competencies. No significant differences were observed

between the two groups in paralinguistic and nonverbal pragmatics.

Areas Needing Further Study

Future research should explore the potential that the challenges observed in this

particular population may arise from language or auditory issues rather than strictly pragmatic

difficulties. Additionally, it's crucial to understand that the pragmatic protocol is designed for

describing specific interactions and serves as a screening tool only. Parameters marked as

inappropriate need further quantitative assessment in different situations to identify the

specific challenges and strengths of the child. This information can guide tailored interventions.

It's also important to mention that in this study, children with normal hearing interacted with a

family member or neighbor, while those with hearing loss interacted with their speech and

language therapist. This raises the possibility of a potential confounding variable.

Evaluation

I think this article did exactly what it wanted to do. It had a strong group of each HL and

NH. There are areas that can use further study, but all the data was clear and logical. Overall,

this article was very well written and fairly easy to understand and navigate.
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Most, T., Shina-August, E., & Meilijson, S. (2010). Pragmatic abilities of children with hearing
loss using cochlear implants or hearing aids compared to hearing children. Journal of Deaf
Studies and Deaf Education, 15(4), 422–437. https://doi.org/10.1093/deafed/enq032