kielen, informaatiotutkimuksen ja logopedian laitos Tämän tutkimuksen tavoitteena oli selvittää, ... more kielen, informaatiotutkimuksen ja logopedian laitos Tämän tutkimuksen tavoitteena oli selvittää, mitä konsonantteja 2-vuotiaat suomalaislapset tuottavat eri sana-asemissa. Lisäksi tutkittiin sanaston laajuuden yhteyttä konsonantti-inventaarin kokoon. Aineisto koostui 24 lapsen spontaaneista 15 minuutin mittaisista puhenäytteistä, jotka litteroitiin IPA:a käyttäen. Tulokset osoittivat, että 2vuotiaiden suomalaislasten konsonantti-inventaarien koossa ja sanaston laajuudessa on suurta variaatiota. Sanaston laajuus korreloi positiivisesti konsonantti-inventaarin koon kanssa.
This three-year follow-up study investigated the associations of narrative and reading skills in ... more This three-year follow-up study investigated the associations of narrative and reading skills in typically developing Finnish children. Twenty children performed narrative retelling and story generation tasks twice-at five and eight years of age. Reading comprehension and word recognition tests were performed at the age of eight. Narratives were analysed for relevant information, total number of word tokens, clausal density and evaluation. The results showed increased narrative abilities with age, but the development was not seen in all narrative variables. This suggests that narrative tasks might capture development somewhat differently. Both narrative tasks were connected to reading skills. However, while retelling was connected to reading comprehension only, story generation related to both reading comprehension and word recognition. This study extends prior research by showing that not only retelling but also story generation is associated with reading.
Kielellisen erityisvaikeuden ajatellaan olevan ensisijaisesti kielellisten taitojen ongelma. On k... more Kielellisen erityisvaikeuden ajatellaan olevan ensisijaisesti kielellisten taitojen ongelma. On kuitenkin todennäköistä, että kielelliseen erityisvaikeuteen liittyy myös ei-kielellisiä vaikeuksia. Tämän artikkelin tavoitteena on luoda katsaus eksekutiivisiin toimintoihin ja prosessointinopeuteen osana kielellistä erityisvaikeutta. Tutkimusten perusteella näyttää siltä, että kielelliseen erityisvaikeuteen liittyy kognitiiviseen joustavuuteen, inhibitioon, työmuistiin, tarkkaavuuteen sekä prosessointinopeuteen liittyviä vaikeuksia ainakin osalla kielihäiriöistä lapsista. Kielellisen erityisvaikeuden kliinisessä diagnostiikassa ja kuntoutuksessa on syytä huomioida myös ei-kielelliset vaikeudet, joita häiriöön todennäköisesti liittyy.
Background: Developmental language disorder (DLD, also called specific language impairment, SLI) ... more Background: Developmental language disorder (DLD, also called specific language impairment, SLI) is a common developmental disorder comprising the largest disability group in preschool aged children. Approximately 7% of the population is expected to have developmental language difficulties. However, the specific etiological factors leading to DLD are not yet known and even the typical linguistic features appear to vary by language. We present here a project that investigates DLD at multiple levels of analysis and aims to make the reliable prediction and early identification of the difficulties possible. Following the multiple deficit model of developmental disorders, we investigate the DLD phenomenon at the etiological, neural, cognitive, behavioral, and psychosocial levels, in a longitudinal study of preschool children. Methods: In January 2013, we launched the Helsinki Longitudinal SLI study (HelSLI) at the Helsinki University Hospital (http://tiny.cc/HelSLI). We will study 227 children aged 3-6 years with suspected DLD and their 160 typically developing peers. Five subprojects will determine how the child's psychological characteristics and environment correlate with DLD and how the child's well-being relates to DLD, the characteristics of DLD in monolingual versus bilingual children, nonlinguistic cognitive correlates of DLD, electrophysiological underpinnings of DLD, and the role of genetic risk factors. Methods include saliva samples, EEG, computerized cognitive tasks, neuropsychological and speech and language assessments, video-observations, and questionnaires. Discussion: The project aims to increase our understanding of the multiple interactive risk and protective factors that affect the developing heterogeneous cognitive and behavioral profile of DLD, including factors affecting literacy development. This accumulated knowledge will form a heuristic basis for the development of new interventions targeting linguistic and non-linguistic aspects of DLD.
