Social and Emotional Difficulties in Deaf Children
This review constitutes an exploration of the research and commentary on the prevalence and nature of the social and emotional difficulties in deaf children. Deafness is broadly defined, for the purposes of this review, as any bilateral hearing impairment that impedes the acquisition of vocal/auditory language.
Many commentators have noted that a diagnosis of profound hearing loss in a child, particularly a child of hearing parents, will elicit many emotions from family members. It will subsequently generate ongoing contact with professionals in the medical, educational and social work fields who are likely to be involved with the child and family over a period of several years (Marschark, 1997, Erting et al,2000; Turner et al, 1998). As Calderon and Greenberg remark, “hearing loss has a profound effect on the child’s communication development and a subsequent effect on the child’s socio-emotional development” (2000,p.168).
A computer search was conducted using an independent search engine together with a search of a university library network of databases which included Article First, Academic Search Premier, Psych-INFO and Med-line using the keywords “social and emotional difficulties deaf children” and “deaf children”. The literature included in the review was limited to that produced within the last ten years with references to some earlier studies reviewed by other researchers, where this was particularly relevant to the topic. Research on children with hearing loss which focuses specifically on educational issues, such as language and literacy development was excluded.
The literature selected was organized into three distinct parts according to the nature of the material found. Chapter One focuses on a variety research studies which examine different aspects of the social and emotional world of deaf children and using different methodologies. This made comparisons between them difficult and tenuous. Methodological limitations were acknowledged, but some common threads were detectable and these have been highlighted. Chapter two describes commentary on an important theme permeating most of the literature on this topic which concerns the debate around conceptions of deafness as a disability or a different realization of the human condition. The literature in Chapter Three represents commentary on the challenges to healthy socio-emotional development which have been identified in the light of research findings, situating problems for deaf children within the wider context of the family, community and society.
Studies of socio-emotional problems in deaf children
(i) Early research studies 1974 to 1989
Some of the earlier available research studies explored the extent to which hearing loss in children interferes with normal psychological development with particular reference to behavioural problems and parent-child relationships. Altschuler (1974), for example, found that deaf children experienced higher levels of clinical behaviour disorders than their hearing counterparts, such levels being higher for those deaf children of hearing parents (Ita, 1999). However, as Ita (1999)observes in her review of these early studies, Altschuler’s findings need to be viewed with caution since they are based on clinical practice cases and may not be representative of deaf children in the general population.
Another study by Galenson et al (1979), which researched the interactions between young deaf children and their parents, both hearing and non-hearing, over a four-year period, was reported by Ita(1999). The findings from this research were that “all of the parents(deaf and hearing) experienced difficulties in creating bonds with their children” and that the children “were at risk in their psychological development” (Ita, 1999, p.3). Ita (1999) records the acknowledgement by these researchers of the methodological limitations of their study, for example, problems in their communication with the deaf parents which were likely to have affected interpretations of the parent-child interactions. A third study, reported by Ita (1999), was that conducted by Maher (1989) which also found pre-linguistic deafness in children together with inconsistencies in parental emotional support to be a major factor in attachment difficulties for deaf children. However, again, there were limitations on the usefulness of this work at a broader level.
There appear to be few studies on this topic which have sought the experiences of deaf children themselves. One exception is the study by Warren and Hasenstab (1986) which investigated the self-concept of children with hearing loss as this was felt to be indicative of these children’s adjustment to the language and communication problems they faced (Ita, 1999). A sample of 58 children aged 5 to 11 years with varying levels of hearing loss were given a picture game designed to elicit responses to determine their vulnerability to emotional difficulties. Parents were also asked to complete an attitude survey and their responses compared with those from the children’s game. It was found that “parental attitudes of indulgence, rejection and protection correlated negatively with self-concept”, while the only attitude to correlate positively with self-concept was discipline (Ita,1999, p.6). There was, therefore, strong evidence for the prediction of children’s self-concept from parental child-rearing attitudes. There were some important methodological limitations, such as the omission of deaf parents from the attitude measure, but the study nonetheless highlights parenting style as a factor in deaf children’self-perceptions (Ita, 1999).
