Associations of childhood hearing loss and adverse childhood experiences in deaf adults.

Childhood trauma and adverse childhood experiences have a strong relationship with health disparities across the lifespan. Despite experiencing approximately doubled rates of trauma, Adverse Childhood Experiences (ACEs) are poorly characterized in deaf populations. We sought to characterize deaf-specific demographic factors and their association with multiple experiences of ACEs before the age of 18 years old. An analytical cross-sectional approach was used to ascertain associations of deaf-specific demographic factors and experiences with ACEs. The complete dataset included 520 participants for a total response rate of 56%. After adjusting for confounding effects, less severe hearing loss of 16-55 dB (2+ OR: 5.2, 4+ OR: 4.7), having a cochlear implant (2+ OR: 2.1, 4+ OR: 2.6), and not attending at least one school with signing access (2+ OR: 2.4, 4+ OR: 3.7) were significantly and independently associated with reported experiences of multiple ACEs. We conclude that factors associated with childhood hearing loss and language experiences increase risk of experiencing ACEs. Given the strong relationship between ACEs and poor social outcomes, early intervention clinical practice and health policies should consider interventions to support healthy home environments for deaf children.

COVID-19 Vaccine Equity and Access: Case Study for Health Care Chatbots.

BACKGROUND: Disparities in COVID-19 information and vaccine access have emerged during the pandemic. Individuals from historically excluded communities (eg, Black and Latin American) experience disproportionately negative health outcomes related to COVID-19. Community gaps in COVID-19 education, social, and health care services (including vaccines) should be prioritized as a critical effort to end the pandemic. Misinformation created by the politicization of COVID-19 and related public health measures has magnified the pandemic's challenges, including access to health care, vaccination and testing efforts, as well as personal protective equipment. Information and Communication Technology (ICT) has been demonstrated to reduce the gaps of marginalization in education and access among communities. Chatbots are an increasingly present example of ICTs, particularly in health care and in relation to the COVID-19 pandemic. OBJECTIVE: This project aimed to (1) follow an inclusive and theoretically driven design process to develop and test a COVID-19 information ICT bilingual (English and Spanish) chatbot tool named "Ana" and (2) characterize and evaluate user experiences of these innovative technologies. METHODS: Ana was developed following a multitheoretical framework, and the project team was comprised of public health experts, behavioral scientists, community members, and medical team. A total of 7 iterations of ß chatbots were tested, and a total of 22 ß testers participated in this process. Content was curated primarily to provide users with factual answers to common questions about COVID-19. To ensure relevance of the content, topics were driven by community concerns and questions, as ascertained through research. Ana's repository of educational content was based on national and international organizations as well as interdisciplinary experts. In the context of this development and pilot project, we identified an evaluation framework to explore reach, engagement, and satisfaction. RESULTS: A total of 626 community members used Ana from August 2021 to March 2022. Among those participants, 346 used the English version, with an average of 43 users per month; and 280 participants used the Spanish version, with an average of 40 users monthly. Across all users, 63.87% (n=221) of English users and 22.14% (n=62) of Spanish users returned to use Ana at least once; 18.49% (n=64) among the English version users and 18.57% (n=52) among the Spanish version users reported their ranking. Positive ranking comprised the "smiley" and "loved" emojis, and negative ranking comprised the "neutral," "sad," and "mad" emojis. When comparing negative and positive experiences, the latter was higher across Ana's platforms (English: n=41, 64.06%; Spanish: n=41, 77.35%) versus the former (English: n=23, 35.93%; Spanish: n=12, 22.64%). CONCLUSIONS: This pilot project demonstrated the feasibility and capacity of an innovative ICT to share COVID-19 information within diverse communities. Creating a chatbot like Ana with bilingual content contributed to an equitable approach to address the lack of accessible COVID-19-related information.

Characterization of sleep among deaf individuals.

