Some ethical dimensions of cochlear implantation for deaf children and their families

A major source of controversy between Deaf people and those who support a "social/cultural" view of Deafness as "a life to be lived" and those who see deafness within a "medical model" as a "condition to be cured" has been over the cochlear implantation of young deaf children. Recent research has shown that there are noticeable inequities in access to such procedures in western countries; inequities that give rise to the need for informed public policy discussions. It has also found that parents of newly diagnosed deaf children are not provided with access to all the possibilities for their children-including that of a "Deaf life." How this information can be provided to parents and the public via widespread discussions in the media and elsewhere and involving Deaf people in the implantation counseling process is an issue that needs to be addressed by those responsible for implantation programs.     

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.     

Motor development of deaf children with and without cochlear implants

The purpose of this study was to investigate the impact of a cochlear implant (CI) on the motor development of deaf children. The study involved 36 mainstreamed deaf children (15 boys, 21 girls; 4- to 12-years old) without any developmental problems. Of these children, 20 had been implanted. Forty-three hearing children constituted a comparison group. Motor development was assessed by three standardized tests: the Movement Assessment Battery for Children, the K?rperkoordinationstest für Kinder, and the One-leg standing test. Results showed that the hearing children performed on average significantly better than the deaf children (whether or not using a CI). Regarding the use of a CI, there was only a significant difference on one subtest between both groups, although there was a nonsignificant trend for the deaf +CI group to score somewhat worse on average than the deaf -CI group. This led to some significant differences between the hearing group and the deaf +CI group on measures requiring balance that did not hold for the hearing/deaf -CI comparison. Although this study could demonstrate neither a positive nor a negative impact of CI on balance and motor skills, the data raise the need for further, preferably longitudinal, research.     

Pediatric cochlear implantation: a qualitative study of parental decision-making processes in Flanders, Belgium

Factors contributing to parents' decision when they choose between cochlear implantation (CI) and traditional hearing aids for their child were examined. The subjects were children with severe/profound hearing loss, born 1999-2001, registered in the universal neonatal hearing screening program in the Flanders region of Belgium. Qualitative data collected retrospectively from parents were subjected to thematic content analysis. In their responses to professional advice, parents were segmented into 3 groups: (a) those whose primary considerations were the importance of oral language development and the relative potential of CI and traditional hearing aids; (b) those for whom alternative factors (e.g., medical risks, ethical issues) were paramount, even in the face of professional advocacy of CI; (c) those who followed professional advice against CI. The researchers conclude that care professionals should be sensitive to the impact of their advice and other factors in parental decision making.     

Neuropsychological correlates of vocabulary, reading, and working memory in deaf children with cochlear implants

The performance of deaf children with cochlear implants was assessed using measures standardized on hearing children. To investigate nonverbal cognitive and sensorimotor processes associated with postimplant variability, five selected sensorimotor and visuospatial subtests from A Developmental Neuropsychological Assessment (NEPSY) were compared with standardized vocabulary, reading, and digit span measures. Participants were 26 deaf children, ages 6-14 years, who received a cochlear implant between ages 1 and 6 years; duration of implant use ranged from 3 to 11 years. Results indicated significant correlations between standard scores on the Design Copying subtest of the NEPSY and standard scores on vocabulary comprehension, reading, and digit span measures. The results contribute to our understanding of the benefits of cochlear implantation and cognitive processes that may support postimplant language and academic functioning.     

Parental resources, parental stress, and socioemotional development of deaf and hard of hearing children

In recent years, empowerment and resource orientation have become vital guidelines for many of the sciences. For the field of deaf education, it is also highly important to look carefully at these guidelines if we are to acquire a better understanding as regards both the situation of the parents involved and the development of the deaf and hard of hearing children themselves. A resource-oriented approach to deaf education has therefore proved especially helpful. If both the theoretical and practical aspects of educating deaf and hard of hearing children are to benefit, research on parental experience with deafness and research on the socioemotional development of the children must always be combined and studied in the context of resource availability. In a study of 213 mothers and 213 fathers of deaf and hard of hearing children, we used an array of different questionnaires (PSI, SDQ, SOC, F-SozU, etc.) to examine the correlation between parental resources, sociodemographic variables, parental stress experience, and child socioemotional problems by way of a path analysis model. The results show that high parental stress is associated with frequent socioemotional problems in the children, thus emphasizing the importance of a resource-oriented consulting and support strategy in early intervention, because parental access to personal and social resources is associated with significantly lower stress experience. Child development seems to profit enormously from a resource-oriented support concept. In addition, the results confirm two earlier findings: parents with additionally handicapped children are especially stressed and the child's communicative competence makes for a more sound prediction than its linguistic medium (spoken language or sign). The path models for mothers and fathers agree in all essential factors. The results are discussed with a view to their meaning for pedagogical practice, and recommendations for further research are given (longitudinal data, more representative samples, cochlear implant).     