A further point to note regarding the latter three research studies is the lack of comparison groups of children with normal hearing and their parents rendering it difficult to draw meaningful conclusions about the impact of these variables upon children with hearing loss as distinct from children with normal hearing.
(ii) Later research studies 1995 to 1998
A more recent study by Capelli and colleagues (1995) explores the social development of children with a hearing loss through the measurement of specific psychosocial factors, such as social status and popularity among peers. 23 deaf children, recruited through a children’s hospital audiology department, were matched with 23 hearing children all of whom completed a series of sociometric assessments designed to determine the children’s affective knowledge, social anxiety and self-perception. The researchers include a detailed critique of the study design, sampling method and the validity of the measures used. The study found that the deaf children scored significantly lower on ratings of like ability and social preference,and perceived themselves as less socially accepted, as compared to their peers with normal hearing. Whilst the sample size in this study is small suggesting limited applicability on a wider level, this presents as a valuable study, giving insight from the child’s perspective, which could generate further similar research on a broader scale.
Two detailed studies were conducted by Mitchell and Quittner (1996) and Vostanis et al (1997) to explore behavioural and emotional difficulties in deaf children, both using written rating scales and tasks completed by deaf children and adolescents and their parents, the former also using a scale completed by teachers. Vostanis and colleagues (1997)point out the lack of research on the prevalence and nature of behaviour problems in deaf and hearing impaired children which they suggest is probably due to the inappropriateness of standard research instruments and interview techniques for this specific group of children Their own study elicited responses from the parents of deaf children from two checklists, one designed specifically for the parents of deaf children (PCL) and the other an established checklist measuring child behaviour as exhibited by children in the general population(CBCL). The sample comprised the parents of 84 deaf children and adolescents attending two schools for the deaf in the West Midlands region, 90% of whom had normal hearing.
Vostanis et al state that “overall, the findings indicate high rates of behavioural and emotional problems in deaf children as detected by their parents” (1997, p.241) and a “very high rate of social maladjustment of deaf children according to general population norms”(1997, p.242). The researchers found a high degree of agreement between the PCL and CBCL scales on the severity of these problems,which included high levels of social isolation and non-participation in structured activities in the deaf children, as reported by their parents Vostanis et al note a variety of methodological limitations in the study and highlight the complex relationship between deafness in children and other developmental, medical and psychosocial predisposing factors. Two particular issues became apparent from a review of this study. One concerns the details around the nature of the comparisons made between these parents’ responses on the CBCL scale and the responses of other parents on the same scale of hearing children (in other studies?) to determine differences between the two, which were not made explicit. The other issue concerns the reliance on rating scales and parents’ assessments of their children’s behavioural and emotional difficulties alone, without the use of control groups or independent validation through the use of other research tools, such as direct observation or interviews.
The research by Mitchell and Quittner (1996) elicited ratings for behaviour problems, using the CBCL checklist mentioned above, from parents and teachers for both hearing impaired and hearing children,aged between 6 and 14. The children also completed 3 tests of attention. The most commonly cited behaviour problems, according to these researchers, include attention difficulties such as impulsivity,distractibility and short attention span. On two of the three tasks undertaken by the children, it was found that the hearing impaired children showed significant attention problems. The main conclusion from this study was that “a substantial number of the hearing impaired children had elevated levels of behaviour problems, particularly those related to hyperactivity and externalising behaviours” (Mitchell and Quittner, 1996, p.94).