OBJECTIVES: Numerous health disparities are documented in deaf population research, but few empirical sleep assessments exist for this under-served population, despite knowledge that sleep contributes to physical and mental health disparities. We sought to document subjective and objective sleep in deaf adults with cross-sectional and prospective measures. METHODS: Twenty deaf participants completed validated sleep and mental health questionnaires, 2-weeks of nightly sleep diaries and continuous wrist-worn actigraphy monitoring, and 1-week of nightly, reduced-montage EEG recordings. RESULTS: Questionnaire data suggest high prevalence of insomnia (70%), poor sleep (75%), daytime sleepiness (25%) and nightmares (20%) among participants. Strong correlations were found between depression and sleep quality, fear of sleep, and insomnia severity (p's < .005). Objective sleep assessments suggest elevated wake after sleep onset and low sleep efficiency and sleep duration. CONCLUSIONS: The prevalence of sleep disturbance recorded from self-report and objective sleep measures provides preliminary evidence of sleep health disparity among deaf adults.

From Vicious Circles to Virtuous Cycles: Vygotskian-Inspired Conclusions for Biomedicine and Deaf Education.

In this concluding article of an American Annals of the Deaf Special Issue, we draw on Vygotsky's Fundamentals of Defectology to argue that the essence of deaf pedagogy is not centered on constructing deaf students' hearing abilities but on a biosocial orientation that considers the whole multimodal child with unfettered access to natural signed languages. In alignment with this biosocial view, we recognize and resist the overarching influence of biomedical professionals and systems on deaf education. Such biomedical influence comes with convenient detachment from accountability in education systems while arguably causing at least significant, if not maximal, harm to the optimal developmental outcomes of deaf children. The article ties together the articles of the Annals Special Issue, along with additional Vygotskian perspectives, to bring forth the emergence and exploration of biosocial accountability in deaf education.

No Taxation Without Representation: Addressing the "Deaf Tax" in Academic Medicine.

Minority faculty and trainees experience unique factors that can hinder their success in academic medicine-collectively referred to as "minority tax." The authors argue that a similar "deaf tax" of unique barriers, experiences, and responsibilities disproportionately burdens deaf trainees and faculty. The cumulative effects of these deaf tax experiences represent a significant disadvantage for deaf professionals in academic medicine. Through a combination of relevant literature and the authors' personal experiences as deaf professionals, several causative domains of deaf tax are outlined, including the fight for reasonable accommodations, prejudice and discrimination, training and diversity barriers, and a lack of deaf mentorship. In addition, a number of practical steps are offered for institutional leaders to consider implementing to improve equity and inclusion in academic medicine, including facilitating language equity and communication access, implementing deaf awareness training, fostering effective deaf mentorship, and promoting deaf professionals into leadership positions. Addressing these issues would help remove the obstacles that create the high deaf tax burden and lower the near-insurmountable barrier of entry, advancement, and retention in academic medicine for deaf professionals.

American Sign Language Interpreters in Public Schools: An Illusion of Inclusion that Perpetuates Language Deprivation.

PURPOSE: Many deaf children have limited access to language, spoken or signed, during early childhood - which has damaging effects on many aspects of development. There has been a recent shift to consider deafness and language deprivation as separate but related conditions. As such, educational plans should differentiate between services related to deafness and services related to language deprivation. DESCRIPTION: Many deaf children attend mainstream public schools, and the primary service offered to students who use American Sign Language (ASL) is generally a sign language interpreter. ASSESSMENT: We argue that while sign language interpreters can be an effective accommodation for deafness (i.e., students who are deaf and not language-deprived), there is no reason to believe they are an effective accommodation for language deprivation (i.e., students who are deaf and language-deprived). CONCLUSION: Using interpreters instead of appropriate educational supports may exacerbate symptoms of language deprivation by prolonging the period of time a child goes with limited access to language.

Education and health of children with hearing loss: the necessity of signed languages.

