Journal of Speech Language and Hearing Research最新文献

{"title":"Short-Term Effects of Semi-Occluded Vocal Tract Therapy on the Phonation of Children With Vocal Fold Nodules: A Randomized Controlled Trial.","authors":"Anke Adriaansen, Iris Meerschman, Kristiane Van Lierde, Sofie Claeys, Estella P-M Ma, Imke Kissel, Tine Papeleu, Evelien D'haeseleer","doi":"10.1044/2024_JSLHR-24-00243","DOIUrl":"10.1044/2024_JSLHR-24-00243","url":null,"abstract":"<p><strong>Purpose: </strong>The aim was to determine and compare the short-term effects of two intensive semi-occluded vocal tract (SOVT) programs, \"straw phonation\" (SP) and \"resonant voice therapy\" (RVT), on the phonation of children with vocal fold nodules.</p><p><strong>Method: </strong>A pretest-posttest randomized controlled study design was used. Thirty children aged 6-12 years were randomly assigned to the SP group (<i>n</i> = 11), RVT group (<i>n</i> = 11), or control group receiving indirect treatment (<i>n</i> = 8) for their voice problems. All participants received 11 hr of group voice therapy over four consecutive days. A multidimensional voice assessment consisting of both objective (dysphonia severity index and acoustic voice quality index) and subjective (pediatric voice handicap index and perceptual rating of overall severity) measures was performed pre- and posttherapy. Voice therapy effectiveness was evaluated using group-level analyses (linear mixed models) and individual-level analyses to investigate what proportion of participants changed to a clinically relevant degree.</p><p><strong>Results: </strong>Group-level analyses found no significant Time × Group interactions, indicating that the evolution over time did not differ among the three groups. Within-group effects of time showed a significant and equal improvement in dysphonia severity index in the SP and RVT groups and a significant improvement in perceptual rating of overall severity in the SP group. For dysphonia severity index, individual-level analyses showed that 36% and 45% of participants improved to a clinically relevant degree in the SP and RVT groups, respectively. For acoustic voice quality index, 38% improved to a clinically relevant degree in the SP group.</p><p><strong>Conclusions: </strong>Results suggest that short-term intensive SOVT programs may have a positive effect on voice quality and vocal capacities of children with vocal fold nodules. Participants seem to benefit more from a SP program than a RVT program.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":"68 2","pages":"456-477"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143124122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of F1-F2 Frequency Spacing on Spectral Integration in Combined Electric and Acoustic Stimulation.","authors":"Priyanka Jaisinghani, Yang-Soo Yoon","doi":"10.1044/2024_JSLHR-24-00273","DOIUrl":"10.1044/2024_JSLHR-24-00273","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to measure the effects of frequency spacing (i.e., F2 minus F1) on spectral integration for vowel perception in simulated bilateral electric-acoustic stimulation (BiEAS), electric-acoustic stimulation (EAS), and bimodal hearing.</p><p><strong>Method: </strong>Twenty listeners with typical hearing participated in synthetic vowel recognition. Four vowels were used with varying frequency spacings (/ͻ/: 270 Hz, /ʊ/: 653 Hz, /æ/: 1040 Hz, and /I/: 1607 Hz). F1 was acoustically simulated with a band-pass filtering, while F2 was electrically simulated using an eight-channel sine wave vocoder with matched input and output frequency range. Vowel recognition was measured in five listening conditions: BiEAS (F1 and F2 in both ears), EAS (F1 and F2 in the left ear), bimodal (F1 and F2 in opposite ears), cochlear implant alone (F2 alone in the left ear), and hearing aid alone (F1 alone in the left ear).</p><p><strong>Results: </strong>In EAS, spectral integration was significantly better at a 270-Hz spacing, while in bimodal hearing, spectral integration was significantly poorer at a 1607-Hz frequency compared to other frequency spacings. BiEAS conditions offered the best spectral integration, regardless of frequency spacing. Vowel confusion remained consistent and below chance level across the first three listening conditions. Bimodal interference occurred for the /I/ vowel when the cochlear implant ear perceives the dominant cue and the hearing aid ear perceives the nondominant cue. The F2 place cue is transmitted significantly better than the F1 height cue in BiEAS, EAS, and bimodal conditions.</p><p><strong>Conclusions: </strong>EAS and bimodal hearing integrates narrower frequency ranges better than wider spacings. EAS hearing provided greater outcomes over bimodal hearing, suggesting that within-ear (EAS) integration is more effective than across-ear (bimodal) integration. Bimodal interference may be a factor for variability in bimodal performance. Cautious interpretation and further research with real EAS and bimodal users are suggested to validate and extend these findings.</p><p><strong>Supplemental material: </strong>https://doi.org/10.23641/asha.28127249.