This chapter provides a summary of global megatrends related to digitalisation and the adoption a... more This chapter provides a summary of global megatrends related to digitalisation and the adoption and use of new technologies. The summary is based on reports published by the UN SDG (2020), (Sitra, 2020), the Organisation for Economic Cooperation and Development (OECD) (2016), McKinsey (2017) and Deloitte (2020) and other international bodies. 2.1 Digitalisation shapes communications During the last 50 years, digital devices, tools and practices have increasingly shaped communication and communication habits (OECD, 2016, p. 14). The members of Generation Z-the generation born after 1995-are the first to have always been surrounded by digital communication tools and are viewed by many as digital natives. The digitalisation megatrend will continue to shape everyday communication (OECD, 2016, p. 15). Humans will be increasingly surrounded by, communicating through or interacting with digital technologies. Human communication and digital technologies will be even more closely intertwined in the future. This trend will be stimulated, for example, by faster wireless technologies made possible by 5G and 6G (the latter in the 2030s). At the same time, the reliability, stability and safety of digital communication will be a pressing issue in the future (OECD, 2016, p. 14). Ubiquitous connectivity will continue to help ease 'the strains of mobility' (OECD, 2016, p. 9). There will be countless options to interact with family members, friends and colleagues, regardless of distance, place and time, affecting when and how we are available and accessible to interaction. The use of a digital device or platform will more often be the only means of contacting service providers, public administrations or officials. The range of languages used for digital communication may narrow down. This is because the English language will continue to play a key role in global communication (OECD 2016, p. 9), but at the same time, it may present a serious hindrance to people's access to information and possibilities to communicate. Digital communication will be even more multimodal and intermedial-involving talk, writing, and visual information-than today. More realistic digital spaces and places for interaction will become commonplace. Social interactions will be possible in and through 'mixed reality' environments, where realistic 3D images of places, objects and people can be projected and replicated to remote places in real time and in full motion (Matinmikko-Blue et al., 2020). Interactions with artificial and intelligent assistants-dramatic improvements to chatbots or the current versions of Alexa and Siri-will be capable of more realistic interactions with humans over time. Along with the accelerating pace of digitalisation and the practices and habits of communication, interaction and co-presence will continue to change (OECD, 2016; McKinsey & Company, 2017; Monitor Deloitte, 2017). For example, with the number of routine-based jobs decreasing, it will be commonplace for work tasks and activities to involve more communication, requiring workers with good interactional, managerial and problem-solving skills (McKinsey & Company, 2017, p. 20, 32, 39). There is a need to better understand how digital technologies afford communication and shape communicative practices across different aspects of life (Monitor Deloitte, 2017, p. 6) (see Section 3.1). This is particularly important in postpandemic societies, where digital and hybrid interactions will be commonplace.
Journal of Speech, Language, and Hearing Research, 2019
PurposeThe purpose of this study was to investigate the time course of vocal development in infan... more PurposeThe purpose of this study was to investigate the time course of vocal development in infants and toddlers with bilateral cochlear implants (CIs; bilateral CI group) who are acquiring Finnish and to compare their progress to that of infants with normal hearing and typical development (TD group).MethodFive thousand nine hundred sixty-four spontaneous utterances of 30 infants and toddlers (15 in both groups) were classified as either precanonical (PC) vocalizations, basic canonical syllables (BCS), or advanced forms (AF) levels. Time course of development and group differences were analyzed in a prospective longitudinal study during a time course of 1 year: before implantation and 1, 3, 6, 9, and 12 months after CI activation for the bilateral CI group and at 6, 9, and 12 months of age for the TD group.ResultsThe least mature PC vocalizations decreased and the BCS and AF vocalizations increased for both the bilateral CI and TD groups during the follow-up period of 1 year. The bi...
