Mode of communication, perceived level of understanding, and perceived quality of life in youth who are deaf or hard of hearing

Emergency department patient-centred care perspectives from deaf and hard-of-hearing patients

BACKGROUND

Deaf and hard-of-hearing (DHH) patients are a priority population for emergency medicine health services research. DHH patients are at higher risk than non-DHH patients of using the emergency department (ED), have longer lengths of stay in the ED and report poor patient-provider communication. This qualitative study aimed to describe ED care-seeking and patient-centred care perspectives among DHH patients.

METHODS

This qualitative study is the second phase of a mixed-methods study. The goal of this study was to further explain quantitative findings related to ED outcomes among DHH and non-DHH patients. We conducted semistructured interviews with 4 DHH American Sign Language (ASL)-users and 6 DHH English speakers from North Central Florida. Interviews were transcribed and analysed using a descriptive qualitative approach.

RESULTS

Two themes were developed: (1) DHH patients engage in a complex decision-making process to determine ED utilization and (2) patient-centred ED care differs between DHH ASL-users and DHH English speakers. The first theme describes the social-behavioural processes through which DHH patients assess their need to use the ED. The second theme focuses on the social environment within the ED: patients feeling stereotyped, involvement in the care process, pain communication, receipt of accommodations and discharge processes.

CONCLUSIONS

This study underscores the importance of better understanding, and intervening in, DHH patient ED care-seeking and care delivery to improve patient outcomes. Like other studies, this study also finds that DHH patients are not a monolithic group and language status is an equity-relevant indicator. We also discuss recommendations for emergency medicine.

PATIENT OR PUBLIC CONTRIBUTION

This study convened a community advisory group made up of four DHH people to assist in developing research questions, data collection tools and validation of the analysis and interpretation of data. Community advisory group members who were interested in co-authorship are listed in the byline, with others in the acknowledgements. In addition, several academic-based co-authors are also deaf or hard of hearing.

Social perception in deaf individuals: A meta-analysis of neuroimaging studies

Deaf individuals may report difficulties in social interactions. However, whether these difficulties depend on deafness affecting social brain circuits is controversial. Here, we report the first meta-analysis comparing brain activations of hearing and (prelingually) deaf individuals during social perception. Our findings showed that deafness does not impact on the functional mechanisms supporting social perception. Indeed, both deaf and hearing control participants recruited regions of the action observation network during performance of different social tasks employing visual stimuli, and including biological motion perception, face identification, action observation, viewing, identification and memory for signs and lip reading. Moreover, we found increased recruitment of the superior-middle temporal cortex in deaf individuals compared with hearing participants, suggesting a preserved and augmented function during social communication based on signs and lip movements. Overall, our meta-analysis suggests that social difficulties experienced by deaf individuals are unlikely to be associated with brain alterations but may rather depend on non-supportive environments.

Hearing and sociality: the implications of hearing loss on social life

Hearing is essential to the formation of social relationships and is the principal afferent of social life. Yet hearing loss, which is one of the most prevalent forms of sensory disability worldwide and is critical for social development, has received little attention from the social interventionalist perspective. The purpose of this mini-review is to describe the basic neurobiological principles of hearing and to explore the reciprocal relationships between social support, hearing loss, and its psychosocial comorbidities. We also discuss the role of social enrichment in sensorineural recovery and identify open questions within the fields of hearing physiology and social networks.

Acculturative Stress, Mental Health, and Well-Being among Deaf Adults

Acculturative stress is associated with negative mental health among culturally diverse individuals. Deaf and Hard-of-Hearing (DHH) individuals experience acculturative stress as they navigate within and between the Hearing and Deaf communities, yet, research has not examined the relationship between deaf acculturative stress and psychological functioning. This study examined the relationships between deaf acculturative stress, well-being, and symptoms of depression and anxiety. One hundred and ten DHH adults (71.6% female, 82.7% White, median age = 30-39) completed an online survey including the Multidimensional Inventory of Deaf Acculturative Stress (MIDAS), demographic questions, and measures of psychological functioning. After controlling for relevant sociodemographic factors, the MIDAS Stress from the Deaf and Hearing Community scales emerged as significant predictors of well-being and symptoms of anxiety and depression. Findings are discussed within the context of DHH sociocultural experiences, and suggestions for future research are offered to inform clinical work with DHH individuals.

Deaf and hard-of-hearing children and adolescents' mental health, Quality of Life and communication

Mental health problems and lower Quality of Life (QoL) are more common in deaf and hard-of-hearing - (D)HH - children than in typically hearing (TH) children. Communication has been repeatedly linked to both mental health and QoL. The aims of this study were to compare mental health and QoL between signing deaf and hard-of-hearing (DHH), hard-of-hearing (HH) and TH children and to study associations between mental health/QoL and severity of hearing loss and communication. 106 children and adolescents (mean age 11;8; SD = 3.42), 59 of them DHH and 47 HH, and their parents reported child mental health and QoL outcomes. Parents also provided information about their children's communication, hearing loss and education while their children's cognitive ability was assessed. Although (D)HH and their parents rated their mental health similar to their TH peers, about twice as many (D)HH children rated themselves in the clinical range. However, (D)HH children rated their QoL as similar to their TH peers, while their parents rated it significantly lower. Associations between communicative competence, parent-reported mental health and QoL were found, whereas severity of hearing loss based on parent-report had no significant association with either mental health or QoL. These results are in line with other studies and emphasise the need to follow up on (D)HH children's mental health, QoL and communication.

Parent American Sign Language skills correlate with child-but not toddler-ASL vocabulary size

Most deaf children have hearing parents who do not know a sign language at birth, and are at risk of limited language input during early childhood. Studying these children as they learn a sign language has revealed that timing of first-language exposure critically shapes language outcomes. But the input deaf children receive in their first language is not only delayed, it is much more variable than most first language learners, as many learn their first language from parents who are themselves new sign language learners. Much of the research on deaf children learning a sign language has considered the role of parent input using broad strokes, categorizing hearing parents as non-native, poor signers, and deaf parents as native, strong signers. In this study, we deconstruct these categories, and examine how variation in sign language skills among hearing parents might affect children's vocabulary acquisition. This study included 44 deaf children between 8- and 60-months-old who were learning ASL and had hearing parents who were also learning ASL. We observed an interactive effect of parent ASL proficiency and age, such that parent ASL proficiency was a significant predictor of child ASL vocabulary size, but not among the infants and toddlers. The proficiency of language models can affect acquisition above and beyond age of acquisition, particularly as children grow. At the same time, the most skilled parents in this sample were not as fluent as "native" deaf signers, and yet their children reliably had age-expected ASL vocabularies. Data and reproducible analyses are available at https://osf.io/9ya6h/.