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"792-807"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delayed Versus Atypical Speech Sound Development: A Markedness-Based Analysis of Speech Sound Disorder in Cantonese.","authors":"Akshay R Maggu, Xinyuan Shi, Rene Kager, Patrick C M Wong, Carol K S To","doi":"10.1044/2024_JSLHR-24-00377","DOIUrl":"10.1044/2024_JSLHR-24-00377","url":null,"abstract":"<p><strong>Purpose: </strong>Speech sound disorder (SSD) is one of the major speech disorders in school-age children. Given the heterogeneity in terms of subtypes within SSD, there is a need to develop techniques for a quick identification of these subtypes. Furthermore, given the paucity of studies from children with SSD from Cantonese-speaking homes and a noted prevalence of SSDs in Cantonese-speaking children, it becomes even more important to investigate the subtypes of SSDs in Cantonese-speaking children. In the current study, using a combined traditional ranking-based and novel weightage-based optimality theory (OT) approach, we conducted an inquiry in Cantonese-speaking 3- to 6-year-olds with and without SSD.</p><p><strong>Method: </strong>We compared the speech sound productions from 31 children with SSD (3 years old: <i>n</i> = 12; 4 years old: <i>n</i> = 9; 5 years old: <i>n</i> = 10) with 30 typically developing children (3 years old: <i>n</i> = 9; 4 years old: <i>n</i> = 10; 5 years old: <i>n</i> = 11). Speech samples were analyzed using a ranking-based and weightage-based OT approach.</p><p><strong>Results: </strong>Using the markedness hierarchy among affricates, fricatives, and plosives, we found that 77.4% of children in the SSD group conformed to the \"delay\" subtype, while 22.6% of children within the SSD group conformed to the \"atypical\" subtype. More specifically, for the typically developing children and the SSD-delay subgroup, stopping, de-affrication, and de-aspiration were observed, and the weight difference between faithfulness and markedness constraints increased with age. On the contrary, for the SSD-atypical subgroup, frication, affrication, and aspiration were found, and the values of weight difference between constraints decreased with age.</p><p><strong>Conclusions: </strong>The findings from the current study suggest that the weightage-based Maximum Entropy grammar approach can delineate between the SSD subgroups (i.e., SSD-delay vs. SSD-atypical) defined by the ranking-based traditional OT approach. These findings offer a starting point into the development of objective tools for clinicians for detecting the SSD subgroups to make decisions on treatment type, as we speculate different treatment approaches for SSD-delay versus SSD-atypical subtypes.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"491-505"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sentence Comprehension in Spanish-Speaking Children With Hearing Loss: On the Integration of Morphosyntactic and Lexico-Semantic Cues.","authors":"Analí Rosa Taboh, Diego Edgar Shalom, Belén Alvares, Carolina Andrea Gattei","doi":"10.1044/2024_JSLHR-24-00444","DOIUrl":"10.1044/2024_JSLHR-24-00444","url":null,"abstract":"<p><strong>Purpose: </strong>Children with hearing loss (CHL) who use hearing devices (cochlear implants or hearing aids) and communicate orally have trouble comprehending sentences with noncanonical order. This study explores sentence comprehension strategies in Spanish-speaking CHL, focusing on their ability to integrate morphosyntactic cues (word order, morphological case marking) with verbs differing in their syntax-to-semantics configuration.</p><p><strong>Method: </strong>Fifty-eight Spanish-speaking CHL and 58 children with typical hearing (CTH) with a hearing age of 3;5-7;8 (years;months; i.e., time of adequate access to sound, in the case of CHL since effective fitting or implantation) were recruited in Argentina. A sentence comprehension task using the truth-value judgment paradigm was designed, including sentences with activity verbs and object-experiencer psych verbs in subject-verb-object (SVO) and object-verb-subject (OVS) orders, thus varying in canonicity.</p><p><strong>Results: </strong>Both groups showed good comprehension of SVO sentences with activity verbs but had difficulties with structures that deviated from canonicity. Comprehension was at chance level in both groups and at all hearing ages for sentences with activity verbs in OVS order and sentences with object-experiencer psych verbs in SVO order (both are noncanonical for the verb type). Sentences with object-experiencer psych verbs in OVS order were also comprehended at chance level by CHL and by the youngest CTH.</p><p><strong>Conclusions: </strong>These results suggest that Spanish-speaking CTH aged 7 years prioritize semantic information over case marking in sentences with a noncanonical syntactic structure. In CHL, difficulties with noncanonical structures seem to extend to semantic deviations, at least until hearing age 7 years. CHL might also struggle with the semantic structures of object-experiencer psych verbs beyond the age when CTH do. These findings are relevant for the linguistic assessment and education of CHL.