Socio-emotional Assessment of Deaf Children

The issue

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When deafness from birth is experienced in non-optimal language and social environments, there is increased likelihood of it being associated with a range of delays and difficulties throughout infancy, childhood, and into adulthood. Most common and well-documented are delays in developing language skills and, later on, academic achievements are often comparatively poor. However, deaf children are also at risk of experiencing difficulties interacting with other children and establishing friendships, may have low self-esteem, struggle to regulate their emotions appropriately, or have behaviour problems, all of which are cause for concern to parents and teachers. At the severe end of the spectrum deaf children may be diagnosed with a mental health disorder such as depression or a neurodevelopmental disorder such as autistic spectrum disorder. Deaf children with additional or complex needs are particularly at risk for poor psychological well-being, social and emotional problems.

What we know

There is mixed research evidence regarding how frequently social, emotional and behavioural problems occur in deaf children and adolescents. Some studies suggest that there are no differences between deaf and hearing children on factors such self-esteem, self-confidence, social competence, independence, anxiety, depression, and anger. Other research suggests that deaf children are at significantly higher risk of mental health problems, perhaps as high as twice the rate. However, it is thought that it is not deafness per se that is the cause of these difficulties, but rather the consequences of being deaf in a hearing-oriented world. Environmental factors contribute to the increased risk, for example lack of access to language and communication, fewer opportunities for interactions with other deaf children, isolation in mainstream settings, bullying and discrimination. In particular, having reduced opportunities for incidental learning and fluent two-way interactions can result in the child not fully understanding what is going on around them and having difficulty forming relationships with peers, teachers and even family members.

The terms ‘socio-emotional’ and ‘mental health’ encompass a wide range of problems and diagnoses, and their assessment is based on an even wider range of possible methods and measures. In the past most traditional tests of child development have not included constructs associated with socio-emotional development.  In addition, those tools that do include these constructs have generally focused on problem behaviors rather than competencies. However it is equally useful to understand the child’s strengths and resiliency in order to guide the design of interventions.

A comprehensive assessment of a deaf child’s socio-emotional strengths and difficulties should be based on both formal and informal methods of gathering information, and include information from a variety of sources using a range of tools. An increasingly wide range of questionnaires are available which assess both problems and competencies in children as young as 12 months old, some of which are intended as screening tools for areas of difficulty whilst others can be used to diagnose clinically significant levels of disorder. It is helpful to obtain information from a number of people who know the child well, including parents and teachers, and many questionnaires have versions for both. In older children with the necessary literacy skills, there are also some self-report questionnaires that can provide useful insights into how the individual views their own difficulties. Alongside these more formal, standardized methods of assessment, it is usually informative to include informal approaches, in particular observation of the child in real-life settings. These should include the home, nursery or school as appropriate, not just the clinic, as the way in which the child behaves and interacts may differ markedly between them.

What we don’t know

Despite a number of studies over many years having attempted to establish the prevalence and nature of socio-emotional, behavioural and mental health problems in deaf children, there is still a lack of consensus.  The major problem facing researchers and clinicians in assessing socio-emotional problems is the lack of appropriate measures that have been designed for or standardised on deaf children. Often some of the items in questionnaires are not relevant or appropriate, skewing the results and making interpreting and drawing conclusions from them difficult. The validity of test results may also be compromised when communication is not effective between the child and the tester, impacting on clinical decision-making as well as research findings.

Implications

Recognizing that a deaf child may be experiencing socio-emotional problems is the first step in addressing them. Comprehensive, appropriate assessment of socio-emotional problems is essential for understanding the specific issues and needs of each deaf child in order to tailor psychotherapeutic and educational interventions accordingly.

Posted on April 1, 2015 by
Lindsey Edwards
Clinical Psychologist
Great Ormond Street Hospital for Children
NHS Foundation Trust
London, United Kingdom
Lindsey.Edwards {at} gosh.nhs.uk

Further reading

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, 2nd edition, (pp. 188-199). New York, NY: Oxford University Press. view details

Brown, P.M. & Cornes, A. (2015) Mental health of deaf and hard-of-hearing adolescents: What the students say. Journal of Deaf Studies and Deaf Education, 20, 75-81. view details

Punch, R., & Hyde, M. (2011). Social participation of children and adolescents with cochlear implants: a qualitative analysis of parent, teacher, and child interviews. Journal of Deaf Studies and Deaf Education, 16, 474-493. view details

Batten, G., Oakes, P.M., & Alexander, T. (2014) Factors associated with social interactions between deaf children and their hearing peers: A systematic literature review. Journal of Deaf Studies and Deaf Education, 19, 285-302. view details