Deaf Children Need Rich Language Input from the Start: Support in Advising Parents

Bilingual bimodalism is a great benefit to deaf children at home and in schooling. Deaf signing children perform better overall than non-signing deaf children, regardless of whether they use a cochlear implant. Raising a deaf child in a speech-only environment can carry cognitive and psycho-social risks that may have lifelong adverse effects. For children born deaf, or who become deaf in early childhood, we recommend comprehensible multimodal language exposure and engagement in joint activity with parents and friends to assure age-appropriate first-language acquisition. Accessible visual language input should begin as close to birth as possible. Hearing parents will need timely and extensive support; thus, we propose that, upon the birth of a deaf child and through the preschool years, among other things, the family needs an adult deaf presence in the home for several hours every day to be a linguistic model, to guide the family in taking sign language lessons, to show the family how to make spoken language accessible to their deaf child, and to be an encouraging liaison to deaf communities. While such a support program will be complicated and challenging to implement, it is far less costly than the harm of linguistic deprivation.

Discrimination and Deaf Adolescents' Subjective Well-Being: The Role of Deaf Identity

This study tested the influence of Deaf identity (cognitive identification and affective identification) on the association between perceived deaf discrimination and subjective well-being among Chinese adolescents who are deaf and hard-of-hearing (DHH), based on the rejection-identification model. Questionnaires on perceived deaf discrimination, subjective well-being, Deaf identity, and demographic information were completed by 246 DHH students (15-23 years old) from special residential schools in China. The results indicated that: (1) higher level of perceived deaf discrimination was significantly associated with lower level of subjective well-being (direct effect = -0.24, 95% confidence interval [CI] = [-0.37, -0.12], p < .001); (2) there was a significant indirect effect of perceived deaf discrimination on subjective well-being via cognitive identification (indirect effect = -0.07, 95% CI = [-0.12, -0.01], p < .05); and (3) positive affective identification due to increased cognitive identification with Deaf community may help counteract the negative impact of perceived deaf discrimination on subjective well-being (indirect effect = 0.06, 95% CI = [0.03, 0.10], p < .001). These findings further support the notion that the different components of group identification should be examined separately.

Attitudes Toward Signing Avatars Vary Depending on Hearing Status, Age of Signed Language Acquisition, and Avatar Type

The use of virtual humans (i.e., avatars) holds the potential for interactive, automated interaction in domains such as remote communication, customer service, or public announcements. For signed language users, signing avatars could potentially provide accessible content by sharing information in the signer's preferred or native language. As the development of signing avatars has gained traction in recent years, researchers have come up with many different methods of creating signing avatars. The resulting avatars vary widely in their appearance, the naturalness of their movements, and facial expressions—all of which may potentially impact users' acceptance of the avatars. We designed a study to test the effects of these intrinsic properties of different signing avatars while also examining the extent to which people's own language experiences change their responses to signing avatars. We created video stimuli showing individual signs produced by (1) a live human signer (Human), (2) an avatar made using computer-synthesized animation (CS Avatar), and (3) an avatar made using high-fidelity motion capture (Mocap avatar). We surveyed 191 American Sign Language users, including Deaf (N = 83), Hard-of-Hearing (N = 34), and Hearing (N = 67) groups. Participants rated the three signers on multiple dimensions, which were then combined to form ratings of Attitudes, Impressions, Comprehension, and Naturalness. Analyses demonstrated that the Mocap avatar was rated significantly more positively than the CS avatar on all primary variables. Correlations revealed that signers who acquire sign language later in life are more accepting of and likely to have positive impressions of signing avatars. Finally, those who learned ASL earlier were more likely to give lower, more negative ratings to the CS avatar, but we did not see this association for the Mocap avatar or the Human signer. Together, these findings suggest that movement quality and appearance significantly impact users' ratings of signing avatars and show that signed language users with earlier age of ASL acquisition are the most sensitive to movement quality issues seen in computer-generated avatars. We suggest that future efforts to develop signing avatars consider retaining the fluid movement qualities integral to signed languages.

Italian Version of the YQOL-DHH Questionnaire: Translation and Cross-cultural Adaptation

Objective

To translate and cross-culturally adapt into Italian the YQOL-DHH (Youth Quality of Life Instrument–Deaf and Hard of Hearing Module), an instrument to evaluate the health-related quality of life in young deaf people. It could be useful for professionals, teachers, and parents to take care of deaf adolescents’ needs.

Study Design

Forward-backward translation, cross-cultural adaptation, and cognitive debriefing.

Setting

The cognitive debriefing was performed online with professionals and during clinical practice with deaf adolescents.

Methods

A methodological study was conducted according to the guidelines provided by the development team. The study consisted of a forward-backward translation and a cross-cultural adaptation. After the original authors’ confirmation, a cognitive debriefing was conducted with 30 professionals who work with deaf young people and with 10 deaf adolescents aged 11 to 18 years.

Results

For the linguistic translation and cross-cultural adaptation, some variations to the original instrument were made to obtain equivalence, such as the expression “deaf or hard of hearing” translated only with the Italian word “sordo.” During the cognitive debriefing, the clarity and comprehensibility of the items were reported by professionals and deaf adolescents. Eventually, the authors approved the final version.

Conclusion

The YQOL-DHH was translated and culturally adapted into Italian. The translated items were pertinent to the Italian culture and equivalent to the original ones. A validation study is suggested to make the instrument feasible for use in different clinical or educational contexts. In addition, to guarantee accessibility and autonomy for young deaf signers, Italian Sign Language translation of the questionnaire is suggested.

Predicting Quality of Life and Behavior and Emotion from Functional Auditory and Pragmatic Language Abilities in 9-Year-Old Deaf and Hard-of-Hearing Children

Children who are deaf or hard of hearing (DHH) are likely to exhibit difficulties in development of psychosocial skills, pragmatic language skills, and use of hearing for social communication in real-world environments. Some evidence suggests that pragmatic language use affects peer-relationships and school engagement in these children. However, no studies have investigated the influence of functional auditory performance and use of language and speech in real-world environments on children's behavior and emotion, and on their health-related quality of life. This study explored the relationship in DHH children at 9 years of age. Data from 144 participants of the Longitudinal Outcomes of Children with Hearing Impairment study were analyzed. Parent reports were obtained on quality of life, behavior and emotion, pragmatic language skills, and auditory functional performance of children in real life. Children's spoken language abilities and speech intelligibility were assessed by research speech pathologists. On average, performance of children in all domains was within the range of typically developing peers. There were significant associations among functional auditory performance, use of speech and language skills, psychosocial skills, and quality of life. Multiple linear regression analyses revealed that better auditory functional performance and pragmatic language skills, rather than structural language abilities, were associated with better psychosocial abilities and quality of life. The novel findings highlight the importance of targeted intervention for improving functional hearing skills and social communication abilities in DHH children, and emphasize the importance of collaborative approaches among medical, audiology, allied health, and educational professionals to identify those at risk so that timely referral and intervention can be implemented for improving psychosocial health and well-being in DHH children.

