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What's That You Say? Communication Breakdowns and Their Repairs in Children Who Are Deaf or Hard of Hearing

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Title: What's That You Say? Communication Breakdowns and Their Repairs in Children Who Are Deaf or Hard of Hearing
Language: English
Authors: Fitzpatrick, Erin, Squires, Bonita, Kay-Raining Bird, Elizabeth
Source: Journal of Deaf Studies and Deaf Education. Oct 2020 25(4):490-504.
Availability: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://jdsde.oxfordjournals.org/
Peer Reviewed: Y
Page Count: 15
Publication Date: 2020
Document Type: Journal Articles
Reports - Research
Descriptors: Children, Deafness, Hearing Impairments, Communication Problems, Interpersonal Communication, Communication Strategies
DOI: 10.1093/deafed/enaa010
ISSN: 1081-4159
Abstract: Conversational fluency is important to form meaningful connections and relationships with the people around us but is understudied in children who are deaf or hard of hearing (D/HH). Communication breakdowns reduce conversational fluency. They occur when a speaker says something that interrupts the flow of conversation requiring a request for clarification or confirmation from their listener to repair the misunderstanding. Young children who are D/HH are at risk of more frequent communication breakdowns and fewer successful repairs than children with typical hearing (The missing link in language development of deaf and hard of hearing children: Pragmatic language development. "Seminars in Speech and Language," 33 (04), 297-309). About 14 children who were D/HH aged 7-12 year and 15 children with typical hearing were matched on chronological age. Comparisons of the number and duration of communication breakdowns, requests for repair, and responses to requests used by children in a 10-min conversation with an adult were completed. Results showed that while children who were D/HH demonstrated some differences, they were more similar to their typically hearing peers in communication breakdowns and repairs than previously reported in the literature.
Abstractor: As Provided
Entry Date: 2020
Accession Number: EJ1273448
Database: ERIC
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  Value: <anid>AN0145718568;big01aug.20;2020Sep15.02:57;v2.2.500</anid> <title id="AN0145718568-1">What's That You Say? Communication Breakdowns and Their Repairs in Children Who Are Deaf or Hard of Hearing </title> <p>Conversational fluency is important to form meaningful connections and relationships with the people around us but is understudied in children who are deaf or hard of hearing (D/HH). Communication breakdowns reduce conversational fluency. They occur when a speaker says something that interrupts the flow of conversation requiring a request for clarification or confirmation from their listener to repair the misunderstanding. Young children who are D/HH are at risk of more frequent communication breakdowns and fewer successful repairs than children with typical hearing (The missing link in language development of deaf and hard of hearing children: Pragmatic language development. Seminars in Speech and Language, 33 (04) , 297–309). About 14 children who were D/HH aged 7–12 year and 15 children with typical hearing were matched on chronological age. Comparisons of the number and duration of communication breakdowns, requests for repair, and responses to requests used by children in a 10-min conversation with an adult were completed. Results showed that while children who were D/HH demonstrated some differences, they were more similar to their typically hearing peers in communication breakdowns and repairs than previously reported in the literature.</p> <p>Effective communication is fundamental to the ability to form meaningful relationships with the people around us (Most, 2002). Conversational fluency refers to how efficiently a conversation progresses (Tye-Murray, 2003). Accurate detection of communication breakdowns and efficient repair are two key features of a fluent conversation (Erber, 1988). The goal of the present study was to examine communication breakdowns and their repairs in children who are deaf or hard of hearing (D/HH). Children who are D/HH are at higher risk for communication breakdowns, not only because of their attenuated hearing but also because hearing loss can lead to speech difficulties and language delays (Most, 2002). The purpose of this study was to compare communication breakdowns and repairs that spontaneously occurred during conversation in typically hearing (TH) children and those who were D/HH.</p> <hd id="AN0145718568-2">Communication Breakdowns and Repairs</hd> <p>Breakdowns in communication are defined as disruptions in the flow of conversation, where misspeaking or misperception of the speaker's message takes place (Caissie & Gibson, 1994). Communication breakdowns that happen in situations where the listener could not hear what the speaker said did not understand what the speaker said, or misinterpreted what the speaker said (Caissie & Gibson, 1994). A breakdown in communication can encompass multiple speaking turns within a conversation when common ground is not established immediately on a topic between conversational partners. When communication breakdowns are repaired, a common understanding is achieved once again, and the conversation can continue progressing. Learning to repair breakdowns is an important pragmatic ability.</p> <p>Breakdowns in communication can be repaired through various strategies implemented by either the speaker or the listener in a conversation. When a listener does not understand a speaker's message, repair can be attempted by requesting clarification or confirmation. When a listener requests clarification, they can do so through specific or nonspecific requests (Caissie & Gibson, 1994). Both types of requests for clarification signify to the speaker that something went wrong and that their conversational partner is confused. Specific requests for clarification are when the listener identifies the exact part of the speaker's message that was misunderstood or specifies the exact reason why they did not understand the speaker's message (e.g. "It has a motor"; "It has a what?"). In nonspecific requests for clarification, the listener requests for the speaker to clarify the message without specifying which part of the message was misunderstood (e.g. "Huh?", "What?", and "I don't understand."). Children's use of specific requests for clarification requires a more advanced pragmatic ability than nonspecific requests (Jeanes, Nienhuys, & Rickards, 2000). Specific requests are generally more effective than nonspecific requests in repairing communication breakdowns, as they identify the exact portion of the speaker's message that was misunderstood (Caissie & Wilson, 1995; Gagné, Stelmacovich, & Yovetich, 1991; Lloyd, 1999). Ultimately, this can guide the speaker toward a response that the listener believes will repair the specific locus of the communication breakdown (Gagné et al. 1991). In addition to being more effective in repairing communication breakdowns than nonspecific requests, specific requests for clarification indicate to a conversational partner that the listener has attempted to understand their message. Therefore, conversations where specific requests of clarification are used tend to be more satisfying for conversational partners (Gagné et al. 1991).</p> <p>In requests for confirmation, the listener seeks to establish that they interpreted a speaker's message correctly by repeating or paraphrasing what the speaker said, for example, "I went to the park." and "You went to the park?" (Caissie & Gibson, 1994). Furthermore, once a listener requests clarification and confirmation from their conversational partner, a repair strategy must be implemented by the speaker to resolve the communication breakdown such as repeating, rephrasing, confirming, or expanding upon previous the previous statement (Caissie & Gibson, 1994).</p> <hd id="AN0145718568-3">Pragmatic Ability in Children Who Are D/HH</hd> <p>Growing up with a hearing loss can negatively affect the development of spoken language (Lederberg, Schick, & Spencer, 2013) and speech intelligibility (Marschark, Shaver, Nagle, & Newman, 2015). A longitudinal study by Bruce Tomblin et al. (2015) examined the language outcomes of children, 6-month to 7-year-old, who were D/HH with mild-to-severe hearing loss who used hearing aids or had no amplification. Children who were D/HH showed lower morphological awareness and receptive language ability than their TH counterparts matched on age and socioeconomic status. The spoken language outcomes of children who are D/HH have improved with advancing technologies (i.e. modern hearing aids, cochlear implants), particularly when provided at an early age in combination with language therapy (Lederberg et al. 2013) and high-quality language input (Bruce Tomblin et al. 2015). Even when these factors align, we still cannot assume that the language abilities of children who are D/HH will develop commensurate with TH peers (Lederberg et al. 2013).</p> <p>Pragmatic skills also tend to be negatively impacted by hearing loss. Most, Shina-August, and Meilijson (2010) studied 24 seven-year-old children who were D/HH and used either hearing aids or cochlear implants. They concluded that the pragmatic skills of children who were D/HH were less advanced when compared with TH peers matched on either chronological age or linguistic age. Additionally, Goberis et al. (2012) asked the parents of children who were D/HH or TH of varying ages to identify pragmatic skills they believed their child had mastered. They found that TH children were reported to have mastered 95.5% of items on the provided checklist by age four and 100% by age six. In contrast, children with severe hearing loss had mastered only 6.6% of the items by age six and 69% by age seven. Children with mild-to-moderate hearing loss fared better, having mastered almost all the items on the checklist by age seven. Skills not mastered by the majority of children who were D/HH included providing information on request, repairing incomplete sentences, and requesting clarification (Goberis et al. 2012) all of which are a focus in the present study.</p> <hd id="AN0145718568-4">Conversational Repair in Children Who Are D/HH</hd> <p>Conversational fluency is one of the main areas of pragmatics that children who are D/HH struggle with. Caissie and Tranquilla (2010) noted that frequent breakdowns can lead to frustration, conversational withdrawal, and diminished the quality of life for individuals who are D/HH and the people that they communicate with on a daily basis. Acquiring skills to effectively manage breakdowns in communication betters the chance that when breakdowns happen, they will not take away from the integrity of conversations (Most, 2002).