Pragmatic competence in children with Cochlear Implant: a new tool to assess the understanding and production of ironic sentences.

Introduction: A growing number of deaf children receive Cochlear Implant (CI) in their first years of life. Early CI implantation could improve the performance of these children in both perceptual and language development. However, although children show that they fall within the normal range in perceptual and linguistic tests, they may show difficulties in complex language structures as pragmatic skills. The Italian Standardized Batteries evaluate pragmatic competence useful for academic skills, but they do not consider some complex use of figurative language, such as irony, that it is useful for social interactions. In the present study a new tool was developed to evaluate the comprehension and production of ironic situations and sentences. This tool was tested to compare the performances of CI users with those of normal hearing peers. Methods: A case-control study was conducted on 10 deaf children (CI group), unilateral or bilateral CI users, with normal perceptive and linguistic competences, and 10 normal hearing peers (NH group). Irony comprehension was evaluated with the support of nine cartoons, ex novo designed, that represent different ironic situations. Whereas two stories with ironic elements, were used to assess irony production. Results: The CI group scored significantly lower than the NH control group in both irony comprehension and production. A positive trend with the increased age was recorded in both groups. However, no deaf subject was able to identify ironic situations as ironic and to produce ironic utterances. Conclusions: Early CI implantation allows children to reach excellent perceptual and linguistic outcomes, however some difficulties in complex pragmatic skills, as irony, may persist. These difficulties could have an impact on the social life of these individuals and should be included in the rehabilitation programs of these subjects.