Links Between Speech Intelligibility and Social-Emotional Functioning

The issue

Speech intelligibility–or how well others can understand a speaker’s words–is an important outcome for deaf and hard-of-hearing (DHH) children who use spoken language. Good intelligibility is a capstone goal of speech therapy, and it is linked to positive outcomes in many other areas, including reading and language skills, working memory, reasoning, and executive functioning. It, therefore, makes sense intuitively to think that speech intelligibility might have a direct effect on daily life, impacting the smoothness of communication and the quality and quantity of social interaction, self-esteem, and academic success. Conversely, it seems logical that if a DHH (or any other) child or teen can’t be understood, classmates might mock or avoid them, and adults might expect less of their abilities and potential. These negative consequences could, in turn, affect the child’s self-esteem, school performance, and opportunities to both learn and socialize. However, not much research has been done to confirm or explain how speech intelligibility affects daily life (or whether daily life affects intelligibility).

What we know

Although research in this area is limited, several studies have found links between speech intelligibility and social-emotional functioning among DHH individuals. One study found that deaf children and teens with cochlear implants had both poorer speech intelligibility and psychosocial functioning than their hearing peers, but even their lowest scores in areas like attention problems, adaptability, withdrawal, anxiety, and depression were still within the normal range. Other studies have found links between speech intelligibility in children with hearing loss and evaluations from teachers, peers, or self-reports of their self-esteem, emotional adjustment, social skills, loneliness, and integration with hearing peers. A few studies have found links between deaf children’s and young adults’ speech intelligibility and hearing peers’ ratings of the deaf speakers’ personal qualities in areas like intelligence, confidence, extroversion, and likeability. Such relationships were particularly relevant for hearing peers without much contact with deaf speakers and for those with more negative attitudes about deaf people’s abilities, suggesting that personal experience or education about deafness and deaf speech patterns might improve hearing peers’ views.

What we don’t know

There’s a lot we don’t know about this topic. One important thing to keep in mind is that we don’t know the direction or causality of the relationship between speech intelligibility and social-emotional functioning (which one causes the other). As discussed above, we can easily imagine ways in which intelligibility impacts socializing and self-esteem, but it could also go the other direction. For example, poor social skills could limit a child’s or teen’s opportunities for practice and feedback on their speech, leading to lower intelligibility outcomes. It could be that the two areas affect each other in a cycle or feedback loop. Or there could be some other underlying factors that affect both intelligibility and social-emotional functioning.

We also don’t know much about these links in children who have very poor outcomes in either speech intelligibility or social-emotional functioning, and we know even less about either area in children with multiple disabilities. Often, children with very poor outcomes (or their parents) do not wish to participate in research studies, resulting in an over-representation of children with better outcomes. Further, most studies exclude participants with other disabilities in order to pinpoint the effects of the specific variables of interest, but that leaves us in the dark about how they interact with the features of other disabilities.


Ultimately, what we want to know most is how to help children succeed in all aspects of life. It may be that helping a child improve speech intelligibility would have a side effect of improving their social-emotional well-being or vice versa. It makes sense that it would, but it also makes sense to target all areas of difficulty for a struggling child. Often, a child is already in speech therapy working on their intelligibility, but they may or may not achieve excellent outcomes. It may be beneficial to add targeted instruction and practice on social and emotional skills, both for the direct effect on everyday functioning and for any side effects to other areas.

Posted on October 2, 2018 by
Valerie Freeman
Oklahoma State University
valerie.freeman {at}

Further reading

Dammeyer, J. (2010). Psychosocial development in a Danish population of children with cochlear implants and deaf and hard-of-hearing children. Journal of Deaf Studies and Deaf Education, 15, 50-58. view details

Freeman, V. (2018). Speech intelligibility and personality peer-ratings of young adults with cochlear implants. Journal of Deaf Studies and Deaf Education, 23, 41-49. view details

Freeman, V., Pisoni, D., Kronenberger, W. G., & Castellanos, I. (2017). Speech intelligibility and psychosocial functioning in deaf children and teens with cochlear implants.  Journal of Deaf Studies and Deaf Education, 22, 278-289. view details

Most, T., Ingber, S., & Heled-Ariam, E. (2012). Social competence, sense of loneliness, and speech intelligibility of young children with hearing loss in individual inclusion and group inclusion. Journal of Deaf Studies and Deaf Education, 17, 259-272. view details