</p> <p>Tye-Murray (2003) reported that 8- to 9-year-old cochlear implant users had relatively poor conversational fluency in that they experienced a significantly greater amount of communication breakdowns and spent more time sitting in silence or attempting to repair breakdowns compared with age-matched TH children. Furthermore, speech intelligibility and receptive language skills were the strongest predictors of communication breakdowns in the children who were D/HH (Tye-Murray, 2003).</p> <p>Several studies have compared children who are D/HH and TH on their abilities to request clarification (Caissie & Wilson, 1995; Church, Paatsch, & Toe, 2017; Lloyd, Lieven, & Arnold, 2005; Most, 2002). Lloyd et al. (2005) compared 20 children who were D/HH with severe to profound hearing loss aged 7;9–12;0 (using hearing aid(s) or cochlear implants) to 10 younger TH children aged 5;10–7;10. They found no significant group differences in children's ability to request clarification when confronted with ambiguous content. The authors concluded that this finding supported the notion of a developmental lag in the conversational repair skills of children who were D/HH, as the TH group was 3.5 years younger than the D/HH group. However, they suggested that in order to confirm this developmental lag, additional studies are required in which children who are D/HH and TH are matched on chronological age or linguistic competence.</p> <p>Additionally, a study by Church et al. (2017) examined the communication breakdowns and conversational repairs of cochlear implant users and their TH peers aged 7;7–12;9 (years;months). In conversational language samples, the children who were TH consistently requested clarification when faced with communication breakdowns, but the children who were D/HH sometimes did not. Both groups made predominately nonspecific requests. Furthermore, TH children had a tendency to end the conversation or refuse to answer their conversational partner when multiple requests for clarification were made. Teachers at the children's schools stated that the children who were D/HH often did not interact with their TH peers (Church et al. 2017). It is possible that the children who were D/HH were fearful that they would be socially isolated if they professed to their peers that they did not understand something during a conversation, thus requesting clarification/confirmation less often than would be useful to them. Consistent with this idea, Erber (1988) noted that children who are D/HH sometimes pretended that there was no breakdown in communication within their conversations and therefore avoided requesting clarification from their partner.</p> <p>Caissie and Wilson (1995) studied 28 children aged 9–12 years, which placed in seven quartets featuring one child who was D/HH and three TH conversational partners. The children who were D/HH all used bilateral hearing aids. In each group, the experimenter read a short story and then instructed the child who was D/HH to ask three questions to and answer three questions from each of their TH group members during conversation. Four groups received intervention on what communication breakdowns are and why/how they happen; effective message sending; evaluating if a listener is understanding your message; using specific and nonspecific requests for clarification; and responding to such requests. The intervention groups also engaged in realistic role play, often in challenging communicative environments. Pre-intervention, communication breakdowns occurred in 19–41% of the speaking turns of participants who were D/HH and all children who were D/HH rarely requested clarification, leaving breakdowns unrepaired. Breakdowns rarely occurred in communications between children who were TH. All children used nonspecific more than specific requests for clarification and usually simply repeated themselves in response to requests to clarify (Caissie & Wilson, 1995). Overall, children in nontreatment quartets showed very little change at posttest. Postintervention treated participants who were D/HH experienced fewer breakdowns and were less likely to use just repetition in response to requests to clarify, although they still used repetition more than any other repair strategy.</p> <p>Additional studies have analyzed the ability to respond to stacked (i.e. consecutive) requests for clarification in children who are D/HH (Caissie & Wilson, 1995; Ciocci & Baran, 1998; Most, 2002). Ciocci and Baran (1998) examined 16 children aged 4;0–7;6. The study included eight children who were D/HH with profound bilateral hearing loss (all hearing aid users) and eight children who were TH. Children who were D/HH and the experimenter used total communication (Pidgin Sign English and spoken communication). Participants engaged in two language sample elicitation activities: discussing familiar picture books and toy play. During both activities, the experimenter initiated 10 instances of three or more stacked nonspecific requests for clarification in a row. Ciocci and Baran determined that children who were D/HH were more likely to use revision than repetition as a repair strategy regardless of how often a request was made in a stacked sequence, while TH children were equally likely to use both revision and repetition (Ciocci & Baran, 1998).</p> <p>Most (2002) studied 26 children between the ages of 11 and 18 years: 10 TH children and 16 children with bilateral severe to profound hearing loss, half with good, and half with poor speech intelligibility. Children who were D/HH used hearing aids. Participants described five photos, while the experimenter made three stacked nonspecific clarification requests (i.e. "Huh?", "What?", and "I don't understand."). All groups usually repeated themselves after the first request. After additional requests, exact repetitions decreased. TH children instead added new information, expanded one sentence into two, and provided additional background information more often than children who were D/HH in either the poor or good intelligibility groups.</p> <p>The reviewed literature shows that communication breakdowns occur more often with children who are D/HH than their TH counterparts. When breakdowns occur, children who are D/HH and TH tend to request clarification infrequently, and when they do, they are more likely to produce nonspecific than specific requests. Finally, repetition and revision are the most common responses to requests for clarification used by both children who are D/HH and TH, but TH children are more likely to change their responses and add more information with stacked requests (Caissie & Wilson, 1995; Ciocci & Baran, 1998; Most, 2002). In addition, repair strategies can be successfully taught in the D/HH population. However, much of the research on communication breakdowns and conversational repairs in children who are D/HH have involved contrived tasks such as experimenters simulating breakdowns, and/or inserting a prespecified number of requests for clarification (Caissie & Wilson, 1995; Ciocci & Baran, 1998; Most, 2002).</p> <hd id="AN0145718568-5">The Present Study</hd> <p>The present study is distinct in that the conversations between the child and experimenter were naturalistic; therefore, the frequency of breakdowns and repairs could be more authentically observed. Additionally, while some previous studies have looked at frequency of breakdowns, in the present study, we also analyze how long it takes for a clear resolution of the communication breakdown to occur. Often several turns between the listener and speaker may pass before a breakdown is repaired and the conversation can move forward again. This negotiation of meaning over several speaking turns has not been studied in children who are D/HH. At last, with regard to the D/HH population, requests for confirmation have typically been studied in combination with specific requests for clarification (Caissie & Gibson, 1994; Caissie & Wilson, 1995), rarely receiving attention in the literature as an individual strategy. The present study examines specific requests for clarification, nonspecific requests for clarification, and requests for confirmation, independently.</p> <p>The goal of the present study, then, was to examine the frequency and duration (from initiation to resolution) of communication breakdowns, the frequency and type of requests for clarification or confirmation given a breakdown, and the frequency and type of responses to requests taking place in 10-min, unstructured conversations with an experimenter. Performance of children who were D/HH and TH was compared.</p> <p>Table 1. Descriptive characteristics for the deaf or hard of hearing (D/HH) and typically hearing (TH) groups including age, socio-economic status information, standardized nonverbal reasoning, standardized expressive vocabulary, language sample data, and hearing information</p> <p> <ephtml> <table><thead><tr><th>. </th><th colspan="2">D/HH (<italic>n</italic> = 14). </th><th colspan="2">TH (<italic>n</italic> = 15). </th></tr><tr><th>Measure. </th><th>M(SD). </th><th>Range. </th><th>M(SD). </th><th>Range. </th></tr></thead><tbody><tr><td>Age (months) at time of testing </td><td>120.57 (15.92) </td><td>94–143 </td><td>110.40 (14.81) </td><td>86–132 </td></tr><tr><td colspan="5"><italic>Socioeconomic status information</italic></td></tr><tr><td># years education–mother </td><td>15.29 (1.27) </td><td>14–18 </td><td>16.73 (2.79) </td><td>13–22 </td></tr><tr><td># years education–father<sup>*</sup></td><td>14.08 (1.75) </td><td>12–16 </td><td>15.80 (2.48) </td><td>13–22 </td></tr><tr><td>Family income </td><td>3.80 (1.48) </td><td>1–5 </td><td>4.25 (0.62) </td><td>3–5 </td></tr><tr><td>Nonverbal reasoning (SS) </td><td>10.00 (2.96) </td><td>3–15 </td><td>8.60 (2.72) </td><td>5–14 </td></tr><tr><td>Expressive vocabulary (SS) </td><td>100.64 (11.50) </td><td>78–122 </td><td>104.40 (10.61) </td><td>91–136 </td></tr><tr><td colspan="5"><italic>Language sample data</italic></td></tr><tr><td>% intelligibility </td><td>98.6 (1.0) </td><td>97.3–100 </td><td>98.9 (1.5) </td><td>95.3–100 </td></tr><tr><td>Total # utterances </td><td>130.9 (23.4) </td><td>92–171 </td><td>136.0 (31.5) </td><td>88–180 </td></tr><tr><td>Total # words </td><td>742.1 (182.3) </td><td>371–986 </td><td>757.1 (242.0) </td><td>349–1292 </td></tr><tr><td># different words </td><td>240.6 (36.3) </td><td>158–282 </td><td>246.1 (50.4) </td><td>147–309 </td></tr><tr><td>MLUm </td><td>6.43 (1.05) </td><td>4.53–7.88 </td><td>6.29 (1.38) </td><td>3.76–9.06 </td></tr><tr><td colspan="5"><italic>Hearing information</italic></td></tr><tr><td>PTA (right)<sup>*</sup></td><td>47.38 (17.92) </td><td>21.70–86.70 </td><td>9.18 (4.25) </td><td>1.70–18.30 </td></tr><tr><td>PTA (left)<sup>*</sup></td><td>53.09 (16.13) </td><td>23.30–76.70 </td><td>10.11 (4.62) </td><td>3.30–21.70 </td></tr><tr><td>Age of hearing loss diagnosis </td><td>32.64 (29.01) </td><td>0–84 </td><td /><td /></tr><tr><td>Age of device acquisition (left) </td><td>45.67 (26.68) </td><td>8–92 </td><td /><td /></tr><tr><td>Age of device acquisition (right) </td><td>45.54 (25.55) </td><td>8–92 </td><td /><td /></tr><tr><td>Device duration (earliest acquired) </td><td>75.15 (30.69) </td><td>35–122 </td><td /><td /></tr></tbody></table> </ephtml> </p> <p> <emph>Notes.