What do we know about deaf clients after thirteen years of ambulatory mental health care? An analysis of the PsyDon database, 1987-1999

Little is known about demographic, deafness-related, and diagnostic characteristics of deaf and partially hearing people with psychosocial or psychiatric problems. A study was conducted derived from data from intake assessment interviews of people with hearing loss treated at a Dutch ambulatory mental health center for the deaf between 1987 and 1999. Both sexes were equally represented. People who were postlingually deaf, hard of hearing, below age 22 years, or above age 65 years were less likely to ask for help than other groups in the study. Men presented more psychiatric disorders, and women more psychosocial problems, especially partially hearing women. The authors recommend stronger emphasis on mental health care for postlingually deaf people, severely hard of hearing people, adolescents, and retirement-age people. They also recommend development of skills for rational and emotional self-expression in the education and rearing of children with hearing loss.     

Theoretical and epidemiological aspects of attention deficit and overactivity in deaf children

Disorders of attention deficit and overactivity, ADHD (DSM-IV), and hyperkinetic syndrome (ICD-10) are common and disabling. However, a number of factors in deaf children's development make the assessment of these disorders in deaf children problematic. The prevalence of ADHD and hyperkinetic disorder does not appear to be higher than expected in children with inherited deafness alone but does appear to be higher in children with acquired deafness and/or additional impairments. Data from a re-analysis of an earlier epdemiological study of psychiatric disorder in deaf children and adolescents suggests that these disorders are commoner than expected in deaf children and share the features of ADHD and hyperkinetic disorder seen in hearing children.     

Characteristics of the population of deaf and hard of hearing students with emotional disturbance in Illinois

The study summarizes a database for the years 1994-1999 on deaf and hard of hearing students in Illinois with a diagnosis of emotional disturbance (N = 115). Data are reported on the group's demographic, domestic, etiologic, communication-related, and intervention-related characteristics. These dually diagnosed students differed from Illinois's general population of deaf and hard of hearing students in many ways, including higher incidences of prematurity, prenatal trauma, and perinatal trauma. They were more likely to have had a later onset of hearing loss, to live in single-parent homes, to belong to an ethnic minority, to live in an urban or suburban area, and to qualify for low-income health care. Many had histories of abuse, 50% were regularly medicated, and 15% were assigned to surrogate parents.     

On creating a workable signing environment: deaf and hearing perspectives

This article studies teams of service providers in education and psychiatric services, in which a substantial number of both deaf and hearing people work together as colleagues. It focuses specifically on the challenges involved in cooperatively creating a signing work environment. Using a methodology that draws on the principles of ethnography, it identifies and explores the meaning constructions associated with signing at work, from deaf and hearing perspectives. Data were collected through interviews in three organizations all in the United Kingdom: two specialist psychiatric units for deaf adults and a school for deaf children. Forty-one informants participated (20 deaf, 21 hearing). Results show that from a deaf perspective, hearing people's use of sign language in their presence at work is closely associated with demonstrating personal respect, value, and confidence, and hearing colleagues' willingness to sign is more significant than their fluency. From a hearing perspective, results demonstrate that sign language use at work is closely associated with change, pressure, and the questioning of professional competence. The challenges involved in improving deaf/hearing relations are perceived from a deaf perspective as largely person-centered, and from a hearing perspective as primarily language-centered. The significance of organizational factors such as imbalances in power and status between deaf and hearing colleagues is explored in relation to the findings.     

Demographic characteristics and rates of progress of deaf and hard of hearing persons receiving substance abuse treatment

A lack of demographic information and data related to the achievement of short-term goals during substance abuse treatment among persons who are deaf or hard of hearing dictated the need for the study. New York State maintains a database on all individuals who participate in treatment. Within this database, 1.8% of persons in treatment for substance use disorder (SUD) were also deaf or hard of hearing. As hypothesized, members of the deaf and hard of hearing sample were older, likelier to be white, and likelier to be female, relative to the SUD-only group. For both groups, alcohol, heroin, and cocaine had the highest rates of reported use. Achievement of short-term goals in the areas of alcohol use, drug use, vocational/educational goals, and overall goals indicated no differences between the deaf and hard of hearing group and the SUD-only group. Implications of these findings are discussed.     

