Working with Hearing Families with A Deaf Child: A Psychological Perspective

The issue

This bulletin highlights some of the issues families face in supporting their deaf children from birth to adulthood. Unfortunately, there is a lack of psychological evidence on how best to support families around diagnosis. The focus here is on why communication from early infancy is important to social and emotional development, how family relationships are affected if few relatives can communicate with a deaf child, how educational placements may impact families, and how transition into adulthood can be challenging for deaf youth and their parents. The bulletin also addresses how psychologists and systemic psychotherapists can assist families as they negotiate these important transitions and the implications for families and clinical practice.

What we know and don’t know

Diagnosis
A child’s deaf diagnosis of hearing loss may have different meanings for parents, depending on their hearing status, the pathway to diagnosis, their resilience and support systems. There is currently little psychological guidance into how professionals optimally share such diagnoses with parents and whether families might benefit from psychological support and education about the importance of early childhood relationships post diagnosis.

Infancy and attachment
Communication between children and caregivers is fundamental for children’s development. Responding to a crying baby, making inferences about its needs, and acting on those inferences in a timely manner helps form the building blocks of successful relationships. This helps children develop appropriate impulse control and regulate emotions. Without sufficient positive attachments it may be difficult for children to understand and predict their environments, leading to them feeling less secure. It is therefore essential that clear communication is established early through speech, sign, and/or visual communication. Indicators that these emotional needs are not being met might include challenging behaviour, withdrawing from family life or clinging to parents. Insecure attachment and emotional dysregulation can subsequently impact on relationships in school, adult life, and employment. Psychologists and systemic therapists could help by promoting effective early relationships and working with families to address barriers to communication.

Family communication
Family members may differ in their communication and advocacy skills. Those adept at communication may act as a filter for the deaf child’s experience and take on parental roles. This can lead to alliances and hierarchies within families. Psychologists can facilitate conversations to help family members reflect on dynamics that may limit or enhance relationships. Where there are additional developmental issues, (e.g., autism, learning difficulties), the psychologist and family can work together to help understand the interaction between communication, deafness and the constraints of the developmental condition. Therapists often work alongside interpreters to ensure that signing deaf children are included in family discussions.

Education
Parents can find educational placements difficult. Deaf children in mainstream placements can feel different or isolated from peers. Special schools may provide more inclusion but can be further from home, affecting activities outside of school. Deaf children may form close bonds with staff who have excellent communication skills. This may be difficult to manage for families for whom communication is a struggle. Psychologists often consult with schools and families to try to understand why placements are breaking down and devise supportive strategies.

Transition to adulthood
A key period for families with deaf children is the transition to adulthood. Many deaf young people, especially those with additional needs, still benefit from advocacy and support at a time when services and key staff may change. Adult services may have very different criteria, work expectations, and cultures than child services, which at first may feel unsettling to deaf young people and their parents. Anecdotally psychologists working in adult services report that where there has been limited support, it is not uncommon for deaf young people to report feeling isolated with significant mental health issues.

Implications

  • Further support around diagnosis may be helpful for parents with deaf children.
  • Attachment in infancy may be facilitated through effective early communication and this is important for later emotional wellbeing.
  • A systemic approach may be helpful in improving family dynamics.
  • Psychological consultation in schools can help families and teachers understand the deaf child’s experience in context and help devise strategies.
  • Therapists should adopt an ethos of inclusion for deaf family members whilst valuing everyone in the family’s experience and beliefs.
  • Psychologists could consider preparing families for the transition to adulthood, ideally, by having child and adult services liaise/consult at least six months prior to transition.

Posted on October 2, 2018 by
John Henning Brodersen
National Deaf CAMHS, (Kent)
John.HenningBrodersen {at} swlstg.nhs.uk

Further reading