Resilience from childhood to young adulthood: retrospective perspectives of deaf and hard of hearing people who studied in regular schools.

OBJECTIVE: Most deaf and hard of hearing (DHH) youth grow up in hearing familial and educational environments, posing unique risks for their socio-emotional well-being. The study's objective was to explore protective processes contributing to resilience among DHH individuals in different life periods. DESIGN: We conducted semi-structured interviews with 23 DHH young adults on their life-long coping with having a hearing loss (HL). MAIN OUTCOME MEASURES: Thematic analysis identified, according to participants' retrospective perceptions, processes that supported their positive adjustment from childhood up to early adulthood. RESULTS: Themes were organised at three ecological levels: individual, including five subthemes (e.g. certain attitudes to HL); family, including various types of parental support; and community, including four subthemes (e.g. extra-curricular activities). Family and community level resources enabled and nurtured personal attitudes and coping abilities. The perceptions of which personal attitudes and contextual resources were helpful changed from childhood to young adulthood. CONCLUSIONS: Findings show how resilience is heterogeneously promoted in the unique context of DHH individuals living in hearing environments. They also show interactions between the individual, family and wider society and the dynamics of coping resources across time. Findings indicate the important of considering DHH individuals' coping choices in their specific life context.

The Assessment of Pragmatic Skills in Young Deaf and Hard of Hearing Children.

The development of pragmatic skills does not often receive attention by professionals who are recommending or undertaking assessment of deaf and hard of hearing (DHH) children, yet social communication is vital for linguistic, social, emotional, and academic development. We acknowledge the challenges that DHH children have with pragmatic skills, advocate for monitoring of pragmatic development for all DHH children by medical professionals, and provide direction for assessment of pragmatic skills in young DHH children, particularly for clinicians and teachers who are tasked with that work. Pragmatic assessment is challenging because it must involve observations of the child in interaction with a communication partner, either directly during a specific interaction or through the reflections of a familiar adult. In this article, we recommend two complementary assessment procedures for young DHH children who use spoken language. Assessment 1 recommends that a parent or caregiver completes The Pragmatic Checklist to provide a picture of the child's functional communication. In assessment 2, the information gained through the checklist is complemented by using direct observations of a child in interaction with an adult or a peer. The Pragmatic Protocol uses a video-recorded conversation sample between the child and familiar person that is analyzed by a DHH professional for 30 different pragmatic behaviors. We conclude this article with a recommendation for pediatricians and health care professionals to monitor pragmatic developmental milestones in DHH children, to refer them for pragmatic assessments, and to collaborate with researchers to develop valid, reliable tools that adequately capture the pragmatic skill strengths and needs of DHH children.

Pragmatics and Peer Relationships Among Deaf, Hard of Hearing, and Hearing Adolescents.

OBJECTIVES: The goals of the current study were to (1) examine differences in pragmatic abilities and peer relationship behaviors among deaf and hard of hearing (DHH) adolescents who use spoken language, in comparison with their hearing peers; and (2) explore the contribution of pragmatic skills and speech (ie, articulation and intelligibility [AI]) to social aspects of school functioning among DHH and typically hearing adolescents. METHODS: Thirty-three DHH adolescents and 34 adolescents with typical hearing participated. All DHH adolescents attended mainstream school settings and used spoken language. Teacher reports were obtained on prosocial behaviors, peer problems, pragmatic abilities, and speech AI of the adolescents. Adolescents self-reported on the supportiveness of their peer relationships and their school emotional engagement. RESULTS: Multiple hierarchical regression analyses revealed that DHH adolescents had greater difficulties with peers than their hearing counterparts. Increased pragmatic difficulties were related to more peer problems and decreased prosocial behaviors, regardless of adolescents' hearing status. A significant positive correlation was found between pragmatic competence and adolescents' perceptions of peers' support. Finally, better speech AI were associated with higher levels of school emotional engagement. CONCLUSIONS: The results emphasize the significant role of pragmatics for both DHH and typically hearing adolescents. Medical care providers and allied health professionals should be aware of possible difficulties that DHH adolescents may have in complex and nuanced pragmatic skills. Some adolescents may require a referral to specialized services to support the development of their pragmatic understanding and their skills.

Phoneme recognition in bimodal hearing.