Psychometric properties of the Inventory of Life Quality in children and adolescents in Norwegian Sign Language

BACKGROUND

Several studies have assessed the Quality of Life (QoL) in Deaf and hard-of-hearing (DHH) children and adolescents. The findings from these studies, however, vary from DHH children reporting lower QoL than their typically hearing (TH) peers to similar QoL and even higher QoL. These differences have been attributed to contextual and individual factors such as degree of access to communication, the participants' age as well as measurement error. Using written instead of sign language measures has been shown to underestimate mental health symptoms in DHH children and adolescents. It is expected that translating generic QoL measures into sign language will help gain more accurate reports from DHH children and adolescents, thus eliminating one of the sources for the observed differences in research conclusions. Hence, the aim of the current study is to translate the Inventory of Life Quality in Children and Adolescents into Norwegian Sign Language (ILC-NSL) and to evaluate the psychometric properties of the self-report of the ILC-NSL and the written Norwegian version (ILC-NOR) for DHH children and adolescents. The parent report was included for comparison. Associations between child self-report and parent-report are also provided.

METHODS

Fifty-six DHH children completed the ILC-NSL and ILC-NOR in randomized order while their parents completed the parent-report of the ILC-NOR and a questionnaire on hearing- and language-related information. Internal consistency was examined using Dillon-Goldstein's rho and Cronbach's alpha, ILC-NSL and ILC-NOR were compared using intraclass correlation coefficients. Construct validity was examined by partial least squares structural equation modeling (PLS-SEM).

RESULTS

Regarding reliability, the internal consistency was established as acceptable to good, whereas the comparison of the ILC-NSL with the ILC-NOR demonstrated closer correspondence for the adolescent version of the ILC than for the child version. The construct validity, as evaluated by PLS-SEM, resulted in an acceptable fit for the proposed one-factor model for both language versions for adolescents as well as the complete sample.

CONCLUSION

The reliability and validity of the ILC-NSL seem promising, especially for the adolescent version, even though the validation was based on a small sample of DHH children and adolescents.

Adverse Childhood Communication Experiences Associated With an Increased Risk of Chronic Diseases in Adults Who Are Deaf

INTRODUCTION

This study explores adverse childhood communication experiences and its RRs for acquiring specific chronic diseases and mental health disorders in adults who are deaf and hard of hearing.

METHODS

A cross-sectional design with snowball sampling was used to recruit adults who were deaf and hard of hearing and were born or became deaf in both ears before age 13 years. Patient-reported outcomes surveys in American Sign Language and English were disseminated to collect data about early life communication experiences with caregivers. Modified Poisson regression with robust SEs was used to calculate RR estimates and 95% CIs for all medical conditions with early life communication experiences as main predictors.

RESULTS

Data collection occurred from May 2016 to July 2016, October 2016 to April 2018, and October 2018 to May 2019. The U.S. sample consisted of 1,524 adults who were born or became deaf early. After adjusting for parental hearing status and known correlates of medical conditions, poorer direct child-caregiver communication was significantly associated with an increased risk of being diagnosed with diabetes (RRR=1.12, 95% CI=1.01, 1.24), hypertension (RRR=1.10, 95% CI=1.03, 1.17), and heart disease (RRR=1.61, 95% CI=1.39, 1.87). Poor indirect family communication/inclusion increased risks for lung diseases (RRR=1.19, 95% CI=1.07, 1.33) and depression/anxiety disorders (RRR=1.34, 95% CI=1.24, 1.44). The absolute risk increase and number needed to harm are also reported.

CONCLUSIONS

Outcomes data reported by patients who were deaf and hard of hearing demonstrated that poorer direct child-caregiver communication and ongoing exclusion from incidental family communication were associated with increased risks for multiple chronic health outcomes. Practices should consider developing and utilizing an adverse childhood communication screening measure to prevent or remediate language deprivation and communication neglect in pediatric patients who were deaf and hard of hearing.

Cross-modal plasticity and central deficiencies: the case of deafness and the use of cochlear implants

The primary objective of this chapter is to describe the consequences of central deficiencies on the neurodevelopment of children. We approach this topic from the standpoint of congenital deafness. Thus we first present the current state of knowledge on cortical reorganization following congenital deafness. The allocation of auditory cortices to other sensory systems can enhance sensory processing and therefore the cognitive functions related to them. Second, we explore the linguistic development of deaf children. Given that the English written system is speech-based, its acquisition is complex and atypical for deaf children, usually leading to poorer achievements. Next, we explore the impact of a neural prosthesis named the cochlear implant on the neurocognitive and linguistic development of deaf children. In some cases, it allows the individuals to, at least partially, regain access to the lost sense. We also comment on the specific needs of the deaf population when it comes to neuropsychological assessment. Finally, we touch on the specific context of deaf children born of deaf parents, and therefore naturally exposed to sign language as the only means of communication.

Global Regulatory Review Needed for Cochlear Implants: A Call for FDA Leadership

INTRODUCTION

Using the United States Food and Drug Administration (FDA) as example, we argue that regulatory agencies worldwide should review their guidance on cochlear implants (CIs).

METHODS

This is a position paper, thus the methods are strictly argumentation. Here we give the motivation for our recommendation. The FDA's original approval of implantation in prelingually deaf children was granted without full benefit of information on language acquisition, on childcaregiver communication, and on the lived experience of being deaf. The CI clinical trials, accordingly, did not address risks of linguistic deprivation, especially when the caregiver's communication is not fully accessible to the prelingually deaf child. Wide variability in the effectiveness of CIs since initial and updated approval has been indicated but has not led to new guidance. Children need to be exposed frequently and regularly to accessible natural language while their brains are still plastic enough to become fluent in any language. For the youngest infants, who are not yet producing anything that could be called language although they might be producing salient social signals (Goldstein et al. Child Dev 80:636-644, 2009), good comprehension of communication from caregiver to infant is critical to the development of language. Sign languages are accessible natural languages that, because they are visual, allow full immersion for deaf infants, and they supply the necessary support for this comprehension. The main language contributor to health outcomes is this combination of natural visual language and comprehension in communication. Accordingly, in order to prevent possible language deprivation, all prelingually deaf children should be exposed to both sign and spoken languages when their auditory status is detected, with sign language being critical during infancy and early childhood. Additionally, all caregivers should be given support to learn a sign language if it is new to them so that they can comprehend their deaf children's language expressions fully. However, both languages should be made accessible in their own right, not combined in a simultaneous or total communication approach since speaking one language and signing the other at the same time is problematic.

RESULTS

Again, because this is a position paper, our results are our recommendations. We call for the FDA (and similar agencies in other countries) to review its approval of cochlear implantation in prelingually deaf children who are within the sensitive period for language acquisition. In the meantime, the FDA should require manufacturers to add a highlighted warning to the effect that results with CI vary widely and CIs should not be relied upon to provide adequate auditory input for complete language development in all deaf children. Recent best information on users' experience with CIs (including abandonment) should be clearly provided so that informed decisions can be made. The FDA should require manufacturers' guidance and information materials to include encouragement to parents of deaf children to offer auditory input of a spoken language and visual input of a sign language and to have their child followed closely from birth by developmental specialists in language and cognition. In this way parents can align with providers to prioritize cognitive development and language access in both audio-vocal and visuo-gestural modalities.