Medical and educational interventions for children with hearing loss often adopt a single approach of spoken language acquisition through the use of technology, such as cochlear implants. These approaches generally ignore signed languages, despite no guarantees that the child will acquire fluency in a spoken language. Research with children who have a cochlear implant and do not use a signed language indicates that language outcomes are very variable and generally worse than their non-deaf peers. In contrast, signing children with cochlear implants have timely language development similar to their non-deaf peers that also exceeds their non-signing peers with cochlear implants. Natural signed languages have been shown to have the same neurocognitive benefits as natural spoken language while being fully accessible to deaf children. However, it is estimated less than 2% of the 34 million deaf children worldwide receive early childhood exposure to a signed language. Most deaf children are, therefore, at risk for language deprivation during the critical period of language acquisition in the first five years of life. Language deprivation has negative consequences for developmental domains, which rely on timely language acquisition. Beyond the adverse effects on a child's education, language deprivation also affects deaf people's mental and physical health and access to health care, among others. Therefore, policies in accordance with the United Nations Convention on the rights of persons with disabilities are needed. Such policies would ensure early intervention and education services include signed languages and bilingual programmes where the signed language is the language of instruction.

Les interventions médicales et éducatives destinées aux enfants souffrant d'une perte de l'acuité auditive s'inscrivent souvent dans une approche unique d'acquisition du langage parlé par des moyens technologiques, comme les implants cochléaires. Ces approches font généralement abstraction des langues des signes alors que rien ne garantit que l'enfant parvienne à maîtriser le langage parlé. Les recherches menées auprès d'enfants qui ont reçu un implant cochléaire et n'utilisent pas de langue des signes montrent que les résultats langagiers sont très variables et généralement pires que ceux des enfants entendants. En revanche, les enfants qui ont reçu un implant cochléaire et utilisent des signes ont un développement langagier en temps voulu similaire à celui des enfants entendants et supérieur à celui des enfants dotés d'un implant cochléaire qui n'utilisent pas de signes. Il a été démontré que les langues des signes naturelles procurent les mêmes bienfaits neurocognitifs que la langue parlée naturelle tout en étant pleinement accessibles aux enfants sourds. On estime néanmoins que moins de 2% des 34 millions d'enfants sourds à travers le monde sont exposés à une langue des signes au cours de leur petite enfance. La plupart des enfants sourds risquent donc de souffrir d'une carence langagière lors de la période critique de l'acquisition du langage, au cours des cinq premières années de vie. La carence langagière a des conséquences négatives sur les domaines du développement qui dépendent d'une acquisition du langage en temps voulu. Au-delà des effets négatifs sur l'éducation de l'enfant, la carence langagière a aussi une incidence sur la santé mentale et physique des sourds et sur leur accès aux soins de santé, notamment. Par conséquent, des politiques conformes à la Convention des Nations Unies relative aux droits des personnes handicapées sont nécessaires. Ces politiques garantiraient l'inclusion par les services d'intervention précoce et d'éducation d'une langue des signes et de programmes bilingues dans le cadre desquels la langue des signes serait la langue d'enseignement.

Las intervenciones médicas y educativas para niños con pérdida auditiva suelen adoptar un único enfoque de adquisición del lenguaje hablado mediante el uso de tecnología, como los implantes cocleares. Estos enfoques generalmente ignoran los lenguajes de señas, a pesar de que no hay garantías de que el niño adquiera fluidez en un lenguaje hablado. La investigación en niños que tienen un implante coclear y no usan lenguaje de señas indica que los resultados del lenguaje son muy variables y generalmente peores que los de sus compañeros sin problemas de audición. Por el contrario, los niños que usan el lenguaje de señas y tienen implantes cocleares se pueden desarrollar a tiempo de manera similar a sus compañeros sin problemas de audición, y también superan a sus compañeros con implantes cocleares que no usan el lenguaje de señas. Se ha demostrado que los lenguajes naturales de señas tienen los mismos beneficios neurocognitivos que el lenguaje natural hablado, a la vez que son totalmente accesibles para los niños sordos. Sin embargo, se estima que menos del 2 % de los 34 millones de niños sordos en todo el mundo están expuestos a un lenguaje de señas en la primera infancia. Por lo tanto, la mayoría de los niños sordos corren el riesgo de sufrir privaciones del lenguaje durante el periodo crítico de adquisición del lenguaje en los primeros cinco años de vida. La privación del lenguaje tiene consecuencias negativas para los dominios del desarrollo que dependen de la adquisición oportuna del lenguaje. Más allá de los efectos adversos sobre la educación de un niño, la privación del lenguaje también afecta a la salud mental y física de las personas sordas y al acceso a la atención sanitaria, entre otras cosas. Por consiguiente, se necesitan políticas acordes con la Convención de las Naciones Unidas sobre los derechos de las personas con discapacidad. Estas políticas garantizarían que los servicios de intervención temprana y educación incluyan el lenguaje de señas y programas bilingües en los que el lenguaje de señas sea el idioma de instrucción.

