Psychologists Working with Deaf Children and Young People

The issue

Clinical psychologists use psychological theory to prevent psychological distress and promote psychological wellbeing, for example, using cognitive theory to understand how people’s thoughts influence how they feel and behave. This helps us understand the nature of potential distress and informs how we can support the person. Hypotheses and therapeutic models generated by these theories are tested in research often with participants who are experiencing psychological distress. However, there is relatively little such research involving deaf participants, who are excluded from being participants in studies such as randomised controlled trials. The deaf population, being small and heterogeneous, creates other challenges for research. Psychologists and other mental health professionals working with deaf children thus face the challenge of implementing assessments and therapeutic models with few evidence-based practices.

What we know

While the same risk factors for developing mental health difficulties are valid for deaf and hearing children (e.g., socio-economic status, familial mental health), deaf children face additional challenges, such as lack of access to incidental learning, that contribute to their vulnerability to developing social-emotional problems, potentially leading to mental health difficulties. Some of these have been highlighted in the Oscar-winning film ‘The Silent Child’, which demonstrates how some deaf children can grow up in families without shared communication, with delayed language skills, and isolated from peers. As much development is socially mediated (e.g., emotions, inhibition, social norms), deaf children become vulnerable and develop a higher risk of mental health problems.

Deaf children, particularly those with limited communication skills, often exhibit ‘externalizing’ presentations (e.g., disruptive or anti-social behaviour, physical aggression). Although the behavioural problems are identified as the outward ‘symptom,’ they can be the expression of underlying issues such as depression, anxiety, low self-esteem, ADHD, etc. Conversely, those deaf children who present with ‘internalized’ behaviour may not get referred until much later, because adults around them may miss their struggles, and the child may not know how to get help.

Deaf children seen by non-specialists run the risk of misdiagnosis and inadequate service provision.

Many referrals indicate concerns about Deaf identity development, particularly in children attending mainstream education with no contact with deaf adults. Recent changes in education policy, neonatal screening, and amplification technology have influenced the range of potential deaf identities. There now is more fluidity among these identities than previously recognized.

What We Don’t Know

The evidence base for deaf children’s development, mental health, and therapeutic approaches is particularly sparse. Even with the current evidence base, we are challenged by every deaf child being so different that assumptions and adaptations have to be made to assessments and interventions.

Implications

It is essential that deaf children are assessed by experienced professionals who understand the development of deaf children, are skilled at adapting and interpreting assessments, and who can recognise the impacts of deafness on family dynamics and identity development. While, ideally, clinicians can meet the child’s language needs directly (adjusting to the child’s level and mode of communication), it is often necessary to work with skilled interpreters or deaf support staff experienced in working in mental health. Deaf colleagues are key in ensuring the inclusion of cultural and socio-cultural aspects in the formulation and consequent intervention and in being role-models for deaf children. Hearing and deaf staff working together represent integration of two cultures, which is valuable for helping young people with their identity and for families accepting difference.

Preventative work is important. This starts with the importance of communication for the child independently but also with their family, peers and appropriate educational provision. The explicit teaching of emotional literacy is paramount to empower children with a language to understand and express the wide range of their emotions. While primarily intended for deaf adults, Glickman’s ‘pre-therapy’ work is also relevant to children. This is often a feature of therapeutic work that precedes work that is guided by more formal approaches.

Having such a heterogeneous caseload, clinicians need to meet the client “where they are” developmentally, linguistically, and culturally. This means having the ability to adapt standard therapeutic techniques and use of more eclectic approaches. Many guidelines suggest Cognitive Behavioural Therapy (CBT) or other therapies reliant on language skill. Often, CBT is challenging, and less linguistically-based therapies are needed. Eye Movement Desensitization and Reprocessing and play therapy are approaches that may give options of psychological work without the need for in-depth linguistic skill.

Close consultation to and from other specialist services is essential, as there can be a wide variance in referred difficulties with the only commonality of being deaf.

Posted on July 6, 2018 by
Constanza Moreno
National Deaf CAMHS – South East: South West London &
St Georges Mental Health NHS Trust
Constanza.Moreno {at} swlstg.nhs.uk

AND

Sylvia Glenn
National Deaf CAMHS – West Midlands: Dudley &
Walsall Mental Health NHS Trust
dwmh.deafcamhs {at} nhs.net

 

Further reading