Children with specific language impairment (SLI) vary widely in their ability to use tense/ agree... more Children with specific language impairment (SLI) vary widely in their ability to use tense/ agreement inflections depending on the type of language being acquired, a fact that current accounts of SLI have tried to explain. Finnish provides an important test case for these accounts because: (1) verbs in first and second person permit null subjects whereas verbs in third person do not; and (2) tense and agreement inflections are agglutinating and thus one type of inflection can appear without the other. Probes were used to compare the verb inflection use of Finnish-speaking children with SLI, and both age-matched and younger typically developing children. The children with SLI were less accurate, and the pattern of their errors did not match predictions based on current accounts of SLI. It appears that children with SLI have difficulty learning complex verb inflection paradigms apart from any problem specific to tense and agreement.
Purpose: This prospective longitudinal study aimed to explore (a) the development of social-pragm... more Purpose: This prospective longitudinal study aimed to explore (a) the development of social-pragmatic understanding of children with bilateral hearing aids (BiHAs), bilateral cochlear implants (BiCIs), and typical hearing (TH) between the ages of 4 and 6 years and (b) group differences between children with BiHAs, BiCIs, and TH. Method: The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years. Results: The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, bu...
Response_Data.csv: Participant responses ('correct' or 'incorrect') to sentences ... more Response_Data.csv: Participant responses ('correct' or 'incorrect') to sentences with quantifiers ('all', 'none', 'some', 'some...not', 'most') in 31 languages presented in the context of different visual displays. Item_Coding.csv: How sentences with quantifiers ('all', 'none', 'some', 'some...not', 'most') were coded.
Journal of Speech, Language and Hearing Research, 2023
Purpose: This prospective longitudinal study aimed to explore (a) the development of social-pragm... more Purpose: This prospective longitudinal study aimed to explore (a) the development of social-pragmatic understanding of children with bilateral hearing aids (BiHAs), bilateral cochlear implants (BiCIs), and typical hearing (TH) between the ages of 4 and 6 years and (b) group differences between children with BiHAs, BiCIs, and TH. Method: The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years. Results: The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, but most children with hearing loss (HL) still did not meet age expectations at the age of 6 years. Children with BiHAs and BiCIs both showed large-scale inferential difficulties, including utilizing theory of mind, utilizing verbal and visual information, and understanding conversational norms and emotions in context. Conclusions: Children with BiHAs and BiCIs are at risk of delays in social-pragmatic understanding despite early detection of HL, early amplification, and cochlear implantation. Therefore, the social-pragmatic abilities of children with HL should be assessed regularly, and the children with HL should have early access to social-pragmatic interventions where utilizing contextual information is practiced comprehensively.
Appendix 2 SLT assessment battery. List of speech and language assessments used in the study. (DO... more Appendix 2 SLT assessment battery. List of speech and language assessments used in the study. (DOCX 25 kb)
kielen, informaatiotutkimuksen ja logopedian laitos Tämän tutkimuksen tavoitteena oli selvittää, ... more kielen, informaatiotutkimuksen ja logopedian laitos Tämän tutkimuksen tavoitteena oli selvittää, mitä konsonantteja 2-vuotiaat suomalaislapset tuottavat eri sana-asemissa. Lisäksi tutkittiin sanaston laajuuden yhteyttä konsonantti-inventaarin kokoon. Aineisto koostui 24 lapsen spontaaneista 15 minuutin mittaisista puhenäytteistä, jotka litteroitiin IPA:a käyttäen. Tulokset osoittivat, että 2vuotiaiden suomalaislasten konsonantti-inventaarien koossa ja sanaston laajuudessa on suurta variaatiota. Sanaston laajuus korreloi positiivisesti konsonantti-inventaarin koon kanssa.