Designated Interpreters: A Model to Promote the Diversity and Inclusion of Deaf Professionals in Academic Medicine.

PROBLEM: Deaf professionals who use American Sign Language (ASL) are a growing population in academic medicine. Reasonable accommodations for this group include providing an ASL interpreter. Many institutions contract with external agencies to provide ad hoc interpreters, but this model has hidden costs for deaf professionals and institutions. APPROACH: The University of Rochester School of Medicine and Dentistry (URSMD) uses the designated interpreter model in which interpreters are on staff and embedded with deaf professionals so they can learn both the work environment and the deaf professionals' specialized science and medicine content. This model addresses many of the limitations of the external agency approach and better facilitates the inclusion of deaf professionals in the institution. OUTCOMES: This model has been in use at URSMD since 1990 but has seen exponential growth recently (increasing from 3 deaf professionals with designated interpreters in 2011 to a peak of 17 in 2016). Designated interpreters have worked in different research and clinical settings from dentistry and nursing to community and global health. This growth highlights the increasing number of deaf professionals in medicine and the need to train more designated interpreters. NEXT STEPS: In response to this growing demand, URSMD is developing an ASL Interpreting in Medicine and Science program, a master's degree-level program to train interpreters who are bilingual in ASL and English to be designated interpreters. The designated interpreter model is one step toward creating an environment that is fully inclusive of deaf professionals to the benefit of the whole institution.

Considering parental hearing status as a social determinant of deaf population health: Insights from experiences of the "dinner table syndrome".

The influence of early language and communication experiences on lifelong health outcomes is receiving increased public health attention. Most deaf children have non-signing hearing parents, and are at risk for not experiencing fully accessible language environments, a possible factor underlying known deaf population health disparities. Childhood indirect family communication-such as spontaneous conversations and listening in the routine family environment (e.g. family meals, recreation, car rides)-is an important source of health-related contextual learning opportunities. The goal of this study was to assess the influence of parental hearing status on deaf people's recalled access to childhood indirect family communication. We analyzed data from the Rochester Deaf Health Survey-2013 (n = 211 deaf adults) for associations between sociodemographic factors including parental hearing status, and recalled access to childhood indirect family communication. Parental hearing status predicted deaf adults' recalled access to childhood indirect family communication (χ2 = 31.939, p < .001). The likelihood of deaf adults reporting "sometimes to never" for recalled comprehension of childhood family indirect communication increased by 17.6 times for those with hearing parents. No other sociodemographic or deaf-specific factors in this study predicted deaf adults' access to childhood indirect family communication. This study finds that deaf people who have hearing parents were more likely to report limited access to contextual learning opportunities during childhood. Parental hearing status and early childhood language experiences, therefore, require further investigation as possible social determinants of health to develop interventions that improve lifelong health and social outcomes of the underserved deaf population.

Influence of Hearing Loss on Child Behavioral and Home Experiences.

