Pragmatic language abilities in children with cochlear implants: a comparison of developmental outcomes with typically hearing peers

Pragmatic skills, essential for effective social interactions, depend on both cognitive development and auditory input. Hearing loss can delay the development of these abilities, leading to potential social and communication challenges. This study examines pragmatic skills of deaf or hard of hearing children who have received a cochlear implant (CI) compared to those of their typical hearing (TH) peers. 48 children were assessed, 24 with CI and 24 with TH. Pragmatic skills were assessed using the standardized Italian "Assessment of Pragmatic Skills in Language MEDEA (APL Medea)" battery, which includes five tasks: Metaphor Comprehension, Implicit Meaning, Comics, Situations, and the Colour Game (a perspective-taking task). The study also investigated the impact of the age at cochlear implantation on pragmatic development. The results showed that CI children scored significantly lower than TH peers on verbal (p < 0.001) and figurative (p = 0.02) metaphor comprehension. No significant differences were found between the groups in the Comics (p = 0.181), Situations (p = 0.117), and the Colour Game (p = 0.187) subtests. Age of CI activation did not significantly correlate with pragmatic skills, although a positive correlation was observed between chronological age and mean subtest scores in the CI group. In conclusion, although children with CI generally perform well in language comprehension, they show difficulties in some of the specific pragmatic skills assessed. Early and targeted interventions are crucial to address improvement in pragmatic language abilities deficit.