Everyday Stressors in Deaf and Hard of Hearing Adolescents: The Role of Coping and Pragmatics

"A lonely time for deaf and hard of hearing kids": A qualitative study of the impact of pandemic precautions on classroom communication for adolescents with hearing loss

BACKGROUND

Pandemic public health measures, such as masks and social distancing, present unique challenges for people who are hard-of-hearing. This study sought to understand how adolescents with varying levels of hearing loss would describe their experiences communicating in a classroom environment during a pandemic and its associated public health measures.

METHODS

Qualitative study utilizing one-on-one semi-structured interviews conducted from July 2021 to April 2022. Interviews were transcribed and analyzed using a reflexive thematic analysis to conceptualize the main themes from the data. Adolescents ages 12-17 who attended school in person during the COVID-19 pandemic with either normal hearing or; bilateral cochlear implants or; bone-anchored hearing aids or; unilateral moderate to severe (40-70 dB) conductive hearing loss secondary to mastoidectomy, were interviewed. Participants were recruited from BC Children's Hospital Otolaryngology clinic via a convenience sample.

RESULTS

Fourteen adolescents were interviewed with a median age of 15, 9 with hearing loss and 5 with normal hearing. Pandemic associated challenges such as masks muffling speech, protocol fatigue, and missing pre-pandemic life were present in both the hearing loss and normal hearing groups. Classroom communication for adolescents with hearing loss was disproportionately affected by pandemic measures, leading to challenges making friends, feeling behind their peers in learning, and listening fatigue. Resilience was noted among adolescents with hearing loss in their ability to adapt to pandemic measures and changing classroom dynamics. For adolescents with unilateral hearing loss, the pandemic provided an improved listening environment via a reduction in background noise.

CONCLUSION

Pre-existing classroom communication challenges for adolescents with hearing loss were amplified under pandemic public health measures and shared, in part, by those with normal hearing. These findings can be used to further inform classroom design to the optimize learning environment for deaf and hard of hearing students.

Understanding identity construction among deaf adolescents and young adults: implications for the delivery of person and family-centered care in audiological rehabilitation

Introduction

The provision of holistic person and family-centered care in the audiological rehabilitation of adolescents and young adults (AYA) requires in-depth consideration of identity construction. The purpose of this research study was to describe the lived experience of identity construction among deaf AYA. The thoughts, perceptions, and feelings of AYA on their identity and the processes underlying the construction of identity, with a focus on navigating disability, social relations and roles, community assimilation and self-perception were explored.

Methods

A qualitative interpretive phenomenological approach was adopted. Participants were a purposive sample of 5 AYA, aged 15 to 19 years. Participants had moderate to profound deafness and were enrolled in schools for the deaf where they partook in semi-structured phenomenological conversations, detailing their lived experiences with identity construction.

Results

The superordinate themes of creating a self-concept, belonging, stress and being deaf emerged from participants' narratives. Identity construction occurs concurrently at several levels. At the personal level, AYA create self-conceived ideals of who they are. At relational level, identity is fostered through person-to-person and person-to-group interactions. At societal level, AYA navigate inherent challenges with hearing impairment and their positionality as deaf individuals.

Conclusions

Understanding the nuances of identity construction gives insights for further research and highlights the self-ascribed identity domains and related psychosocial variables that appeal to person and family-centered care, uncovering opportunities and barriers to successful delivery. Findings have implications for the transitional care of deaf AYA that is responsive to their needs.

Self-Reported Listening Abilities in Educational Settings of Typically Hearing Children and Those Who Are Deaf/Hard-of-Hearing

Children who are deaf or hard-of-hearing (D/HH) learning in inclusive educational settings must be aware of how well they hear and understand spoken language to advocate for themselves. This study explored elementary-age children's self-reported listening abilities using thematic analysis of brief interviews. Participants were 16 D/HH and 16 typically hearing (TH) 7- to 12-year-old monolingual English speakers in Canada. Children were asked about their ability to hear and understand the teacher, other students, and people in different environments. Findings showed surprising similarities across groups in terms of numbers of "no difficulty" responses and awareness of listening barriers related to speaker and environmental characteristics. Unsurprisingly, children who are D/HH were more likely to discuss hearing technologies and to attribute difficulties to their hearing abilities. Findings suggest that children who are D/HH with poor speech discrimination in noise abilities require support in developing awareness of and expressing difficulties with listening abilities.