</emph> M = mean. SD = standard deviation. Education level was ordered from 1 (high school) to 6 (doctoral degree or professional degree, e.g. medicine, law). Family income was ordered from 1 (<$30,000/year) to 5 (>$125,000/year) and reported for 10 children who are D/HH and 12 TH children. SS = standard scores. MLUm = mean length of utterance in morphemes for complete and intelligible utterances. PTA = pure tone average thresholds of 500, 1000, and 2000 Hz, measured in decibels. Device duration was calculated by subtracting the age of the first device required (as reported by the parent) from the child's age at testing. D/HH: age of device acquisition in the left ear (<emph>n</emph> = 12), age of device acquisition in the right ear (<emph>n</emph> = 13), education level of father (<emph>n</emph> = 13), and family income (<emph>n</emph> = 10); TH: family income (<emph>n</emph> = 12). Normative means (and standard deviations) for tests of nonverbal reasoning = 10 (<reflink idref="bib3" id="ref1">3</reflink>) and expressive vocabulary = 100 (<reflink idref="bib15" id="ref2">15</reflink>). <sups>*</sups> = significantly different at an alpha of <emph>p</emph> <.05.</p> <p>It was hypothesized that conversations with children who were D/HH would include more communication breakdowns, more coded utterances before repair, and more unresolved breakdowns than conversations with TH children (Caissie & Wilson, 1995; Tye-Murray, 2003). Furthermore, it was predicted that children would request clarification/confirmation infrequently in both groups, but when present, nonspecific requests would be more frequent than specific requests for clarification (Church et al. 2017). At last, it was hypothesized that both groups of children would use repetition and revision as repair strategies most often in response to requests for clarification made by the experimenter (Caissie & Wilson, 1995; Ciocci & Baran, 1998; Most, 2002).</p> <hd id="AN0145718568-6">Methods</hd> <p></p> <hd id="AN0145718568-7">Participants</hd> <p>This study was a secondary analysis of data collected for a larger study examining morphological and reading ability in children who are D/HH in comparison to TH children. Participants were 29 children between the ages of 7 and 12 years, 14 D/HH and 15 TH, group-matched on chronological age.</p> <hd id="AN0145718568-8">Inclusion and exclusion criteria</hd> <p>According to parent report, all children were monolingual English speakers and nonsigners, did not attend French immersion before grade three, and did not have a diagnosed intellectual disability. TH children with any parent-reported diagnosis that could impact development were excluded. We included children who were D/HH with parent-reported diagnoses of attention-deficit hyperactivity disorder (ADHD), reading impairment, or language impairment because these diagnoses often overlap with and may be diagnosed as a consequence of being D/HH. One child who was D/HH was excluded from the analysis even though he did not have a reported diagnosis of intellectual disability because he scored more than 2 standard deviations (SDs) below the mean on our measure of nonverbal reasoning but also exhibited concerning behaviors during testing that were not age-appropriate and required considerable support from his mother. For these reasons, we suspected that the report of no intellectual disability was probably not accurate.</p> <hd id="AN0145718568-9">Recruitment</hd> <p>Participants were recruited through word of mouth, social media, and participation in previous studies. Children who were D/HH were additionally recruited through Atlantic Provinces Special Education Authority (APSEA), an organization that oversees the education of over 900 children who are D/HH across Nova Scotia and New Brunswick. All were currently receiving direct or consultative APSEA services from an itinerant teacher.</p> <hd id="AN0145718568-10">D/HH group</hd> <p>The D/HH group included three females and 11 males, one who was reported to have a diagnosis of ADHD and literacy difficulties. Group and individual demographic data, measures related to hearing loss, and nonverbal reasoning and language measures are reported in Tables 1 and 2, respectively. Level of hearing loss varied from mild to severe (25–90 decibels) in both ears, with the exception of one child who had a severe loss (pure tone average = 70.0 decibels) in one ear and typical hearing (pure tone average = 21.7 decibels) in the other ear. About 11 of the participants who were D/HH wore hearing aids (<reflink idref="bib1" id="ref3">1</reflink>, right ear only), two used bone-anchored hearing devices (<reflink idref="bib1" id="ref4">1</reflink>, left ear only), and the child who had typical hearing in one ear wore no assistive device. The two participants who wore bone-anchored hearing devices were adopted from China as babies. Mean age of hearing loss diagnosis was approximately 2.5 years and mean age of assistive technology acquisition was about 4 years. Consequently, mean duration of device use (i.e. age at testing minus age at which the first device was acquired, according to parent report) for all aided children was more than 6 years. If reported, parents in this group had at least a high school education.</p> <p>Table 2. Individual data for participants who were D/HH (<emph>n</emph> = 14): age at testing, grade, gender, age of diagnosis of D/HH, pure-tone average thresholds in the right ear (PTA-R), pure-tone average thresholds in the left ear (PTA-L), duration of device use, hearing devices used, and additional diagnoses</p> <p> <ephtml> <table><thead><tr><th>ID#. </th><th>Age (months). </th><th>Grade. </th><th>Gender. </th><th>Age of diagnosis of D/HH (months). </th><th>PTA-R (dB). </th><th>PTA-L (dB). </th><th>Duration of device use (months). </th><th>Hearing devices. </th><th>Additional diagnoses. </th></tr></thead><tbody><tr><td>D01 </td><td>123 </td><td>4 </td><td>M </td><td>82 </td><td>28.3 </td><td>73.3 </td><td>39 </td><td>2 HA </td><td>ADHD, literacy disorder </td></tr><tr><td>D02 </td><td>119 </td><td>4 </td><td>M </td><td>36 </td><td>21.7 </td><td>70.0 </td><td>n/a </td><td>none </td><td /></tr><tr><td>D04 </td><td>114 </td><td>4 </td><td>F </td><td>0 </td><td>43.3 </td><td>46.7 </td><td>98 </td><td>2 HA </td><td /></tr><tr><td>D05 </td><td>118 </td><td>4 </td><td>M </td><td>50 </td><td>45.0 </td><td>43.3 </td><td>75 </td><td>2 HA </td><td /></tr><tr><td>D06 </td><td>131 </td><td>5 </td><td>M </td><td>48 </td><td>31.7 </td><td>28.3 </td><td>59 </td><td>2 HA </td><td /></tr><tr><td>D07 </td><td>95 </td><td>2 </td><td>M </td><td>60 </td><td>33.3 </td><td>23.3 </td><td>35 </td><td>2 HA </td><td /></tr><tr><td>D10 </td><td>96 </td><td>2 </td><td>M </td><td>0 </td><td>86.7 </td><td>76.7 </td><td>48 </td><td>2 HA </td><td /></tr><tr><td>D11 </td><td>143 </td><td>6 </td><td>F </td><td>33 </td><td>75.0 </td><td>68.3 </td><td>99 </td><td>1 BAHA (left) </td><td /></tr><tr><td>D12 </td><td>130 </td><td>6 </td><td>M </td><td>84 </td><td>45.0 </td><td>50.0 </td><td>38 </td><td>2 HA </td><td /></tr><tr><td>D13 </td><td>124 </td><td>5 </td><td>F </td><td>0 </td><td>58.3 </td><td>61.7 </td><td>88 </td><td>2 HA </td><td /></tr><tr><td>D14 </td><td>132 </td><td>6 </td><td>M </td><td>18 </td><td>51.7 </td><td>48.3 </td><td>96 </td><td>2 HA </td><td /></tr><tr><td>D15 </td><td>94 </td><td>2 </td><td>M </td><td>28 </td><td>48.3 </td><td>50.0 </td><td>61 </td><td>2 HA </td><td /></tr><tr><td>D17 </td><td>139 </td><td>6 </td><td>M </td><td>12 </td><td>58.3 </td><td>60.0 </td><td>119 </td><td>2 BAHA </td><td /></tr><tr><td>D18 </td><td>130 </td><td>5 </td><td>M </td><td>6 </td><td>36.7 </td><td>43.3 </td><td>122 </td><td>2 HA </td><td /></tr></tbody></table> </ephtml> </p> <p> <emph>Notes.</emph> D/HH = deaf or hard of-hearing. PTA-R = pure tone average thresholds of 500, 1000, and 2000 Hz in the right ear. PTA-L = pure tone average thresholds of 500, 1000, and 2000 Hz in the left ear. F = female. M = male. HA = hearing aid. BAHA = bone-anchored hearing aid. ADHD = Attention-deficit hyperactivity disorder.</p> <p>Table 3. Individual data for participants who were D/HH (<emph>n</emph> = 14): standardized nonverbal reasoning, standardized expressive vocabulary, and language sample measures (percent intelligibility, number of utterances, total number of words [TW], number of different words [NDW], and mean length of utterance in morphemes for complete and intelligible utterances [MLUm])</p> <p> <ephtml> <table><thead><tr><th rowspan="2">ID#. </th><th rowspan="2">Nonverbal reasoning (SS). </th><th rowspan="2">Expressive vocabulary (SS). </th><th colspan="5">Language sample measures. </th></tr><tr><th>% intelligibility. </th><th># utterances. </th><th>TW. </th><th>NDW. </th><th>MLUm. </th></tr></thead><tbody><tr><td>D01 </td><td>11 </td><td>78 </td><td>97.8 </td><td>137 </td><td>863 </td><td>261 </td><td>7.23 </td></tr><tr><td>D02 </td><td>11 </td><td>104 </td><td>99.3 </td><td>144 </td><td>891 </td><td>261 </td><td>7.25 </td></tr><tr><td>D04 </td><td>15 </td><td>122 </td><td>98.3 </td><td>118 </td><td>825 </td><td>282 </td><td>7.88 </td></tr><tr><td>D05 </td><td>9 </td><td>102 </td><td>97.5 </td><td>122 </td><td>600 </td><td>226 </td><td>5.45 </td></tr><tr><td>D06 </td><td>11 </td><td>106 </td><td>98.0 </td><td>102 </td><td>610 </td><td>219 </td><td>6.87 </td></tr><tr><td>D07 </td><td>6 </td><td>115 </td><td>97.9 </td><td>146 </td><td>784 </td><td>264 </td><td>6.13 </td></tr><tr><td>D10 </td><td>11 </td><td>95 </td><td>100.0 </td><td>142 </td><td>751 </td><td>214 </td><td>6.04 </td></tr><tr><td>D11 </td><td>3 </td><td>85 </td><td>97.3 </td><td>149 </td><td>986 </td><td>261 </td><td>7.60 </td></tr><tr><td>D12 </td><td>9 </td><td>100 </td><td>97.9 </td><td>140 </td><td>698 </td><td>254 </td><td>5.78 </td></tr><tr><td>D13 </td><td>9 </td><td>99 </td><td>99.4 </td><td>171 </td><td>899 </td><td>280 </td><td>5.89 </td></tr><tr><td>D14 </td><td>10 </td><td>100 </td><td>98.7 </td><td>156 </td><td>893 </td><td>260 </td><td>6.66 </td></tr><tr><td>D15 </td><td>11 </td><td>112 </td><td>100.0 </td><td>92 </td><td>371 </td><td>158 </td><td>4.53 </td></tr><tr><td>D17 </td><td>10 </td><td>91 </td><td>100.0 </td><td>115 </td><td>792 </td><td>246 </td><td>7.72 </td></tr><tr><td>D18 </td><td>14 </td><td>100 </td><td>98.9 </td><td>98 </td><td>426 </td><td>183 </td><td>5.01 </td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph>. SS = standard score.</p> <p>Individual and group scores on measures of nonverbal reasoning and language are provided in Table 3 for the children who are D/HH. Participant D11 scored more than 2 SD below the mean on the nonverbal reasoning subtest but was retained as her parents expressed no diagnoses or concerns, and no other indications of intellectual disability were observed. All children produced 92 or more utterances in their language samples, and the percent of intelligible utterances was consistently high.