Technological and therapeutic advances have allowed many children who are born deaf or hard of hearing (DHH) to start school with age-appropriate speech and spoken language skills. Yet many of these children continue to find everyday conversations challenging. This scoping review maps the evidence related to the development of conversation and pragmatic skills in children who are DHH.  

The review followed Arksey and O’Malley’s methodological framework and the PRISMA-ScR guidelines. Quality appraisal, data extraction and inductive thematic analysis were used to describe the data.  

Systematic searches identified 36 articles for inclusion. Sample sizes were small and heterogenous. Most studies focussed on school-aged children with severe hearing loss or greater. Methodological rigour varied. Thematic analysis revealed two global themes. Firstly, children who are DHH still find interacting with other people difficult. Secondly, children who are DHH need support to harness fixed and malleable factors that may help them achieve better conversation and pragmatic outcomes. 

Focussed attention on designing valid and reliable assessments for conversation and pragmatic skills, and development of therapeutic approaches targeting early conversation and pragmatic skill development, is needed to reduce the impact conversation and pragmatic differences across the lifespan.

1. With appropriate supports, children who are deaf or hard of hearing are able to achieve age appropriate spoken language skills.
2. Age appropriate language skills do not necessarily correlate with age appropriate conversation and pragmatic skills.
3. There are factors that may correlate with improved conversation and pragmatic outcomes, and we can use this information to inform development of targeted assessments and intervention for this population.