Mitchell and Quittner offer explanations for these findings,particularly the role of language in mediating behaviour, particularly attention, problems. They suggest that children are likely to “stay on task, withstand distracting influences and inhibit inappropriate behaviours by the explicit verbal instructions of adults” (1996,p.94). Since self-regulation is most probably achieved through theinternalization of speech, this is most likely to be impeded, and delayed, by the disruption in communication between parent and child through the child’s hearing impairment (Mitchell and Quittner, 1996). Evidence from studies of deaf children raised by deaf parents indicates that early manual communication corresponds to lower levels of impulsive responses in these children. As Mitchell and Quittner suggest, “better social and emotional adjustment has been documented inhering-impaired children raised by parents who are also hearing-impaired and conversant in sign language, when compared to hearing-impaired children with hearing parents who use oral methods”(1996, p.94). Mitchell and Quittner underline the point mentioned earlier that further research could better inform us on these issues if it includes direct observation of children, interacting in the more‘natural’ settings of home and school, rather than a sole reliance on written measures and ratings.
Contrasting research studies by Gregory and colleagues (1995; 1998)sought to explore how deaf children experience their identity,including the notions of deafness and ‘hearingness’. In one study,semi-structured interviews were conducted with 25 deaf children aged between 7 and 11 by a deaf researcher using British Sign Language(Gregory et al, 1995). Analysis of the data indicated that, although describing some disadvantages of being deaf, most of the respondents did not see deafness as a problem. Gregory et al recorded that the children “were confident they would grow up to be deaf adults and seemed to have a secure sense of worth as developing deaf young people”(1995, p.3). A later study, of similar design, involved interviews with 61 deaf young people to explore their sense of identity as a deaf person (Gregory et al, 1998). The parents of these young people were also interviewed and their responses were compared to the data from interviews with the same parents conducted at an earlier time, when the young people were of pre-school age. This enabled insights into continuities over time. Almost half of the young people, having wished to be hearing in the past, no longer wished not to be deaf and most now saw deafness as an intrinsic part of themselves.
For the most part, there was a high level of agreement in the perceptions of both the young people and their parents; however, there was one interesting discrepancy in terms of social experience. When asked about the young person’s friendships, parents were likely to see their children as more isolated than the young people themselves. Gregory comments that “over three quarters (77%) of the young people reported themselves as having a special friend or a stable group of friends while only just over half (55%) of their parents made the same judgement” (1998, p.6). This finding echoes the caution highlighted earlier regarding the efficacy of relying solely on parental or other adults’ perceptions of deaf children’s social experiences/problems.
Gregory (1998) asserts that previous studies, especially those which rely on quantitative measures such as rating checklists in the form of questionnaires, have tended to focus on severe behaviour difficulties or psychiatric disturbance. In contrast, they cite Hindley (1994)whose studies have found that degree of hearing loss was not significantly associated with poor psychological health and Griggs(1998) who “in a study of psychiatric disorder in a cohort of 468 deaf people, did not find hearing loss to be a distinguishing factor”(Gregory et al, 1997, p.9). Gregory suggests that caution is needed in using questionnaires as a research tool, especially in any exploration into the quality of social and emotional life, and she poses three thought-provoking questions to be considered by any researcher before embarking on study in this area, as follows:
• “Can adults assess the quality of life of children?
• Can hearing people assess, or make judgments about the quality of life of deaf people?
• What assumptions can be made about the relationship between degree of hearing loss
and quality of life?”(Gregory, 1997, p.7)
The latter two of these questions are central to the debate,acknowledged by Gregory, concerning the two contrasting models of deafness identified as the medical model, which tends to characterise deafness as a deficit in need of repair, and the cultural model which sees deaf people as a minority group with its own language, community and identity. Since this debate features prominently in the literature and is inextricably linked to the different approaches reflected in the research undertaken in this field, it is the subject of the next chapter in this review.
The debate about deafness as a disability
Crouch (1997) is critical of the prevailing practice to fitprelingually deaf children with cochlea implants, suggesting that rather than enhance the quality of life for these children, it has potentially detrimental effects. Crouch points out that deafness is seen as abnormal and tragic in a world of predominantly hearing people and the parents of a deaf child, particularly hearing parents, tend to turn to the medical community in a bid to have the deafness ‘fixed’. This, he maintains inevitably turns the child into a person characterised by functions and deficits and the child’s deafness‘condition’ placed into categories ranging from mild to severe or profound. Crouch quotes an editorial in 1994 which states “It is not only to the advantage of the child and his or her family to eliminate hearing loss, but also to society, which will see increased benefits from these productive individuals” (1997, p.14). The purpose of the cochlea implant, then, is widely seen as offering the child an opportunity to learn an oral language and ultimately “to acquire meaningful engagement with the hearing world” (Crouch, 1997, p.15).