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"602-617"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hearing Loss Health Literacy in Speech-Language Pathologists: Impact of Academic Training and On-the-Job Experience.","authors":"Ellie Cooper, Lisa Fitton, Krystal Werfel","doi":"10.1044/2024_JSLHR-24-00185","DOIUrl":"10.1044/2024_JSLHR-24-00185","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to explore if academic training and/or on-the-job experience predicts general health literacy, hearing loss health literacy, and self confidence levels of speech-language pathologists (SLPs).</p><p><strong>Method: </strong>Participants included 423 SLPs with differing levels of academic training and on-the-job experience working with children who are deaf or hard of hearing (DHH). General health literacy, hearing loss health literacy, and confidence levels treating children who are DHH were assessed. Data were analyzed using SPSS, with descriptive statistics, Pearson's <i>r</i> correlations, and multiple linear regression models.</p><p><strong>Results: </strong>SLPs had high levels of general health literacy but marginal to low levels of hearing loss health literacy. Neither academic training nor on-the-job experience predicted general health literacy, but they were predictive of hearing loss terminology knowledge. Only on-the-job experience predicted in-depth hearing loss content knowledge. There was an interaction of training and experience for confidence of SLPs in treating children who are DHH. SLPs with greater years of experience exhibited lower confidence with an increasing amount of coursework, whereas SLPs with fewer years of experience displayed higher confidence with an increasing amount of coursework.</p><p><strong>Conclusions: </strong>Results indicated that the driving factor for development of in-depth hearing loss health literacy in SLPs is on-the-job experience. Methods of integrating experiential learning into academic training should be evaluated.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"740-761"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum to \"Vocal Characteristics of Infants at Risk for Speech Motor Involvement: A Scoping Review\".","authors":"","doi":"10.1044/2024_JSLHR-24-00820","DOIUrl":"10.1044/2024_JSLHR-24-00820","url":null,"abstract":"","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"578"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speech Technology for Automatic Recognition and Assessment of Dysarthric Speech: An Overview.","authors":"Chitralekha Bhat, Helmer Strik","doi":"10.1044/2024_JSLHR-23-00740","DOIUrl":"10.1044/2024_JSLHR-23-00740","url":null,"abstract":"<p><strong>Purpose: </strong>In this review article, we present an extensive overview of recent developments in the area of dysarthric speech research. One of the key objectives of speech technology research is to improve the quality of life of its users, as evidenced by the focus of current research trends on creating inclusive conversational interfaces that cater to pathological speech, out of which dysarthric speech is an important example. Applications of speech technology research for dysarthric speech demand a clear understanding of the acoustics of dysarthric speech as well as of speech technologies, including machine learning and deep neural networks for speech processing.</p><p><strong>Method: </strong>We review studies pertaining to speech technology and dysarthric speech. Specifically, we discuss dysarthric speech corpora, acoustic analysis, intelligibility assessment, and automatic speech recognition. We also delve into deep learning approaches for automatic assessment and recognition of dysarthric speech. Ethics committee or institutional review board did not apply to this study.</p><p><strong>Conclusions: </strong>Overcoming the challenge of limited data and exploring new avenues in data collection, artificial intelligence-powered analysis and teletherapy hold immense potential for significant advancements in dysarthria research. To make longer and faster strides, researchers typically rely on existing research and data on a global scale. Therefore, it is imperative to consolidate the existing research and present it in a form that can serve as a basis for future work. In this review article, we have reviewed the contributions of speech technologists to the area of dysarthric speech with a focus on acoustic analysis, speech features, and techniques used. By focusing on the existing research and future directions, researchers can develop more effective tools and interventions to improve communication, quality of life, and overall well-being for people with dysarthria.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"547-577"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142985378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying Tinnitus Perception Improvement: Deriving the Minimal Clinically Important Difference of the Minimum Masking Level.","authors":"Tae-Jun Jin, Sumin Lee, Donghyeok Lee, In-Ki Jin","doi":"10.1044/2024_JSLHR-24-00374","DOIUrl":"10.1044/2024_JSLHR-24-00374","url":null,"abstract":"<p><strong>Purpose: </strong>Tools that can reliably measure changes in the perception of tinnitus following interventions are lacking. The minimum masking level, defined as the lowest level at which tinnitus is completely masked, is a candidate for quantifying changes in tinnitus perception. In this study, we aimed to determine minimal clinically important differences for minimum masking level.