Factors Associated With Social-Pragmatic Understanding in Deaf and Hard of Hearing and Typically Hearing 6-Year-Old Children

Purpose: Children develop social-pragmatic understanding with the help of sensory, cognitive, and linguistic functions by interacting with other people. This study aimed to explore (a) associations between auditory, demographic, cognitive, and linguistic factors and social-pragmatic understanding in children who use bilateral hearing aids (BiHAs) or bilateral cochlear implants (BiCIs) and in typically hearing (TH) children and (b) the effect of the group (BiHA, BiCI, TH) on social-pragmatic understanding when the effects of demographic, cognitive, and linguistic factors are controlled for. Method: The Pragma test was used to assess social-pragmatic understanding in 119 six-year-old children: 25 children who use BiHAs, 29 who use BiCIs, and 65 TH children. The Pragma test is a standardized test that requires answering socially and contextually demanding questions with varying focuses and thus enables a comprehensive assessment of social-pragmatic understanding. Associations between auditory, demographic, cognitive, and linguistic factors and the Pragma test performance were analyzed. Between-groups differences in the Pragma test performance were analyzed while statistically controlling for the effects of factors that were associated with the Pragma test scores. Results: The BiHA users who had better unaided pure-tone average hearing thresholds had better social-pragmatic understanding. A higher level of maternal education and nonverbal intelligence were associated with a better social- pragmatic understanding in the BiHA and BiCI groups. Linguistic abilities correlated strongly with social-pragmatic understanding in all groups. The deaf and hard of hearing (DHH) groups differed from the TH children in social-pragmatic understanding even after the effects of maternal education, nonverbal intelligence, and linguistic skills were controlled for. Conclusions: Despite early diagnosis of hearing loss and intervention, many DHH children are still at risk for social-pragmatic difficulties. Several factors may associate with social-pragmatic understanding in DHH children, which highlights the importance of a wide-ranging, multidisciplinary assessment, and the planning of focused, assessment-based interventions.