Hearing mothers and their deaf children: the relationship between early, ongoing mode match and subsequent mental health functioning in adolescence

In the few studies that have been conducted, researchers have typically found that deaf adolescents have more mental health difficulties than their hearing peers and that, within the deaf groups, those who use spoken language have better mental health functioning than those who use sign language. This study investigated the hypotheses that mental health functioning in adolescence is related to an early and consistent mode match between mother and child rather than to the child's use of speech or sign itself. Using a large existing 15-year longitudinal database on children and adolescents with severe and profound deafness, 57 adolescents of hearing parents were identified for whom data on language experience (the child's and the mother's) and mental health functioning (from a culturally and linguistically adapted form of the Achenbach Youth Self Report) was available. Three groups were identified: auditory/oral (A/O), sign match (SM), and sign mismatch (SMM). As hypothesized, no significant difference in mental health functioning was found between the A/O and SM groups, but a significant difference was found favoring a combined A/O and SM group over the SMM group. These results support the notion of the importance of an early and consistent mode match between deaf children and hearing mothers, regardless of communication modality.     

Influence and adaptability in families with deaf parents and hearing children

This study assessed the influence of individual family members in functional families, primarily to determine whether hearing children of deaf parents have more influence than do hearing children of hearing parents. Eight families with deaf parents and a hearing child and eight all hearing families were videotaped while planning a family meal together. It was found that deaf-parented families share many traits with hearing families. However, there were some differences. The hearing children of deaf parents had a greater number and percentage of their ideas accepted than did the hearing children of hearing parents. Differences were also noted between the deaf fathers and the hearing fathers. The deaf-parented families were more adaptable, as measured by the Family Adaptability and Cohesion Evaluation Scale. The observed difference in child influence, in and of itself, is neither good nor bad. Deafness of one family member, in an auditory dependent environment, may require a more flexible family power structure. Professionals assessing deaf-parented families should be sensitive to the special adaptive needs required for healthy functioning of the family.     

Mental health services for people who are deaf

The issue of mental health services available to adults and children in the United States who are deaf is addressed. Included is a historical perspective on the changes in these services over the last 50 years. Within this scope, the current status of services is described in some detail. Psychological research on children who are deaf is reviewed, and current issues faced by school psychology and psychologists who evaluate deaf children in school settings are examined. The disturbing current trend toward the criminalization of people with mental illness, which affects both hearing and deaf adults with psychiatric diagnoses, is covered. Suggestions are made for improving mental health services for children and adults who are deaf.     

Sexual abuse of deaf children. A retrospective analysis of the prevalence and characteristics of childhood sexual abuse among deaf adults in Norway

OBJECTIVE: North American studies conclude that deaf children may have a 2-3 times greater risk of sexual abuse than hearing children. No comparative studies are available in the Nordic countries. The present study was initiated to estimate the prevalence of childhood sexual abuse among deaf children in Norway, describe the nature of the abuse, and to examine risk factors. METHOD: A self-administered questionnaire was sent in 1999 to all 1150 adult deaf members of the Norwegian Deaf Register. The Deaf Register includes all deaf Norwegians. The questionnaire, which was also available videotaped in sign language, was an adapted version of a questionnaire used in a Norwegian survey among the general adult population in 1993. The results from this earlier study were used as a comparison group. RESULTS: Deaf females aged 18-65 who lost their hearing before the age of 9 (N = 177) reported sexual abuse with contact before the age of 18 years more than twice as often as hearing females, and deaf males more than three times as often as hearing males. The abuse of the deaf children was also more serious. Very few cases were reported to parents, teachers, or authorities. CONCLUSIONS: Deaf children are at greater risk of sexual abuse than hearing children. The special schools for the deaf represent an extra risk of abuse, regardless of whether the deaf pupils live at home or in boarding schools.     

Historical overview of inpatient care of mental patients who are deaf

A review of published studies of deaf mentally ill inpatients is reported. While there are conflicts in the findings of some of the studies, several generalizations seem fairly universal across countries and time periods. For example, the data indicate a greater overall prevalence of mental illness in the deaf population than in the general population as a whole, based on the relative number of each group who are patients in psychiatric hospitals. In general, deaf patients have longer hospital stays. Characteristics symptoms leading to hospitalization of deaf people tend to be different from those of hearing patients. It was thought by most investigators that restriction of sign language use in schools was one reason for these differences. For both hearing and deaf inpatients, dual diagnosis (mental illness and substance abuse) is far more common today than in years past. All investigators found frequent misdiagnoses among deaf patients. The paucity of research on deaf inpatients over the last 2 decades is noted.     