DISCUSSION

The arguments and recommendations in this paper are discussed at length as they come up.

Emotional Functioning, Positive Relationships, and Language Use in Deaf Adults

This study aimed to explore emotional regulation, alexithymia, and interpersonal relations in a Spanish sample of 146 adult deaf participants and 146 typical hearing participants. For the deaf sample, the associations between type of language used and the above variables were also analyzed. Results showed that deaf participants scored higher on alexithymia and lower for positive relationships. However, no differences were found between deaf and typical hearing participants on emotional regulation. Regarding language use (Spanish Oral Language, SOL; Spanish Sign Language; or both), deaf participants used both languages in most contexts. Deaf participants who reported using SOL as their main mode of expression showed greater positive relationships than deaf participants who use both languages. Deaf participants who reported using both languages scored higher in emotional attention and emotional repair. These results evidence an association between the language use of deaf participants and alexithymia.

Education and health of children with hearing loss: the necessity of signed languages

Medical and educational interventions for children with hearing loss often adopt a single approach of spoken language acquisition through the use of technology, such as cochlear implants. These approaches generally ignore signed languages, despite no guarantees that the child will acquire fluency in a spoken language. Research with children who have a cochlear implant and do not use a signed language indicates that language outcomes are very variable and generally worse than their non-deaf peers. In contrast, signing children with cochlear implants have timely language development similar to their non-deaf peers that also exceeds their non-signing peers with cochlear implants. Natural signed languages have been shown to have the same neurocognitive benefits as natural spoken language while being fully accessible to deaf children. However, it is estimated less than 2% of the 34 million deaf children worldwide receive early childhood exposure to a signed language. Most deaf children are, therefore, at risk for language deprivation during the critical period of language acquisition in the first five years of life. Language deprivation has negative consequences for developmental domains, which rely on timely language acquisition. Beyond the adverse effects on a child’s education, language deprivation also affects deaf people’s mental and physical health and access to health care, among others. Therefore, policies in accordance with the United Nations Convention on the rights of persons with disabilities are needed. Such policies would ensure early intervention and education services include signed languages and bilingual programmes where the signed language is the language of instruction.

Understanding Theory of Mind in Deaf and Hearing College Students

Theory of Mind-the understanding that people have thoughts, wants, and beliefs that influence their interpersonal behavior-is an aspect of social cognition that develops with consistent, increasing complexity across age groups, languages, and cultures. Observed delays in theory of mind development among deaf children and others has led to a conversational account of theory of mind development and its delays in terms of the nature and amount of social communication experienced by children directly (conversationally) and indirectly (via overhearing). The present study explored theory of mind in deaf young adults by evaluating their understanding of sarcasm and advanced false belief (second-order false belief and double bluff), as well as related cognitive abilities. Consistent with previous studies, deaf participants scored significantly below hearing peers on all three theory of mind tasks. Performance was unrelated to their having had early access to social communication via either sign language (from deaf parents) or spoken language (through cochlear implants), suggesting that deaf participants' performance was not solely a function of access to social communication in early childhood. The finding of different predictors of theory of mind performance for deaf and hearing groups is discussed in terms of its language, social, and cognitive foundations.

Support for parents of deaf children: Common questions and informed, evidence-based answers

To assist medical and hearing-science professionals in supporting parents of deaf children, we have identified common questions that parents may have and provide evidence-based answers. In doing so, a compassionate and positive narrative about deafness and deaf children is offered, one that relies on recent research evidence regarding the critical nature of early exposure to a fully accessible visual language, which in the United States is American Sign Language (ASL). This evidence includes the role of sign language in language acquisition, cognitive development, and literacy. In order for parents to provide a nurturing and anxiety-free environment for early childhood development, signing at home is important even if their child also has the additional nurturing and care of a signing community. It is not just the early years of a child's life that matter for language acquisition; it's the early months, the early weeks, even the early days. Deaf children cannot wait for accessible language input. The whole family must learn simultaneously as the deaf child learns. Even moderate fluency on the part of the family benefits the child enormously. And learning the sign language together can be one of the strongest bonding experiences that the family and deaf child have.

Deaf Stigma: Links Between Stigma and Well-Being Among Deaf Emerging Adults

Although stigma has been linked to suboptimal psychological and physical health outcomes in marginalized communities such as persons of color, sexual minorities, and people living with HIV/AIDS, no known research has examined these effects among deaf individuals. In the present research, we examine the associations between anticipated, enacted, and internalized stigma and psychological well-being (i.e., depressive symptoms, anxiety) and physical well-being (i.e., quality of life, alcohol use) among a sample of 171 deaf emerging adults. Furthermore, we consider whether trait resilience and benefit-finding moderate these effects. Enacted stigma, but not anticipated or internalized stigma, was related to worse depressive symptoms, anxiety, and quality of life. However, none of these variables predicted alcohol use and neither resilience nor benefit-finding moderated these effects. These findings are consistent with other research among marginalized populations, though they are also the first to suggest that experiences of discrimination are related to suboptimal well-being among deaf emerging adults. The discussion considers how these findings may illuminate the potential causes of disparities in well-being between hearing and deaf emerging adults.

Personality Traits, Self-Efficacy, and Cochlear Implant Use Among Deaf Young Adults

A variety of studies have examined ways in which cognitive and social-emotional factors may be linked to and affected by hearing loss, use of cochlear implants (CIs), and sign language. A related domain that largely has been overlooked, however, is personality. This paper reports a study of personality traits and self-efficacy among deaf and hard-of-hearing (DHH; n = 223) college students, with and without CIs, as compared to hearing peers (n = 106). All participants completed (HEXACO) personality trait and self-efficacy inventories; DHH participants also completed a communication questionnaire. Hearing participants scored higher on the personality trait Conscientiousness than both DHH CI users and non-CI users, as well as higher on Openness to Experience compared to DHH CI users. Hearing participants also scored higher on self-efficacy compared to DHH non-CI users. Among DHH non-CI users, greater self-rated sign language skills were associated with higher Extraversion and Agreeableness scores. Among the DHH CI users, earlier sign language acquisition was associated with higher Openness to Experience scores, and earlier cochlear implantation was associated with greater Emotionality scores. Self-efficacy was associated with both better self-rated spoken language skills and a stronger preference for spoken language over sign language use among DHH CI users.