BACKGROUND: Many unilateral cochlear implant (CI) users have residual hearing in the nonimplanted ear, allowing them to use bimodal hearing. Assessing the hearing aid (HA) contribution is important. OBJECTIVE: To examine the contribution of a contralateral HA in unilateral CI users with severe-profound hearing loss (HL) in the non-implanted ear to phonetic features perception.Participants and method: Monosyllabic word test in noise was used to assess the phonetic features perception in 29 adult bimodal users with severe-profound HL and only minimal speech recognition using HA alone in the nonimplanted ear. RESULTS: For all consonants and vowel features, participants scored better in the bimodal condition than in the CI-alone condition. Better low frequencies thresholds in the HA ear correlated with better perception of phonetic features in the bimodal condition. CONCLUSION: CI/HA users with only minimal speech recognition using HA alone in the nonimplanted ear extract low-frequency information provided by the HA ear and combine it with information coming from the implanted ear.Significance: The results of the study provide a reasoning for unilateral CI users to insist on using a contralateral HA as long as contralateral implantation is not performed, and suggest how to monitor the benefit derived from the HA.

Parent Couples' Coping Resources and Involvement in their Children's Intervention Program.

Parental involvement is vital to the implementation of intervention programs for deaf and hard-of-hearing (DHH) children. The current study examined the dyadic relationships between mothers' and fathers' coping resources and their involvement in their child's intervention program. In addition, the moderating roles of parent's gender and family religiosity on the associations between coping resources and involvement were examined. Seventy Jewish couples of parents of DHH children, representing various levels of religiosity, completed questionnaires regarding involvement in their child's intervention program, child acceptance, parental self-efficacy, and perceived social support. Multilevel modeling analyses were used to test actor-partner interdependence. The findings indicated significant actor effects for child acceptance, parental self-efficacy, and social support. All were positively associated with parental involvement. Gender was found to moderate the actor effect of child acceptance. Partner effects were found only for mothers, for child acceptance, and social support. Fathers' child acceptance and social support were negatively associated with mothers' involvement. Religiosity did not moderate neither actor nor partner effects. These results have important implications for planning intervention programs that are sensitive to each of the parent's needs.

Cultural Identity of Young Deaf Adults with Cochlear Implants in Comparison to Deaf without Cochlear Implants and Hard-of-Hearing Young Adults.

This study examined the relationships between cultural identity, severity of hearing loss (HL), and the use of a cochlear implant (CI). One hundred and forty-one adolescents and young adults divided into three groups (deaf with CI, deaf without CI, and hard-of-hearing (HH)) and 134 parents participated. Adolescents and young adults completed questionnaires on cultural identity (hearing, Deaf, marginal, bicultural-hearing, and bicultural-deaf) and communication proficiencies (hearing, spoken language, and sign language). Parents completed a speech quality questionnaire. Deaf participants without CI and those with CI differed in all identities except marginal identity. CI users and HH participants had similar identities except for a stronger bicultural-deaf identity among CI users. Three clusters of participants evolved: participants with a dominant bicultural-deaf identity, participants with a dominant bicultural-hearing identity and participants without a formed cultural identity. Adolescents and young adults who were proficient in one of the modes of communication developed well-established bicultural identities. Adolescents and young adults who were not proficient in one of the modes of communication did not develop a distinguished cultural identity. These results suggest that communication proficiencies are crucial for developing defined identities.

Mothers' and fathers' involvement in intervention programs for deaf and hard of hearing children.

PURPOSE: Parental involvement in the rehabilitation process of deaf and hard of hearing (DHH) children is considered vital to children's progress. Today, fathers are more likely to be involved in their children's care. Nevertheless, father involvement has been understudied and relatively little is known about their involvement in families with children who are deaf or hard of hearing. In addition, there are scant data on the correlates of parents' involvement. This study explored similarities and differences in parental involvement between mothers and fathers in intervention programs for their D/HH children and tested a set of personal and social contextual variables that posited to affect parental involvement in a unique socio-cultural group. METHODS: Thirty Israeli-Arab couples (mothers and fathers) of young D/HH children took part. Each parent completed four self-report measures of parental involvement, parenting stress, parental self-efficacy, and social support. RESULTS: Mothers were significantly more involved than fathers in their child's intervention. Specifically, they report on higher interest and attendance and overall being more actively engaged with professionals in the child's intervention. Both mothers and fathers had a rather passive style of involvement in their child's intervention. Parental self-efficacy and informal and formal social support were associated with father involvement. For mothers, only formal social support was associated with involvement. CONCLUSION: For the Israeli-Arab population, the findings underscore the differences between mothers' and fathers' multiple dimensions of involvement in the intervention program of their D/HH children and their predictors. The results suggest important avenues for prevention and intervention activities when working with families of children who are D/HH. Implications for rehabilitation Parental involvement in intervention programs for children who are deaf or hard of hearing (D/HH) is vital to children's progress and an essential component of implementing family-centered service provision. Understanding of both mothers and fathers multiple dimensions of involvement and the factors that facilitate or hinder their parental involvement in their children's intervention programs, will equip professionals to better support parents of D/HH children aligned with the principles of family centered care service delivery. Mothers and fathers style of involvement reflects on gaps between the goals of family centered care and their implementation in the realities of everyday practice. The experiences and behaviors of mothers and fathers should not be seen as interchangeable.

