The Impact of Pragmatic Delays for Deaf and Hard of Hearing Students in Mainstream Classrooms Louise Paatsch, PhD, Dianne Toe, PhD abstract Increasingly, across the globe, deaf and hard of hearing (DHH) students are educated in mainstream schools using spoken language for communication. Classroom interactions require the use of sophisticated pragmatic language skills. Pragmatic skills can be delayed in DHH students and create challenges for the social and emotional adjustment of DHH students at school. School-aged DHH children may present to pediatric health care providers with concerns about communicating effectively and forming friendships with hearing school peers. This review of pragmatic research between school-aged DHH students and their typically hearing peers reveals that this group of students displays some well-developed pragmatic skills such as turn taking, questioning, seeking general clarifications, and using a range of turn types. In it, we identify key areas in which DHH students experience significant challenges in both the social use of language and expository interactions (involving descriptions or explanations) that characterize classroom communication. DHH students tend to dominate interactions and have challenges with being contingent on their partners’ contributions. In addition, many DHH students display some difficulty with sequencing instructions and may use referents poorly, making it difficult for peers to follow their instructions and fully grasp their meaning. The conversation model is presented in this article as a guide for pediatric health care providers, clinicians, educators, and parents and/or caregivers to understand these pragmatic challenges. The model guides medical and education practitioners with the development of targeted intervention that will support these students’ ability to interact with others, learn more effectively, and develop friendships. Faculty of Arts and Education, School of Education, Deakin University, Geelong, Victoria, Australia Drs Paatsch and Toe developed the conceptualization, design, and all aspects of the manuscript preparation and approved the final manuscript as submitted. DOI: https://doi.org/10.1542/peds.2020-0242I Accepted for publication Aug 31, 2020 Address correspondence to Louise Paatsch, PhD, Faculty of Arts and Education, Deakin University, Locked Bag 20000, Geelong, VIC 3220, Australia. E-mail: louise.paatsch@deakin.edu.au PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). Copyright © 2020 by the American Academy of Pediatrics FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. FUNDING: No external funding. POTENTIAL CONFLICT OF INTEREST : The authors have indicated they have no potential conflicts of interest to disclose. SUPPLEMENT ARTICLE PEDIATRICS Volume 146, number s3, November 2020:e20200242I by guest on November 2, 2020 www.aappublications.org/news Downloaded from