Pragmatic Skills in Children with Hearing Impairment

Background: Pragmatic language skills and the social use of language to communicate effectively are essential for functional interactions and peer relationships. Children with hearing impairment often experience delays in pragmatic development due to reduced auditory access, limited incidental learning, and fewer opportunities for naturalistic communication. Despite improvements in structural language outcomes through early hearing interventions, pragmatic competence remains underexplored, particularly in low-resource settings such as Pakistan. Objective: To evaluate and compare pragmatic communication skills in children with hearing impairment and their typically hearing peers. To assess the influence of age and hearing status on pragmatic outcomes. Methods: This cross-sectional observational study included 88 children aged 6–12 years, with equal representation of hearing impaired and typically hearing participants. Pragmatic skills were assessed using a standardized Pragmatic Communication Skills Checklist (PCCS), and data were analyzed using SPSS v20. Independent t-tests, chi-square tests, Pearson correlations, and multivariable linear regression were applied to evaluate group differences and predictive associations. Results: Typically hearing children scored higher on total PCCS and across all subdomains, with significant differences observed in 'personal' (p=0.04) and 'wants explanation' (p=0.04) domains. Age showed a significant positive association with total pragmatic scores (B=0.54, p=0.004). Hearing status did not significantly predict overall pragmatic performance after adjustment (p=0.11). Conclusion: Pragmatic language abilities improve with age in both groups; however, specific deficits persist in children with hearing impairment. Early, targeted interventions addressing expressive and explanatory functions are essential to support pragmatic development in this population.