The Impact of Childhood Hearing Loss on the Family: Mothers' and Fathers' Stress and Coping Resources.

Parenting children who are deaf or hard of hearing (D/HH) presents unique long-term challenges that can place the parents at a greater risk for elevated levels of parenting stress. Adaptation of families to the various challenges presented by childhood hearing loss is influenced by their personal and social coping resources available for managing these stressors and challenges. The current study examined differences in parenting stress and personal (i.e., acceptance of the child who is D/HH and parents' sense of parenting self-efficacy) and social (i.e., formal and informal social support) coping resources between mothers and fathers of children who are D/HH in the Arab sector in Israel. Further, the study examined the relations between coping resources and parenting stress among these parents. Participants included 30 Israeli Arab mother-father couples (n = 60) having a child who is D/HH aged 3-8 years. Findings revealed no significant differences between mothers and fathers regarding parenting stress, child acceptance, or parental support systems. However, mothers reported significantly higher self-efficacy. In addition, correlation analysis indicated that higher coping resources decreased parenting stress levels. Theoretical and practical implications of parental gender in the context of cultural background are discussed regarding parent intervention programs.

What Shapes Adolescents' Future Perceptions? The Effects of Hearing Loss, Social Affiliation, and Career Self-Efficacy.

The current study examined the contribution of hearing loss, social affiliation, and career self-efficacy to adolescents' future perceptions. Participants were 191 11th and 12th grade students: 60 who were deaf, 36 who were deaf or hard of hearing, and 95 who were hearing. They completed the Future Perceptions Scale, the Career Decision-Making Self-Efficacy (CDMSE) Scale, and the Self-Efficacy for the Management of Work-Family Conflict Scale. Results indicated that participants who were deaf reported significantly higher levels of future clarity and intensity than the other groups. However, no significant differences were found in career self-efficacy. Hearing status and affiliation and the efficacy to manage future conflict between work and family roles were significant predictors of participants' future clarity. CDMSE was a significant predictor of future planning. Implications for theory and practice are discussed.

Career-related parental support of adolescents with hearing loss: relationships with parents' expectations and occupational status.

The study examined the contribution of parents' occupational status and expectations regarding persons with hearing loss to career-related support they provide their deaf and hard of hearing (dhh) adolescent children. Thirty-eight parents completed the Evaluation of Occupational Competence Scale (Weisel & Cinamon, 2005), the Evaluation of Family Competence Scale (Caprara, Regalia, Scabini, Barbaranelli, & Bandura, 2004), the Career-Related Parent Support Scale (Turner, Alliman-Brissett, Lapan, Udipi, & Ergun, 2003), and a background questionnaire. Parents' occupational expectations were positively correlated with their family expectations regarding deaf persons. Parents' occupational status contributed to expectations of success for deaf persons in prestigious occupations with high communication demands. Different types of expectations contributed to career-related parental support. Implications for theory and practice are discussed.

[COCHLEAR IMPLANTATION IN ELDERLY INDIVIDUALS: INSIGHTS BASED ON A RETROSPECTIVE EVALUATION].