This three-year follow-up study investigated the associations of narrative and reading skills in ... more This three-year follow-up study investigated the associations of narrative and reading skills in typically developing Finnish children. Twenty children performed narrative retelling and story generation tasks twice-at five and eight years of age. Reading comprehension and word recognition tests were performed at the age of eight. Narratives were analysed for relevant information, total number of word tokens, clausal density and evaluation. The results showed increased narrative abilities with age, but the development was not seen in all narrative variables. This suggests that narrative tasks might capture development somewhat differently. Both narrative tasks were connected to reading skills. However, while retelling was connected to reading comprehension only, story generation related to both reading comprehension and word recognition. This study extends prior research by showing that not only retelling but also story generation is associated with reading.
Kielellisen erityisvaikeuden ajatellaan olevan ensisijaisesti kielellisten taitojen ongelma. On k... more Kielellisen erityisvaikeuden ajatellaan olevan ensisijaisesti kielellisten taitojen ongelma. On kuitenkin todennäköistä, että kielelliseen erityisvaikeuteen liittyy myös ei-kielellisiä vaikeuksia. Tämän artikkelin tavoitteena on luoda katsaus eksekutiivisiin toimintoihin ja prosessointinopeuteen osana kielellistä erityisvaikeutta. Tutkimusten perusteella näyttää siltä, että kielelliseen erityisvaikeuteen liittyy kognitiiviseen joustavuuteen, inhibitioon, työmuistiin, tarkkaavuuteen sekä prosessointinopeuteen liittyviä vaikeuksia ainakin osalla kielihäiriöistä lapsista. Kielellisen erityisvaikeuden kliinisessä diagnostiikassa ja kuntoutuksessa on syytä huomioida myös ei-kielelliset vaikeudet, joita häiriöön todennäköisesti liittyy.
Background: Developmental language disorder (DLD, also called specific language impairment, SLI) ... more Background: Developmental language disorder (DLD, also called specific language impairment, SLI) is a common developmental disorder comprising the largest disability group in preschool aged children. Approximately 7% of the population is expected to have developmental language difficulties. However, the specific etiological factors leading to DLD are not yet known and even the typical linguistic features appear to vary by language. We present here a project that investigates DLD at multiple levels of analysis and aims to make the reliable prediction and early identification of the difficulties possible. Following the multiple deficit model of developmental disorders, we investigate the DLD phenomenon at the etiological, neural, cognitive, behavioral, and psychosocial levels, in a longitudinal study of preschool children. Methods: In January 2013, we launched the Helsinki Longitudinal SLI study (HelSLI) at the Helsinki University Hospital (http://tiny.cc/HelSLI). We will study 227 children aged 3-6 years with suspected DLD and their 160 typically developing peers. Five subprojects will determine how the child's psychological characteristics and environment correlate with DLD and how the child's well-being relates to DLD, the characteristics of DLD in monolingual versus bilingual children, nonlinguistic cognitive correlates of DLD, electrophysiological underpinnings of DLD, and the role of genetic risk factors. Methods include saliva samples, EEG, computerized cognitive tasks, neuropsychological and speech and language assessments, video-observations, and questionnaires. Discussion: The project aims to increase our understanding of the multiple interactive risk and protective factors that affect the developing heterogeneous cognitive and behavioral profile of DLD, including factors affecting literacy development. This accumulated knowledge will form a heuristic basis for the development of new interventions targeting linguistic and non-linguistic aspects of DLD.