Considering parental hearing status as a social determinant of deaf population health: Insights from experiences of the "dinner table syndrome"

The influence of early language and communication experiences on lifelong health outcomes is receiving increased public health attention. Most deaf children have non-signing hearing parents, and are at risk for not experiencing fully accessible language environments, a possible factor underlying known deaf population health disparities. Childhood indirect family communication–such as spontaneous conversations and listening in the routine family environment (e.g. family meals, recreation, car rides)–is an important source of health-related contextual learning opportunities. The goal of this study was to assess the influence of parental hearing status on deaf people’s recalled access to childhood indirect family communication. We analyzed data from the Rochester Deaf Health Survey–2013 (n = 211 deaf adults) for associations between sociodemographic factors including parental hearing status, and recalled access to childhood indirect family communication. Parental hearing status predicted deaf adults’ recalled access to childhood indirect family communication (χ² = 31.939, p < .001). The likelihood of deaf adults reporting “sometimes to never” for recalled comprehension of childhood family indirect communication increased by 17.6 times for those with hearing parents. No other sociodemographic or deaf-specific factors in this study predicted deaf adults’ access to childhood indirect family communication. This study finds that deaf people who have hearing parents were more likely to report limited access to contextual learning opportunities during childhood. Parental hearing status and early childhood language experiences, therefore, require further investigation as possible social determinants of health to develop interventions that improve lifelong health and social outcomes of the underserved deaf population.

Caregiver-Reported Indicators of Communication and Social Functioning for Young Children Who Are Deaf or Hard of Hearing

We elicited caregiver-reported observations of children aged 5-10 who were deaf or hard of hearing (DHH) that resulted in two age-specific instruments: Caregiver Report of Behaviors and Events (CROBE-DHH 5-7 and 8-10). These new instruments record observations on communication and social behaviors/events. In Study 1, 36 caregivers provided qualitative data on important content on what they were able to observe for instrument development and in Study 2, 271 provided data for studying cross-sectional measurement properties. Two modules resulted in 11 items for children age 5-7 and 15 items for children 8-10 years. Items showing good 7-day reproducibility (ICC over .70) and fair 4-week reproducibility (ICC over .50) were retained. Children with milder hearing loss received higher (better) scores. Items did not distinguish between those with or without cochlear implants. Analyses suggest that the instruments are best used as individual indicator items. In both age groups, caregivers reported youths missed out on family conversations and spent little time on their own. These content-validated indicators apply to all children with DHH. Further work will evaluate the usefulness of these indicators in evaluating change in communication and social behaviors, and the implications of results for intervention.

Positive Psychology in Research with the Deaf Community: An Idea Whose Time Has Come

The emergence of positive psychology as an approach to studying what makes life worth living has inspired a new wave of research. Studies have focused on the prevalence and degree of positive attributes, attitudes, and characteristics in the wider population. Increasingly, lessons learned from positive psychology have been applied to understanding the more diverse experiences of individuals belonging to various groups. Only recently, however, has positive psychology research incorporated a disability perspective, and very little research from a positive psychology stance has been conducted with deaf people. This article addresses the application of positive psychology constructs in the context of deaf communities and individuals who are deaf or hard of hearing. We argue that utilization of a positive psychology paradigm can broaden and enrich a collective understanding of deaf people, and suggest a different set of research questions. A positive psychology mindset encourages scholars to learn how people who are deaf or hard of hearing, and those within the larger deaf community1, may define and attain "the good life."

Communication barrier in family linked to increased risks for food insecurity among deaf people who use American Sign Language

OBJECTIVE

Food security is defined as being able to access enough food that will help maintain an active, healthy lifestyle for those living in a household. While there are no studies on food security issues among deaf people, research shows that communication barriers early in life are linked to poor physical and mental health outcomes. Childhood communication barriers may also risk later food insecurity. Design/Setting/Subjects A single food security screener question found to have 82 % sensitivity in classifying families who are at risk for food insecurity was taken from the six-item US Household Food Security Survey Module. Questions related to food insecurity screener, depression diagnosis and retrospective communication experience were translated to American Sign Language and then included in an online survey. Over 600 deaf adult signers (18-95 years old) were recruited across the USA.

RESULTS

After adjusting for covariates, deaf adults who reported being able to understand little to none of what their caregiver said during their formative years were about five times more likely to often experience difficulty with making food last or finding money to buy more food, and were about three times more likely to sometimes experience this difficulty, compared with deaf adults who reported to being able to understand some to all of what their caregiver said.

CONCLUSIONS

Our results have highlighted a marked risk for food insecurity and related outcomes among deaf people. This should raise serious concern among individuals who have the potential to effect change in deaf children's access to communication.

Examining States’ Responses to the IDEA Special Factors Requirements for DHH Students

Deaf and hard-of-hearing (DHH) students have exhibited deficient language competencies and low academic achievement for over four decades. As a result, Individuals With Disabilities Education Act (IDEA) 2004 requires schools to address special language and communication factors through each student’s Individualized Education Program (IEP). States have responded in a variety of ways with several that supplement their IEPs using a communication plan. This article examined states’ IEP or communication plan templates to identify the format and specificity with which they addressed these requirements. The IDEA language was parsed into distinct items to allow ratings using a Likert-type scale. The analyses performed descriptive, t test, and ANOVA comparisons on the forms posted on states’ website. Those states using a communication plan had significantly higher ratings overall. Kentucky’s form was the most highly rated IEP and identified each required item. Most state IEP forms identified these factors more generally with a majority rated as only minimally specified. Use of a communication plan or IEP form that incorporates IDEA language similar was the most effective strategy. Overt specificity ensures that DHH students’ language and communication needs are being met in the educational environment and facilitates states’ oversight in meeting their educational responsibilities.

Language and Psychosocial Functioning among Deaf Learners with and without Cochlear Implants

Various studies have examined psychosocial functioning and language abilities among deaf children with and without cochlear implants (CIs). Few, however, have explored how relations among those abilities might change with age and setting. Most relevant studies also have failed to consider that psychosocial functioning among both CI users and nonusers might be influenced by having language abilities in both signed and spoken language. The present investigation explored how these variables might influence each other, including the possibility that deaf individuals' psychosocial functioning might be influenced differentially by perceived and actual signed and spoken language abilities. Changes in acculturation and quality of life were examined over their first year in college, together with changes in perceived and assessed language abilities. Students with and without CIs differed significantly in some aspects of psychosocial functioning and language ability, but not entirely in the directions expected based on studies involving school-aged deaf students. Participants' cultural affiliations were related as much or more to perceived language abilities as to the reality of those abilities as indicated by formal assessments. These results emphasize the need to consider the heterogeneity of deaf learners if they are to receive the support services needed for personal and academic growth.

Perceived Quality of Life Among Adults With Hearing Loss: Relationships With Amplification Device and Financial Well-Being

The current study explored the relationship between perceived quality of life and financial well-being among adult cochlear implant (CI) users as compared with hearing aid (HA) users. Participants were 66 adults: 30 CI users and 36 HA users. They completed the Perceived Quality of Life for Deaf and Hard-of-Hearing (DHH) scale, the In Charge Financial Distress/Financial Well-Being scale, and a background questionnaire. Significant differences were found between the two study groups in two perceived quality-of-life factors: participation, t(58) = 1.71, p < .05, and perceived stigma, t(58) = −1.80, p < .05. CI users reported higher levels of participation and lower levels of perceived stigma as compared with HA users. In addition, financial well-being was a significant predictor of participation (β = .32, p < .05), and CI users who used their device for a longer time reported higher levels of financial well-being ( r = .35, p < .05). Research findings emphasize the possible contribution that both CIs and financial well-being may have on the perceived quality of life of DHH adults. In addition, time since implantation may be an important variable when measuring improvements after cochlear implantation, especially when evaluating long-term processes, such as changes in financial well-being.

