Current Research in Pragmatic Language Use Among Deaf and Hard of Hearing Children

Document Type

Peer-Reviewed Article

Publication Date



In this article, we provide a narrative review of research literature on the development of pragmatic skills and the social uses of language in children and adolescents, with a focus on those who are deaf and hard of hearing (DHH). In the review, we consider how pragmatic skills may develop over time for DHH children and adolescents depending on age, language context, amplification devices, and languages and communication modalities. The implications of these findings for enhancing intervention programs for DHH children and adolescents and for considering ideal contexts for optimizing the pragmatic development of DHH children are considered.

  • Abbreviations:
    CI —
    cochlear implant
    DHH —
    deaf and hard of hearing

Many deaf and hard of hearing (DHH)* children and adolescents are at risk for limited access to language during the early years of life because of restricted auditory access to spoken language and a lack of signed language models. Language deprivation has significant consequences for children’s and adolescents’ cognitive, academic, and socio-emotional well-being.1 Although formal language skills, such as vocabulary and syntax, are important, perhaps the most critical linguistic competence is the ability to use language as a means of connecting and engaging with others, known as pragmatics. Pragmatic rules are socially constructed, culturally- and context-dependent norms for using language to engage with others.2 Pragmatics play a central role in an individual’s ability to take part in all social settings, including home, preschool, and school, as well as the larger community, and involves skills that guide our choice of language forms, topics, and functions. In working to understand the challenges faced by DHH children in communicating with others, it is important for pediatricians and other health care providers to attend to children’s ability to use language meaningfully for engaging in social relationships, beyond their ability to produce words and sentences. Difficulties in pragmatic use of language will impact the child’s ability to participate in many community and social activities, form friendships, and find meaningful work. It is critical for pediatric health care providers to be sensitive to these less obvious communication skills when interacting with DHH children and adolescents in their care and to support the development of these pragmatic skills to enable full participation of DHH children and adolescents within communities.


Published online November 2, 2020.












American Academy of Pediatrics