This chapter provides a summary of global megatrends related to digitalisation and the adoption a... more This chapter provides a summary of global megatrends related to digitalisation and the adoption and use of new technologies. The summary is based on reports published by the UN SDG (2020), (Sitra, 2020), the Organisation for Economic Cooperation and Development (OECD) (2016), McKinsey (2017) and Deloitte (2020) and other international bodies. 2.1 Digitalisation shapes communications During the last 50 years, digital devices, tools and practices have increasingly shaped communication and communication habits (OECD, 2016, p. 14). The members of Generation Z-the generation born after 1995-are the first to have always been surrounded by digital communication tools and are viewed by many as digital natives. The digitalisation megatrend will continue to shape everyday communication (OECD, 2016, p. 15). Humans will be increasingly surrounded by, communicating through or interacting with digital technologies. Human communication and digital technologies will be even more closely intertwined in the future. This trend will be stimulated, for example, by faster wireless technologies made possible by 5G and 6G (the latter in the 2030s). At the same time, the reliability, stability and safety of digital communication will be a pressing issue in the future (OECD, 2016, p. 14). Ubiquitous connectivity will continue to help ease 'the strains of mobility' (OECD, 2016, p. 9). There will be countless options to interact with family members, friends and colleagues, regardless of distance, place and time, affecting when and how we are available and accessible to interaction. The use of a digital device or platform will more often be the only means of contacting service providers, public administrations or officials. The range of languages used for digital communication may narrow down. This is because the English language will continue to play a key role in global communication (OECD 2016, p. 9), but at the same time, it may present a serious hindrance to people's access to information and possibilities to communicate. Digital communication will be even more multimodal and intermedial-involving talk, writing, and visual information-than today. More realistic digital spaces and places for interaction will become commonplace. Social interactions will be possible in and through 'mixed reality' environments, where realistic 3D images of places, objects and people can be projected and replicated to remote places in real time and in full motion (Matinmikko-Blue et al., 2020). Interactions with artificial and intelligent assistants-dramatic improvements to chatbots or the current versions of Alexa and Siri-will be capable of more realistic interactions with humans over time. Along with the accelerating pace of digitalisation and the practices and habits of communication, interaction and co-presence will continue to change (OECD, 2016; McKinsey & Company, 2017; Monitor Deloitte, 2017). For example, with the number of routine-based jobs decreasing, it will be commonplace for work tasks and activities to involve more communication, requiring workers with good interactional, managerial and problem-solving skills (McKinsey & Company, 2017, p. 20, 32, 39). There is a need to better understand how digital technologies afford communication and shape communicative practices across different aspects of life (Monitor Deloitte, 2017, p. 6) (see Section 3.1). This is particularly important in postpandemic societies, where digital and hybrid interactions will be commonplace.
Journal of Speech, Language, and Hearing Research, 2019
PurposeThe purpose of this study was to investigate the time course of vocal development in infan... more PurposeThe purpose of this study was to investigate the time course of vocal development in infants and toddlers with bilateral cochlear implants (CIs; bilateral CI group) who are acquiring Finnish and to compare their progress to that of infants with normal hearing and typical development (TD group).MethodFive thousand nine hundred sixty-four spontaneous utterances of 30 infants and toddlers (15 in both groups) were classified as either precanonical (PC) vocalizations, basic canonical syllables (BCS), or advanced forms (AF) levels. Time course of development and group differences were analyzed in a prospective longitudinal study during a time course of 1 year: before implantation and 1, 3, 6, 9, and 12 months after CI activation for the bilateral CI group and at 6, 9, and 12 months of age for the TD group.ResultsThe least mature PC vocalizations decreased and the BCS and AF vocalizations increased for both the bilateral CI and TD groups during the follow-up period of 1 year. The bi...
Children with specific language impairment (SLI) vary widely in their ability to use tense/ agree... more Children with specific language impairment (SLI) vary widely in their ability to use tense/ agreement inflections depending on the type of language being acquired, a fact that current accounts of SLI have tried to explain. Finnish provides an important test case for these accounts because: (1) verbs in first and second person permit null subjects whereas verbs in third person do not; and (2) tense and agreement inflections are agglutinating and thus one type of inflection can appear without the other. Probes were used to compare the verb inflection use of Finnish-speaking children with SLI, and both age-matched and younger typically developing children. The children with SLI were less accurate, and the pattern of their errors did not match predictions based on current accounts of SLI. It appears that children with SLI have difficulty learning complex verb inflection paradigms apart from any problem specific to tense and agreement.