Discourses of prejudice in the professions: the case of sign languages

There is no evidence that learning a natural human language is cognitively harmful to children. To the contrary, multilingualism has been argued to be beneficial to all. Nevertheless, many professionals advise the parents of deaf children that their children should not learn a sign language during their early years, despite strong evidence across many research disciplines that sign languages are natural human languages. Their recommendations are based on a combination of misperceptions about (1) the difficulty of learning a sign language, (2) the effects of bilingualism, and particularly bimodalism, (3) the bona fide status of languages that lack a written form, (4) the effects of a sign language on acquiring literacy, (5) the ability of technologies to address the needs of deaf children and (6) the effects that use of a sign language will have on family cohesion. We expose these misperceptions as based in prejudice and urge institutions involved in educating professionals concerned with the healthcare, raising and educating of deaf children to include appropriate information about first language acquisition and the importance of a sign language for deaf children. We further urge such professionals to advise the parents of deaf children properly, which means to strongly advise the introduction of a sign language as soon as hearing loss is detected.

Social Dominance Orientation, Language Orientation, and Deaf Identity

The notion of the Deaf community as a linguistic-cultural minority has been increasingly recognized and studied over the last two decades. However, significant differences of opinion and perspective within that population typically have been neglected in the literature. Social dominance orientation (SDO), a theoretical construct, typically focusing on intergroup perceptions and relations, is one aspect that has been left unexplored and might prove particularly enlightening. The present study investigated SDO among 119 deaf and 49 hearing young adults through a standardized SDO questionnaire. SDO was examined with regard to cultural identities (deaf, hearing, bicultural, and marginal), cochlear implant use, and language orientation (sign language or spoken language). The deaf participants were found to be more egalitarian than hearing individuals overall. Deaf individuals who held the strongest deaf identities, those who were sign language oriented, and not cochlear implant users, were the most egalitarian.

Retrospective Basic Parent-Child Communication Difficulties and Risk of Depression in Deaf Adults

This paper describes the relationship between retrospective communication difficulties and current depressive symptomatology. A total of 143 deaf/hard-of-hearing late adolescents and adults (64 % White; 55 % female) completed questionnaires related to parent communication, language history and current psychological functioning. Logistic regression models were used to estimate the likelihood of having depression that is associated with understanding parents' communication after controlling for gender, hearing level, and language history. Significant odds ratio indicated that the difficulties in understanding basic communication with parents increased the odds of depression symptomatology. The odds ratio indicates that when holding all other variables constant, the odds of reporting depression were at least 8 times higher for those who reported being able to understand some to none of what the same-sex parent said. For the different-gender parent, only the mother's communication with the male individual was associated with depression. Although our study findings suggest that DHH men and women with history of communication difficulties at home are at risk for depression in adulthood, they do not provide information on the causal mechanisms linking communication difficulties early in life and depression later in life. Greater attention should be given to promoting healthy communication between DHH girls and their mothers as well as DHH boys and their fathers, which might reduce the impact on later emergence of depression in the DHH individual.

Auditory Deprivation Does Not Impair Executive Function, But Language Deprivation Might: Evidence From a Parent-Report Measure in Deaf Native Signing Children

Deaf children are often described as having difficulty with executive function (EF), often manifesting in behavioral problems. Some researchers view these problems as a consequence of auditory deprivation; however, the behavioral problems observed in previous studies may not be due to deafness but to some other factor, such as lack of early language exposure. Here, we distinguish these accounts by using the BRIEF EF parent report questionnaire to test for behavioral problems in a group of Deaf children from Deaf families, who have a history of auditory but not language deprivation. For these children, the auditory deprivation hypothesis predicts behavioral impairments; the language deprivation hypothesis predicts no group differences in behavioral control. Results indicated that scores among the Deaf native signers (n = 42) were age-appropriate and similar to scores among the typically developing hearing sample (n = 45). These findings are most consistent with the language deprivation hypothesis, and provide a foundation for continued research on outcomes of children with early exposure to sign language.

Intelligence development of pre-lingual deaf children with unilateral cochlear implantation

OBJECTIVE

The present study aims to test whether deaf children with unilateral cochlear implantation (CI) have higher intelligence quotients (IQ). We also try to find out the predictive factors of intelligence development in deaf children with CI.

METHODS

Totally, 186 children were enrolled into this study. They were divided into 3 groups: CI group (N = 66), hearing loss group (N = 54) and normal hearing group (N = 66). All children took the Hiskey-Nebraska Test of Learning Aptitude to assess the IQ. After that, we used Deafness gene chip, Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) methods to evaluate the genotype, auditory and speech performance, respectively.

RESULTS

At baseline, the average IQ of hearing loss group (HL), CI group, normal hearing (NH) group were 98.3 ± 9.23, 100.03 ± 12.13 and 109.89 ± 10.56, while NH group scored higher significantly than HL and CI groups (p < 0.05). After 12 months, the average IQ of HL group, CI group, NH group were99.54 ± 9.38,111.85 ± 15.38, and 112.08 ± 8.51, respectively. No significant difference between the IQ of the CI and NH groups was found (p > 0.05). The growth of SIR was positive correlated with the growth of IQ (r = 0.247, p = 0.046), while no significant correlation were found between IQ growth and other possible factors, i.e. gender, age of CI, use of hearing aid, genotype, implant device type, inner ear malformation and CAP growth (p > 0.05).

CONCLUSIONS

Our study suggests that CI potentially improves the intelligence development in deaf children. Speech performance growth is significantly correlated with IQ growth of CI children. Deaf children accepted CI before 6 years can achieve a satisfying and undifferentiated short-term (12 months) development of intelligence.

Hearing Parents' Appraisals of Parenting a Deaf or Hard-of-Hearing Child: Application of a Positive Psychology Framework

Hearing parents of deaf and hard-of-hearing children face unique challenges and stressors, the understanding of which has been the focus of numerous studies; yet, relatively little is known about their positive experiences. Using a qualitative purposive sampling design, interviews were conducted with 11 hearing parents (8 mothers, 3 fathers) exploring parents' positive appraisals of their experiences in raising a child who is deaf or hard of hearing (D/HH). Interviews were transcribed and a thematic analysis was conducted, which allowed the researchers to identify themes and patterns in the parents' appraisals. Nine key themes emerged, which characterized parents' positive perceptions of raising a child who is D/HH: knowing the child, appreciating everyday positives, increasing involvement with the child, relishing the highs, taking less for granted, letting go, learning, advocating, and experiencing personal growth A positive psychology framework was employed to foster understanding of the interview findings and their implications. When asked about the positive aspects of raising a D/HH child, hearing parents were readily able to identify ways in which their parenting experience had been enhanced and their lives improved as a result of their unique situations. The implications of these findings are discussed.