Korean deaf adolescents' awareness of thematic and taxonomic relations among ordinary concepts represented by pictures and written words

Individuals' relative awareness of thematic and taxonomic relations is influenced by factors such as language and background knowledge. Relatively weak in Korean language skills and also having relatively limited social opportunities, Korean deaf adolescents might be different from hearing adolescents in how they make decisions in taxonomically and thematically associated entities represented by pictures and words. Experiment 1 indicated that deaf adolescents had longer reaction times than hearing adolescents in a forced-choice decision-making task. Both deaf and hearing adolescents had shorter reaction times and higher accuracies with pictures than with words, but deaf adolescents' differences were bigger than those of hearing adolescents. Experiment 2 further showed that deaf adolescents had lower accuracies than hearing adolescents in a priming task of living-nonliving categorization. Both deaf and hearing adolescents had shorter reaction times with taxonomic than with thematic categories, but deaf adolescents' difference was bigger than that of hearing adolescents. In conclusion, Korean deaf adolescents were aware of thematic and taxonomic relations less than hearing adolescents in general. They were more likely than hearing adolescents to show the advantage of pictures over words in their performance in conceptual activities and to prefer taxonomic to thematic associations for written words in Experiment 2.     

The functional assessment of deaf and hard of hearing students.

The study reports on a set of questions added to the 1997-98 Annual Survey of Deaf and Hard of Hearing Children and Youth designed to take into consideration the functioning of children in their classroom in nine functional areas. Basing information on 30,198 students, the study describes prevalence rates of reported limitations in these functional areas for deaf and hard of hearing students, compares these to rates resulting from the reporting of categorically defined additional disabilities, and examines interrelationships among the items. Results of school estimates of students' functional hearing abilities are presented. The study's findings suggest a broader range and higher prevalence of functional limitations than would be assumed by analyzing categories of additional disabilities alone. The study's findings support the viability of functional assessment through large surveys. The discussion emphasizes the importance of functional assessment for the provision of appropriate educational services to deaf and hard of hearing children.     

Behavior change in a student with a dual diagnosis of deafness and pervasive developmental disorder: a case study

The broad term pervasive developmental disorder (PPD) describes a set of symptoms that occur along a continuum of severity; these symptoms are often referred to as autism spectrum disorders (ASDs). Little is known about the incidence and prevalence of ASDs among students who are deaf or hard of hearing (DHH). Teachers of DHH students, who must work with individuals with dual diagnoses, are at a loss for guidance from the literature. The authors review the literature on ASDs (also referred to as PDD) within the DHH population, provide results of a single-subject study to reduce PDD-type behaviors in a child with hearing loss, and argue that teachers of students who are DHH must learn about practices associated with applied behavior analysis as an tool for intervening therapeutically with children with dual diagnoses of hearing loss plus an ASD.     

Conversations between deaf children and their hearing mothers: pragmatic and dialogic characteristics

We examined communication between hearing mothers and their deaf or hearing children longitudinally at child-ages 22 months and 3 years. Specifically, we analyzed both the effects of child deafness and developmental change on pragmatic and dialogic characteristics of communication. From 22 months to 3 years, deaf and hearing children's communicative skills improved similarly along some dimensions: as they grew older, both deaf and hearing children increased the amount they communicated, became increasingly responsive to their mothers' attentional focus, and were responsible for initiating a higher proportion of the dyads' conversations. On the other hand, deaf children were less skilled at maintaining topics, and the pragmatic function of their communication was more likely to be unclear compared to hearing children. Deaf children were also more likely to direct their mothers and less likely to ask questions than hearing children. Communication by hearing mothers was primarily examined to determine the degree to which they controlled the interactions. Overall, mothers of deaf children were only more controlling along one dimension. Mothers of deaf children used more response controls than mothers of hearing children. However, the majority of measures suggested they did not exert more topic or turn-taking controls than did mothers of hearing children. In addition, mothers of deaf and hearing children seemed equally sensitive to their children's communication abilities. Communication by mothers of both deaf and hearing children changed in similar ways as their children developed. Most of the differences in communication by mothers of deaf and hearing children seemed attributable to the deaf children's linguistic delays. The results suggest that intervention efforts should be focused on fostering linguistic development and not general communication skills or changing maternal conversational control.     