Purpose: This prospective longitudinal study aimed to explore (a) the development of social-pragm... more Purpose: This prospective longitudinal study aimed to explore (a) the development of social-pragmatic understanding of children with bilateral hearing aids (BiHAs), bilateral cochlear implants (BiCIs), and typical hearing (TH) between the ages of 4 and 6 years and (b) group differences between children with BiHAs, BiCIs, and TH. Method: The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years. Results: The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, bu...
Response_Data.csv: Participant responses ('correct' or 'incorrect') to sentences ... more Response_Data.csv: Participant responses ('correct' or 'incorrect') to sentences with quantifiers ('all', 'none', 'some', 'some...not', 'most') in 31 languages presented in the context of different visual displays. Item_Coding.csv: How sentences with quantifiers ('all', 'none', 'some', 'some...not', 'most') were coded.
Journal of Speech, Language and Hearing Research, 2023
Purpose: This prospective longitudinal study aimed to explore (a) the development of social-pragm... more Purpose: This prospective longitudinal study aimed to explore (a) the development of social-pragmatic understanding of children with bilateral hearing aids (BiHAs), bilateral cochlear implants (BiCIs), and typical hearing (TH) between the ages of 4 and 6 years and (b) group differences between children with BiHAs, BiCIs, and TH. Method: The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years. Results: The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, but most children with hearing loss (HL) still did not meet age expectations at the age of 6 years. Children with BiHAs and BiCIs both showed large-scale inferential difficulties, including utilizing theory of mind, utilizing verbal and visual information, and understanding conversational norms and emotions in context. Conclusions: Children with BiHAs and BiCIs are at risk of delays in social-pragmatic understanding despite early detection of HL, early amplification, and cochlear implantation. Therefore, the social-pragmatic abilities of children with HL should be assessed regularly, and the children with HL should have early access to social-pragmatic interventions where utilizing contextual information is practiced comprehensively.
Appendix 2 SLT assessment battery. List of speech and language assessments used in the study. (DO... more Appendix 2 SLT assessment battery. List of speech and language assessments used in the study. (DOCX 25 kb)
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Papers by Sari Kunnari
Method: The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years.
Results: The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, but most children with hearing loss (HL) still did not meet age expectations at the age of 6 years. Children with BiHAs and BiCIs both showed large-scale inferential difficulties, including utilizing theory of mind, utilizing verbal and visual information, and understanding conversational norms and emotions in context.
Conclusions: Children with BiHAs and BiCIs are at risk of delays in social-pragmatic understanding despite early detection of HL, early amplification, and cochlear implantation. Therefore, the social-pragmatic abilities of children with HL should be assessed regularly, and the children with HL should have early access to social-pragmatic interventions where utilizing contextual information is practiced comprehensively.
Method: The Pragma test was used for a comprehensive assessment of social-pragmatic understanding of a total of 86 children: 19 children with BiHAs, 22 children with BiCIs, and 45 children with TH. The Pragma test requires answering socially and contextually demanding questions and explaining the right answers. The explanation tasks are targeted at studying the participant's own awareness of the inferencing process. The children in this study were assessed yearly at the ages of 4, 5, and 6 years.
Results: The participants with BiHAs, BiCIs, and TH showed significant development in their social-pragmatic understanding between the ages of 4 and 6 years, but most children with hearing loss (HL) still did not meet age expectations at the age of 6 years. Children with BiHAs and BiCIs both showed large-scale inferential difficulties, including utilizing theory of mind, utilizing verbal and visual information, and understanding conversational norms and emotions in context.
Conclusions: Children with BiHAs and BiCIs are at risk of delays in social-pragmatic understanding despite early detection of HL, early amplification, and cochlear implantation. Therefore, the social-pragmatic abilities of children with HL should be assessed regularly, and the children with HL should have early access to social-pragmatic interventions where utilizing contextual information is practiced comprehensively.