Quality of Life in Children with Hearing Impairment: Systematic Review and Meta-analysis

OBJECTIVE

To determine the impact of pediatric hearing loss (HL) on quality of life (QOL).

DATA SOURCES

A qualified medical librarian conducted a literature search for relevant publications that evaluate QOL in school-aged children with HL.

REVIEW METHODS

Studies were assessed independently by 2 reviewers for inclusion in the systematic review and meta-analysis.

RESULTS

From 979 abstracts, 69 were identified as relevant; ultimately, 40 articles were included in the systematic review. This review revealed that children with HL generally report a lower QOL than their normal-hearing peers and that QOL improves after interventions. The extent of these differences is variable among studies and depends on the QOL measure. Four studies using the Pediatric Quality of Life Inventory (PedsQL) had sufficient data for inclusion in a meta-analysis. After studies were pooled, statistically and clinically significant differences in PedsQL scores were found between children with normal hearing and those with HL, specifically in the social and school domains. Statistically significant differences were also noted in total scores for children with unilateral HL and in the physical domain for children with bilateral HL as compared with those having normal hearing; however, these differences were not clinically meaningful.

CONCLUSIONS

Our analysis reveals that decreased QOL in children with HL is detected in distinct domains of the PedsQL. These domains-school activities and social interactions-are especially important for development and learning. Future work should focus on these aspects of QOL when assessing HL in the pediatric population.

Deaf adolescents in a hearing world: a review of factors affecting psychosocial adaptation

Adolescence has long been viewed as a time of rapid change in many domains including physical, cognitive, and social. Adolescents must adapt based on developing skills and needs and acclimate to growing environmental pressures. Deaf adolescents are often faced with the additional challenge of managing these adaptations in a hearing world, where communication and access to information, especially about their social world, are incomplete at best and nonexistent at worst. This article discusses the research on several factors that influence a deaf adolescent's adaptation, including quality of life, self-concept, and identity development. Gaps in our knowledge are pointed out with suggestions for future research programs that can facilitate optimal development in adolescents who are deaf.

Deaf Adolescents' Learning of Cardiovascular Health Information: Sources and Access Challenges

Deaf individuals have more cardiovascular risks than the general population that are believed to be related to their cardiovascular health knowledge disparities. This phenomenological study describes where 20 deaf sign language-using adolescents from Rochester, New York, many who possess many positive characteristics to support their health literacy, learn cardiovascular health information and their lived experiences accessing health information. The goal is to ultimately use this information to improve the delivery of cardiovascular health education to this population and other deaf adolescents at a higher risk for weak health literacy. Deaf bilingual researchers interviewed deaf adolescents, transcribed and coded the data, and described the findings. Five major sources of cardiovascular health information were identified including family, health education teachers, healthcare providers, printed materials, and informal sources. Despite possessing advantageous characteristics contributing to stronger health literacy, study participants described significant challenges with accessing health information from each source. They also demonstrated inconsistencies in their cardiovascular health knowledge, especially regarding heart attack, stroke, and cholesterol. These findings suggest a great need for additional public funding to research deaf adolescents' informal health-related learning, develop accessible and culturally appropriate health surveys and health education programming, improve interpreter education, and disseminate information through social media.

Mental health problems in adolescents with cochlear implants: peer problems persist after controlling for additional handicaps

The aims of the present multi-center study were to investigate the extent of mental health problems in adolescents with a hearing loss and cochlear implants (CIs) in comparison to normal hearing (NH) peers and to investigate possible relations between the extent of mental health problems of young CI users and hearing variables, such as age at implantation, or functional gain of CI. The survey included 140 adolescents with CI (mean age = 14.7, SD = 1.5 years) and 140 NH adolescents (mean age = 14.8, SD = 1.4 years), their parents and teachers. Participants were matched by age, gender and social background. Within the CI group, 35 adolescents were identified as “risk cases” due to possible and manifest additional handicaps, and 11 adolescents were non-classifiable. Mental health problems were assessed with the Strengths and Difficulties Questionnaire (SDQ) in the versions “Self,” “Parent,” and “Teacher.” The CI group showed significantly more “Peer Problems” than the NH group. When the CI group was split into a “risk-group” (35 “risk cases” and 11 non-classifiable persons) and a “non-risk group” (n = 94), increased peer problems were perceived in both CI subgroups by adolescents themselves. However, no further differences between the CI non-risk group and the NH group were observed in any rater. The CI risk-group showed significantly more hyperactivity compared to the NH group and more hyperactivity and conduct problems compared to the CI non-risk group. Cluster analyses confirmed that there were significantly more adolescents with high problems in the CI risk-group compared to the CI non-risk group and the NH group. Adolescents with CI, who were able to understand speech in noise had significantly less difficulties compared to constricted CI users. Parents, teachers, and clinicians should be aware that CI users with additionally special needs may have mental health problems. However, peer problems were also experienced by CI adolescents without additional handicaps.

Sense of coherence, social networks, and mental health among children with a cochlear implant

OBJECTIVE

The aim of this study was to explore the personal and social resources of children with a cochlear implant from a child's perspective.

METHOD

This descriptive cross-sectional study included 19 children with cochlear implants, aged 9-12 years. Data was collected, using the children's sense of coherence (CSOC) scale, the Network map, and the strengths and difficulties questionnaire (SDQ). The data was analyzed using descriptive and correlation statistics.

RESULTS

Most children had a strong sense of coherence. School life was an important arena for their social network. The mental health was comparable to normal hearing children. Still, some of the children with implants had low SOC and poor mental health. High SOC and closeness of the social network, especially in school, were associated with good mental health.

CONCLUSION

This study shows that Swedish school-aged children with cochlear implants as a group have access to personal and social resources as strong sense of coherence and social networks. Still, there are individual children with psychosocial problems who need support and treatment.

Impact of late toxicities on quality of life for survivors of nasopharyngeal carcinoma

BACKGROUND

To investigate the impact of physician-assessed late toxicities on patient-reported quality of life (QoL) for nasopharyngeal carcinoma (NPC) patients with long-term survival.

METHODS

A cross-sectional survey of QoL and late toxicities was conducted in 242 NPC patients with disease-free survival of more than 5 years after treatment. The QoL was assessed by the European Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Late toxicities including neuropathy, hearing loss, dysphagia, xerostomia, and neck fibrosis were recorded based on the criteria of Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0). The general linear model multiple analysis of variance (GLM-MANOVA) was performed to predict factors associated with the QoL.

RESULTS

In the multifactor model of GLM-MANOVA, of the five late toxicities of CTCAE scales, neuropathy, hearing loss, and xerostomia were observed to be significantly associated with the overall outcome of the fifteen QLQ-C30 scales. A statistically significant trend (p <0.05) was observed, indicating that NPC survivors with more severe neuropathy, hearing loss or xerostomia had a worse outcome on global QoL, all five functional scales, and a variety of symptomatic scales.