INTRODUCTION: In old age, the typical decline in temporal processing, auditory memory, speed of information processing, and ability to filter out irrelevant competing auditory input lead to deterioration in speech perception. This thereby broadens the target population for cochlear implantation among elderly individuals with severe-to-profound hearing loss. These features also raise concern regarding cochlear implant (CI) fitting and outcomes. AIM: To establish expectations from CI in older individuals. METHODS: This is a retrospective case review of 20 individuals with severe or severe-to-profound hearing loss, aged 60 or older (mean, 66.6 ± 5.25; range, 60-81 at the time of CI. Evaluation included speech-perception tests and the Glasgow Benefit Inventory (GBI) for testing quality of life. RESULTS: Between pre- and post-implantation, mean group values improved from 18.6% to 55.5%, from 37.2% to 84.5%, and from 11.2% to 60.5%, respectively, on the above speech-perception tests. No major postoperative complications were observed. The device was used consistently by all but one patient. GBI revealed improvement on all subscales. CONCLUSIONS: After implantation speech perception improved, there were no major post-CI complications, and post-implantation vertigo was less significant than expected in this age group. These results diminish concerns regarding CI in elderly individuals.

Risk factors for sensorineural hearing loss in pediatric chronic otitis media.

OBJECTIVES: To assess the clinical significance of sensorineural hearing loss (SNHL) in a group of pediatric patients suffering from unilateral chronic otitis media (COM) with or without cholesteatoma, using the contralateral healthy ear as a control, and to define risk factors for the development of SNHL in such patients. METHODS: The subjects of this retrospective study were 124 pediatric patients with unilateral COM admitted for surgery. Mean age at surgery was 13.3±3.2 years (range, 7-18) and mean duration of the disease was 88.4±45.0 months (range, 6-192 months). The preoperative pure-tone average value (PTA) for bone conduction (BC) was calculated in each ear (BC-PTA) as the average of BC thresholds at 500, 1000, 2000, and 4000Hz. Potential risk factors for SNHL that we evaluated were demographics, duration of disease, presence of cholesteatoma, and previous otologic history. RESULTS: Mean BC-PTA values in the diseased ears prior to surgery differed significantly from those in the healthy ears (12.74±8.75dB and 9.36±6.33dB, respectively; P<0.01). The degree of SNHL in the diseased ear at 2000Hz was found to be significantly correlated with the presence of cholesteatoma and with age above 10 years. CONCLUSIONS: One of the complications of COM, with or without cholesteatoma, in addition to the conductive hearing loss, is the development of clinically significant SNHL. It is therefore imperative to actively treat pediatric patients diagnosed with COM, with the aim of preventing the possible development of SNHL.

From hearing with a cochlear implant and a contralateral hearing aid (CI/HA) to hearing with two cochlear implants (CI/CI): a within-subject design comparison.

OBJECTIVE: To compare within-subject bilateral-binaural and bimodal complementary abilities between bimodal (cochlear implant and hearing aid; CI/HA) and bilateral CI hearing (CI/CI), thereby enabling better-informed counseling of experienced CI/HA users contemplating contralateral implantation. STUDY DESIGN: Comparative within-subject case review. SETTING: Outpatient hearing clinic. PATIENTS: Ten experienced adult CI/HA users with severe-to-profound hearing loss in the HA ear, who converted to CI/CI between 2 and 11 years after initial implantation. INTERVENTION: Task-specific testing of bilateral-binaural hearing (sound lateralization, binaural summation/redundancy/unmasking, head-shadow effect), bimodal complementary benefit (contribution of low-frequency information), and a self-report Speech, Spatial, and Qualities of Hearing (SSQ) questionnaire, all before and 1 year after contralateral cochlear implantation. MAIN OUTCOME MEASURES: Test result differences between CI/HA and CI/CI conditions. RESULTS: CI/CI hearing was better than CI/HA for speech lateralization and for perception of semantically unpredictable sentences in speech noise with speech at 0 degrees and noise at +90 degrees azimuth on the old CI side. CI/HA was better than CI/CI only for differences between perception of natural prosody speech and of speech with flattened fundamental frequency (F0) contour with speech and noise in front (at 0 degrees azimuth). Total scores on the SSQ questionnaire were higher in CI/CI than in CI/HA users. CONCLUSION: Counseling regarding contralateral implantation for CI/HA users with severe-to-profound hearing loss in the HA ear, though generally positive, should consider individual functional needs, and cover expectations about the expected trade-off between gaining improved understanding and speech lateralization in challenging listening conditions and losing some low-frequency cues still available with CI/HA hearing.

Song recognition by young children with cochlear implants: comparison between unilateral, bilateral, and bimodal users.