Drinking to cope and coping strategies in Deaf/Hard of hearing college students

INTRODUCTION

Deaf and hard of hearing (DHH) students experience unique stressors as a minority linguistic and cultural group that may contribute to problematic substance and alcohol use behavior. Proper coping strategies may be one protective factor to avoid reliance on alcohol as a means to reduce stress.

METHODS

The current study compared the endorsement of coping strategies by DHH students and hearing individuals and their relationship to drinking to cope behavior. Data was collected among DHH (n = 126) and hearing students (n = 349) at a large university.

RESULTS

While these two groups did not differ in their levels of problematic drinking behavior, there were differences observed in drinking to cope motives as well as in the levels of coping styles used. DHH students were found to endorse greater levels of emotion-oriented and task-oriented coping than hearing students. Drinking to cope motivations were also higher for DHH students, particularly those who endorsed greater emotion focused coping.

CONCLUSIONS

Interventions and educational efforts involving coping skills is a potentially important area of focus for the DHH student population. Further implications for understanding drinking behavior in this population are discussed.

Technology assisted language intervention (TALI) for children who are deaf/hard of hearing: promising impact on pragmatic skills

Children who are deaf and hard of hearing (DHH) often demonstrate pragmatic language difficulties which can impact academic and social outcomes. This randomized control trial for DHH children, ages 3-12 years, explored the Technology-Assisted Language Intervention (TALI), incorporating augmentative and alternative communication technology (AAC) into traditional speech/language therapy, compared to treatment-as-usual (TAU) to determine impact on pragmatics. Pragmatic outcome measures included parent reported Pragmatics Profile of the CELF-5 (for children age ≥5 years) and CELF-P Descriptive Pragmatics Profile (for children <5 years) in addition to parent reported Social and Communication domains of the Vineland Adaptive Behavior Scales,Third Edition (VABS). Over 24 weeks, children ≥5 years in the TALI made significantly more progress (increase in raw scores) on the Pragmatics Profile compared to children in TAU (12.7 points vs. -6.0 points; p = 0.04) and also showed significant gains on two of the three subscales. For children ≥5 years, no significant VABS changes were seen in either intervention group. For children <5 years, there were no statistically significant differences in growth on the CELF-P total pragmatics raw score or on any subdomain. However, children in TALI had significant increases in the mean VABS Communication (86.7-99.1) and Social domain standard scores (91.8-97.4;p = 0.01), while gains for children in TAU on the Communication and Social domain standard scores were not statistically significant. These promising results support the need for additional research exploring the effectiveness of AAC supported speech/language therapy to enhance DHH children's pragmatic language skills.

Trial registration

ClinicalTrials.gov identifier: NCT02998164.

Examination of Predictive Factors Healthy Lifestyle Behaviours and Compare Coping Styles with Stress of Adolescents with and without Hearing Loss: A Comparative Study

Objective: Examination of predictive factors healthy lifestyle behaviours and compare coping styles with stress of adolescents with and without Hearing Loss (HL). Methods: A comparative cross‐sectional design was employed. The participants comprise high school students with (n= 272) and without (n= 272) HL. Participants completed questionnaires on coping styles with stress and Adolescent Lifestyle Profile Scale 2 (ALP‐R2). Descriptive statistics, chi‐square, t‐test, and multiple linear regression analysis were used to analyze the responses given to the above instruments. Results: Adolescents without HL (116.46±16.89) had significantly higher scores on the lifestyle profile scale than another group (113.68±16.12) (p

Supporting the Social-Emotional Well-Being of Elementary School Students Who Are Deaf and Hard of Hearing: A Pilot Study

PURPOSE

Children who are Deaf and Hard of Hearing (DHH), their parents, Teachers of the Deaf, and other community stakeholders were involved in co-designing a web-based resource to support students' social-emotional well-being. The resource was designed to provide families and teachers with strategies to enhance the social and emotional well-being of Grade 4-6 students who are DHH. This study reports outcomes of a pilot study of the web-based resource intervention.