</p> <hd id="AN0145718568-11">TH group</hd> <p>Four TH females and 11 males were participated. Individual and group demographic, hearing, nonverbal reasoning, and language measure data are provided in Tables 1 and 4. All TH children had mean PTAs for both the right ear and the left ear that fell within typical hearing limits (i.e. <25 decibels). All reporting parents revealed educational levels at least at a high school level. All scored within 1 SD of the mean on an expressive language test, and none scored more than 2 SD below the mean on the nonverbal reasoning test. Intelligibility was consistently high in this group also and all children produced 88 or more utterances in their language samples.</p> <p>Table 4. Individual typically hearing (<emph>n</emph> = 15) participant data: age at testing, grade, gender, standardized nonverbal reasoning, standardized expressive vocabulary, and language sample measures (percent intelligibility, number of utterances, total number of words [TW], number of different words [NDW], and mean length of utterance in morphemes for complete and intelligible utterances [MLUm])</p> <p> <ephtml> <table><thead><tr><th rowspan="2">ID#. </th><th rowspan="2">Age (months). </th><th rowspan="2">Grade. </th><th rowspan="2">Gender. </th><th rowspan="2">Nonverbal reasoning (SS). </th><th rowspan="2">Expressive vocabulary (SS). </th><th colspan="5">Language sample measures. </th></tr><tr><th>% intelligibility. </th><th># utterances. </th><th>TW. </th><th>NDW. </th><th>MLUm. </th></tr></thead><tbody><tr><td>H01 </td><td>128 </td><td>5 </td><td>M </td><td>9 </td><td>105 </td><td>100.0 </td><td>154 </td><td>703 </td><td>238 </td><td>5.21 </td></tr><tr><td>H02 </td><td>103 </td><td>3 </td><td>M </td><td>5 </td><td>95 </td><td>100.0 </td><td>90 </td><td>350 </td><td>147 </td><td>4.29 </td></tr><tr><td>H03 </td><td>102 </td><td>3 </td><td>M </td><td>5 </td><td>101 </td><td>100.0 </td><td>159 </td><td>922 </td><td>309 </td><td>6.47 </td></tr><tr><td>H04 </td><td>132 </td><td>6 </td><td>F </td><td>11 </td><td>106 </td><td>97.7 </td><td>88 </td><td>551 </td><td>209 </td><td>7.18 </td></tr><tr><td>H05 </td><td>86 </td><td>2 </td><td>M </td><td>11 </td><td>113 </td><td>100.0 </td><td>139 </td><td>813 </td><td>259 </td><td>6.59 </td></tr><tr><td>H06 </td><td>119 </td><td>5 </td><td>F </td><td>7 </td><td>110 </td><td>98.8 </td><td>166 </td><td>1292 </td><td>290 </td><td>9.06 </td></tr><tr><td>H07 </td><td>95 </td><td>3 </td><td>M </td><td>10 </td><td>105 </td><td>100.0 </td><td>119 </td><td>681 </td><td>211 </td><td>6.38 </td></tr><tr><td>H08 </td><td>126 </td><td>5 </td><td>M </td><td>14 </td><td>136 </td><td>100.0 </td><td>180 </td><td>996 </td><td>304 </td><td>6.34 </td></tr><tr><td>H09 </td><td>106 </td><td>4 </td><td>M </td><td>9 </td><td>103 </td><td>97.0 </td><td>102 </td><td>349 </td><td>152 </td><td>3.76 </td></tr><tr><td>H10 </td><td>126 </td><td>5 </td><td>F </td><td>6 </td><td>92 </td><td>99.1 </td><td>109 </td><td>772 </td><td>285 </td><td>8.38 </td></tr><tr><td>H11 </td><td>87 </td><td>2 </td><td>F </td><td>8 </td><td>103 </td><td>99.0 </td><td>102 </td><td>602 </td><td>233 </td><td>6.56 </td></tr><tr><td>H12 </td><td>117 </td><td>4 </td><td>M </td><td>8 </td><td>99 </td><td>100.0 </td><td>176 </td><td>824 </td><td>272 </td><td>5.13 </td></tr><tr><td>H13 </td><td>111 </td><td>4 </td><td>M </td><td>9 </td><td>91 </td><td>99.3 </td><td>148 </td><td>885 </td><td>276 </td><td>6.86 </td></tr><tr><td>H15 </td><td>118 </td><td>5 </td><td>M </td><td>12 </td><td>104 </td><td>96.8 </td><td>159 </td><td>887 </td><td>280 </td><td>6.54 </td></tr><tr><td>H16 </td><td>100 </td><td>3 </td><td>M </td><td>5 </td><td>103 </td><td>95.3 </td><td>149 </td><td>729 </td><td>227 </td><td>5.60 </td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes</emph>. SS = standard scores. F = female. M = male.</p> <hd id="AN0145718568-12">Group comparisons</hd> <p>Data on income and parental education were not available for four in the D/HH group and three in the TH group. Independent <emph>t</emph>-tests revealed no group differences on age at testing, nonverbal reasoning, reported family income, or mother's education, but a significant group difference on father's education (<emph>t</emph>(<reflink idref="bib26" id="ref5">26</reflink>) = –2.09, <emph>p</emph> =.047, <emph>d</emph> = 0.80) established via parent report.</p> <hd id="AN0145718568-13">Procedure</hd> <p>Prior to testing, parents filled out a questionnaire indicating their education level of up to two guardians as well as family income (relevant sections of the questionnaire provided in Appendix A). The education levels and incomes were then converted to numbers as described in the appendix. The questionnaire also required parents to report on whether children had any diagnosed difficulties. For the children who were D/HH, type of assistive devices used (if any), age of D/HH diagnosis, and age of acquisition of the device were also queried.</p> <p>Children were seen for a single session, apart from one child whose audio recording was corrupted and was therefore seen 5 days later to rerecord a language sample. All data were collected in either the child's home or a private testing room, and sessions were audio recorded. To ensure that testing location did not significantly impact the results, a two-way ANOVA was conducted with the independent variables being group (D/HH, TH) and testing location (testing room, child's home), and the dependent variable being number of communication breakdowns. No significant main effect or significant interaction was found. In the testing session, first, background noise level (<emph>M =</emph> 37.6 decibels, <emph>SD =</emph> 5.4 dB) was measured to ensure that the experiment was always conducted in a quiet room. Hearing tests were then conducted, followed by either three measures of reading (real-word reading, nonword reading, then passage comprehension) or language testing (conversational sample, morphological awareness, phonological awareness). Measures within the block of language testing were counterbalanced, and the blocks of reading and language measures were also counterbalanced across participants. The protocol ended with a nonverbal test of cognition followed by an expressive vocabulary test. All language samples were collected, and tests administered, by the second author—a certified speech-language pathologist and doctoral student who had extensive experience working with children who are D/HH. For the purposes of this study, only hearing thresholds, nonverbal cognition, expressive vocabulary, and language sample measures are considered further.</p> <hd id="AN0145718568-14">Hearing</hd> <p>Unmasked pure tone average thresholds were calculated for three tone frequencies in Hertz (Hz; 500, 1000, and 2000 Hz) tested in each ear (see Tables 1 and 2) using a portable audiometer with supra-aural (TDH) headphones.</p> <hd id="AN0145718568-15">Nonverbal cognition</hd> <p> <emph>The Fluid Reasoning</emph> subtest of the <emph>Stanford-Binet Intelligence</emph> Scales, 5th edition (Roid, 2003), was used as a measure of nonverbal cognition. In this test, children looked at an incomplete pattern and selected the missing shape from a selection of five options. Raw and standard scores were calculated following manual instructions.</p> <hd id="AN0145718568-16">Expressive vocabulary</hd> <p>The <emph>Picture Vocabulary</emph> subtest of the <emph>Woodcock-Johnson III Tests of Achievement</emph> (Woodcock, McGrew, & Mather, 2001) was used to measure participants' expressive vocabulary. In this subtest, participants were asked to name pictures. Raw and standard scores were calculated following manual instructions.</p> <hd id="AN0145718568-17">Conversational sample</hd> <p>A conversational language sample was collected and audio-recorded by the second author using the protocol described by Miller and Chapman (2012) for the Systematic Analysis of Language Transcripts (SALT). Common topics (i.e. friends/family, school, sports, vacations, and pets) were introduced into the conversation as needed while allowing the conversation to progress naturally and following the child's expressed interests. Communication breakdowns, requests, and repair strategies were coded from conversational samples and provided the critical experimental measures. Several expressive language measures were collected from each transcript using standard SALT analyses and used to describe the language abilities of the children. These included the percent of intelligible to total utterances, total number of utterances, total number of words, number of different words, and mean length in morphemes of complete and intelligible utterances.</p> <p>Table 5 Group means, standard deviations, and ranges for child and experimenter breakdowns and requests</p> <p> <ephtml> <table><thead><tr><th rowspan="2">Measure. </th><th colspan="2">D/HH (<italic>n</italic> = 14). </th><th colspan="2">TH (<italic>n</italic> = 15). </th><th>Effect size. </th></tr><tr><th>M(SD). </th><th>Range. </th><th>M(SD). </th><th>Range. </th><th>(Cohen's <italic>d</italic>). </th></tr></thead><tbody><tr><td>Total number of breakdowns </td><td>7.36 (3.27) </td><td>2–14 </td><td>6.53 (2.75) </td><td>1–10 </td><td>0.27 </td></tr><tr><td>Number of coded utterances in breakdown </td><td>3.79 (0.84) </td><td>3.0–6.1 </td><td>4.09 (0.96) </td><td>3.0–6.2 </td><td>0.33 </td></tr><tr><td colspan="6">Number of requests, Child </td></tr><tr><td>Total </td><td>1.21 (1.19) </td><td>0–4 </td><td>0.40 (0.83) </td><td>0–4 </td><td>0.79 </td></tr><tr><td>Specific requests for clarification </td><td>0.07 (0.27) </td><td>0–1 </td><td>0.10 (0.31) </td><td>0–1 </td><td>0.10 </td></tr><tr><td>Nonspecific requests for clarification </td><td>0.26 (0.50) </td><td>0–1 </td><td>0.21 (0.41) </td><td>0–1 </td><td>0.11 </td></tr><tr><td>Requests for confirmation </td><td>0.79 (1.05) </td><td>0–4 </td><td>0.48 (0.83) </td><td>0–1 </td><td>0.33 </td></tr><tr><td colspan="6">Number of requests, Experimenter </td></tr><tr><td>Total </td><td>9.14 (4.38) </td><td>3–18 </td><td>(4.03) </td><td>1–14 </td><td>0.00 </td></tr><tr><td>Specific requests for clarification </td><td>3.57 (2.82) </td><td>0–10 </td><td>3.86 (2.67) </td><td>0–8 </td><td>0.11 </td></tr><tr><td>Nonspecific requests for clarification </td><td>0.57 (0.65) </td><td>0–2 </td><td>0.52 (0.69) </td><td>0–2 </td><td>0.07 </td></tr><tr><td>Requests for confirmation </td><td>5.00 (2.18) </td><td>2–9 </td><td>4.76 (2.49) </td><td>0–10 </td><td>0.10 </td></tr></tbody></table> </ephtml> </p> <p> <emph>Notes.</emph> D/HH = deaf or hard of hearing. TH = typically hearing. Cohen's <emph>d</emph> = ~0.2 is considered a small effect size; ~0.5 is considered a medium effect size, and ~0.8 is considered a large effect size.</p> <hd id="AN0145718568-18">Analyses</hd> <p></p> <hd id="AN0145718568-19">Transcription</hd> <p>To equate language sample length, samples were cut to 10 min. They were transcribed using SALT software conventions. Thirty percent of the conversational samples were transcribed by the first author and checked with audio for transcription accuracy by the second author. The rest of the conversational samples were transcribed by the second author and rechecked for accuracy by the same author at a later date.