PURPOSE: To examine song identification by preschoolers with normal hearing (NH) versus preschoolers with cochlear implants (CIs). METHOD: Participants included 45 children ages 3;8-7;3 (years;months): 12 with NH and 33 with CIs, including 10 with unilateral CI, 14 with bilateral CIs, and 9 bimodal users (CI-HA) with unilateral CI and contralateral hearing aid. Preschoolers were asked to identify children's songs presented via 5 versions: (a) full (lyrics sung with piano accompaniment); (b) a cappella (only lyrics); (c) melodic (matching main melodic contour); (d) tonal (only pitch information); and (e) rhythmic (only song's rhythm). RESULTS: The NH group surpassed all CI groups at identifying songs via melodic and tonal versions, but no significant differences emerged between the NH group and any CI group via full, a cappella, or rhythmic versions. Among the CI groups, no significant differences emerged via melodic or rhythmic versions, but bimodal users performed significantly better than bilateral users via the tonal version. Chronological age and duration of CI use correlated significantly with identification via the rhythmic version. CONCLUSION: Bimodal users showed an advantage in identifying songs in the tonal version through use of complementary information.

Fundamental frequency information for speech recognition via bimodal stimulation: cochlear implant in one ear and hearing aid in the other.

OBJECTIVE: The aim of this study was to examine the role of fundamental frequency (F0) information in improving speech perception of individuals with a cochlear implant (CI) who use a contralateral hearing aid (HA). The authors hypothesized that in bilateral-bimodal (CI/HA) users the perception of natural prosody speech would be superior to the perception of speech with monotonic flattened F0 contour, whereas in unilateral CI users the perception of both speech signals would be similar. They also hypothesized that in the CI/HA listening condition the speech perception scores would improve as a function of the magnitude of the difference between the F0 characteristics of the target speech signal and the F0 characteristics of the competitors, whereas in the CI-alone condition such a pattern would not be recognized, or at least not as clearly. DESIGN: Two tests were administered to 29 experienced CI/HA adult users who, regardless of their residual hearing or speech perception abilities, had chosen to continue using an HA in the nonimplanted ear for at least 75% of their waking hours. In the first test, the difference between the perception of speech characterized by natural prosody and speech characterized by monotonic flattened F0 contour was assessed in the presence of babble noise produced by three competing male talkers. In the second test the perception of semantically unpredictable sentences was evaluated in the presence of a competing reversed speech sentence spoken by different single talkers with different F0 characteristics. Each test was carried out under two listening conditions: CI alone and CI/HA. RESULTS: Under both listening conditions, the perception of speech characterized by natural prosody was significantly better than the perception of speech in which monotonic F0 contour was flattened. Differences between the scores for natural prosody and for monotonic flattened F0 speech contour were significantly greater, however, in the CI/HA condition than with CI alone. In the second test, the overall scores for perception of semantically unpredictable sentences in the presence of all competitors were higher in the CI/HA condition in the presence of all competitors. In both listening conditions, scores increased significantly with increasing difference between the F0 characteristics of the target speech signal and the F0 characteristics of the competitor. CONCLUSIONS: The higher scores obtained in the CI/HA condition than with CI alone in both of the task-specific tests suggested that the use of a contralateral HA provides improved low-frequency information, resulting in better performance by the CI/HA users.

Risk factors for sensorineural hearing loss in chronic otitis media.

CONCLUSIONS: Risk factors for sensorineural hearing loss (SNHL) development in patients with chronic otitis media (COM) are longer duration of disease, older age and the presence of cholesteatoma. To prevent the expected development of SNHL, it is imperative to treat COM actively. OBJECTIVES: To assess the severity of SNHL in patients with unilateral COM and to define risk factors for its development. METHODS: The study included 317 patients with unilateral COM. Mean age was 28.7 ± 16.7 years (range 7-78 years) and mean duration of disease was 12.2 ± 11.3 years (range 0.25-60 years). In all patients, air conduction (AC) and bone conduction (BC) thresholds in both ears were measured at 500, 1000, 2000 and 4000 Hz. The parameters evaluated were demographics, duration of disease, presence and location of cholesteatoma and otologic history. RESULTS: The difference in mean BC thresholds between the diseased ears and the healthy ears was statistically significant, ranging from 4.55 ± 10.89 dB to 12.55 ± 19.09 dB across the measured frequency range (p < 0.0001). Multivariate regression analysis revealed statistically significant correlations between advanced age, longer duration of disease and presence of cholesteatoma, and the BC threshold differences between the affected and healthy ears.