Role-taking ability and social behavior in deaf school children

This study assessed the relationship between role-taking skill and social-emotional adjustment in deaf children. Twenty-three prelingually deafened boys and girls between 7 and 14 years of age were administered a role-taking task, surreptitious behavioral measures of helping and altruism, and a measure of nonverbal intelligence. In addition, two professionals experienced in working with deaf children rated the social and emotional adjustment, language/communication skills and role-taking ability of the participants. Performance on the role-taking task correlated positively with ratings of emotional adjustment, self-image, communicative effectiveness and role-taking skill. Role-taking performance, however, was not reliably related to any of the measures of social behavior. The study also considered several factors which may account for the apparent independence of role-taking and social behavior.     

The prevalence of behavior problems in deaf children

The appropriateness of the Behavior Problem Checklist for deaf children has been established in various studies. The objective of this study was to use the Behavior Problem Checklist to assess the prevalence of behavior problems in deaf children and to compare these results to earlier studies of behavior problems of hearing and hearing-impaired children. A lesser prevalence of behavior problems was found than in some earlier studies of deaf children. Results were somewhat more consistent with past findings regarding children with no hearing problems. Comparisons by sex found, as in earlier studies, that boys tended to evidence more behavior problems than girls.     

Family counseling in the Netherlands for Turkish-origin parents of deaf children with a cochlear implant

Cultural elements such as language, beliefs about health, and family context play important roles in the uptake of rehabilitation and treatment of deafness. Because of cultural issues, minority groups often do not receive optimal care. Focusing on the Netherlands, the researchers explored how the rehabilitation and counseling of deaf children of Turkish-origin parents can be improved. The most important findings were that (a) most parents initially did not believe their child was deaf and regretted later that they did not start hearing rehabilitation earlier; (b) parents had little confidence in the Dutch health care system and sought a second opinion from a medical doctor of their own national origin; (c) parents did not know how to be actively involved in the care of their deaf child. Implications for practice aimed at improving rehabilitation and counseling for these children are described.     

The horror of being deaf and in prison

Being Deaf and in prison is a horror. The main fear of prison inmates, whether Deaf or hearing, is that they will be raped, killed, or subjected to other forms of violence. Such fears are based in reality. The recent overcrowding of jails and prisons has increased these problems significantly. A major reason for this situation is the blatant violation of the Americans With Disabilities Act by most jails and prisons in the United States. This includes the failure to provide interpreting services for necessary activities and facilities such as religious services, educational programs, vocational training, faith-based prisons, and mental health treatment for addiction. The author discusses other problems faced by inmates who are Deaf and offers suggestions for correcting injustices faced by those who are Deaf in American jails and prisons.     

Assessing parental understanding of sexualized behavior in children and adolescents

The current study assessed parents’ ability to identify normal, concerning and harmful sexualized behaviors in children and adolescents, as well as the parents’ ability to identify and select an appropriate level of intervention. The influence of a parent’s relationship with the victim or the perpetrator on the level of action taken was also examined. A cross-sectional survey incorporating a randomized experimental vignette condition determined that parents (N = 244) were not able to consistently identify sexualized behaviors accurately, and they provided lower-than-recommended levels of intervention responses. Parents were best able to identify and respond to behaviors considered normal and age-appropriate, but had greater difficulty with behaviors considered concerning or harmful. Parents were significantly less able to accurately identify and respond to behaviors exhibited by very young children (in the 0–4 year-old age-bracket). In three vignette comparisons, no significant difference in the level of intervention responses was found between parents who viewed the victim as their own child and parents who viewed the perpetrator as their child; while parents who viewed both the victim and perpetrator as being their children (siblings) reported lower intervention response levels. Because a lack of accurate knowledge around risks and indicators of child sexual abuse negatively affects the ability to prevent and detect abuse, the results have implications for a shift from a forensic model of child protection towards a public health model, which emphasizes parent and community education.     