</p> <hd id="AN0145718568-20">Consensus coding</hd> <p>Coding was done on transcriptions checked for accuracy. The transcripts were coded for: the point where communication breakdowns began (a request for clarification or confirmation was made by the listener) and the point of resolution (speaker employed a successful repair strategy), specific and nonspecific requests for clarification or confirmation, and repairs (i.e. responses to requests: repetition, revision, elaboration, confirmation response). Failures to respond (no audible response) to requests were also coded. Caissie and Gibson's (1994) definitions of specific and nonspecific requests for clarification and responses to requests were adapted for the present study. See Appendix B for detailed descriptions of each code.</p> <p>All conversational samples were initially coded independently by the first author. Subsequently, the second author reviewed each coded transcript and identified points of disagreement in coding decisions made by the first author. Disagreements included additional codes or disagreements on the original coding. All disagreements were subsequently resolved through discussion.</p> <hd id="AN0145718568-21">Communication breakdowns</hd> <p>The number of communication breakdowns within each participant's 10-min conversation with the experimenter was tallied. In addition, for the breakdowns that were resolved, the number of experimenter and child coded utterances (i.e. utterances addressing the communication breakdown), from the point of a communication breakdown to its resolution, was calculated. Only communication breakdowns that were successfully resolved were included in this calculation. The minimum length, maximum length, and average number of coded utterances within resolved breakdowns were recorded for every participant.</p> <hd id="AN0145718568-22">Requests for clarification and confirmation</hd> <p>The number of specific and nonspecific requests for clarification and the number of requests for confirmation made by the child and the experimenter were calculated separately to indicate how often each conversational partner felt there was a miscommunication as well as how they chose to communicate that misunderstanding. The proportion of such requests made by the experimenter that were responded to by the child by implementing a repair strategy was also calculated.</p> <hd id="AN0145718568-23">Repair strategies</hd> <p>The number of each type of repair strategy (repetition, revision, elaboration, verbal confirmation response) that the child used or the absence of an audible repair strategy in response to experimenter requests was calculated. The proportion of each type of repair strategy to total repair strategies used by a child was also calculated to determine the relative frequency of various repair strategies. Proportional use of each repair strategy by participants was calculated by dividing the number of each specific strategy that the child used by the total number of repair strategies used by the child, resolving the communication breakdown. Additionally, the proportion of experimenter requests responded to by the child was calculated by dividing the number of repair strategies used by the child by the total number of requests made by the experimenter. At last, the proportion of each type of repair strategy the children used in response to each of the three request types from the experimenter was calculated.</p> <hd id="AN0145718568-24">Statistical analyses</hd> <p>Descriptive statistics for each measure were calculated for the D/HH and TH groups separately. Independent samples <emph>t</emph>-tests along with two-way ANOVAs were used to compare groups on relevant measures. Alpha was set a priori at.05. The assumption of sphericity was controlled for using a Greenhouse-Geisser correction when applicable. For independent samples <emph>t</emph>-tests, where homogeneity of variance was not met, the corrected statistic was used.</p> <hd id="AN0145718568-25">Results</hd> <p></p> <hd id="AN0145718568-26">Preliminary Analyses of Language Abilities</hd> <p>Table 1 provides descriptive statistics for each language measure. Groups were compared on standard scores of expressive vocabulary (Woodcock et al. 2001) and did not differ significantly. Additionally, groups did not differ significantly on any expressive language measure (percent of intelligible utterances, total number of utterances, total number of words, number of different words, and mean length of utterance in morphemes for complete and intelligible utterances) obtained through SALT analyses of each 10-min conversational transcript (see Table 1).</p> <p>Table 6. Group means and standard deviations for proportion of total responses to three request types.</p> <p> <ephtml> <table><thead><tr><th>. </th><th colspan="2">D/HH (<italic>n</italic> = 14). </th><th colspan="2">TH (<italic>n</italic> = 15). </th></tr><tr><th>Measure. </th><th>M(SD). </th><th>Range. </th><th>M(SD). </th><th>Range. </th></tr></thead><tbody><tr><td colspan="5">Proportion responses to all requests combined1 </td></tr><tr><td>Repetition </td><td>0.10 (0.12) </td><td>0–0.33 </td><td>0.10 (0.13) </td><td>0–0.5 </td></tr><tr><td>Revision </td><td>0.06 (0.12) </td><td>0–0.40 </td><td>0.10 (0.20) </td><td>0–1.00 </td></tr><tr><td>Elaboration </td><td>0.45 (0.26) </td><td>0–1.00 </td><td>0.43 (0.26) </td><td>0–0.86 </td></tr><tr><td>Confirmation response </td><td>0.39 (0.20) </td><td>0–0.75 </td><td>0.38 (0.21) </td><td>0–0.88 </td></tr><tr><td>Proportion of experimenter requests responded to with a repair strategy </td><td>0.85 (0.26) </td><td>0.4–1.25 </td><td>0.98 (0.36) </td><td>0.42–2.00 </td></tr></tbody></table> </ephtml> </p> <p>1 1Proportions can be greater than one if a child responds to a request with multiple repair strategies.</p> <hd id="AN0145718568-27">Analyses of Experimental Measures</hd> <p>Table 5 provides descriptive statistics for each experimental measure.</p> <hd id="AN0145718568-28">Communication breakdowns</hd> <p>The average number of communication breakdowns, whether resolved or not within the 10-min conversational sample, was similar across groups, averaging about seven breakdowns for each group. Independent means <emph>t</emph>-test revealed that the number of communication breakdowns was not significantly different for the two groups. Furthermore, the number of coded utterances between experimenter and child within communication breakdowns before successful repair did not significantly differ across groups. Repairs were conducted quite efficiently, averaging approximately four coded utterances in a breakdown for each group. Almost all breakdowns were resolved; only one was left unresolved, at least verbally, in the D/HH group, and two in the TH group (Table 5).</p> <hd id="AN0145718568-29">Requests for clarification or confirmation, child</hd> <p>The total child request frequency was low for both groups (Table 5). As seen in Table 5, the most common request type made by children in both groups was requests for confirmation followed by nonspecific, and finally, specific requests for clarification. A two-way mixed ANOVA with group (2; D/HH, TH) as the between-subject's variable and request type (3; specific requests for clarification, nonspecific requests for clarification, and requests for confirmation) made by the child as the within-subject's variable was calculated. The sphericity assumption for the within-subjects variable (<emph>p</emph> =.03) was not met; thus, a Greenhouse-Geisser correction was used for within subjects factors. Significant main effects of both request type [<emph>F</emph>(1.48,39.84) = 4.45, <emph>p</emph> =.027, <emph>η<subs>p</subs><sups>2</sups></emph> =.142] and group [<emph>F</emph>(<reflink idref="bib1" id="ref6">1</reflink>,<reflink idref="bib27" id="ref7">27</reflink>) = 4.64, <emph>p</emph> =.040, <emph>η<subs>p</subs><sups>2</sups></emph> =.147] were found, but no significant interaction was found. The D/HH group produced significantly more requests than the TH group. <emph>Post hoc</emph> pairwise comparisons of the request main effect revealed that, regardless of group, requests for confirmation were made significantly more often (<emph>M</emph> =.48, SD =.829) than specific requests for clarification (<emph>M</emph> =.10, SD =.31; <emph>p</emph> <.015). No other comparisons were significant.</p> <hd id="AN0145718568-30">Requests for clarification or confirmation, experimenter</hd> <p>Requests made by the experimenter were considerably more common than requests made by children in either group (see Table 5). The experimenter's combined requests averaged about eight per conversation, regardless of group. A two-way mixed ANOVA with group (2; D/HH, TH) as the between-subject's variable and request type (3; specific requests for clarification, nonspecific requests for clarification, and requests for confirmation) as the within-subject's variable was calculated to examine these requests. The sphericity assumption for the within-subjects variable was met for these data. Only a significant main effect of request type was found [<emph>F</emph>(<reflink idref="bib2" id="ref8">2</reflink>,<reflink idref="bib54" id="ref9">54</reflink>) = 33.96, <emph>p</emph> <.001, <emph>η<subs>p</subs><sups>2</sups></emph> =.447]. <emph>Post hoc</emph>, pairwise comparisons revealed that the experimenter used requests for confirmation (<emph>M</emph> = 4.77, SE = 0.47; <emph>p</emph> <.001, <emph>d</emph> = 2.32), and specific requests for clarification (<emph>M</emph> = 3.85, SE = 0.50; <emph>p</emph> <.001, <emph>d</emph> = 1.71) significantly more often than nonspecific requests for clarification (<emph>M</emph> = 0.52, SE = 0.13). The experimenter's use of specific requests for clarification and requests for confirmation was not significantly different.</p> <hd id="AN0145718568-31">Child responses to experimenter requests</hd> <p>Table 6 shows the proportion of repair strategies produced by participants in each group and the proportion experimenter requests that were responded to with each repair strategy in each group. As can be seen, most requests made by the experimenter were responded to by children in both groups. A two-way mixed ANOVA was conducted with group (2; D/HH, TH) as the between-subject's variable and proportion of each repair strategy (4; repetition, revision, elaboration, confirmation response) to total experimenter requests as the within-subjects variable. A Greenhouse-Geisser correction was used for this analysis as the sphericity assumption for the within-subjects factors was not met (<emph>p</emph> <.001). Analysis revealed a significant main effect of repair strategy only [<emph>F</emph>(2.16, 58.40) = 15.97, <emph>p</emph> <.001, <emph>η<subs>p</subs><sups>2</sups></emph> =.372]. <emph>Post hoc</emph> pairwise comparisons revealed that children used both elaboration (<emph>M</emph> = 0.43, SE = 0.50) and confirmation (<emph>M</emph> = 0.38, SE = 0.50) strategies significantly more than repetitions (<emph>M</emph> = 0.10, SE = 0.02) and revisions (<emph>M</emph> = 0.10, SE = 0.04). No other pairwise comparisons were significantly different.