Functional status of hearing aids in bilateral-bimodal users.

OBJECTIVE: To assess the functional status of the hearing aid (HA) in bilateral-bimodal users, in whom HA monitoring is often neglected because fitting efforts are focused on the cochlear implant (CI). Also, to define an audiometric pattern of residual hearing that might explain why, despite nonoptimal bimodal fitting, certain cochlear implantees still opt to use a HA. STUDY DESIGN: Retrospective case review. SETTING: Ambulatory care clinic. PARTICIPANTS: Experienced bimodal (CI/HA) adult users (N = 31) who use their HA during most of their waking hours. HA settings were required to meet a selected prescriptive (NAL-NL1) electro-acoustical Verifit Speechmap target at low frequencies using the simulated real-ear mode. INTERVENTION: After initial evaluation, HAs that did not meet the Speechmap target underwent appropriate fitting and reevaluation. MAIN OUTCOME MEASURE(S): Number of patients whose HAs met the defined Speechmap criteria after refitting; residual hearing levels in patients who achieved optimal bimodal fitting and in those who did not. RESULTS: At initial evaluation, the HA in 25 (81%) of the 31 participants was malfunctioning or poorly tuned. After HA replacement or retuning, 19 participants (61%) met the Speechmap targets, and 12 (39%) did not. However, the 2 groups had similar mean levels of unaided and aided residual hearing thresholds at 250 or 500 Hz. CONCLUSION: To maximize the benefit for bilateral-bimodal users, specific guidelines must be established also for fitting of their HAs. The focus should be on achieving the maximum amplification possible at low frequencies.

The contribution of perceived parental support to the career self-efficacy of deaf, hard-of-hearing, and hearing adolescents.

The current study examined the contribution of different types of parental support to career self-efficacy among 11th and 12th grade students (N = 160): 66 students with hearing loss (23 hard of hearing and 43 deaf) and 94 hearing students. Participants completed the Career-Related Parent Support Scale, the Career Decision-Making Self-Efficacy Scale, and the Self-Efficacy for the Management of Work-Family Conflict questionnaire. Different aspects of parental support predicted different types of career self-efficacies across the 3 groups. Differences among groups were also found when levels of parental support were compared. The deaf group perceived lower levels of parental career-related modeling and verbal encouragement in comparison with the hard-of-hearing students and higher levels of parental emotional support compared with the hearing participants. No significant differences were found among the research groups in career decision-making self-efficacy and self-efficacy in managing work-family conflict. Implications for theory and practice are discussed.

Understanding of emotions and false beliefs among hearing children versus deaf children.

Emotion understanding and theory of mind (ToM) are two major aspects of social cognition in which deaf children demonstrate developmental delays. The current study investigated these social cognition aspects in two subgroups of deaf children-those with cochlear implants who communicate orally (speakers) and those who communicate primarily using sign language (signers)-in comparison to hearing children. Participants were 53 Israeli kindergartners-20 speakers, 10 signers, and 23 hearing children. Tests included four emotion identification and understanding tasks and one false belief task (ToM). Results revealed similarities among all children's emotion labeling and affective perspective taking abilities, similarities between speakers and hearing children in false beliefs and in understanding emotions in typical contexts, and lower performance of signers on the latter three tasks. Adapting educational experiences to the unique characteristics and needs of speakers and signers is recommended.

Fathers' involvement in preschool programs for children with and without hearing loss.

The authors compared the involvement in children's development and education of 38 fathers of preschoolers with hearing loss to the involvement of a matched group of 36 fathers of preschoolers with normal hearing, examining correlations between child, father, and family characteristics. Fathers completed self-reports regarding their parental involvement and parenting self-efficacy and reported on their family cohesion and adaptability. Mothers also reported on their husbands' involvement. Similarly high levels of involvement on the part of both groups of fathers were found. Involvement correlated positively with fathers' self-reported parenting self-efficacy, family cohesion, and adaptability, and mother-reported paternal involvement. Implications for professionals and mothers are discussed, including the need to encourage mothers' support for their husbands' involvement and to empower fathers' sense of competency in order to increase their involvement.