Behavioral Issues and Hearing Loss: Its Far Reaching Impact

The issue

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Life has gotten better for children with hearing loss, which is being detected at much younger ages. Technology, particularly cochlear implants, has opened easier access for many to spoken language; educational changes have provided more schooling options. Despite these advances, however, there are still reports from around the world that deaf children exhibit more behavior problems than their hearing peers. Deaf children generally are reported to have higher rates of aggression, noncompliance, and inattention. The magnitudes of these higher rates vary, but range from two to three times more behavior problems in deaf than hearing children. Mental health problems, such as depression, are also reported to be more than twice as high and affect all aspects of a child’s life.

What we know

The literature from a number of areas suggests strongly that language and communication competence are deeply implicated in behavior problems. Language is a tool that individuals use to manage their lives. Language allows for internal conversations where options for responding to life’s challenges can be considered and evaluated. Research from hearing children with language disorders shows increased rates of difficulties with impulse control, planning, and regulating affect. Studies with deaf children show those with better developed communication skills often have better skills for organizing behavior, maintaining attention, and inhibiting impulses. Deaf children from deaf families and those with cochlear implants—who have better-developed language—frequently exhibit development in most areas that is more comparable to hearing peers.

The vast majority of deaf and hard of hearing children have hearing parents, with language barriers present from the beginning. Most hearing parents are not naturally talented at visual communication and most do not know sign language. Therefore, the opportunities for a child with hearing loss to be immersed in an accessible language are more limited. Research has shown that deaf and hard of hearing adolescents who rated their communication with their families to be poor reported more symptoms of depression.

Communication issues underscore many related areas of development. Deaf children typically develop a theory of mind—an understanding of how other people think and feel—later than hearing children. Theory of mind skills are needed in guiding behavior in social interaction, which can also be a challenge for deaf and hard of hearing children. Because most deaf children are now educated in mainstream settings with other hearing children, they will be interacting with hearing children to a large degree. Yet, data from several studies found that deaf children in hearing mainstream schools tend to be overlooked by the hearing children, limiting opportunities for social interaction and growth.

We also know that besides child and school factors, parents and parenting styles can be influential. Deaf children with behavior problems tend to have parents who report higher levels of stress, particularly related to issues surrounding hearing loss. While the parents may be more stressed due to their child’s behavior, research suggests that stressed parents do not make the best decisions regarding parenting, leading to further problems. Parent personality also plays a role, with parents who are extroverted seeming to have an easier time managing their children, while parents who are prone to anxiety having a more difficult time.

What we don’t know

We recognize the problems, but the complex interaction of variables is less clear. Cochlear implants are influential and helpful to deaf children. It is not clear, however, just how much they help deaf children to manage their behavior better. To the extent that language skills improve in children with CIs, behavior regulation should also improve, but more data is needed here. More research is also needed to understand exactly how deaf children self-regulate and the interaction between hearing loss, communication, family environment, education program and self-regulation.

Implications

The good news is that a number of studies have demonstrated that intervention makes a difference. The Providing Alternative Thinking Strategies (PATHS) program has been shown to be effective in teaching impulse control and social skills. Other researchers have shown that specific social skills can be taught and sustained in deaf children. Programs that focus specifically on social interaction and regulating one’s own behavior, however, must be regular parts of the school curriculum. Language and communication must remain a major focus. Co-enrollment programs, where deaf and hearing children come together in a purposeful language rich environment, also offer promise and point to the need to encourage acceptance in an entire school population. This is especially important in inclusion and mainstream programs, where most deaf children enroll. Lastly, the early intervention programs that support family functioning and family communication must be recognized as critical. They would benefit from understanding parental personality styles and resources to best aid them in facilitating development of positive self-esteem and self-regulation in deaf children.

Posted on December, 11, 2013 by
Patrick J. Brice, Gallaudet University, Washington, DC
Patrick.Brice{at}gallaudet.edu

Further reading

Antia, S.D., Kreimeyer, K.H., Metz, K.K., & Spolsky, S. (2011). Peer interactions of deaf and hard of hearing children.  In M. Marschark & P.E. Spencer (Eds.) The Oxford handbook of deaf studies, language, and education, volume 1, second edition. New York: Oxford University Press. view details

Calderon, R. & Greenberg, M. (2011). Social and emotional development of deaf children:  Family, School, and Program Effects.  In M. Marschark & P.E. Spencer (Eds.) The Oxford handbook of deaf studies, language, and education, volume 1, second edition. New York: Oxford University Press. view details

Hintermair, M. (2006). Parental resources, parental stress, and socioemotional development of deaf and hard of hearing children. Journal of Deaf Studies and Deaf Education, 11, 493-513.view details

Lederberg, A. R., & Golbach, T. (2002). Parenting stress and social support in hearing mothers of deaf and hearing children.  Journal of Deaf Studies and Deaf Education, 7, 330-345. view details

Yoshinaga-Itano, C. (2003). From screening to early identification and interventions: Discovering predictors to successful outcomes for children with significant hearing loss.  Journal of Deaf Studies and Deaf Education, 8, 11-30 view details