</p> <p>The proportion of each repair strategy as a function of each type of request was compared descriptively across groups given the small numbers involved. Figure 1 shows the proportion of repair strategies in response to each request type. Note that proportions could be greater than 1.0 in these calculations as children sometimes produced multiple responses to the same request. Repair strategies were used very similarly by the groups across request types made by the experimenter. For both groups, elaboration followed by confirmation responses was the most commonly used repair strategies in response to each type of request. Furthermore, both groups were more likely not to respond to a request than to use either repetitions or revisions regardless of request type and repetitions followed by revisions were the least commonly used repair strategies by both groups.</p> <p>Graph: Figure 1. class="chapter-para">Proportion of each repair strategy used by participants in (A) the deaf or hard of hearing (D/HH) and (B) typically hearing (TH) groups in response to each type of request made by the experimenter. Error bars represent standard deviation. *Note: Proportions can be greater than one if a child responds to a request with multiple repair strategies.</p> <hd id="AN0145718568-32">Discussion</hd> <p>The purpose of the present study was to compare communication breakdowns in children who are D/HH and TH and how they were repaired. Of particular, interest was the examination of use of requests for clarification or confirmation and responses to those requests. Overall, findings from the present study were not as anticipated. Children who were D/HH and TH were far more similar in their communication breakdown frequency, requests for clarification/confirmation, and repair strategy usage than reported previously.</p> <hd id="AN0145718568-33">Communication Breakdowns</hd> <p>In the present study, children who were D/HH and TH experienced approximately equal numbers of communication breakdowns during 10-min conversations (on average ~7 in a 10-min sample). Furthermore, the number of coded utterances from the onset of a breakdown to its repair was not significantly different across groups, averaging approximately 4 coded utterances regardless of group, and suggesting a similar level of ability in the children who were D/HH and their age-matched TH peers. These findings are in contrast to that of Tye-Murray (2003). She studied breakdowns experienced by 8- to 9-year-old children in 10-min conversations and found that children who were D/HH spent more time in conversational repair than their TH counterparts. Several differences in methodology may explain the lack of converging results. First, operational definitions for initiating and resolving communication breakdowns were not reported by Tye-Murray (2003) and the percentage of time in breakdown was measured rather than the number of coded utterances before repair of breakdowns as was done in the present study, making it difficult to directly compare across studies. Second, we included only oral communicators who were D/HH, while those who signed were also included in the Tye-Murray study. When Tye-Murray examined the percentage of time in breakdowns for children who are D/HH who communicated using different modalities, she found that oral communicators spent considerably less conversational time repairing breakdowns (on average, 9%) than those who both signed and spoke (21%), although both groups spent significantly more time on breakdowns than TH controls (0.4%). Notably, the oral communicators in the present study and the Tye-Murray study performed more similarly to each other than they did to the signers in Tye-Murray (2003).</p> <hd id="AN0145718568-34">Requests</hd> <p>Previous research (Church et al. 2017) has shown that children who are D/HH rarely request clarification from their TH same-age conversational partners, and when they do, they are more likely to use nonspecific requests for clarification such as "Huh?" or "What?". Requests for clarification were made infrequently by children who were D/HH in the present study as well—less than two times per 10-min conversation, on average. However, when requests for clarification were made, specific requests were produced more often than nonspecific requests. Specific requests for clarification require greater pragmatic ability than nonspecific requests (Jeanes et al. 2000) as well as an understanding of the exact locus of the breakdown (Gagné et al. 1991; Lloyd, 1999), which suggests that the children who were D/HH in the present study had productive pragmatic abilities sufficient to ask these complex questions and receptive comprehension skills sufficient to identify the breakdown source. This may have not been the case of the children in the Church et al. (2017) study. Additionally, Church et al. studied conversations between children who are D/HH wearing cochlear implants and their same-age peers. They suggested that in this setting, children who were D/HH may have avoided requesting repair for a variety of reasons. They may find the 'interactional work' involved daunting or they may have a history of more frequent communication breakdowns because of their hearing difficulties that make them more reticent to acknowledge their lack of understanding. In contrast, children who were D/HH in the present study requested clarification as often as the TH children. This may be because the children who were D/HH were speaking to an adult who would be more likely to facilitate their communication than would a TH peer. Additionally, the children in the present study used hearing aids or bone-anchored hearing devices, rather than cochlear implants, and had hearing losses that varied from mild to severe which may have also altered the dynamics of the interaction, compared with the children in the Church et al. study.</p> <p>Previous studies have rarely analyzed requests for confirmation independently from specific requests for clarification. Findings from the present study suggest that requests for confirmation were the most common request type used by children in both groups. More frequent requests for confirmation may reflect the need for children to check that they have heard or are interpreting correctly during a conversation, something that may be particularly important for children who are D/HH. The following excerpt is taken from a conversational sample with a participant who was D/HH in the present study. In this excerpt, the child uses a request for confirmation to verify that their conversational partner said, "Refugees."</p> <p> <bold>Experimenter:</bold> Do you have any refugees in your class?</p> <p> <bold>Child:</bold> Refugees?</p> <p> <bold>Experimenter:</bold> Yeah.</p> <p>The frequency of requests for clarification or confirmation made by an adult experimenter has not been analyzed previously because requests were usually strategically inserted in a conversation in order to study responses to those requests (Caissie & Wilson, 1995; Ciocci & Baran, 1998; Most, 2002). In the present study, experimenter requests for clarification or confirmation occurred naturally and reflected bona fide attempts to repair communication breakdowns. The frequency of the experimenter's combined requests for clarification and confirmation did not differ across groups. Somewhat surprisingly, this suggests that both groups were equally effective in delivering their message to their adult conversational partner. The children who were D/HH in the present study had highly intelligible speech (measured by % intelligible utterances), which could partially explain why the experimenter did not query them more (Samuelsson & Lyxell, 2014).</p> <hd id="AN0145718568-35">Repair Strategies</hd> <p>In the present study, children rarely ignored requests for clarification or confirmation, resulting in few unresolved breakdowns. Indeed, they tended to respond in ways that positively resolved the communication breakdown. Thus, previous research that suggests that children who are D/HH might be reticent to acknowledge requests for clarification (Church et al. 2017) was not fully supported here. Nonetheless, both children who were D/HH and TH would fail to respond to requests made by the experimenter on occasion; however, in almost all cases, the breakdowns were resolved, nonetheless. Nonverbal strategies (e.g. head nods) could have been used to negotiate meaning between the two conversational partners, but these were not detectible with audiotapes.</p> <p>An early meta-analysis (Lloyd, 1999) reviewing the literature on children's abilities to repair communication breakdowns concluded that little was known about the differences in abilities between children who are D/HH versus TH. Several studies have shown that children who are D/HH or TH respond to requests for clarification most often with exact repetition or revision (Caissie & Wilson, 1995; Ciocci & Baran, 1998; Most, 2002). In the present study, elaborations were the most commonly used strategy by both groups. Elaboration is a more sophisticated response as it requires the children to provide additional relevant information, not simply to repeat or modify previously stated semantic information. Thus, choosing to repair breakdowns in this way suggests that both groups of children have quite well-developed repair abilities. Confirmation responses were also used frequently by both groups, providing insight into a type of repair strategy not previously studied in children who are D/HH. In contrast to previous research, repetitions and revisions were used least frequently by both groups. Nonetheless, all repair strategy types were used by both groups. Thus, both groups showed an ability to respond to requests for clarification and confirmation using a variety of strategies, some quite sophisticated.</p> <hd id="AN0145718568-36">Limitations</hd> <p>Several study limitations need to be acknowledged. First, the sample size was relatively small (29 participants; 14 D/HH, 15 TH), which could have limited the ability to detect significant differences should they exist. That being said, the sample size in the present study was comparable to or better than that of several previous studies (Caissie & Wilson, 1995; Ciocci & Baran, 1998; Most, 2002). When no group differences were obtained on experimental measures, effect sizes were also low suggesting that increasing sample sizes with the same methodology would not necessarily lead to significant results, or at least not meaningful ones.</p> <p>Second, the number of exemplars for some measures was low. Increasing the length of the language sample from 10 to 20 min would increase the number of spontaneously produced requests and provide more opportunities for responding using various strategies. This, in turn, would provide greater capacity to test group differences on request and strategy measures.