OBJECTIVES: To assess the influence of hearing loss on child behavioral diagnoses, and socioemotional and behavior status. METHODS: We analyzed US National Health Interview Survey (NHIS) child data, years 2011 to 2015, for associations between reported hearing loss and relevant NHIS items. RESULTS: Compared with hearing children, NHIS respondents with a deaf child were more likely to report developmental delays (adjusted odds ratio [AOR] = 11.1; 95% confidence interval [CI] = 3.8, 32.4), attention-deficit disorder (AOR = 3.1; 95% CI = 2.5, 3.9), autism diagnoses (AOR = 2.9; 95% CI = 1.8, 4.9), and minor to severe socioemotional difficulties (AOR = 3.9; 95% CI = 3.2, 4.7). When asked if their child was well behaved, respondents were more likely to reply "somewhat true" or "not true" (AOR = 2.7; 95% CI = 2.2, 3.4). CONCLUSIONS: Hearing loss increases likelihood of reporting child behavioral diagnoses, behavior issues, and socioemotional difficulties. Although etiology and professional misdiagnoses likely contribute to elevated prevalence, lack of attention toward language deprivation as a public health issue prevents any further epidemiological insights. Public Health Implications. Despite widespread use of cochlear implants, concerns about deaf children's well-being remain significant. Language deprivation requires investigation and awareness as a social determinant of health.

What You Don't Know Can Hurt You: The Risk of Language Deprivation by Impairing Sign Language Development in Deaf Children.

A long-standing belief is that sign language interferes with spoken language development in deaf children, despite a chronic lack of evidence supporting this belief. This deserves discussion as poor life outcomes continue to be seen in the deaf population. This commentary synthesizes research outcomes with signing and non-signing children and highlights fully accessible language as a protective factor for healthy development. Brain changes associated with language deprivation may be misrepresented as sign language interfering with spoken language outcomes of cochlear implants. This may lead to professionals and organizations advocating for preventing sign language exposure before implantation and spreading misinformation. The existence of one-time-sensitive-language acquisition window means a strong possibility of permanent brain changes when spoken language is not fully accessible to the deaf child and sign language exposure is delayed, as is often standard practice. There is no empirical evidence for the harm of sign language exposure but there is some evidence for its benefits, and there is growing evidence that lack of language access has negative implications. This includes cognitive delays, mental health difficulties, lower quality of life, higher trauma, and limited health literacy. Claims of cochlear implant- and spoken language-only approaches being more effective than sign language-inclusive approaches are not empirically supported. Cochlear implants are an unreliable standalone first-language intervention for deaf children. Priorities of deaf child development should focus on healthy growth of all developmental domains through a fully-accessible first language foundation such as sign language, rather than auditory deprivation and speech skills.

Language deprivation syndrome: a possible neurodevelopmental disorder with sociocultural origins.

PURPOSE: There is a need to better understand the epidemiological relationship between language development and psychiatric symptomatology. Language development can be particularly impacted by social factors-as seen in the developmental choices made for deaf children, which can create language deprivation. A possible mental health syndrome may be present in deaf patients with severe language deprivation. METHODS: Electronic databases were searched to identify publications focusing on language development and mental health in the deaf population. Screening of relevant publications narrowed the search results to 35 publications. RESULTS: Although there is very limited empirical evidence, there appears to be suggestions of a mental health syndrome by clinicians working with deaf patients. Possible features include language dysfluency, fund of knowledge deficits, and disruptions in thinking, mood, and/or behavior. CONCLUSION: The clinical specialty of deaf mental health appears to be struggling with a clinically observed phenomenon that has yet to be empirically investigated and defined within the DSM. Descriptions of patients within the clinical setting suggest a language deprivation syndrome. Language development experiences have an epidemiological relationship with psychiatric outcomes in deaf people. This requires more empirical attention and has implications for other populations with behavioral health disparities as well.

A Pilot Study of Deaf Trauma Survivors' Experiences: Early Traumas Unique to Being Deaf in a Hearing World.

Conducting semi-structured American Sign Language interviews with 17 Deaf trauma survivors, this pilot study explored Deaf individuals' trauma experiences and whether these experiences generally align with trauma in the hearing population. Most commonly reported traumas were physical assault, sudden unexpected deaths, and "other" very stressful events. Although some "other" events overlap with traumas in the general population, many are unique to Deaf people (e.g., corporal punishment at oral/aural school if caught using sign language, utter lack of communication with hearing parents). These findings suggest that Deaf individuals may experience developmental traumas distinct to being raised in a hearing world. Such traumas are not captured by available trauma assessments, nor are they considered in evidence-based trauma treatments.