METHOD

A pre-post pilot study was conducted to quantitatively examine reported anxiety, well-being, social relationships, school experience, student-teacher relationship, and parent and teacher self-efficacy. A total of 37 students, their parents (n = 37), and their classroom teachers (n = 40) participated in the intervention program and were provided access to the resource.

RESULTS

In total, 19 students, 22 parents, and 17 teachers completed both pre- and postsurvey measures. Paired t tests revealed that there was a statistically significant increase in parents' self-efficacy scores from pre- to posttest. Multivariate analysis of covariance revealed a significant association between parent use of the website and student-reported improved peer support and reduced school loneliness. No other statistically significant differences were found.

CONCLUSIONS

The use of a web-based resource codeveloped with students who are DHH, their parents, and teachers could potentially be beneficial for the well-being of students who are DHH as well as parents' self-efficacy. Further research is needed to confirm the benefits.

Longitudinal effects of emotion awareness and regulation on mental health symptoms in adolescents with and without hearing loss

Emotion awareness (EA) and regulation (ER) are each known to associate with mental health symptoms, yet there is a paucity of longitudinal studies examining them jointly during adolescence. Furthermore, little is known about these skills and their relations in deaf and hard-of-hearing (DHH) adolescents, who are at risk for reduced emotion socialization and for more mental health symptoms. This longitudinal study examined the development and unique contributions of EA (emotion differentiation, emotion communication and bodily unawareness) and ER (approach, avoidance and worry/rumination) to internalizing and externalizing symptoms in adolescents with and without hearing loss. Using self- and parent's reports, we assessed 307 adolescents (age 9-15) three times over 18-month period. We found stability over time in development of EA and avoidance ER, increase in approach ER and decrease in worry/rumination. High levels and increases over time in two aspects of EA, emotion differentiation and communication, and in approach and avoidance ER were related to decreases in depressive symptoms. An increase in approach ER was also related to a decrease in anxiety symptoms. Yet, low levels or decreases in worry/rumination were related to decreased levels of depressive, anxiety and externalizing symptoms. Hearing loss did not moderate any of the variables or relations tested. Preliminary tests suggested heterogeneity within the DHH group according to educational placement, language abilities and parental education level. Overall, findings pointed at unique contributions of EA and ER to mental health development, suggesting that DHH adolescents, especially in mainstream schools, do not differ from their hearing peers in their emotion awareness and regulation.

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.

Resilience from childhood to young adulthood: retrospective perspectives of deaf and hard of hearing people who studied in regular schools

OBJECTIVE

Most deaf and hard of hearing (DHH) youth grow up in hearing familial and educational environments, posing unique risks for their socio-emotional well-being. The study's objective was to explore protective processes contributing to resilience among DHH individuals in different life periods.

DESIGN

We conducted semi-structured interviews with 23 DHH young adults on their life-long coping with having a hearing loss (HL).

MAIN OUTCOME MEASURES

Thematic analysis identified, according to participants' retrospective perceptions, processes that supported their positive adjustment from childhood up to early adulthood.

RESULTS

Themes were organised at three ecological levels: individual, including five subthemes (e.g. certain attitudes to HL); family, including various types of parental support; and community, including four subthemes (e.g. extra-curricular activities). Family and community level resources enabled and nurtured personal attitudes and coping abilities. The perceptions of which personal attitudes and contextual resources were helpful changed from childhood to young adulthood.

CONCLUSIONS

Findings show how resilience is heterogeneously promoted in the unique context of DHH individuals living in hearing environments. They also show interactions between the individual, family and wider society and the dynamics of coping resources across time. Findings indicate the important of considering DHH individuals' coping choices in their specific life context.

Social Capital, Loneliness, and Peer Relationships of Adolescents who are Deaf or Hard of Hearing

There are many documented benefits of social capital to adolescents in general, and for young people who are deaf or hard of hearing social capital can potentially have a buffering effect against adverse life outcomes. Using the Loneliness and Social Dissatisfaction Questionnaire ( Asher et al., 1984; Cassidy & Asher, 1992) and the Looman Social Capital Scale ( Looman, 2006), this research investigated changes in levels of social capital and loneliness and peer relationships of deaf or hard of hearing adolescents before attending a residential camp and then three, six- and 12-months post-camp. The camp was specifically for DHH adolescents whose primary communication mode was spoken language. The study also investigated associations between social capital and adolescents' perceptions of loneliness and peer relationships. Results indicated no statistically significant change in social capital and loneliness and peer relations over the four-time points. There was a significant association between one social capital scale, common good, and loneliness. Implications of these findings are discussed, and recommendations are made for enhancing social capital development within a residential camp experience.