</p> <p>Third, the second author did all testing and the first and second authors completed the coding through consensus. Since neither were blind to the purposes of the study, bias could have been introduced. Future studies should seek to introduce blind testing and coding. It should be noted, however, that the second author completed half the testing before the questions for this study were developed. A perusal of the data suggested no clear differences in experimenter behaviors before versus after the research question was identified, which would suggest that the knowledge of the questions did not impact her performance on the measures of interest.</p> <p>At last, analyses of the conversations were based on auditory rather than video recordings. As a result, nonverbal indications of communication breakdown (e.g. quizzical expressions, shrugs) or responses to requests for clarification or confirmation (e.g. thumbs up, nodding head 'yes', shaking head 'no') could not be observed during coding. However, even in situations where no audible strategy was implemented by the child, the breakdown was still typically resolved. For example, in the conversational segment below, the child did not employ an audible repair strategy after the experimenter requested clarification, yet the breakdown was resolved, and the conversation progressed.</p> <p> <bold>Child:</bold> That the tower of London used to be a torture place.</p> <p> <bold>Experimenter:</bold> What?</p> <p> <bold>Experimenter:</bold> Ok, I did not know that.</p> <p>In the future, researchers should use video instead of audio recording to collect language samples.</p> <hd id="AN0145718568-37">Conclusions</hd> <p>Perhaps the most thought-provoking finding of the present study was how similarly children who were D/HH and TH communicated with the experimenter. This sample of children who were D/HH varied considerably in age and hearing levels. The variability in age and hearing loss likely makes group differences harder to detect. However, it may also allow for greater generalizability. The children who were D/HH in this study were all fully integrated into regular education classrooms. Therefore, they represent an interesting subgroup of children who are D/HH. Further studies of other subgroups are warranted to extend the current findings.</p> <p>Contrary to hypotheses, these 7- to 12-year-old children who wore hearing aids or bone-anchored hearing devices did not experience significantly more breakdowns in their conversations, turns encompassing breakdowns, or breakdowns left unresolved than children who were TH. Furthermore, while it was hypothesized that repetition and revision would be the most common repair strategies implemented by both children who were D/HH and TH, a more sophisticated strategy, elaboration, was the most used repair for requests for clarification and confirmation. Thus, pragmatic strengths, as opposed to weaknesses, of children who are D/HH are highlighted in the present findings—at least in conversation with an adult.</p> <p>Given that the present study had many noteworthy elements (e.g. unstructured conversation, unfamiliar experimenter, analysis of negotiation of meaning, and analyses of requests for confirmation independent from specific requests for clarification), in addition to its recency relative to previous literature on the topic, these promising results should encourage researchers and educators to consider that at least some children who are D/HH have developed abilities to manage and respond to communication breakdowns more so than previously thought.</p> <hd id="AN0145718568-38">Funding</hd> <p>Interprovincial School Development Association [to B.S.].</p> <hd id="AN0145718568-39">Conflicts of Interest</hd> <p>No conflicts of interest were reported.</p> <p>Appendix A. Education and income options as listed in questionnaire</p> <p> <ephtml> <table><thead><tr><td /></tr><tr><td /></tr><tr><td colspan="2">Demographic information </td></tr><tr><td colspan="2"><italic>Your responses to the following questions help us to describe the children as a group.</italic></td></tr><tr><th colspan="2">What is the highest level of education that you and any other parent/guardian have completed?. </th></tr></thead><tbody><tr><th>□ Some high school. </th><th>□ Some high school. </th></tr><tr><td>□ High school or equivalent </td><td>□ High school or equivalent </td></tr><tr><td>□ Vocational/technical school </td><td>□ Vocational/technical school </td></tr><tr><td>□ Some college </td><td>□ Some college </td></tr><tr><td>□ Bachelor's degree </td><td>□ Bachelor's degree </td></tr><tr><td>□ Master's degree </td><td>□ Master's degree </td></tr><tr><td>□ Doctoral degree </td><td>□ Doctoral degree </td></tr><tr><td>□ Professional degree (e.g. MD) </td><td>□ Professional degree (e.g. MD) </td></tr><tr><td>□ Prefer not to say </td><td>□ Prefer not to say </td></tr></tbody></table> </ephtml> </p> <p></p> <p> <ephtml> <table><thead><tr><th>Your family income is:. </th></tr></thead><tbody><tr><td>□ less than $30,000 </td><td>□ Between $30,000 and $60,000 </td><td>□ Between $60,000 and $80,000 </td><td>□ Between $80,000 and $125,000 </td><td>□ More than $125,000 </td></tr></tbody></table> </ephtml> </p> <p>□ Prefer not to say</p> <p></p> <p> <ephtml> <table><thead><tr><th colspan="2">Conversion of education level selection to the number of years of education. </th></tr></thead><tbody><tr><th>Some high school = 10 years. </th><th>Bachelor's degree = 16 years. </th></tr><tr><td>High school or equivalent = 12 years </td><td>Master's degree = 18 years </td></tr><tr><td>Vocational/technical school = 13 years </td><td>Doctoral degree = 22 years </td></tr><tr><td>Some college = 14 years </td><td>Professional degree (e.g. MD) = 18 years </td></tr></tbody></table> </ephtml> </p> <p></p> <p> <ephtml> <table><thead><tr><th colspan="2">Conversion of family income bracket selection to rank order score. </th></tr></thead><tbody><tr><th>Less than $30,000' = 1. </th><th>Between $80,000 and $125,000 = 4. </th></tr><tr><td>Between $30,000 and $60,000 = 2 </td><td>More than $125,000' = 5 </td></tr><tr><td>Between $60,000 and $80,000 = 3 </td><td /></tr></tbody></table> </ephtml> </p> <p>If the parent selected 'Prefer not to say,' the data point was left empty.</p> <p>Appendix B. Coding scheme used to identify communication breakdowns, requests, and responses to requests. Includes code, label, operational definition, and examples for each measure</p> <p> <ephtml> <table><thead><tr><th>Code. </th><th>Meaning. </th><th>Operational definition. </th><th>Example. </th></tr></thead><tbody><tr><td colspan="4">Communication breakdowns </td></tr><tr><td>[bi] </td><td>Breakdown initiated </td><td>The utterance at which something the speaker said became unclear to the listener eliciting a request for clarification/confirmation from the listener. </td><td><italic>Speaker:</italic> "I'm going to Katie's party tomorrow [bi]." </td></tr><tr><td /><td /><td /><td><italic>Listener:</italic> "Katie's what?" </td></tr><tr><td>[br] </td><td>Breakdown resolved </td><td>The utterance at which the speaker employs a repair strategy successfully making it clear that the breakdown has been fixed. If the breakdown is not resolved, then [bi] will be present without [br] (see [bu]). </td><td><italic>Speaker:</italic> "I can't wait to go to Katie's party [bi]." </td></tr><tr><td /><td /><td /><td><italic>Listener:</italic> "Whose party?" </td></tr><tr><td /><td /><td /><td><italic>Speaker:</italic> "Katie's [br]." </td></tr><tr><td /><td /><td /><td><italic>Listener:</italic> "Oh, cool." </td></tr><tr><td>[bu] </td><td>Breakdown unresolved </td><td>The utterance at which it becomes clear that the breakdown has not been resolved. </td><td><italic>Speaker: "</italic>I made Katie a cheesecake for her birthday [bi]." </td></tr><tr><td /><td /><td>(1) Speaker uses unsuccessful repair strategy that fails to address what the listener's request for clarification/confirmation was asking for; </td><td><italic>Listener: "</italic>You made Katie what for her birthday?" </td></tr><tr><td /><td /><td>(2) Speaker fails to use repair strategy by ignoring the listener's request for clarification/confirmation. The conversation moves on without repair of prior misunderstanding. </td><td><italic>Speaker:</italic></td></tr><tr><td /><td /><td /><td>(1) "Yeah [bu]." </td></tr><tr><td /><td /><td /><td>(2) <sup>*</sup>no response<sup>*</sup> [bu] </td></tr><tr><td colspan="4">Requests for clarification or confirmation </td></tr><tr><td>[rcls] </td><td>Specific request for clarification </td><td>Listener requests clarification in a way that targets a specific portion of the message to be clarified. </td><td><italic>Speaker: "</italic>I'm going to a party tomorrow night to celebrate Katie's recent success." </td></tr><tr><td /><td /><td /><td><italic>Listener:</italic></td></tr><tr><td /><td /><td /><td>(1) "To celebrate Katie's what [rcls]?" </td></tr><tr><td /><td /><td /><td>(2) "You are going to whose party tomorrow [rcls]?" </td></tr><tr><td>[rcln] </td><td>Nonspecific request for clarification </td><td>Neutral request from the listener for the speaker to repeat their message. Request does not specify which part of the message was not understood or the type of information that the speaker should provide. </td><td>"What [rcln]?", "Huh [rcln]?", "I didn't get that [rcln].", "Can you repeat that [rcln]?", "What do you mean [rcln]?", "What did you say [rcln]?". </td></tr><tr><td>[rco] </td><td>Request for confirmation </td><td>(1) Listener repeats part or all of the speaker's message with or without rising intonation; </td><td><italic>Speaker:</italic> The party tomorrow is at 6 o'clock. </td></tr><tr><td /><td /><td>(2) Listener queries part or all of a message; </td><td><italic>Listener:</italic></td></tr><tr><td /><td /><td>(3) Listener paraphrases speaker's message to verify understanding. </td><td>(1) "6 o'clock [rco]?" </td></tr><tr><td /><td /><td><italic>Note</italic>. [RCO] does not include backchannel responses that do not appear to query specific content of the speaker's previously stated message (e.g. "Mhm." "Huh." "Yeah." "Yeah?", "No." "No?"). </td><td>(2) "Did you say 6 o'clock [rco]?" </td></tr><tr><td /><td /><td /><td>(3) "Oh, so you're going to go to the party tomorrow evening [rco]." </td></tr><tr><td colspan="4">Responses to requests for clarification or confirmation </td></tr><tr><td>[srep] </td><td>Repetition repair strategy </td><td>Speaker repeats either all or a portion of the misperceived message exactly. </td><td><italic>Speaker:</italic> "The party is tomorrow." </td></tr><tr><td /><td /><td /><td><italic>Listener:</italic> "The party is when?" </td></tr><tr><td /><td /><td /><td><italic>Speaker:</italic> "Tomorrow [srep]." </td></tr><tr><td>[srev] </td><td>Revision repair strategy </td><td>(1) Syntactic revision–Speaker rephrases their message using new words and grammatically reorganizing the sentence (can include making the original statement into two sentences instead of one); </td><td><italic>Speaker:</italic> "I