Assessment Analysis and Interventions for Pragmatic Skills

  • Recent research suggests that pragmatic skills are delayed in children who are deaf or hard of hearing (D/HH) despite great gains in other aspects of language skills.
  • Formal assessment tools for pragmatic skills are often limited to checklists.
  • We share a detailed model for analysis and intervention, the CONVERSATION model.
  • Two key foundations to the model are the focus on interaction as a collaborative endeavour between two or more people, and the need for children and young people to engage in a wide variety of naturally occurring interactions.
  • The CONVERSATION model focuses upon both the individual with a hearing loss and their hearing partners and the role they both play in developing pragmatic skills.

Recent research into the pragmatic skills of children and young people who are Deaf or Hard of Hearing

Many children who are diagnosed with hearing loss in the first six months of life and who use cochlear implants or quality hearing aids are starting school with age appropriate spoken language in terms of syntax and vocabulary. There is growing awareness, however, that their pragmatic skills may lag behind these skills, impacting on social interactions and the opportunities to build strong friendships in inclusive educational settings. Recent studies show that pragmatic skills have been found to be delayed in toddlers despite early use of cochlear implants and auditory verbal therapy (Toe, Rinaldi, Caselli, Paatsch & Church, 2016). The authors query the nature of parent-child interactions and the way that parent control might impact on pragmatic development. Conversation Analysis (Sacks, Schegloff & Jefferson,1974) as a way of investigating the pragmatic skills during talk-in-interaction has provided insights into some of the challenges that primary school aged pairs of friends experience when negotiating a conversation, especially in relation to contingency, repairing communication breakdown, and providing listener feedback. By adolescence, conversations between young people who are D/HH and their hearing friends have many similarities to those between hearing friends, although contingency appears to remain a challenge.


The main type of assessment tool that has been used to assess pragmatic skills in children and young people is the checklist. These take several forms (Bishop, 1998; Prutting & Kirchner, 1987). Most recently, Yoshinago-itano (2015) has published a small study using the Pragmatic Checklist developed by Goberis et al. (2012). This checklist is simple to use and may provide a starting point for exploring pragmatic challenges in young children.

The CONVERSATION Model for supporting the development of pragmatic skills in students who are D/HH

We originally developed the CONVERSE model to support assessment and intervention for pragmatic skills in students who are D/HH (Paatsch & Toe, 2016). This model drew on the findings from our research to identify the areas in need of focus to support the development of pragmatic skills in children and young people who are D/HH.  We have further refined this model based on additional research, including further findings using Conversation Analysis, which has resulted in the development of the CONVERSATION model. This model is outlined in detail in an upcoming publication (Paatsch, Toe & Church, in press).

The starting point for this model is Collaboration. Conversations and interactions are collaborative endeavours, involving all participants in the way they co-construct the interaction. The next element of the model is Opportunities, where we focus on the importance of interacting with a range of conversational partners to support the development of pragmatic skills.

The third element of the CONVERSATION model acknowledges the importance of Non-verbal cues as essential components of a collaborative conversation. Listeners provide many cues or 'listener tokens' to speakers such as nods, change of posture and eye contact to send clear messages to their speaking partner that they are engaged in the conversation. These are just some of the many critical non-verbal cues that help to sustain and develop a satisfying conversation. However, it appears from our research that many children and young people who are D/HH may lack awareness of the importance of non-verbal cues. The fourth element of the model is Verbal cues. Although many students with hearing loss are developing strong spoken language skills, there are still some gaps and these are often more evident in more demanding activities such as expository tasks where more precise language is required. The fifth element of the model is Eye gaze. Eye gaze is a non-verbal cue used by speakers to negotiate turn-taking. In our research in to pragmatic skills of students who are D/HH, atypical eye gaze was common in many of the conversations investigated (Paatsch & Toe, 2016). The next element of the CONVERSATION model acknowledges the importance of Repair in sustaining conversation. Repair refers to the ways in which speakers manage to identify or resolve any misunderstanding in a conversation. Repair is constantly negotiated in all conversations but many school-aged students who are D/HH and conversing with their hearing friends do not appear to know how to repair the talk when they encounter difficulties, and this is an area where support may be needed. ​

To maintain a satisfying conversation, individuals need to be able to sustain Sequences of talk. These sequences go beyond a query and a response but involve sustained interactions where turns are fully contingent upon preceding turns. One of the ways that conversations are sustained is through the provision of acknowledgements. These are conversational devices such as 'yeah',' really' and 'oh' that function as listener tokens and let the speaker know that you are following their story. They are an important piece in the 'pragmatic skills tool box' and although some young people who are D/HH are adept users of acknowledgements we know little about their early development (Toe et al., 2016). The final four elements of the CONVERSATION model are Turn Taking, Initiating Topics, Otherness and Naturally Occurring Interactions. This model places a strong focus on the importance of naturally occurring interactions for supporting the development of effective pragmatic skills in children who are D/HH. Conversations have frequently been practised between teachers and students who are D/HH and it is possible that these more 'clinical' interactions may not be as productive as intended, and some may even undermine the development of pragmatic skills. For example, some forms of topic initiation modelled by teachers and speech pathologists with students with hearing loss have been found to shut down the conversation (Radford & Tarplee, 2000).

The CONVERSATION model aims to provide an excellent tool for teachers, parents and allied health professionals to support the process for assessing, analysing and planning for the development of pragmatic skills in children and young people who are deaf or hard of hearing.


Bishop, D. (1998). Development of the Children's Communication Checklist (CCC): A method for assessing qualitative aspects of communication impairment in children. Journal of Child Psychology and Psychiatry, 39, 879-891.

Goberis, D., Beams, D., Dalpes, M., Abrisch, A., Baca, R., & Yoshinaga-Itano, C. (2012). The missing link in language development of deaf and hard of hearing children: Pragmatic language development. Seminars in Speech and Language, 33(4), 297-309.

Paatsch, L., & Toe, D. (2016). The fine art of conversation: The pragmatic skills of school-aged children with hearing loss. In M. Marschark and P. E. Spencer (Eds.), The Oxford handbook of deaf studies in language: Research, policy and practice (pp. 94-113)New York: Oxford University Press.

Paatsch, L, Toe, D., & Church, A. (in press). Hearing loss and cochlear implantation. In L. Cummings (Ed.), Research in Clinical Pragmatics, Springer.

Prutting, C., & Kirchner, D. (1987). A clinical appraisal of the pragmatic aspects of language. Journal of Speech and Language Disorders, 52, 105-119.

Radford, J., & Tarplee, C. (2000). The management of conversational topic by a ten-year-old child with pragmatic difficulties. Clinical Linguistics & Phonetics14(5), 387-403.

Sacks, H., Schegloff, E. A., & Jefferson, G. (1974). A simplest systematics for the organization of turn-taking for conversation. Language50(4), 696–735.

Toe, D., Rinaldi, P., Caselli,  M., Paatsch, L., & Church, A. (2016).The development of pragmatic skills in children and young people who are deaf and hard of hearing. In M. Marschark, V. Lampropoulou & E.K. Skordilis (Eds.), Diversity in Deaf Education (pp 247-270) New York: Oxford University Press​

Yoshinago-Itano, C. (2015). The missing link in language learning of children who are deaf or hard of hearing: pragmatics. Cochlear Implants International, 16 Suppl 1:S53-4.