The Assessment of Pragmatic Skills in Young Deaf and Hard of Hearing Children

The development of pragmatic skills does not often receive attention by professionals who are recommending or undertaking assessment of deaf and hard of hearing (DHH) children, yet social communication is vital for linguistic, social, emotional, and academic development. We acknowledge the challenges that DHH children have with pragmatic skills, advocate for monitoring of pragmatic development for all DHH children by medical professionals, and provide direction for assessment of pragmatic skills in young DHH children, particularly for clinicians and teachers who are tasked with that work. Pragmatic assessment is challenging because it must involve observations of the child in interaction with a communication partner, either directly during a specific interaction or through the reflections of a familiar adult. In this article, we recommend two complementary assessment procedures for young DHH children who use spoken language. Assessment 1 recommends that a parent or caregiver completes The Pragmatic Checklist to provide a picture of the child's functional communication. In assessment 2, the information gained through the checklist is complemented by using direct observations of a child in interaction with an adult or a peer. The Pragmatic Protocol uses a video-recorded conversation sample between the child and familiar person that is analyzed by a DHH professional for 30 different pragmatic behaviors. We conclude this article with a recommendation for pediatricians and health care professionals to monitor pragmatic developmental milestones in DHH children, to refer them for pragmatic assessments, and to collaborate with researchers to develop valid, reliable tools that adequately capture the pragmatic skill strengths and needs of DHH children.

Relational Factors in Pragmatic Skill Development: Deaf and Hard of Hearing Infants and Toddlers

In this article, we review relational factors in early childhood believed to contribute in unique ways to pragmatic skill development in deaf and hard of hearing (DHH) infants and toddlers. These factors include attending to infant interactions with caregivers and others, supporting development of theory of mind through play and use of mental state language (ie, describing one's own or others' thoughts, feelings, and beliefs), and providing accessible opportunities for social interaction. On the basis of a review of the literature and clinical experience, we offer prescriptive strategies for supporting DHH children's development in these areas. To improve outcomes for DHH children, medical care providers and allied health professionals have a responsibility to support the development of young DHH children's pragmatic abilities by understanding these variables, coaching caregivers regarding their importance, and facilitating referrals for support when necessary.

Pragmatics and Peer Relationships Among Deaf, Hard of Hearing, and Hearing Adolescents

OBJECTIVES

The goals of the current study were to (1) examine differences in pragmatic abilities and peer relationship behaviors among deaf and hard of hearing (DHH) adolescents who use spoken language, in comparison with their hearing peers; and (2) explore the contribution of pragmatic skills and speech (ie, articulation and intelligibility [AI]) to social aspects of school functioning among DHH and typically hearing adolescents.

METHODS

Thirty-three DHH adolescents and 34 adolescents with typical hearing participated. All DHH adolescents attended mainstream school settings and used spoken language. Teacher reports were obtained on prosocial behaviors, peer problems, pragmatic abilities, and speech AI of the adolescents. Adolescents self-reported on the supportiveness of their peer relationships and their school emotional engagement.

RESULTS

Multiple hierarchical regression analyses revealed that DHH adolescents had greater difficulties with peers than their hearing counterparts. Increased pragmatic difficulties were related to more peer problems and decreased prosocial behaviors, regardless of adolescents' hearing status. A significant positive correlation was found between pragmatic competence and adolescents' perceptions of peers' support. Finally, better speech AI were associated with higher levels of school emotional engagement.

CONCLUSIONS

The results emphasize the significant role of pragmatics for both DHH and typically hearing adolescents. Medical care providers and allied health professionals should be aware of possible difficulties that DHH adolescents may have in complex and nuanced pragmatic skills. Some adolescents may require a referral to specialized services to support the development of their pragmatic understanding and their skills.