can't wait to go to the party tomorrow." </td></tr><tr><td /><td /><td>(2) Lexical revision – Speaker uses a synonym for a word used in initial message, <italic>and/or</italic> switches a pronoun to noun. </td><td><italic>Listener:</italic> "What did you say?" </td></tr><tr><td /><td /><td /><td>(1) <italic>Speaker:</italic> "The party is tomorrow. I'm excited [srev]." </td></tr><tr><td /><td /><td /><td><italic>Speaker:</italic> "I can't wait to give it to Katie. She'll love it!" </td></tr><tr><td /><td /><td /><td><italic>Listener:</italic> "Give what to Katie?" </td></tr><tr><td /><td /><td /><td>(2) <italic>Speaker:</italic> "The present [srev]." </td></tr><tr><td>[sela] </td><td>Elaboration repair strategy </td><td>Speaker adds additional information or defines key words in order to cue listener to meaning of misperceived message. </td><td><italic>Speaker:</italic> "I can't wait to go to that party tomorrow." </td></tr><tr><td /><td /><td /><td><italic>Listener:</italic> "Sorry, I missed that." </td></tr><tr><td /><td /><td /><td><italic>Speaker:</italic> "Katie's birthday party is tomorrow, and I have been looking forward to it for weeks [sela]!" </td></tr><tr><td>[scr] </td><td>Confirmation response </td><td>Speaker confirms the partner's request for confirmation or clarification with yes/no answer. </td><td><italic>Speaker:</italic> "I can't wait for Katie's party." </td></tr><tr><td /><td /><td /><td><italic>Listener:</italic> "Katie's [rco]?" </td></tr><tr><td /><td /><td /><td><italic>Speaker:</italic> "Yeah [scr]." </td></tr><tr><td /><td /><td /><td><italic>Speaker:</italic> "I'm so excited to go to Katie's birthday party." </td></tr><tr><td /><td /><td /><td><italic>Listener:</italic> "Tonight's party [rcls]?" </td></tr><tr><td /><td /><td /><td><italic>Speaker:</italic> "No [scr]." </td></tr><tr><td>[sm] </td><td>No response </td><td>(1) Speaker ignores listener's request for clarification or possibly uses a gestural response that could not be coded from audio; </td><td><italic>Listener:</italic> "You say you went to Katie's party [bi]?" </td></tr><tr><td /><td /><td>(2) Speaker uses an inappropriate response that resolves in unresolved breakdown. </td><td><italic>Speaker:</italic></td></tr><tr><td /><td /><td><italic>Note</italic>. Only verbal responses to requests were assessed as deliberate strategies used by children to repair communication breakdowns. </td><td>(1) <sup>*</sup>no response<sup>*</sup> [sm]. </td></tr><tr><td /><td /><td /><td>(2) <italic>"</italic>I love parties [sm]." </td></tr></tbody></table> </ephtml> </p> <ref id="AN0145718568-40"> <title> References </title> <blist> <bibl id="bib1" idref="ref3" type="bt">1</bibl> <bibtext> Caissie, R., & Gibson, C. L. (1994). The effectiveness of repair strategy intervention with a hearing-impaired adult. Journal of Speech-Language Pathology and Audiology, 18 (1), 14 – 22. OpenURL Placeholder Text WorldCat</bibtext> </blist> <blist> <bibl id="bib2" idref="ref8" type="bt">2</bibl> <bibtext> Caissie, R., & Tranquilla, M. (2010). Enhancing conversational fluency: Training conversation partners in the use of clear speech and other strategies. 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Seminars in Speech and Language, 33 (04), 297 – 309. doi: 10.1055/s-0032-1326916 Google Scholar Crossref Search ADS PubMed WorldCat Crossref</bibtext> </blist> <blist> <bibl id="bib9" type="bt">9</bibl> <bibtext> Jeanes, R. C., Nienhuys, T. G. W. M., & Rickards, F. W. (2000). The pragmatic skills of profoundly deaf children. The Journal of Deaf Studies and Deaf Education, 5 (3), 237 – 247. doi: 10.1093/deafed/5.3.237 Google Scholar Crossref Search ADS PubMed WorldCat Crossref</bibtext> </blist> <blist> <bibtext> Lederberg, A. R., Schick, B., & Spencer, P. E. (2013). Language and literacy development of deaf and hard-of-hearing children: Successes and challenges. Developmental Psychology, 49 (1), 15 – 30. doi: 10.1037/a0029558 Google Scholar Crossref Search ADS PubMed WorldCat Crossref</bibtext> </blist> <blist> <bibtext> Lloyd, J. (1999). Hearing-impaired children's strategies for managing communication breakdowns. 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Madison, WI : University of Wisconsin, Language Analysis Lab. Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC</bibtext> </blist> <blist> <bibtext> Most, T. (2002). The use of repair strategies by children with and without hearing impairment. Language, Speech, and Hearing Services in Schools, 33 (2), 112 – 123. doi: 10.1044/0161-1461(2002/009) Google Scholar Crossref Search ADS PubMed WorldCat Crossref</bibtext> </blist> <blist> <bibtext> Most, T., Shina-August, E., & Meilijson, S. (2010). Pragmatic abilities of children with hearing loss using cochlear implants or hearing aids compared to hearing children. Journal of Deaf Studies and Deaf Education, 15 (4), 422 – 437. doi: 10.1093/deafed/enq032 Google Scholar Crossref Search ADS PubMed WorldCat Crossref</bibtext> </blist> <blist> <bibtext> Roid, G. H. (2003). Stanford-binet intelligence scales (5th Ed.). Itasca, IL : Riverside Publishing. Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC</bibtext> </blist> <blist> <bibtext> Samuelsson, C., & Lyxell, B. (2014). Clarification requests in everyday interaction involving children with cochlear implants. Logopedics, Phoniatrics, Vocology, 39 (3), 130 – 138. doi: 10.3109/14015439.2013.777113 Google Scholar Crossref Search ADS PubMed WorldCat Crossref</bibtext> </blist> <blist> <bibtext> Bruce Tomblin, J., Harrison, M., Ambrose, S. E., Walker, E. A., Oleson, J. J., & Moeller, M. P. (2015). Language outcomes in young children with mild to severe hearing loss. Ear and Hearing, 36 (1), 76S – 91S. doi: 10.1097/AUD.0000000000000219 Google Scholar Crossref Search ADS PubMed WorldCat Crossref</bibtext> </blist> <blist> <bibtext> Tye-Murray, N. (2003). Conversational fluency of children who use cochlear implants. 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Google Scholar Google Preview OpenURL Placeholder Text WorldCat COPAC</bibtext> </blist> </ref> <aug> <p>By Erin Fitzpatrick; Bonita Squires and Elizabeth Kay-Raining Bird</p> <p>Reported by Author; Author; Author</p> <p></p> <p>Correspondence should be sent to Bonita Squires, School of Communication Sciences and Disorders, Sir Charles Tupper Medical Building, Dalhousie University, 5850 College Street, 2nd Floor, Room 2C01, PO Box 15000, Halifax, NS B3H 4R2, Canada</p> </aug> <nolink nlid="nl1" bibid="bib15" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib26" firstref="ref5"></nolink> <nolink nlid="nl3" bibid="bib27" firstref="ref7"></nolink> <nolink nlid="nl4" bibid="bib54" firstref="ref9"></nolink>
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Items – Name: Title
  Label: Title
  Group: Ti
  Data: What's That You Say? Communication Breakdowns and Their Repairs in Children Who Are Deaf or Hard of Hearing
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Fitzpatrick%2C+Erin%22">Fitzpatrick, Erin</searchLink><br /><searchLink fieldCode="AR" term="%22Squires%2C+Bonita%22">Squires, Bonita</searchLink><br /><searchLink fieldCode="AR" term="%22Kay-Raining+Bird%2C+Elizabeth%22">Kay-Raining Bird, Elizabeth</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Deaf+Studies+and+Deaf+Education%22"><i>Journal of Deaf Studies and Deaf Education</i></searchLink>. Oct 2020 25(4):490-504.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Oxford University Press. Great Clarendon Street, Oxford, OX2 6DP, UK. Tel: +44-1865-353907; Fax: +44-1865-353485; e-mail: jnls.cust.serv@oxfordjournals.org; Web site: http://jdsde.oxfordjournals.org/
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 15
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2020
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Deafness%22">Deafness</searchLink><br /><searchLink fieldCode="DE" term="%22Hearing+Impairments%22">Hearing Impairments</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Problems%22">Communication Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Communication+Strategies%22">Communication Strategies</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1093/deafed/enaa010
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1081-4159
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Conversational fluency is important to form meaningful connections and relationships with the people around us but is understudied in children who are deaf or hard of hearing (D/HH). Communication breakdowns reduce conversational fluency. They occur when a speaker says something that interrupts the flow of conversation requiring a request for clarification or confirmation from their listener to repair the misunderstanding. Young children who are D/HH are at risk of more frequent communication breakdowns and fewer successful repairs than children with typical hearing (The missing link in language development of deaf and hard of hearing children: Pragmatic language development. "Seminars in Speech and Language," 33 (04), 297-309). About 14 children who were D/HH aged 7-12 year and 15 children with typical hearing were matched on chronological age. Comparisons of the number and duration of communication breakdowns, requests for repair, and responses to requests used by children in a 10-min conversation with an adult were completed. Results showed that while children who were D/HH demonstrated some differences, they were more similar to their typically hearing peers in communication breakdowns and repairs than previously reported in the literature.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2020
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1273448
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1273448
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1093/deafed/enaa010
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
        StartPage: 490
    Subjects:
      – SubjectFull: Children
        Type: general
      – SubjectFull: Deafness
        Type: general
      – SubjectFull: Hearing Impairments
        Type: general
      – SubjectFull: Communication Problems
        Type: general
      – SubjectFull: Interpersonal Communication
        Type: general
      – SubjectFull: Communication Strategies
        Type: general
    Titles:
      – TitleFull: What's That You Say? Communication Breakdowns and Their Repairs in Children Who Are Deaf or Hard of Hearing
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Fitzpatrick, Erin
      – PersonEntity:
          Name:
            NameFull: Squires, Bonita
      – PersonEntity:
          Name:
            NameFull: Kay-Raining Bird, Elizabeth
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 10
              Type: published
              Y: 2020
          Identifiers:
            – Type: issn-print
              Value: 1081-4159
          Numbering:
            – Type: volume
              Value: 25
            – Type: issue
              Value: 4
          Titles:
            – TitleFull: Journal of Deaf Studies and Deaf Education
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