Self-concept in hearing and prelingual, profoundly deaf students. A comparison of teachers' perceptions.

A self-concept measure was administered to a group of 68 deaf students aged 8-19 years and a comparison group of 68 hearing students. Teachers for both of the groups completed observer reports of self-concept. Although tentative, the findings indicate that hearing teachers' perceptions of students' self-concepts are in closer agreement for hearing students than they are for deaf students. At the same time, the results show that deaf students do not appear markedly different from hearing students in their own reports of self-concept.     

Deaf students’ metacognitive awareness during language comprehension

This study explored deaf and hearing university students’ metacognitive awareness with regard to comprehension difficulties during reading and classroom instruction. Utilising the Reading Awareness Inventory (Milholic, V. 1994. An inventory to pique students’ metacognitive awareness of reading strategies. Journal of Reading 38: 84–6), parallel inventories were created to tap metacognitive awareness during comprehension of sign language (deaf students) and spoken language (hearing students). Overall, both deaf and hearing students appeared to have greater metacognitive awareness of ongoing comprehension and repair strategies during reading than during instruction in the classroom, but deaf students scored lower than hearing students in both modalities. Deaf students were no more likely than hearing students to report adopting inappropriate strategies, but both groups indicated they were more likely to do so in classroom contexts than during reading.     

Do you see what I see? School perspectives of deaf children,hearing children and their parents☆

Perspectives on academic and social aspects of children’s school experiences were obtained from deaf and hearing children and their (deaf or hearing) parents. Possible differences between (1) the views of children and their parents and (2) those of hearing children and their parents compared to deaf children and their parents were of particular interest. Overall, parents gave their children higher school friendship ratings than the children gave themselves, and hearing children and their parents were more positive about children’s friendships than were deaf children and their parents. Both children and parents also saw deaf children as less successful in reading than hearing children. However, deaf children having deaf parents, attending a school for the deaf and using sign language at home all were associated with more positive perceptions of social success. Use of cochlear implants was not associated with perceptions of greater academic or social success. These and related findings are discussed in the context of parent and child perspectives on social and academic functioning and particular challenges confronted by deaf children in regular school settings.     

Social processes and outcomes of in-school contact between deaf and hearing peers

Studies of social processes and outcomes of the placement of deaf students with hearing peers cannot be easily summarized, but can be grouped into a least four major categories of focus: social skills, interaction and participation, sociometric status and acceptance, and affective functioning. We review 33 studies available since 1980 in which a mainstreamed or included deaf sample was compared to another group. Studies indicated (1) that hearing students were more socially mature than deaf students in public schools, (2) that deaf students interacted with deaf classmates more than hearing ones, (3) that deaf students were somewhat accepted by their hearing classmates, and (4) that self-esteem was not related to extent of mainstreaming. There was a tendency for studies to use observational methods with very young children, teacher evaluations with middle school children, and questionnaires with older children. Three major areas of methodology limit general conclusions: samples, measurements of variables, and experimental manipulations. The reviewed studies provide a basis for understanding the social processes and outcomes in these placement situations; however, it is not possible to make broad generalizations about effects of placement.     

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.     

Is there a link between hearing aid use, employment, and income?

This paper examines hearing aid use by 60 congenitally deaf individuals who attended special education units in South Australia. The study indicates that only one-third to half of deaf adults wore their hearing aids in social situations for speech detection. Just over one-third (n = 22) of the deaf adults involved in this study wore their hearing aids at work and less than half (n = 27) wore their hearing aids at home. Younger deaf adults were more likely to wear their hearing aids in the home than older deaf adults. Younger deaf adults tended to wear their hearing aids more frequently when they were at school if they had perceived their teachers had a positive attitude to deafness. This study found that there was no statistically significant relationship between wearing hearing aids and employment status. There was also no statistically significant difference in hearing aid use between men and women. The low use of hearing aids could be attributed at least in part to the current Australian policy regarding supply and servicing of hearing aids to congenitally deaf individuals which ceases to be free after the individual reaches 21 years of age.