Crouch records that longitudinal studies have shown that many deaf children, using cochlea implants over long periods of time, “do not improve their oral communication skills sufficiently to become functioning members of a hearing society” (1997, p.16). He suggests that those children who are fitted with these implants make limited gains in speech production and have to undergo intensive training in order to produce each sound. Crouch essentially champions the use of sign languages for deaf children and concludes that by rejecting cochlea implants for their child, a parent, rather than “condemning him or her to a world of meaningless silence, opens the child up to membership in the Deaf community, a unique community with a rich history, a rich language and a value system of its own” (1997, p.16).
Campbell (2001), writing as a campaigning representative of the American Deaf community, asserts that “deafness is not a disability,but simply another realisation of the human condition” (p.18). In similar vein, De Halleux and Poncelet (2001), as two parents of deaf children, also make a plea for deafness not to be regarded as advisability. They, too, argue against the medical approach which sees their child’s deafness as something to be repaired, suggesting that this only serves to perpetuate parents’ illusions about deafness as temporary condition and failing to recognise that children must learn to live with their deafness. These authors point out that regardless of treatment advances, with prostheses such as cochlea implants, “deaf child remains deaf” and “deafness is an essential characteristic of their identity” (De Halleux and Poncelet, 2001, p.358).
These parents describe their own approach to rearing their deaf children which includes the use of sign language, treating their child first and foremost as a normal child, thereby providing him with “the best chance to realise the same goals as a child with good hearing” (DeHalleux and Poncelet, 2001, p.358). Prostheses, it is suggested, can improve the child’s access to the world of sound, however, “if such reparative treatment is presented as a scientific gold standard, it jeopardises the normal development and education of the deaf child and is, objectively and subjectively, a cause of pain in the heart of the deaf community” (De Halleux and Poncelet, 2001, p.358).
These commentators, then, offer a conception of deafness which effectively renders deaf people as ‘normal but different’ as opposed to‘disabled and defective’. The way in which the socio-emotional development of deaf children is viewed, and researched, seems likely to be coloured by the particular conception of deafness espoused. For those who see deafness as a normal, but different manifestation of the human condition, many of the problems experienced by deaf children are conceived as originating not with the children themselves, but within the wider society. De Halleux and Poncelet, for example, suggest that“if deafness is properly managed, that is to say that if the deaf have the means to access knowledge and are given opportunities to use their intelligence, a person’s life need not be hampered by their inability to hear”(2001, p.358). However, since 90% of deaf children are born to hearing parents (Crouch, 1997) and the hearing world is that which predominates in society, the challenges to parents and involved others in the promotion of positive socio-emotional development in deaf children cannot, it seems, be underestimated.
Challenges for the healthy socio-emotional development in deaf children
In his exposition of the raising and educating of deaf children,Marschark (1997) situates the deaf child’s social and emotional experiences within the context of the socialization of all children,both hearing and deaf. He discusses, for example, the importance of communication modes for the child’s acquisition of the rules and expectations regarding social behaviour. Marschark describes the wayan adult can respond orally to one hearing child hitting another, for example, by explaining the consequences of such an action which is likely to elicit positive changes in behaviour. Deaf children will learn about social interactions in the same way as hearing children however, as Marschark points out, “parents who do not share a common,fluent language with their children cannot engage in such moral teaching as effectively as parents who do” and their children are less likely to learn the reasons for social rules as a consequence (1997,p.168).
Marschark highlights, along with other researchers noted in Chapter Two(Altschuler, 1974; Mitchell and Quittner, 1996), the common finding that deaf children with deaf parents are often more comfortable and competent socially than deaf children with hearing parents. He asserts also that “deaf children of deaf parents are more likely than those with hearing parents to have experienced consistent parenting behaviours and effective communication from an early age” (Marschark,1997, p.168). Marschark suggests that deaf children of hearing parents need not be less confident or secure, it is just that there needs to be more conscious planning and effort on the part of hearing parents, and other adults, to ensure that deaf children receive effective communicative experiences.