Relationships Among Deaf/Hard-of-Hearing Siblings: Developing a Sense of Self

While sibling relationships are known to be important for children's social and emotional well-being, little is known about sibling relationships when both siblings are deaf or hard-of-hearing (DHH). In-depth interviews were conducted with 10 young DHH adults (20-30 years old) who had studied in mainstream schools to explore their retrospective experiences of growing up with a DHH sibling. Interviews were analyzed using interpretive phenomenological analysis. Findings revealed two superordinate themes: (1) sibling relationship and sense of self and (2) family coping and relationships, with each superordinate theme containing several subthemes. Findings highlighted the various ways sibling relationships contribute to siblings' psychological development, identity formation, and coping with deafness. Potential challenges were identifed, as well as the role of parents' attitudes and coping with hearing loss in promoting supportive sibling relationships. Parents and professionals should be aware of the valuable and unique aspects of DHH siblingship and attend to imporatnt relationship asepcts such as sibling communication, sibling comparisons, and parental differential treatment.

The Interplay Between Theory of Mind and Social Emotional Functioning in Adolescents With Communication and Language Problems

Adolescents with developmental language disorders (DLDs) and adolescents who are deaf or hard of hearing (D/HH) are at greater risk of social emotional problems. These problems may not only be attributed to communication and language problems but, at least in part, to Theory of Mind (ToM) deficits as well. In this mini review, an overview is provided of studies on social emotional functioning and ToM performance in adolescents with DLD and D/HH adolescents. A possible interplay between social emotional functioning and Theory of Mind is discussed. There is empirical evidence for social emotional problems and ToM problems in both adolescents with DLD and D/HH. We hypothesized that language deficits as seen in adolescents with DLD and impoverished exposure to language and communication, as seen in adolescents who are D/HH can explain differences in social emotional functioning and ToM performance. The present mini review provides a possible framework for the relation between ToM and social emotional functioning in adolescents with communication and language problems, which is mediated by their limited linguistic ability or restricted language exposure and gives suggestions for future research.

Assessing Pragmatic Skills Using Checklists with Children who are Deaf and Hard of Hearing: A Systematic Review

This paper investigates the use of checklists to assess pragmatics in children and adolescents who are deaf and hard of hearing. A systematic literature review was undertaken to identify all of the published research articles between 1979 and 2018 on the topic of the assessment of pragmatics for this population of children and adolescents. The 67 papers identified in this review were analyzed and all papers that utilized a checklist to assess pragmatic skills were identified. Across the 18 different published papers on the use of pragmatic skills among children who are deaf and hard of hearing, nine checklists were identified. These nine checklists were then compared and contrasted on six key features including identification of a theoretical framework or model; the type of pragmatic skills measured; the age range of the child assessed; the information/outputs generated; the primary informant for the assessment; and reliability, validity, and normative data. The resulting analysis provides a comprehensive guide to aid clinicians, educators, and researchers in selecting an appropriate checklist to assess pragmatic skills for children and adolescents who are deaf and hard of hearing.

Friendship and Emotion Control in Pre-Adolescents With or Without Hearing Loss

Emotional functioning plays a crucial role in the social development of children and adolescents. We examined the extent to which emotion control was related to the quality of friendships in pre-adolescents with and without hearing loss. We tested 350 pre-adolescents (75 deaf/hard of hearing in mainstream education (DHHm), 48 deaf/hard of hearing in special education (DHHs), and 227 hearing) through self-report. Outcomes confirmed a positive association between emotion control and positive friendships for all groups, with one notable exception: more approach strategies for emotion regulation were associated with more negative friendship features in the DHHs group. In addition, the DHHm group demonstrated high levels of emotion control, while their levels of positive friendship features were still lower compared to the hearing group.

Late emotional effects of rehabilitation during childhood and their impact on coping with deafness in adulthood

This study examined potential influences of childhood rehabilitation and over-normalization on coping with disability in adulthood. A total of 88 deaf and hard-of-hearing students were interviewed retrospectively about their childhood and completed self-report questionnaires assessing psychological environment-directedness and present emotional and behavioral coping with deafness. It was partially supported that over-normative parental attitude negatively affected coping with deafness through the mediation of elevated environment-directedness. Intensity of childhood rehabilitation was not found to affect adulthood coping with deafness. However, post-hoc analyses supported this mediation path when rehabilitation had been intensive yet not prolonged. Alleviating changes in the perception and practice of rehabilitation are suggested.