CONCLUSIONS

To improve QoL outcome for NPC survivors, the development of a modern radiotherapeutic technique should not only focus on reduction of the dose to the salivary glands, but also on anatomical structures that are involved in neuropathy and hearing loss.

Child maltreatment and trauma exposure among deaf and hard of hearing young adults

The purpose of the present study was to examine the prevalence of child maltreatment and lifetime exposure to other traumatic events in a sample of deaf and hard of hearing (DHH; n=147) and matched hearing (H; n=317) college students. Participants completed measures of child maltreatment (CM), adult victimization and trauma exposure, and current symptoms of posttraumatic stress disorder (PTSD). Overall, DHH participants reported significantly more instances of CM compared to H participants, with 76% of DHH reporting some type of childhood abuse or neglect. Additionally, DHH participants reported experiencing a higher number of different types of CM, and also reported increased incidents of lifetime trauma exposure and elevated PTSD symptoms. Severity of deafness increased the risk of maltreatment, with deaf participants reporting more instances of CM than hard of hearing participants, and hard of hearing participants reporting more instances of CM than H participants. Among DHH participants, having a deaf sibling was associated with reduced risk for victimization, and identification with the Deaf community was associated with fewer current symptoms of PTSD. A regression model including measures of childhood physical and sexual abuse significantly predicted adult re-victimization and accounted for 27% of the variance among DHH participants. DHH participants report significantly higher rates of CM, lifetime trauma, and PTSD symptoms compared to H participants. Severity of deafness appears to increase the risk of being victimized. Being part of the Deaf community and having access to others who are deaf appear to be important protective factors for psychological well-being among DHH individuals.

Conceptual model for quality of life among adults with congenital or early deafness

BACKGROUND

A conceptual model of health-related quality of life (QoL) is needed to describe key themes that impact perceived QoL in adults with congenital or early deafness.

OBJECTIVE

To revise University of Washington Center for Disability Policy and Research's conceptual model of health promotion and QoL, with suggestions for applying the model to improving programs or services that target deaf adults with early deafness.

METHODS

Purposive and theoretical sampling of 35 adults who were born or became deaf early was planned in a 1-year study. In-depth semi-structured interviews probed deaf adult participants' perceptions about quality of life as a deaf individual. Data saturation was reached at the 17th interview with 2 additional interviews for validation, resulting in a total sample of 19 deaf adults. Coding and thematic analysis were conducted to develop the conceptual model.

RESULTS

Our conceptual model delineates the relationships between health status (self-acceptance, coping with limitations), intrinsic (functional communication skills, navigating barriers/self-advocacy, resilience) and extrinsic (acceptance by others, access to information, educating others) factors in their influence on deaf adult quality of life outcomes at home, college, work, and in the community.

CONCLUSIONS

Findings demonstrate the need for the programs and services to consider not only factors intrinsic to the deaf individual but also extrinsic factors in enhancing perceived quality of life outcomes among people with a range of functional hearing and language preferences, including American Sign Language.

Bilingualism: A Pearl to Overcome Certain Perils of Cochlear Implants

Cochlear implants (CI) have demonstrated success in improving young deaf children's speech and low-level speech awareness across a range of auditory functions, but this success is highly variable, and how this success correlates to high-level language development is even more variable. Prevalence on the success rate of CI as an outcome for language development is difficult to obtain because studies vary widely in methodology and variables of interest, and because not all cochlear implant technology (which continues to evolve) is the same. Still, even if the notion of treatment failure is limited narrowly to those who gain no auditory benefit from CI in that they cannot discriminate among ambient noises, the reported treatment failure rate is high enough to call into question the current lack of consideration of alternative approaches to ensure young deaf children's language development. Recent research has highlighted the risks of delaying language input during critical periods of brain development with concomitant consequences for cognitive and social skills. As a result, we propose that before, during, and after implantation deaf children learn a sign language along with a spoken language to ensure their maximal language development and optimal long-term developmental outcomes.

Children with cochlear implants: cognitive skills, adaptive behaviors, social and emotional skills

OBJECTIVE

The aim of this study is to examine cognitive skills, adaptive behavior, social and emotional skills in deaf children with cochlear implant (CI) compared to normal hearing children.

METHODS

The study included twenty children affected by profound hearing loss implanted with a CI compared to 20 healthy children matched to chronological age and gender.

RESULTS

Results of this study indicated that 55% of children with CI showed a score in the normal range of nonverbal intelligence (IQ > 84), 40% in the borderline range (71 < IQ < 84) and 5% were in mild range(50 < IQ < 70). No significant differences were found after comparison with normal hearing children.Children with CI reported more abnormalities in emotional symptoms (p = .018) and peer problems(p = .037) than children with normal hearing. Age of CI was negatively correlated with IQ (p = .002),positively correlated with emotional symptoms (p = .04) and with peer problems (p = .02).

CONCLUSIONS

CI has a positive effect on the lives of deaf children, especially if it is implanted in much earlier ages.

School placement and perceived quality of life in youth who are deaf or hard of hearing

In the education of students who are deaf and hard of hearing (DHH), there is much debate about how placement affects educational outcomes and quality of life. This study examined the relationship between quality of life and educational placement that include and do not include other DHH youth. Participants included 221 DHH youth, ages 11-18 with bilateral hearing loss. Results showed that there were few differences in quality of life related to school placement (with age, gender, depression symptoms, and hearing level as covariates). For both participation and perceived stigma, there was an interaction between school placement and parent hearing status, with no single school placement showing the best results. DHH youth with hearing parents in schools specifically for DHH students scored lower than DHH with deaf parents in some domains (Participation and Perceived Stigma). When the DHH youth were compared with the general population, those in schools that included DHH students scored lower in some aspects of quality of life, particularly Self and Relationships. This study demonstrates that DHH students may not differ much in terms of quality of life across schools placements, but that there may be differences in subsets of DHH youth.

Strengths and difficulties in children with cochlear implants--comparing self-reports with reports from parents and teachers

OBJECTIVE

The aim was to explore and compare how children with cochlear implants, their parents, and their teachers perceive the children's mental health in terms of emotional and behavioral strengths and difficulties.

METHODS

The self-report, parents', and teachers' versions of the Strengths and Difficulties Questionnaire (SDQ) were used to assess the mental health of 22 children with cochlear implants. The children's assessments were then compared to the parents' and 17 teachers' assessments. The data were analyzed using the SPSS software package.

RESULTS

Total difficulties (p=.000), emotional symptoms (p=.000), and conduct problems (p=.007) were greater according to the children than according to parents and teachers. Younger children (9 years, n=12) reported more emotional symptoms than older children (12 and 15 years, n=10). Almost a quarter of the children rated themselves in a way indicating mental ill-health. Parents and teachers each indicated mental ill-health for one child.

CONCLUSIONS

Children with cochlear implants express greater concerns about their mental health than their parents and teachers do. This is important knowledge for adults in families, schools, and health care in order to support these children and offer treatment when needed.