</p><p><strong>Method: </strong>A 3-month tinnitus intervention combining counseling and sound therapy was conducted in 74 participants with chronic tinnitus. Minimum masking levels were measured at baseline and 3 months. The clinical global impression was evaluated at 3 months to measure changes in participants' self-perception of tinnitus. The minimal clinically important difference of the minimum masking level was calculated using anchored-based, effect size, standard error measurement, and receiver operating characteristic curve analysis.</p><p><strong>Results: </strong>The minimal clinically important difference analysis of the minimum masking level yielded a -5.5 dB SL from the receiver operating characteristic curve, a -8.1 dB SL from the standard error measurement, a -9.2 dB SL from the effect size, and a -10.3 dB SL from the anchor-based analysis. Of these, the minimal clinically important difference value with optimized sensitivity (.704) and specificity (.957) was a -5.5 dB SL, determined using receiver operating characteristic analysis.</p><p><strong>Conclusions: </strong>The proposed minimal clinically important difference value of the minimum masking level (-5.5 dB SL) provides a good level of sensitivity and specificity. Therefore, the minimum masking level may be an alternative for measuring changes in tinnitus perception.</p><p><strong>Supplemental material: </strong>https://doi.org/10.23641/asha.28156229.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"827-838"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speechreading Ability Affects Mandarin Tone Perception in Young Adults With Prelingual Hearing Impairment in China.","authors":"Fen Zhang, Xuehan Wei, Xiangyu Jiang, Liang Chen, Haifen Wang, Jianghua Lei","doi":"10.1044/2024_JSLHR-23-00676","DOIUrl":"10.1044/2024_JSLHR-23-00676","url":null,"abstract":"<p><strong>Purpose: </strong>This cross-sectional study explored how the speechreading ability of adults with hearing impairment (HI) in China would affect their perception of the four Mandarin Chinese lexical tones: high (Tone 1), rising (Tone 2), falling-rising (Tone 3), and falling (Tone 4). We predicted that higher speechreading ability would result in better tone performance and that accuracy would vary among individual tones.</p><p><strong>Method: </strong>A total of 136 young adults with HI (ages 18-25 years) in China participated in the study and completed Chinese speechreading and tone awareness tests. The participants were divided into three groups on their basis of their speechreading performance (HIGH, MIDDLE, and LOW speechreading ability), and their ability to recognize the four Mandarin tones was compared.</p><p><strong>Results: </strong>HI adults with high speechreading ability identified tones more accurately than HI adults with low speechreading ability. The overall performance for Tone 2 was the lowest across all the groups. We found a significant interaction between speechreading ability groups and tone levels; the high speechreading ability group performed significantly better than the low ability group when identifying Tones 1 and 4, and performance on Tone 3 also differed by speechreading ability.</p><p><strong>Conclusions: </strong>These results suggest that speechreading ability affects Mandarin tone perception in adults with HI in China. Higher speechreading ability was associated with better overall tone perception. Tone 2 was the most difficult tone to identify, while identification of the other three lexical tones depended on speechreading ability. In visual language processing, adults with HI must reconstitute phonological units from visual and auditory fragments. To determine the generalizability of these results, they should be examined in languages beyond Mandarin Chinese.</p><p><strong>Supplemental material: </strong>https://doi.org/10.23641/asha.28207784.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"654-664"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Associated With Social-Pragmatic Understanding in Deaf and Hard of Hearing and Typically Hearing 6-Year-Old Children.","authors":"Krista Tuohimaa, Soile Loukusa, Heikki Löppönen, Antti A Aarnisalo, Aarno Dietz, Antti Hyvärinen, Jaakko Laitakari, Satu Rimmanen, Jaakko Salonen, Ville Sivonen, Tanja Tennilä, Teija Tsupari, Sari Vikman, Nonna Virokannas, Johanna Hautala, Anna-Kaisa Tolonen, Taina Välimaa, Sari Kunnari","doi":"10.1044/2024_JSLHR-23-00574","DOIUrl":"10.1044/2024_JSLHR-23-00574","url":null,"abstract":"<p><strong>Purpose: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":51254,"journal":{"name":"Journal of Speech Language and Hearing Research","volume":" ","pages":"808-826"},"PeriodicalIF":2.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143034519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}