Marschark also observes that many children who are physically or psychologically challenged can often experience difficulties establishing their independence due to overprotection by well-meaning adults. He cites a prominent researcher, Kathryn Meadow-Orlans (1997),who found that parents often assume, from the narrow range of tasks that their disabled child actually cannot do, that he or she will therefore be incapable of a much larger range of tasks. Meadow-Orlanssuggests that skill acquisition for such a child can be a lengthy,trial-and-error process which requires a large measure of time and patience on the part of parents, and other involved adults. Communication barriers are flagged up by Marschark as highly significant. Firstly, if deaf children receive fewer explanations for the causes of other people’s social and emotional behaviours and states, they are less likely to learn to express and control these behaviours appropriately in themselves. Secondly, lack of knowledge about social rules and lack of social skills may hinder the acquisition of independence and high self-esteem for deaf children. A third hurdle is a lack of social role models with whom deaf children can identify and communicate, especially for deaf children in hearing families(Marschark, 1997).
Calderon and Greenberg (2000) uphold the evidence which has found that as a group, deaf children and adolescents have a reduced mastery of skills in social competence and are therefore at risk of a number of adverse outcomes, including low academic achievement and underemployment as well as higher levels of social problems, such as drug and alcohol misuse and psychological disorders. They stress that such problems are not inevitable for all deaf children and that the impact of deafness is influenced by a complex array of factors, such as“the quality of the family environment, parental adaptation to deafness, family coping, the nature of school and community resource sand the child’s own characteristics” (2000, p.171).
Two critical issues, along similar lines to those espoused by Marschark, are highlighted by Calderon and Greenberg as central to the challenge facing parents and professionals in the promotion of socio-emotional competence in deaf children. These are described as“developing effective and positive communication with the child and building social networks for the child” (Calderon and Greenberg, 2000,p.171). The first of these issues concerns the deaf child’s need for meaningful and elaborated exchanges. For example, adults using sign language should be discouraged from attempting to reduce the linguistic and cognitive complexity of their exchanges in their efforts to be understood. Thorough training in alternative modes of communication to spoken language is therefore seen as vital. The second issue is derived from research findings highlighting the isolation of deaf children in hearing families from both close and extended social networks. Sustained efforts to provide deaf children, as they grow older, with access to a variety of social groups, and individuals with whom they may develop informal relationships will contribute positively to their mental health and coping ability (Calderon and Greenberg,2000).
Two more recent commentaries echo and extend the issues raised by marschark and Calderon and Greenberg and implicated in the promotion of socio-emotional skills in deaf children. Hindley (2004) describes the ways in which teachers of the deaf can help to enhance these skills. Three key factors are identified by Hindley as likely to make significant difference for deaf children. These are as follows:
“1. Supporting parents so that their deaf infants can form secure attachment relationships.
2. Encouraging early conversations regarding thoughts and feelings.
3. Enabling deaf children to meet in order to foster peer relationships and a sense of deaf
identity”(Hindley, 2004, p.1).
In contrast to research which tends to adopt a child-centred focus interns of the problems and outcomes for deaf children, such as that described in Chapter Two of this review, some researchers advocate holistic view of the impact of deafness on children from a family systems perspective (Turn bull and Turn bull, 2001). Wood Jackson andTurnbull (2004) suggest that such a perspective can generate a greater understanding of the impact of deafness on children. They cite the assertion of Henderson and Hendershott (1991) that “because the deaf child is a component of the family system, the deafness belongs not just to the child but to the entire family” (Wood Jackson and Turn bull,2004, p.15). Factors contributing to the impact of deafness on family life included “the hearing status of parents, the education of parents,the mode of communication used, the proficiency of partners in the child’s communication mode and the family’s access to social support sand parenting modes”(Wood Jackson and Turn bull, 2004, p.27).