A comparison of the anticipated benefits and received outcomes of pediatric cochlear implantation: parental perspectives

Findings of a study that investigated parents' expectations and experiences of their children's outcomes with cochlear implants are presented. A survey completed by 247 parents whose children had received implants in eastern Australia compared parents' reports of their preimplant expectations with their experiences of postimplant outcomes on several items related to communication, academic, and psychosocial domains. Quantitative findings derived from the survey data were extended and elaborated on by qualitative findings from interviews with 27 of the parents. The findings indicated that parents' relatively high expectations of their children's outcomes largely had been met, although a tenth of survey respondents reported that their expectations had not been met. It appeared that professionals generally provided parents with realistic expectations. The qualitative findings revealed a complex interaction among parents' expectations, hopes, and determination that their children would do well with the implant. Implications for professionals are discussed.     

Learning to look in the right place: a comparison of attentional behavior in deaf children with deaf and hearing mothers

Eleven 18-month-old children with profound prelingual hearing loss were video-recorded in a free-play session with their mothers. Five of the mothers were profoundly deaf and fluent users of British Sign Language (BSL) or Auslan. The other six were hearing and had enrolled in a signing program. Ten-minute segments from each session were analyzed to determine the number of switches in attention shown by each child. Switches in attention were subdivided into three categories: spontaneous (where the child spontaneously looked to the mother); responsive (where the child responded to some maternal action such as moving an object); and elicited (where the mother made a direct attempt to gain the child's attention. Failed attempts to gain attention were also noted. A comparison of deaf and hearing mothers revealed no difference in the proportion of spontaneous or responsive switches in attention shown by their children. Responsive switches were by far the most frequent category for both groups, but these most commonly focused on objects and did not provide an opportunity for maternal signing. Successful perception of signing typically followed from spontaneous or elicited attentional switches. Deaf mothers were generally more insistent on their children turning to look at them, and they were more successful in eliciting attentional switches although they also had more failed attempts. These overall differences between the two groups were overshadowed by large individual differences within the groups. Within the sample there were both deaf and hearing mothers who achieved successful signed communication with their children.     

Deafness and attention in deaf children

The study shows the differences between hearing parents and deaf instructors interacting with deaf children and directing their attention. Data were collected at home and at a service for special needs in Bristol, England. The mother or instructor was asked to play naturally with the child with the toys provided. When the child's attention was focused during their play, the mother or instructor had to try to direct the child's attention to each of the toys. The results suggest that both groups (mothers and instructors) were effective in directing attention to objects not in the immediate area of play; however, hearing mothers were more successful than deaf instructors.     

Executive function and language in deaf children

The relationship between language and executive function (EF) and their development in children have been the focus of recent debate and are of theoretical and clinical importance. Exploration of these functions in children with a peripheral hearing loss has the potential to be informative from both perspectives. This study compared the EF and language skills of 8- to 12-year-old children with cochlear implants (n = 22) and nonimplanted deaf children (n = 25) with those of age-matched hearing controls (n = 22). Implanted and nonimplanted deaf children performed below the level of hearing children on tests assessing oral receptive language, as well as on a number of EF tests, but no significant differences emerged between the implanted and nonimplanted deaf groups. Language ability was significantly positively associated with EF in both hearing and deaf children. Possible interpretations of these findings are suggested and the theoretical and clinical implications considered.     

Mental health in deaf adults: symptoms of anxiety and depression among hearing and deaf individuals

Individuals with disabilities encounter practical and social problems beyond those experienced by nondisabled individuals. This extra burden may in turn increase the risk of developing mental health problems. The objective of this article is to disclose the mental health situation among deaf individuals compared to a control sample of hearing individuals. The analyses are based on two separate Norwegian postal surveys, one among the general population (1995-1997) and one among the deaf population (2001). A shortened version of the Hopkins Symptom Checklist was used to disclose the degree of mental distress among the respondents. Three questions common to the studies were analyzed to determine differences between the two groups. Analyses revealed that the deaf respondents showed significantly more symptoms of mental health problems than the hearing respondents. The results point to the need for focussing more attention on the mental health of deaf children and adults. Society must be made aware of the special risks that deaf children and adults encounter with respect to mental health.