A number of researchers have explored the ways in which families with deaf children can overcome barriers to inclusion in both the hearing and Deaf communities (Hintermair, 2000; Freeman et al, 2002). The advantages of social networks and relationships with other families have been documented by Calderon and Greenberg (1999). Hintermair(2000) has recorded that parents who had many contacts with other parents of deaf children and deaf adults reported less isolation and enhanced emotional bonds and connectedness with their child. It seems clear from this brief outline of commentary focusing on the socialization and the wider environment of deaf children that there Pisa high degree of consensus regarding the factors likely to play a key role in the quality of the socio-emotional development of the deaf child
This review has demonstrated that the study of the social and emotional problems in deaf children can be approached from contrasting perspectives. Chapter One cites a number of quantitative research studies, most of which made use of rating scales and checklists to measure a variety of different variables, such as parent-child interactions, child-rearing attitudes, social anxiety and self-perception, attention and general behavioural difficulties and emotional adjustment. Methodological limitations included problematic communication with deaf parent respondents, or the omission of such data altogether from some studies (Galenson et al, 1979; Warren and Hasenstab, 1986; Maher, 1989) small sample sizes in almost all of the studies and the notable lack of control groups including children with normal hearing and their parents in all but a few of the studies. All these factors made comparisons between studies and the ability to generalize findings to deaf children and families in the wider population difficult.
Despite the acknowledged problems in research design and methodology,certain recurrent themes emerged from the research. Many studies highlighted the importance of communication modes in mediating behaviour, such as the tendency for impulsive responses found by Mitchell and Quittner (1996; Vostanis et al, 1997). The lack of as hared, fluent language between deaf children and significant others was flagged up by many commentators as influential in socio-emotional development (Marschark, 1997; Crouch, 1997; Calderon and Greenberg,2000; Hindley, 2004). Linked to this is the recurrent finding amongst researchers that deaf children raised by deaf parents seem to achieve somewhat better social and emotional adjustment than those raised by hearing parents. This suggests that future research to explore the interactions between deaf children and deaf parents as compared to those between deaf children and hearing parents, using observational methods in natural settings, would increase our understanding of this issue. Another important factor important for healthy socio-emotional development highlighted in many of the studies was the need for deaf children to have access to social relationships and networks in the wider community, especially the Deaf community (Gregory, 1997;Marschark, 1997; Calderon and Greenberg; Stein berg et al, 1997;Hintermair, 2000; Freeman et al, 2002).
Strong evidence emerged for embracing the condition of deafness as just another manifestation of the human condition rather than as advisability. to be corrected (Crouch, 1997; De Halleux and Poncelet,2001; Campbell, 2001). Social and emotional problems, as much of the contemporary commentary described in Chapter Three indicates, must be situated within the wider context of the whole family and community,with the onus upon the hearing world to adjust to the deaf child and vice versa through an essentially reciprocal and interactive process. The writers cited in Chapter Three move towards this kind of approach,underlining the crucial role of language in mediating the child’acquisition of social rules. More studies to explore this phenomenon in matched groups of both hearing and deaf children could enhance our understanding of the differences between them.
Few of the studies reviewed sought to explore the social and emotional experiences of deaf children themselves. Notable exceptions were the studies of Gregory et al(1995; 1997) which explored deaf children’s own experiences of their identity. Interviews in these studies were conducted by deaf researchers using British Sign Language and demonstrated that there can be discrepancies between children’s own views of their social and emotional experiences and the perceptions of these by their parents Ethnographic studies like this have been traditionally criticized for their small sample size and lack of applicability to wider population; however they can offer a richness and depth of data production and analysis that is difficult to achieve in survey or quantitative methods. Since there seems to have been few of these carried out in this field, further ethnographic studies involving researchers skilled in the use of a standard sign language could prove illuminating. These could take the form of interviews, a focus group or perhaps participant observation with a small number of young people who are deaf to explore their experiences of growing up and/or participating in a hearing world.